{"id":679,"date":"2007-08-11T01:25:52","date_gmt":"2007-08-11T05:25:52","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=679"},"modified":"2007-08-11T01:25:52","modified_gmt":"2007-08-11T05:25:52","slug":"167-consulte-a-un-colega-n-1-que-hacer","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/679","title":{"rendered":"167: Consulte a un Colega N\u00b0 1: \u00bfQu\u00e9 hacer?"},"content":{"rendered":"<p><strong>Enviado por: Graterol F, S\u00fanico N, Qui\u00f1onez J, Ortega J, Valecillos S, V\u00e1squez W.<br \/> Instituto de Biomedicina. Hospital Vargas. Caracas Venezuela<\/strong><br \/> &nbsp;<\/p>\n<p>Carcinoma espinocelular<br \/> Paciente: L.M.P., Sexo: Masculino,&nbsp;  Edad: 79 a\u00f1os<br \/> Natural y procedente: La Pe\u00f1ita, Edo. Vargas.&nbsp;&nbsp;&nbsp;<br \/> V\u00eda&nbsp; Puerto Cruz.<\/p>\n<ul>\n<li>EA: 4 meses de evoluci\u00f3n.<\/li>\n<li>Lesi\u00f3n papular en labio inferior izquierdo.<\/li>\n<li>Aumenta de tama\u00f1o con posterior ulceraci\u00f3n.<\/li>\n<li>Por presentar molestia para comer, en dicha \u00e1rea consulta a facultativo.<\/li>\n<li><strong>Antecedentes Personales<\/strong><\/li>\n<li>HTA desde 2006, tto con Captopril hasta su ingreso cuando cambia a Enalapril 20 mg BID y Amlodipino 10 mg OD.<\/li>\n<li>Tab\u00e1quicos:<\/li>\n<li>Pipa desde hace mas de 30 a\u00f1os.<\/li>\n<li>Mastica Tabaco<\/li>\n<li>Agricultor.<\/li>\n<\/ul>\n<p>&nbsp;<!--more--><\/p>\n<ul>\n<li><strong>Impresi\u00f3n diagn\u00f3stiga al ingreso<\/strong><\/li>\n<li>Tumor en labio inferior<\/li>\n<li>Carcinoma espinocelular vs<\/li>\n<li>Granuloma por agente vivo mic\u00f3tico: Paracoccidiodomicosis.<\/li>\n<li>HTA<\/li>\n<\/ul>\n<ul>\n<li><strong>Paracl\u00ednicos (12\/06\/07).<\/strong><\/li>\n<\/ul>\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; HC:<\/p>\n<ul>\n<li>GB: 6400   60% N 32%L<\/li>\n<li>Hb: 12 mg\/dl Hto: 30%<\/li>\n<li>PLT: 200000<\/li>\n<\/ul>\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Qu\u00edmica sangu\u00ednea:<\/p>\n<ul>\n<li>Glicemia: 92 mg%<\/li>\n<li>Urea: 20 mg%<\/li>\n<li>Creatinina: 1 mg%<\/li>\n<\/ul>\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; PT y PTT: normales<\/p>\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; VDRL y HIV: negativos<\/p>\n<ul>\n<li><strong>Plan de trabajo<\/strong><\/li>\n<li>Biopsia de lesi\u00f3n<\/li>\n<li>HE<\/li>\n<li>Cultivo micol\u00f3gico: negativo<\/li>\n<li>Cultivo bacteriol\u00f3gico: negativo<\/li>\n<li>Evaluaci\u00f3n cardiovascular.<\/li>\n<li>Pruebas intrad\u00e9rmicas.<\/li>\n<li>PPD y Leishmanina: negativo<\/li>\n<li>Esporotriquina: 17 mm<\/li>\n<li>Candidina: 18 mm<\/li>\n<li>EKG<\/li>\n<\/ul>\n<p>Hipertrofia ventricular izquierda<\/p>\n<ul>\n<li>Rx de T\u00f3rax PA: arco a\u00f3rtico prominente.<\/li>\n<li>Evaluaci\u00f3n cardiovascular:<\/li>\n<\/ul>\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Riesgo Qx ASA II.<\/p>\n<ul>\n<li><strong>Biopsia de lesi\u00f3n:<\/strong><\/li>\n<\/ul>\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strong>Carcinoma espinocelular bien diferenciado<\/strong>.<\/p>\n<ul>\n<li>Evaluaci\u00f3n Cirug\u00eda Dermatol\u00f3gica<\/li>\n<li>Evaluaci\u00f3n Cirug\u00eda Pl\u00e1stica<\/li>\n<li>Evaluaci\u00f3n Cirug\u00eda Oncol\u00f3gica<\/li>\n<li>Comisi\u00f3n de tumores<\/li>\n<li><strong>Pendiente en la actualidad<\/strong><\/li>\n<\/ul>\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; TAC de cabeza y cuello 3D<\/p>\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Panor\u00e1mica dental<\/p>\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Intervenci\u00f3n Qx&nbsp; para exc\u00e9resis de lesi\u00f3n y biopsia de ganglios cervicales<\/p>\n<p><strong>\u00bf;Que sugieren ustedes que deber\u00eda ser el manejo terap\u00e9utico?<\/strong><\/p>\n<p><strong>Radioterapia Vs Cirug\u00eda<\/strong><\/p>\n<p><strong>Si les parece Cirug\u00eda como ser\u00eda el abordaje y alcance<\/strong><\/p>\n<p><a href=\"\/blog\/wp-content\/uploads\/2007\/08\/167\/consulteColega\/1\/fig1.jpg\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"\/blog\/wp-content\/uploads\/2007\/08\/167\/consulteColega\/1\/fig1p.jpg\" alt=\"caso\" width=\"250\" height=\"156\" \/><\/a><\/p>\n<p><a href=\"\/blog\/wp-content\/uploads\/2007\/08\/167\/consulteColega\/1\/fig2.jpg\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"\/blog\/wp-content\/uploads\/2007\/08\/167\/consulteColega\/1\/fig2p.jpg\" alt=\"caso\" width=\"250\" height=\"156\" \/><\/a><\/p>\n<p><a href=\"\/blog\/wp-content\/uploads\/2007\/08\/167\/consulteColega\/1\/fig3.jpg\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"\/blog\/wp-content\/uploads\/2007\/08\/167\/consulteColega\/1\/fig3p.jpg\" alt=\"caso\" width=\"250\" height=\"156\" \/><\/a><\/p>\n<p><a href=\"\/blog\/wp-content\/uploads\/2007\/08\/167\/consulteColega\/1\/fig4.jpg\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"\/blog\/wp-content\/uploads\/2007\/08\/167\/consulteColega\/1\/fig4p.jpg\" alt=\"caso\" width=\"250\" height=\"156\" \/><\/a><\/p>\n<p><a href=\"\/blog\/wp-content\/uploads\/2007\/08\/167\/consulteColega\/1\/fig5.jpg\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"\/blog\/wp-content\/uploads\/2007\/08\/167\/consulteColega\/1\/fig5p.jpg\" alt=\"caso\" width=\"250\" height=\"156\" \/><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Enviado por: Graterol F, S\u00fanico N, Qui\u00f1onez J, Ortega J, Valecillos S, V\u00e1squez W. Instituto de Biomedicina. Hospital Vargas. Caracas Venezuela &nbsp; Carcinoma espinocelular Paciente: L.M.P., Sexo: Masculino,&nbsp; Edad: 79 a\u00f1os Natural y procedente: La Pe\u00f1ita, Edo. Vargas.&nbsp;&nbsp;&nbsp; V\u00eda&nbsp; Puerto Cruz. EA: 4 meses de evoluci\u00f3n. Lesi\u00f3n papular en labio inferior izquierdo. Aumenta de tama\u00f1o &hellip;<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[25],"tags":[],"class_list":["post-679","post","type-post","status-publish","format-standard","","category-consulte-a-un-colega"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/679","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\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=679"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/679\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=679"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=679"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=679"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}