{"id":3252,"date":"2008-07-11T22:22:00","date_gmt":"2008-07-12T02:52:00","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=3252"},"modified":"2017-03-31T12:48:40","modified_gmt":"2017-03-31T17:18:40","slug":"respuesta-al-caso-para-diagnostico-n-1-dolor-en-antebrazo-derecho-y-parestesias-de-5-dias-de-evolucion-presentado-en-la-edicion-202","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/3252","title":{"rendered":"Respuesta al Caso para diagn\u00f3stico N\u00b0 1: dolor en antebrazo derecho y parestesias de 5 d\u00edas de evoluci\u00f3n, presentado en la edicion 202"},"content":{"rendered":"<p><strong>Primer caso para Diagn\u00f3stico presentado por los Dres. Mart\u00edn Moreno, Jos\u00e9 Casas y Ana Kaminsky del Hospital Durand Servicio de Dermatolog\u00eda Facultad de Medicina. Universidad de Buenos Aires&nbsp; Argentina<br \/> <\/strong><a href=\"http:\/\/piel-l.org\/blog\/3210\">(Ir a al Edici\u00f3n 202)<\/a> <strong><br \/> <\/strong><\/p>\n<p><strong>De los diagnosticos diferenciales planteados:<\/strong><\/p>\n<p><!--more--> <\/p>\n<ul>\n<li><strong>Panarteritis Nodosa : <\/strong>Vasculitis piel, nervios.perif., N\u00f3dulos inflamat. Livedo,Dolor en brotes y activ.f\u00edsica, En piernas. Bilateral<\/li>\n<li><strong>Angiolipomas M\u00faltiples: <\/strong>Comp. mixto adip-vascular, N\u00f3dulos desplazables, 50 % dolor (sordo, leve), Tronco y extremidades<\/li>\n<li><strong>Lipedema: <\/strong>Enf no inflam.del tej adiposo, Induraci\u00f3n difusa no depr., Dolorosa, En piernas<\/li>\n<li><strong>Lipomatosis: <\/strong>Enf. tejido adiposo, M\u00faltiples lipomas, Existen formas dolorosas, Tronco y extremid. proxim.<\/li>\n<\/ul>\n<p><strong>Con&nbsp; los resultados obtenidos nos replanteamos el diagn\u00f3stico de :<\/strong><\/p>\n<p><strong>LIPOMATOSIS<\/strong><\/p>\n<p>Entre las lipomatosis pensamos en:<\/p>\n<p>&#8211; Lipomatosis segementaria de Touraine-Renault Muy rara. Causa ?, Lipomas capsulados, Distribuci\u00f3n metam\u00e9rica: cint. escap., pelv., t\u00f3rax inf.<\/p>\n<p>&#8211; Lipomatosis sim\u00e9trica m\u00faltiple. Enf. de Madelung: Hombres. Espor\u00e1dica, Lipomas grandes indoloros, Hemi-cuerpo sup. (cuello), Alcoholismo cr\u00f3nico.<\/p>\n<p>&#8211; Lipomatosis m\u00faltiple familiar&nbsp; de Roch-Lery: Hombres. Hereditaria (AD), Lipomas chicos indoloros, Zona media: t\u00f3rax, abdom., reg. lumbo-sacra, MMSS, &nbsp;<\/p>\n<p>-Adiposis dolorosa: Mujeres menopaus. Hered. Lipomas dolorosos, Extremidades inferiores, Trast. Ps\u00edquicos. Obesidad<\/p>\n<p>Haciendo correlaci\u00f3n Cl\u00ednico-Histol\u00f3gica<\/p>\n<p>Adiposis dolorosa&nbsp; (Enfermedad de Dercum)<\/p>\n<p>Conducta posterior<br \/> Interconsulta con Endocrinolog\u00eda. Estudio del perfil lip\u00eddico.<\/p>\n<ul>\n<li>Interconsulta con servicio de Psiquiatr\u00eda: Escitalopram 10 mg. por la noche.<\/li>\n<li>Tratamiento instituido: aplicaci\u00f3n t\u00f3pica 2 v\/d\u00eda, de lidoca\u00edna al 2,5% + priloca\u00edna al 2,5% (EMLA). Mejor\u00eda del 70% de la sensaci\u00f3n dolorosa de horas o d\u00edas de duraci\u00f3n.<\/li>\n<\/ul>\n<p>Breve recordatorio de la Adiposis  Dolorosa<\/p>\n<ul>\n<li>Enfermedad de etiolog\u00eda desconocida, curso cr\u00f3nico y progresivo<\/li>\n<li>Criterios diagn\u00f3sticos:<\/li>\n<\/ul>\n<p>&Oslash; M\u00faltiples lipomas&nbsp; dolorosos<\/p>\n<p>&Oslash; Obesidad generalizada (por lo general mujeres post-menopausicas)<\/p>\n<p>&Oslash; Astenia, debilidad y fatiga<\/p>\n<p>&Oslash; Trastornos psiconeur\u00f3ticos (inestabilidad emocional, depresi\u00f3n y\/o demencia)<\/p>\n<p>Tratamiento sintom\u00e1tico<\/p>\n<p>&#8211;<strong>Analg\u00e9sicos: <\/strong>paracetamol y dextropropoxifeno<strong> <\/strong><\/p>\n<p>&#8211;<strong>Corticoides: <\/strong>prednisona 20mg. VO<\/p>\n<p>&#8211;<strong>Anest\u00e9sicos locales:<\/strong><\/p>\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; a) Lidoca\u00edna intravenosa 5mg\/kg (30-90 minutos)<\/p>\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; b) Mexiletina oral 150-750 mg\/d\u00eda<\/p>\n<p>&#8211;<strong>Otros: diur\u00e9ticos, INF alfa 2b<\/strong><\/p>\n<p>&#8211;<strong>Cirug\u00eda: liposucci\u00f3n, ex\u00e9resis de lipomas<\/strong><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/202\/k11.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3253\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/202\/k11-300x225.jpg\" title=\"k11\" width=\"300\" height=\"225\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/202\/k11-300x225.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/202\/k11.jpg 1062w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/202\/k21.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3254\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/202\/k21-300x228.jpg\" title=\"k21\" width=\"300\" height=\"228\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/202\/k21-300x228.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/202\/k21.jpg 1052w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/202\/k31.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3255\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/202\/k31-300x233.jpg\" title=\"k31\" width=\"300\" height=\"233\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/202\/k31-300x233.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/202\/k31.jpg 1027w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a> <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Primer caso para Diagn\u00f3stico presentado por los Dres. Mart\u00edn Moreno, Jos\u00e9 Casas y Ana Kaminsky del Hospital Durand Servicio de Dermatolog\u00eda Facultad de Medicina. Universidad de Buenos Aires&nbsp; Argentina (Ir a al Edici\u00f3n 202) De los diagnosticos diferenciales planteados:<\/p>\n","protected":false},"author":37,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-3252","post","type-post","status-publish","format-standard","","category-caso-clinico-reto-terapeutico"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/3252","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/users\/37"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=3252"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/3252\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=3252"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=3252"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=3252"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}