{"id":{"repo_id":"rosario","oai_identifier":"oai:repository.urosario.edu.co:10336/44940"},"canonical_url":"https://search.dev.ndltd.org/etd/rosario/oai:repository.urosario.edu.co:10336/44940","repository":{"repo_id":"rosario","name":"Universidad del Rosario","base_url":"https://repository.urosario.edu.co/oai/request"},"display":{"title":"Síndrome de McKittrick Wheelock: Serie de casos","abstract":"El síndrome de McKittrick Wheelock es una entidad clínica poco frecuente caracterizada por diarrea crónica, desequilibrio y adenoma velloso colorectal de gran tamaño (1,2). Esta entidad representa un alto riesgo de morbimortalidad en la población. La baja sospecha clínica genera un retraso en el diagnóstico y aumento en las complicaciones Métodos: Reporte de caso con 3 pacientes con síndrome de McKittrick Wheelock entre el 2021 a 2024 que describe las características clínicas, imagenológicas y el tratamiento. El análisis se realizó en el software RStudio Resultados: Nosotros reportamos 3 casos con hallazgos compatibles con síndrome de McKittrick : El primer paciente un hombre de 74 años con diarrea crónica, alteración electrolítica y un adenoma velloso con componente circunferencial manejado con una resección abdominoperineal. El segundo paciente, una mujer de 60 años con diarrea crónica, alteración hidroelectrolítica y pólipo gigante pediculado en recto manejado exitosamente con una resección local por vía transanal y el tercer paciente, una mujer de 70 años con diarrea crónica, pérdida sustancial de peso, desequilibrio con un adenoma velloso que generaba intususcepción manejada de forma exitosa con una resección anterior baja de recto. Discusión: Los casos discutidos ilustran la relevancia del manejo e intervención quirúrgica oportuna y la consideración del síndrome de McKittrick Wheelock en el diagnóstico diferencial de los pacientes. Conclusión: El síndrome de McKittrick Wheelock requiere un enfoque multidisciplinario. La sospecha diagnóstica y el manejo quirúrgico oportuno son clave para mejorar los resultados clínicos y prevenir complicaciones mejorando el pronóstico de los pacientes","abstract_html":"El síndrome de McKittrick Wheelock es una entidad clínica poco frecuente caracterizada por diarrea crónica, desequilibrio y adenoma velloso colorectal de gran tamaño (1,2). Esta entidad representa un alto riesgo de morbimortalidad en la población. La baja sospecha clínica genera un retraso en el diagnóstico y aumento en las complicaciones Métodos: Reporte de caso con 3 pacientes con síndrome de McKittrick Wheelock entre el 2021 a 2024 que describe las características clínicas, imagenológicas y el tratamiento. El análisis se realizó en el software RStudio Resultados: Nosotros reportamos 3 casos con hallazgos compatibles con síndrome de McKittrick : El primer paciente un hombre de 74 años con diarrea crónica, alteración electrolítica y un adenoma velloso con componente circunferencial manejado con una resección abdominoperineal. El segundo paciente, una mujer de 60 años con diarrea crónica, alteración hidroelectrolítica y pólipo gigante pediculado en recto manejado exitosamente con una resección local por vía transanal y el tercer paciente, una mujer de 70 años con diarrea crónica, pérdida sustancial de peso, desequilibrio con un adenoma velloso que generaba intususcepción manejada de forma exitosa con una resección anterior baja de recto. Discusión: Los casos discutidos ilustran la relevancia del manejo e intervención quirúrgica oportuna y la consideración del síndrome de McKittrick Wheelock en el diagnóstico diferencial de los pacientes. Conclusión: El síndrome de McKittrick Wheelock requiere un enfoque multidisciplinario. La sospecha diagnóstica y el manejo quirúrgico oportuno son clave para mejorar los resultados clínicos y prevenir complicaciones mejorando el pronóstico de los pacientes","abstract_has_math":false,"creators":["Tobar Bonilla, Ronald Yesid"],"institution":"Universidad del Rosario","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2024,"date_issued":"2024-12-13","date_published":"2024-12-13","updated_at":"2026-07-27T20:46:31Z","subjects":["Síndrome de McKittrick wheelock","Diarrea crónica","Desequilibrio hidroelectrolitico","Adenoma velloso","McKittrick Wheelock Syndrome","Chronic diarrhea","Electrolyte imbalance","Villous adenoma"],"languages":["spa"],"rights":["info:eu-repo/semantics/openAccess"],"rights_urls":["http://creativecommons.org/licenses/by/4.0/"],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["https://repository.urosario.edu.co/handle/10336/44940"],"render_values":[{"text":"https://repository.urosario.edu.co/handle/10336/44940","href":"https://repository.urosario.edu.co/handle/10336/44940","code":true}]}]},"links":{"outbound_url":"https://doi.org/10.48713/10336_44940","outbound_label":"DOI","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Tobar Bonilla, Ronald Yesid"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2024-12-13","2025-02-07T12:25:56Z"]},{"key":"dc:publisher","label":"Institution","values":["Universidad del Rosario","Escuela de Medicina y Ciencias de la Salud","Especialización en Coloproctología"]},{"key":"dc:type","label":"Dc Type","values":["info:eu-repo/semantics/masterThesis","info:eu-repo/semantics/acceptedVersion"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Síndrome de McKittrick wheelock","Diarrea crónica","Desequilibrio hidroelectrolitico","Adenoma velloso","McKittrick Wheelock Syndrome","Chronic diarrhea","Electrolyte imbalance","Villous adenoma"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["spa"]},{"key":"dc:rights","label":"Dc Rights","values":["info:eu-repo/semantics/openAccess","http://creativecommons.org/licenses/by/4.0/"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://doi.org/10.48713/10336_44940","https://repository.urosario.edu.co/handle/10336/44940"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["El síndrome de McKittrick Wheelock es una entidad clínica poco frecuente caracterizada por diarrea crónica, desequilibrio y adenoma velloso colorectal de gran tamaño (1,2). Esta entidad representa un alto riesgo de morbimortalidad en la población. La baja sospecha clínica genera un retraso en el diagnóstico y aumento en las complicaciones Métodos: Reporte de caso con 3 pacientes con síndrome de McKittrick Wheelock entre el 2021 a 2024 que describe las características clínicas, imagenológicas y el tratamiento. El análisis se realizó en el software RStudio Resultados: Nosotros reportamos 3 casos con hallazgos compatibles con síndrome de McKittrick : El primer paciente un hombre de 74 años con diarrea crónica, alteración electrolítica y un adenoma velloso con componente circunferencial manejado con una resección abdominoperineal. El segundo paciente, una mujer de 60 años con diarrea crónica, alteración hidroelectrolítica y pólipo gigante pediculado en recto manejado exitosamente con una resección local por vía transanal y el tercer paciente, una mujer de 70 años con diarrea crónica, pérdida sustancial de peso, desequilibrio con un adenoma velloso que generaba intususcepción manejada de forma exitosa con una resección anterior baja de recto. Discusión: Los casos discutidos ilustran la relevancia del manejo e intervención quirúrgica oportuna y la consideración del síndrome de McKittrick Wheelock en el diagnóstico diferencial de los pacientes. Conclusión: El síndrome de McKittrick Wheelock requiere un enfoque multidisciplinario. La sospecha diagnóstica y el manejo quirúrgico oportuno son clave para mejorar los resultados clínicos y prevenir complicaciones mejorando el pronóstico de los pacientes","McKittrick-Wheelock syndrome is a rare clinical entity characterized by chronic diarrhea, electrolyte imbalance, and a large villous colorectal adenoma (1,2). This condition poses a high risk of morbidity and mortality in affected patients. Low clinical suspicion often leads to delayed diagnosis and an increased risk of complications. A case report of three patients diagnosed with McKittrick-Wheelock syndrome between 2021 and 2024 is presented, describing their clinical, imaging, and treatment characteristics. Data analysis was performed using RStudio software. We report three cases with findings consistent with McKittrick-Wheelock syndrome: • Case 1: A 74-year-old man with chronic diarrhea, electrolyte imbalance, and a circumferential villous adenoma, managed with abdominoperineal resection. • Case 2: A 60-year-old woman with chronic diarrhea, hydroelectrolytic imbalance, and a giant pedunculated rectal polyp, successfully treated with local transanal resection. • Case 3: A 70-year-old woman with chronic diarrhea, significant weight loss, and electrolyte imbalance, diagnosed with a villous adenoma causing intussusception, successfully managed with a low anterior rectal resection. Discussion The cases presented highlight the importance of timely diagnosis and appropriate surgical management in patients with McKittrick-Wheelock syndrome. Early recognition of this condition is crucial to prevent severe complications and reduce morbidity and mortality. Conclusion McKittrick-Wheelock syndrome requires a multidisciplinary approach. High diagnostic suspicion and prompt surgical intervention are essential to improve clinical outcomes and prevent complications, ultimately enhancing patient prognosis."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:source","label":"Dc Source","values":["Villanueva MEP, Onglao MAS, Tampo MMT, Lopez MPJ. McKittrick-Wheelock Syndrome: A Case Series. Ann Coloproctology [Internet]. 2022 Jun [cited 2024 Sep 10];38(3):266– 70. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9263311/","Caron M, Dubrûle CE, Letarte F, Lemelin V, Lafleur A. McKittrick-Wheelock Syndrome Presenting with Acute Kidney Injury and Metabolic Alkalosis: Case Report and Narrative Review. Case Rep Gastrointest Med. 2019;2019:3104187.","McKittrick LS, Wheelock FC. Carcinoma of the colon. 1954. Dis Colon Rectum. 1997 Dec;40(12):1494–5; discussion 1495-1496.","Sullivan BA, Noujaim M, Roper J. Cause, Epidemiology, and Histology of Polyps and Pathways to Colorectal Cancer. Gastrointest Endosc Clin N Am. 2022 Apr;32(2):177–94.","Wong MCS, Huang J, Huang JLW, Pang TWY, Choi P, Wang J, et al. Global Prevalence of Colorectal Neoplasia: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2020 Mar;18(3):553-561.e10.","Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL. Natural history of untreated colonic polyps. Gastroenterology. 1987 Nov;93(5):1009–13.","López-Fernández J, Fernández-San Millán D, Navarro-Sánchez A, Hernández Hernández JR. McKittrick-Wheelock syndrome: A rare cause of metabolic coma. Gastroenterol Hepatol. 2017 May;40(5):349–51.","Orchard M, Hooper J, Wright J, McCarthy K. A systematic review of McKittrick– Wheelock syndrome. Ann R Coll Surg Engl [Internet]. 2018 Nov [cited 2024 Sep 10];100(8):591– 7. Available from: https://publishing.rcseng.ac.uk/doi/full/10.1308/rcsann.2018.0184","Chaudhry H, Iqbal H, Gill A, Prajapati D. McKittrick-Wheelock syndrome: A rare cause of chronic diarrhea treated with endoscopic polypectomy. SAGE Open Med Case Rep. 2023;11:2050313X231177762.","Lee YS, Lin HJ, Chen KT. McKittrick-Wheelock syndrome: a rare cause of life-threatening electrolyte disturbances and volume depletion. J Emerg Med. 2012 Sep;43(3):e171-173.","Hashash JG, Holder-Murray J, Aoun E, Yadav D. The McKittrick-Wheelock syndrome: a rare cause of chronic diarrhoea. BMJ Case Rep. 2013 Apr 15;2013:bcr2013009208.","van der Pool AEM, de Graaf EJR, Vermaas M, Barendse RM, Doornebosch PG. McKittrick Wheelock Syndrome Treated by Transanal Minimally Invasive Surgery: A Single-Center Experience and Review of the Literature. J Laparoendosc Adv Surg Tech A. 2018 Feb;28(2):204–8.","Hsieh MC, Chen CJ, Huang WS. McKittrick-Wheelock Syndrome. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2016 Apr;14(4):e41-42.","Ohara Y, Toyonaga T, Watanabe D, Hoshi N, Adachi S, Yoshizaki T, et al. Electrolyte depletion syndrome (McKittrick-Wheelock syndrome) successfully treated by endoscopic submucosal dissection. Clin J Gastroenterol. 2015 Oct;8(5):280–4.","de Sousa Miranda I, Ferreira JR, Rocha S, Monteiro M, Guillerme J, Domingos R. McKittrick-Wheelock Syndrome: A Neoplastic Cause of Electrolyte Imbalance. Eur J Case Rep Intern Med. 2022;9(3):003231.","Langeron P, Prévost AG, Boudailliez C. [Rectosigmoid villous tumors with hydroelectrolytic disorders]. J Sci Med Lille. 1969 Jan;87(1):5–23.","Choi WH, Ryuk J, Kim HJ, Park SY, Park JS, Kim JG, et al. A case of giant rectal villous tumor with severe fluid-electrolyte imbalance treated by laparoscopic low anterior resection. J Korean Surg Soc. 2012 May;82(5):325–9.","Emrich J, Niemeyer C. [The secreting villous adenoma as a rare cause of acute renal failure]. Med Klin Munich Ger 1983. 2002 Oct 15;97(10):619–23.","Fukami N. Surgery Versus Endoscopic Mucosal Resection Versus Endoscopic Submucosal Dissection for Large Polyps: Making Sense of When to Use Which Approach. Gastrointest Endosc Clin N Am. 2019 Oct;29(4):675–85.","Nakhla SG, Murakami TT, Sundararajan S. Poorly Differentiated Neuroendocrine Tumor of the Rectum Coexistent with Giant Rectal Villous Adenoma Presenting as McKittrick-Wheelock Syndrome. Case Rep Oncol Med. 2015;2015:242760.","Guney I, Burgucu HC, Ergul F, Hasirci I, Omeroglu E. A Rare Case of Acute Kidney Injury: McKittrick Wheelock Syndrome. Iran J Kidney Dis. 2019 Mar;13(2):132–3.","instname:Universidad del Rosario","reponame:Repositorio Institucional EdocUR"]},{"key":"dc:title","label":"Title","values":["Síndrome de McKittrick Wheelock: Serie de casos","McKittrick Wheelock: Case series"]}]}],"canonical_facts":{"dc:creator":["Tobar Bonilla, Ronald Yesid"],"dc:date":["2024-12-13","2025-02-07T12:25:56Z"],"dc:description":["El síndrome de McKittrick Wheelock es una entidad clínica poco frecuente caracterizada por diarrea crónica, desequilibrio y adenoma velloso colorectal de gran tamaño (1,2). Esta entidad representa un alto riesgo de morbimortalidad en la población. La baja sospecha clínica genera un retraso en el diagnóstico y aumento en las complicaciones Métodos: Reporte de caso con 3 pacientes con síndrome de McKittrick Wheelock entre el 2021 a 2024 que describe las características clínicas, imagenológicas y el tratamiento. El análisis se realizó en el software RStudio Resultados: Nosotros reportamos 3 casos con hallazgos compatibles con síndrome de McKittrick : El primer paciente un hombre de 74 años con diarrea crónica, alteración electrolítica y un adenoma velloso con componente circunferencial manejado con una resección abdominoperineal. El segundo paciente, una mujer de 60 años con diarrea crónica, alteración hidroelectrolítica y pólipo gigante pediculado en recto manejado exitosamente con una resección local por vía transanal y el tercer paciente, una mujer de 70 años con diarrea crónica, pérdida sustancial de peso, desequilibrio con un adenoma velloso que generaba intususcepción manejada de forma exitosa con una resección anterior baja de recto. Discusión: Los casos discutidos ilustran la relevancia del manejo e intervención quirúrgica oportuna y la consideración del síndrome de McKittrick Wheelock en el diagnóstico diferencial de los pacientes. Conclusión: El síndrome de McKittrick Wheelock requiere un enfoque multidisciplinario. La sospecha diagnóstica y el manejo quirúrgico oportuno son clave para mejorar los resultados clínicos y prevenir complicaciones mejorando el pronóstico de los pacientes","McKittrick-Wheelock syndrome is a rare clinical entity characterized by chronic diarrhea, electrolyte imbalance, and a large villous colorectal adenoma (1,2). This condition poses a high risk of morbidity and mortality in affected patients. Low clinical suspicion often leads to delayed diagnosis and an increased risk of complications. A case report of three patients diagnosed with McKittrick-Wheelock syndrome between 2021 and 2024 is presented, describing their clinical, imaging, and treatment characteristics. Data analysis was performed using RStudio software. We report three cases with findings consistent with McKittrick-Wheelock syndrome: • Case 1: A 74-year-old man with chronic diarrhea, electrolyte imbalance, and a circumferential villous adenoma, managed with abdominoperineal resection. • Case 2: A 60-year-old woman with chronic diarrhea, hydroelectrolytic imbalance, and a giant pedunculated rectal polyp, successfully treated with local transanal resection. • Case 3: A 70-year-old woman with chronic diarrhea, significant weight loss, and electrolyte imbalance, diagnosed with a villous adenoma causing intussusception, successfully managed with a low anterior rectal resection. Discussion The cases presented highlight the importance of timely diagnosis and appropriate surgical management in patients with McKittrick-Wheelock syndrome. Early recognition of this condition is crucial to prevent severe complications and reduce morbidity and mortality. Conclusion McKittrick-Wheelock syndrome requires a multidisciplinary approach. High diagnostic suspicion and prompt surgical intervention are essential to improve clinical outcomes and prevent complications, ultimately enhancing patient prognosis."],"dc:format":["application/pdf"],"dc:identifier":["https://doi.org/10.48713/10336_44940","https://repository.urosario.edu.co/handle/10336/44940"],"dc:language":["spa"],"dc:publisher":["Universidad del Rosario","Escuela de Medicina y Ciencias de la Salud","Especialización en Coloproctología"],"dc:rights":["info:eu-repo/semantics/openAccess","http://creativecommons.org/licenses/by/4.0/"],"dc:source":["Villanueva MEP, Onglao MAS, Tampo MMT, Lopez MPJ. McKittrick-Wheelock Syndrome: A Case Series. Ann Coloproctology [Internet]. 2022 Jun [cited 2024 Sep 10];38(3):266– 70. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9263311/","Caron M, Dubrûle CE, Letarte F, Lemelin V, Lafleur A. McKittrick-Wheelock Syndrome Presenting with Acute Kidney Injury and Metabolic Alkalosis: Case Report and Narrative Review. Case Rep Gastrointest Med. 2019;2019:3104187.","McKittrick LS, Wheelock FC. Carcinoma of the colon. 1954. Dis Colon Rectum. 1997 Dec;40(12):1494–5; discussion 1495-1496.","Sullivan BA, Noujaim M, Roper J. Cause, Epidemiology, and Histology of Polyps and Pathways to Colorectal Cancer. Gastrointest Endosc Clin N Am. 2022 Apr;32(2):177–94.","Wong MCS, Huang J, Huang JLW, Pang TWY, Choi P, Wang J, et al. Global Prevalence of Colorectal Neoplasia: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2020 Mar;18(3):553-561.e10.","Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL. Natural history of untreated colonic polyps. Gastroenterology. 1987 Nov;93(5):1009–13.","López-Fernández J, Fernández-San Millán D, Navarro-Sánchez A, Hernández Hernández JR. McKittrick-Wheelock syndrome: A rare cause of metabolic coma. Gastroenterol Hepatol. 2017 May;40(5):349–51.","Orchard M, Hooper J, Wright J, McCarthy K. A systematic review of McKittrick– Wheelock syndrome. Ann R Coll Surg Engl [Internet]. 2018 Nov [cited 2024 Sep 10];100(8):591– 7. Available from: https://publishing.rcseng.ac.uk/doi/full/10.1308/rcsann.2018.0184","Chaudhry H, Iqbal H, Gill A, Prajapati D. McKittrick-Wheelock syndrome: A rare cause of chronic diarrhea treated with endoscopic polypectomy. SAGE Open Med Case Rep. 2023;11:2050313X231177762.","Lee YS, Lin HJ, Chen KT. McKittrick-Wheelock syndrome: a rare cause of life-threatening electrolyte disturbances and volume depletion. J Emerg Med. 2012 Sep;43(3):e171-173.","Hashash JG, Holder-Murray J, Aoun E, Yadav D. The McKittrick-Wheelock syndrome: a rare cause of chronic diarrhoea. BMJ Case Rep. 2013 Apr 15;2013:bcr2013009208.","van der Pool AEM, de Graaf EJR, Vermaas M, Barendse RM, Doornebosch PG. McKittrick Wheelock Syndrome Treated by Transanal Minimally Invasive Surgery: A Single-Center Experience and Review of the Literature. J Laparoendosc Adv Surg Tech A. 2018 Feb;28(2):204–8.","Hsieh MC, Chen CJ, Huang WS. McKittrick-Wheelock Syndrome. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2016 Apr;14(4):e41-42.","Ohara Y, Toyonaga T, Watanabe D, Hoshi N, Adachi S, Yoshizaki T, et al. Electrolyte depletion syndrome (McKittrick-Wheelock syndrome) successfully treated by endoscopic submucosal dissection. Clin J Gastroenterol. 2015 Oct;8(5):280–4.","de Sousa Miranda I, Ferreira JR, Rocha S, Monteiro M, Guillerme J, Domingos R. McKittrick-Wheelock Syndrome: A Neoplastic Cause of Electrolyte Imbalance. Eur J Case Rep Intern Med. 2022;9(3):003231.","Langeron P, Prévost AG, Boudailliez C. [Rectosigmoid villous tumors with hydroelectrolytic disorders]. J Sci Med Lille. 1969 Jan;87(1):5–23.","Choi WH, Ryuk J, Kim HJ, Park SY, Park JS, Kim JG, et al. A case of giant rectal villous tumor with severe fluid-electrolyte imbalance treated by laparoscopic low anterior resection. J Korean Surg Soc. 2012 May;82(5):325–9.","Emrich J, Niemeyer C. [The secreting villous adenoma as a rare cause of acute renal failure]. Med Klin Munich Ger 1983. 2002 Oct 15;97(10):619–23.","Fukami N. Surgery Versus Endoscopic Mucosal Resection Versus Endoscopic Submucosal Dissection for Large Polyps: Making Sense of When to Use Which Approach. Gastrointest Endosc Clin N Am. 2019 Oct;29(4):675–85.","Nakhla SG, Murakami TT, Sundararajan S. Poorly Differentiated Neuroendocrine Tumor of the Rectum Coexistent with Giant Rectal Villous Adenoma Presenting as McKittrick-Wheelock Syndrome. Case Rep Oncol Med. 2015;2015:242760.","Guney I, Burgucu HC, Ergul F, Hasirci I, Omeroglu E. A Rare Case of Acute Kidney Injury: McKittrick Wheelock Syndrome. Iran J Kidney Dis. 2019 Mar;13(2):132–3.","instname:Universidad del Rosario","reponame:Repositorio Institucional EdocUR"],"dc:subject":["Síndrome de McKittrick wheelock","Diarrea crónica","Desequilibrio hidroelectrolitico","Adenoma velloso","McKittrick Wheelock Syndrome","Chronic diarrhea","Electrolyte imbalance","Villous adenoma"],"dc:title":["Síndrome de McKittrick Wheelock: Serie de casos","McKittrick Wheelock: Case series"],"dc:type":["info:eu-repo/semantics/masterThesis","info:eu-repo/semantics/acceptedVersion"]},"updated_at":"2026-07-27T20:46:31Z"}