[Translated article] Mechanical resistance of polylactic acid bone matrices developed by 3D printing for the reconstruction of bone defects.

INTRODUCTION: Bone defects are one of the main limitations in orthopaedic surgery and traumatology. For this reason, multiple bone replacement systems have been developed, either by prosthetic implant or by substitution with osteoforming substances, whose limitations are their survival and lack of structurality, respectively. The objective of this work is the generation of a new material for the creation of biologically active structures that have sufficient tensile strength to maintain the structure during remodelling. MATERIAL AND METHODS: A new filament based on the fusion of natural polylactide acid (PLA) powder was designed for the generation of pieces by means of fused deposition modelling (FDM) on which to carry out tensile mechanical tests of osteosynthesis material. A total of 13 groups with different cortical thickness, filling and layer height were carried out, with 10 tensile tests in each group, defining the tensile breaking limit for each group. The regression lines for each group and their mechanical resistance to traction on the filament used were determined. RESULTS: The filament ratio per contact surface unit with the osteosynthesis used was the main determinant of the mechanical resistance to traction, either at the expense of the increase in cortical thickness or by the increase in the percentage of cancellous bone filling. Layer height had a minor effect on tensile strength. The regression value was high for cortical thickness and cancellous filling, being elements with a predictable biomechanical behaviour. CONCLUSIONS: The new methodology allows the creation of personalised neutral and implantable PLA bone matrices for the reconstruction of large bone defects by means of 3D printing by FDM with a mechanical resistance to traction greater than that of current biological support structures.

Mechanical resistance of polylactic acid bone matrices developed by 3D printing for the reconstruction of bone defects. / Resistencia mecánica de matrices óseas de ácido poliláctico desarrolladas por impresión 3D para la reconstrucción de defectos óseos.

INTRODUCTION: Bone defects are one of the main limitations in orthopedic surgery and traumatology. For this reason, multiple bone replacement systems have been developed, either by prosthetic implant or by substitution with osteoforming substances, whose limitations are their survival and lack of structurality, respectively. The objective of this work is the generation of a new material for the creation of biologically active structures that have sufficient tensile strength to maintain the structure during remodeling. MATERIAL AND METHODS: A new filament based on the fusion of natural polylactide acid (PLA) powder was designed for the generation of pieces by means of fused deposition modeling (FDM) on which to carry out tensile mechanical tests of osteosynthesis material. A total of 13 groups with different cortical thickness, filling and layer height were carried out, with 10 tensile tests in each group, defining the tensile breaking limit for each group. The regression lines for each group and their mechanical resistance to traction on the filament used were determined. RESULTS: The filament ratio per contact surface unit with the osteosynthesis used was the main determinant of the mechanical resistance to traction, either at the expense of the increase in cortical thickness or by the increase in the percentage of cancellous bone filling. Layer height had a minor effect on tensile strength. The regression value was high for cortical thickness and cancellous filling, being elements with a predictable biomechanical behavior. CONCLUSIONS: The new methodology allows the creation of personalized neutral and implantable PLA bone matrices for the reconstruction of large bone defects by means of 3D printing by FDM with a mechanical resistance to traction greater than that of current biological support structures.

Prevalence and spatial distribution of bovine brucellosis in San Luis and La Pampa, Argentina.

BACKGROUND: Bovine brucellosis (BB) is a zoonotic disease caused by Brucella abortus. BB is endemic in Argentina, where vaccination with Brucella abortus strain 19 is compulsory for 3-to-8 month-old heifers. The objectives of this study were to quantify the prevalence of BB and to identify factors associated with its occurrence, along with the spatial distribution of the disease, in the provinces of La Pampa and San Luis. A two-stage random sampling design was used to sample 8,965 cows (3,513 in La Pampa and 5,452 in San Luis) from 451 farms (187 in La Pampa and 264 in San Luis). RESULTS: Cow and herd prevalence were 1.8 % (95 % CI: 1.3-2.2; n = 157) and 19.7 % (95 % CI: 17.0-22.4; n = 89), respectively. Both cow-level and herd-level prevalence in La Pampa (2.4 and 26.0 %, respectively) were significantly higher than in San Luis (1.4 and 15.5 %, respectively). There were not differences between the proportions of reactive cattle compared to that obtained in a survey conducted in 2005. However, herd prevalence in La Pampa was significantly (P < 0.05) higher compared to that study. Disease was found to be spatially clustered in west La Pampa. The lower the bovine density and the calf/cow ratio, the higher odds of belonging to the cluster. CONCLUSIONS: The increase of farm prevalence in the last five years suggests that the disease is spreading and that control measures should be applied in the region. The cluster of infected farms was located in the west region of La Pampa. There, farms have lower animal densities and smaller cow/calf indices compared to the rest of the province. Although western La Pampa has more infected herds, within-farm prevalence was not higher, which suggests that the control program has been relatively successful in controlling the disease at the farm level, and/or that low animal density inherently results in low disease prevalence. Our results provide baseline information on the epidemiology of BB and its potential pattern of transmission in Argentina, which will ultimately help to improve BB control programs in the country.

Alternativas para el tratamiento de las fracturas complejas de pilón tibial / Alternatives for the treatment of complex tibial pilon fractures

Las fracturas de pilón tibial representan una de las fracturas más graves, no sólo por la complejidad de su tratamiento, sino también por las importantes secuelas que pueden originar. Además de que un importante porcentaje de éstas son abiertas o con importante afectación de partes blandas, lo que dificulta aún más su tratamiento. Se revisaron 37 pacientes con fractura de pilón tibial tratados de forma quirúrgica, analizando los resultados con la escala de valoración funcional FREMAP y con los criterios radiográficos de Burwell-Charnley. Aunque no existe consenso en relación al tratamiento ideal, parece evidente que el tratamiento combinado con fijación externa e interna con placa ofrece los mejores resultados.

Tibial pilon fractures are one of the most severe types of fractures, not only due to the complexity of their treatment, but also due to the important sequelae they may cause. Moreover, an important percentage of them are open fractures or importantly involve the soft tissues, thus making treatment even more difficult. Thirty-seven patients with tibial pilon fractures treated surgically were included in this study. The results of the FREMAP functional assessment scale were analyzed together with Burwell-Charnley's radiographic criteria. Although there is no consensus on which is the best treatment, it is evident that combined treatment including external and internal fixation with a plate provides the best results.

Seasonal changes of fish assemblages in a subtropical lagoon in the SE Gulf of California.

The composition and seasonal changes of the fish assemblage in a coastal lagoon system in southeastern Gulf of California were assessed from December 2001 to July 2005. A total of 20,877 organisms belonging to 191 species and 47 families were analyzed. We determined that almost all the species inhabiting the system were found; however some rare species were not captured in our study. The majority of the species found were demersal but in every season at least one pelagic or benthopelagic species showed high abundances. The moonfish, Selene peruviana, was the most abundant species, whilst the puffer, Sphoeroides annulatus, was the main species in terms of biomass. The species composition changed seasonally; results from the Simpson diversity index and the cumulative species curve show that seasonally almost all the species in the system for a given season were found. These changes were also reflected in the multivariate results. The seasonal variations could be attributed to the migration of species out of the system as they grow and the arrival of new ones, which could also be related to temperature patterns since this environmental factor changes considerably through the year.

[Alternatives for the treatment of complex tibial pilon fractures]. / Alternativas para el tratamiento de las fracturas complejas de pilón tibial.

Tibial pilon fractures are one of the most severe types of fractures, not only due to the complexity of their treatment, but also due to the important sequelae they may cause. Moreover, an important percentage of them are open fractures or importantly involve the soft tissues, thus making treatment even more difficult. Thirty-seven patients with tibial pilon fractures treated surgically were included in this study. The results of the FREMAP functional assessment scale were analyzed together with Burwell-Charnley's radiographic criteria. Although there is no consensus on which is the best treatment, it is evident that combined treatment including external and internal fixation with a plate provides the best results.

Raoultella planticola bacteraemia secondary to gastroenteritis.

We present the first case of Raoultella planticola bacteria in human infections with a direct relationship between fish intake and enteric infection. The patient was treated with antibiotherapy (cefotaxime). It is important to consider this organism in the differential diagnosis of enteric fever and even more with previous ingestion of fish.

Diferencias en la utilización de los servicios de Atención Primaria entre niños autóctonos e inmigrantes / Differences in the use of Primary Care services among native and immigrant children

Introducción: el presente estudio pretende: 1) analizar el uso de los servicios de Atención Primaria de la población infantil inmigrante en relación con la española, y 2) analizar las diferencias existentes en esta frecuentación según la distinta procedencia. Material y métodos: se trata de un estudio observacional retrospectivo de todas las consultas a menores de 15 años llevadas a cabo el año 2007, en 26 centros de salud de Zaragoza. La variable principal, la frecuentación, se definió como el número total de visitas/año. La variable secundaria fue el tipo de atención solicitada. La información sobre los datos de las visitas se obtuvieron a partir de la agenda de la historia clínica electrónica (OMI(C): oficina médica informatizada) de los centros de salud. Las tasas de frecuentación se ajustaron por edad y sexo. Resultados: se analizaron un total de 547 524 citas pediátricas sobre una población de 71 114 niños (el 10,87% eran inmigrantes). La frecuencia anual ajustada de visitas en los niños autóctonos fue de 8,05 frente a la de inmigrantes, que fue de 5,66. Dent Introducción: el presente estudio pretende: 1) analizar el uso de los servicios de Atención Primaria de la población infantil inmigrante en relación con la española, y 2) analizar las diferencias existentes en esta frecuentación según la distinta procedencia. Material y métodos: se trata de un estudio observacional retrospectivo de todas las consultas a menores de 15 años llevadas a cabo el año 2007, en 26 centros de salud de Zaragoza. La variable principal, la frecuentación, se definió como el número total de visitas/año. La variable secundaria fue el tipo de atención solicitada. La información sobre los datos de las visitas se obtuvieron a partir de la agenda de la historia clínica electrónica (OMI(C): oficina médica informatizada) de los centros de salud. Las tasas de frecuentación se ajustaron por edad y sexo. Resultados: se analizaron un total de 547 524 citas pediátricas sobre una población de 71 114 niños (el 10,87% eran inmigrantes). La frecuencia anual ajustada de visitas en los niños autóctonos fue de 8,05 frente a la de inmigrantes, que fue de 5,66. Dentro de los niños inmigrantes, la mayor frecuentación (6,15) se da en los niños procedentes del África subsahariana, y la menor en los de Asia (4,02). La menor frecuentación se da en todos los tipos de asistencia (demanda, programada, atención continuada y domicilios), independientemente de que los equipos sean de mañana o de mañana y tarde. Conclusiones: la población infantil inmigrante (en todas sus procedencias) hace un menor de uso las consultas de Atención Primaria que la población autóctona (AU)

Introduction: the current study intends: to analyze the use of Primary Health Care Services by the immigrant population under 15 years of age in comparison to the Spanish population of the same age group; and to analyze differences in the frequentation according to different origins of the immigrant population. Material and methods: this is an observational retrospective study including all consultations of children less than 15 years of age of 26 health centers in Zaragoza, Spain, during the year 2007. The main variable, frequentation, was defined as total number of visits/year. Secondary variables were the type of attention that was requested. The information on the number and type of visits was obtained from the agenda in the electronic database ("OMI(C): oficina médica informatizada") of the health centers. The frequentation was adjusted according to age and sex. Results: a total of 547,524 pediatric appointments in a population of 71,114 children (10.87% were immigrants) were analyzed. The adjusted annual frequency of visits in autochthonous children was 8.05 while this frequency was 5.66 in immigrant children. Among immigrant children, the highest annual frequentation (6.15) was seen among children from Sub-Saharan Africa and the lowest frequentation (4.02) was seen in children from Asia. This lower frequentation among immigrant children was seen in all types of attention (visits on request, programmed visits, emergency visits and home visits) and was independent of the opening hours of the different health centers (only morning or morning and afternoon). Conclusions: the immigrant children’s population shows a lower use of the public primary health care than the autochthonous population of the same age group, independently of the region of origin (AU)

Adaptación Metodológica al EEES de la asignatura de Técnicas Instrumentales del Grado de Farmacia de la Universidad de Barcelona / Methodological Adaptation to EHEA of the of Instrumental Techniques subject of Pharmacy degree at the University of Barcelona

En el plan de estudios del Grado de Farmacia de la Universidad de Barcelona, la asignatura de Técnicas Instrumentales se imparte en el cuarto semestre, después de haber cursado Física, Fisicoquímica y Química Analítica.El equipo docente de la asignatura está integrado por once profesores que mediante trabajo colaborativo y adecuada coordinación organizan la docencia de la misma que se distribuye en clases teóricas y prácticasCon el objetivo de adaptar la asignatura a las necesidades del Espacio Europeo de Educación Superior, se distribuyó en tres Bloques: I, Técnicas Espectroscópicas; II, Técnicas Electroquímicas y III, Técnicas de Separación.Las actividades teórico-prácticas se han planificado de manera secuencial. Así se inicia el ciclo con las clases teóricas del Bloque I y a continuación de manera paralela se imparten las clases prácticas del Bloque I y las clases teóricas del Bloque II y así sucesivamente, de manera que se termina la docencia con las prácticas del último Bloque. En este proceso adquiere especial relevancia tanto la formación práctica en el laboratorio como el trabajo tutorizado que debe realizar el estudiante.Se realiza un proceso de evaluación continuada teórico/práctico en cada uno de los Bloques. Se da especial relevancia a la adquisición de habilidades y destrezas que permitan una correcta realización de las prácticas de laboratorio, es decir la integración de los contenidos específicos a la aplicación de las diferentes técnicas instrumentales, la resolución de los cálculos numéricos y la interpretación resultados(AU)

In the new syllabus of the Pharmacy degree at the University of Barcelona, the subject Analytical Techniques is taught at the fourth semester, after the subjects Physics, Physical chemistry and Analytical chemistry.The teaching team of this subject is integrated by eleven teachers that by means of collaborative work and an appropriate coordination, organize the docent activity into practical and theoretical classes.With the aim to adapt this subject to the requirements of the European space for higher education, it has been designed in three blocs: I. Spectroscopic techniques, II. Electrochemical techniques and, III. Separation techniques, by planning the theoretical and practical activities in a sequential manner. Therefore, the cycle begins with the theory of the first bloc followed with the practice corresponding to it together with the theory of the second bloc, and so on. The course ends with the practical part of the third bloc. In this process is of great importance the tutorial work that the student should do.The evaluation of the theory and of the practical part of each bloc is done in a continuous way paying special focus on the acquisition of abilities and handiness that will allow the correct performance in the laboratory. In summary, the integration of the specific contents to the application of the different instrumental techniques, the resolution of the numerical calculations and the interpretation of the results(AU)

Incidence of obesity is lower in persons who consume olive oil.

We undertook a population-based cohort study in Pizarra (Spain). Anthropometric and nutritional variables were recorded for 613 persons. The type of fat used was determined by measurement of the fatty acids contained in cooking oil. Serum fatty acid was used as a biological marker of the type of fat consumed. Obesity incidence in persons who were not obese at baseline was greater in those who consumed sunflower oil (Group 1: 41.5 (95% CI, 25.4-67.8) cases per 1000 person-years) than in those who consumed olive oil or a mixture of oils (Group 2: 17.3 (95% CI, 11.6-25.8) cases per 1000 person-years). The risk of developing obesity over 6 years, adjusted for age, sex, physical activity, smoking, instruction level, energy intake and baseline BMI, was 2.3 (95% CI, 1.06-5.02) in group 1 compared with that in group 2. The increase in the prevalence of obesity in the free-living population is associated with the type of fatty acids in the diet.

[Multicenter study of satisfaction with fast-dissolving ebastine, 20 mg/ day, in Mexican patients with allergic rhinitis]. / Estudio multicéntrico de satisfacción con ebastina de disolución rápida 20 mg/día en pacientes mexicanos con rinitis alérgica.

BACKGROUND: Allergic rhinitis is an inflammatory disease of the nasal mucosa, with common symptoms, which is essentially characterized by nasal itching, nasal congestion, sneezing, hyaline rhinorrhea and repetitive sneezing. The disease is very common, 15% of the population worldwide suffers it. Among many treatments that have been used to relieve the symptoms of this disease there is a selective inhibitor of H1 receptors, ebastine. OBJECTIVE: To evaluate patient satisfaction using the scale of Treatment Satisfaction Questionnaire for Medication (TSQM). MATERIAL AND METHODS: A multicentric, retrospective, observational study performed in 250 Mexican patients with the diagnosis of intermittent allergic rhinitis (IAR) or persistent allergic rhinitis (PER), confirmed by prick test, specific IgE, or both, treated with lyophilised ebastine in fast-dissolving (FDT) 20 mg at any time in the last two months, prescribed for at least two weeks by their doctor to relieve the symptoms of intermittent allergic rhinitis or persistent allergic rhinitis. We used a validated questionnaire assessment scales, TSQM. RESULTS: The presentation of ebastine fast-dissolving (FDT) is effective and has good tolerability, over 80% of patients reported comfort and satisfaction using it. CONCLUSIONS: Assessment of overall satisfaction, efficacy, tolerability and comfort showed that ebastine in fast-dissolving is an antihistamine with clear benefits to encourage compliance.

Ammonia adsorption on nanostructured silica materials for hydrogen storage and other applications.

Our focus in the present study is to apply high specific surface area silica nanostructured porous materials (about 2200 m2/g, as synthesized, and 600-700 m2/g, after stabilization) to adsorb ammonia (NH3) for hydrogen storage and other chemical and pollution abatement applications. We describe here the synthesis, and characterization of these silica materials, and the adsorption study of N2 and NH3. These materials were obtained with the help of a modification of the Stöber-Fink-Bohn (SFB) method. The main change, made here to the SFB method, was the use of amines, i.e., triethylamine as catalysts instead of ammonium hydroxide. The silica materials have been characterized with the help of SEM and FTIR Spectrometry. The N2 adsorption study was carried out with the help of the Quantachrome-Autosorb-1 and the NH3 adsorption with the Quantachrome-Autosorb-l-C. The amount of hydrogen adsorbed in the form of NH3 in the studied silica samples at: P=760 [Torr] (1.01325 x 10(5) [Pa]), was 2 [wt.%] and the amount of hydrogen stored in the form of NH3 at about: P=7500 [Torr] (10.0 x 10(5) [Pa]), in the studied stabilized silica samples was 11 wt.%, a magnitude higher than the goal figure of 6.5 [wt.%] established by the United States of America, Department of Energy.

Frecuencia de aspergiloma en pacientes con antecedente de tuberculosis, hemoptisis, radiografía anormal y baciloscopía negativa / Frequency of aspergilloma in patients with history of tuberculosis, hemoptysis, abnormal chest x-ray films and negative sputum smears

Objetivo: Determinar la frecuencia de aspergilomas en pacientes con antecedentes de tuberculosis pulmonar curada,hemoptisis, radiografía de tórax anormal y BK negativo. Materiales y métodos: Se enroló 28 pacientes entre diciembrede 2002 y septiembre de 2004 en el Hospital Nacional Hipólito Unanue de Lima y Hospital Belén de Trujillo. A los pacientesevaluados en el Hospital Belén se les solicitó tres muestras de esputo, seriadas y consecutivas, mientras que lospacientes evaluados en el Hospital Nacional Hipólito Unanue y que fueron sometidos a cirugía de tórax, se les colectóuna porción de la pieza quirúrgica tisular pulmonar. Ambas muestras biológicas fueron cultivadas en agar sabourauddextrosa - cloramfenicol 0,05 por ciento e incubados a temperatura ambiente y 37 °C por 15 días. A todos los pacientes se lesextrajo 5 mL de sangre total para realizar la prueba de inmunodifusión contra Aspergillus sp. Resultados: La frecuenciade aspergiloma fue de 43 por ciento (12/28). Se identificó por cultivo Aspergillus fumigatus en cinco casos, Aspergillus sp endos, A. niger en uno, A. flavus en uno y en dos casos positivos por serología no se logró aislar el hongo. En los dospacientes donde se identificó A. niger, no se detectó presencia de anticuerpos contra Aspergillus sp. En el HospitalBelén la frecuencia de aspergiloma fue 39 por ciento (7/18) y en el Hospital Hipólito Unanue 50 por ciento (5/10). Conclusiones: Lafrecuencia de aspergiloma en los 28 pacientes investigados en ambos hospitales fue de 43 por ciento y el principal agenteetiológico fue A. fumigatus.

Objective: To determine the frequency of aspergilloma in patients with history of cured pulmonary tuberculosis, hemoptysis, abnormal chest X-ray films, and negative sputum smears for acid-fast bacilli. Materials and methods: 28 patients were enrolled between December 2002 and September 2004 in Hipolito Unanue National Hospital in Lima and Belen Hospital in Trujillo. Patients from Belen Hospital had three serial and consecutive sputum samples taken, while those patients from Hipolito Unanue Hospital who underwent thoracic surgery had a portion of the surgical specimen collected. Both biological samples were cultured in Sabouraud dextrose agar – 0,05% chloramphenicol, and they were incubated at room temperature and at 37° C for 15 days. All patients had a 5-mL blood sample taken in order to perform immunodifusion tests for Aspergillus sp. Results: The frequency of aspergilloma was 43%) (12/28). Aspergillus fumigatus was identified in cultures in five cases, Aspergillus sp. was identified in two cases, A. niger in one, A. flavus in one, and in two cases reported as positive for serological tests the fungus could not be isolated. In the two patients in whom A. niger was identified, no presence of antibodies against Aspergillus sp. was detected. In Belen Hospital the frequency of aspergilloma was 39% (7/18), and in Hipolito Unanue Hospital it was 50% (5/10). Conclusions: Aspergilloma frequency in 28 patients studied in both hospitals was 43%, and the main etiological agent was A. fumigatus.

Ozonoterapia en diferentes protocolos para tratamientos de la osteoartritis en los pacientes adultos

Hemos empleado ozonoterapia en el tratamiento de 200 enfermos portadores de diversas modalidades de Osteoartritis, teniendo en cuenta el efecto revitalizante, activador de la circulación sanguínea,homeostático y euforizante de este producto natural, para contrarrestar los efectos vasculares de la enfermedad articulat degenerativa y los efectos psíquicos, principalmente depresivos de este gripo de pacientes. En este grupo de enfermos hubo formas clínicas más frecuentes de osteoartritis: Artrosis lumbar, artrosis generalizada, artrosis cervical, osteoartritis de cadera y artrosis de rodillas. La forma de administrar el ozono por vía de insuflacci¢n rectal es volumen 200cc, flujo 1 concentraci¢n 80 en 20 secciones y por vía intramuscular: volumen 40 cc, flujo 1 concentración 60.[AU]

Fractura del húmero: tratamiento por enclavado cerrojado / Humeral fracture throughout a clavage technique: treatment

Aunque la mayoría de las fracturas diafisárias de húmero se pueden tratar de forma satisfactoria con métodos conservadores, el tratamiento quirúrgico también puede ser una buena opción terapéutica, si bien a veces, sea difícil determinar cuando usar una u otra opción. Además existen diferentes modalidades quirúrgicas, cada una de ellas con sus ventajas y desventajas, lo que amplía la gama de posibilidades a la hora de elegir el tratamiento adecuado. El objetivo de este trabajo es proponer las principales indicaciones y complicaciones que plantea el clavo cerrojado de Seidel en el tratamiento de estas fracturas, basándonos en un estudio retrospectivo de 25 casos tratados en nuestro servicio de COT del H. Clínico de Valencia entre 1999 y 2002 (AU)

Técnicas quirúrgicas de osteosíntesis conagujas de Kirschner y cerclaje alámbrico enlas fracturas de rótula / Internal fixation with k-wives and a tension band in the fracture of the patella

Cuarenta y seis casos han sido analizados de forma retrospectiva desde el año 1990 hasta el año 2000, con una media de seguimiento de los pacientes de un año. Todos ellos sufrieron fractura de rótula y fueron tratados quirúrgicamente con la técnica de la osteosíntesis axial y cerclaje alámbrico o banda tensional. Se han evaluado los resultados de forma objetiva, midiendo los grados de movilidad y la trofia de cuadriceps, y de forma subjetiva mediante la entrevista con el paciente. La valoración final se ha realizado mediante la aplicación de una escala que estima una serie de parámetros. En 27 casos se obtuvieron buenos resultados con esta técnica, en 16 se obtuvo un resultado regular y en 3 casos el resultado fue malo. La escala aplicada es arbitraria y está inspirada en el trabajo realizado por Levack B, et al (1985) (AU)

Valores normales de andrógenos en el embarazo. Resultados preliminares / Normal values of androgens in pregnancy

No disponible

Efectos tóxicos de la infusión de morfina subcutánea en paciente con síndrome de vena cava superior / Toxic effects of the infusion of subcutaneos morphine in a patient with upper cava vein syndrome

Introducción: El objetivo del presente caso es describir un cuadro de toxicidad por opiáceos en un paciente con cáncer de pulmón y Síndrome de Vena Cava Superior (SVCS). Los efectos secundarios de la morfina fueron más acentuados en el territorio de drenaje de la vena. Caso clínico: Se presenta el caso clínico de un paciente de 65 años diagnosticado de cáncer de pulmón que desarrolla un SVCS. El enfermo refería dolor severo en región torácica y miembro superior derecho que requirió tratamiento con coadyuvantes, corticoides y opiáceos vía oral. En su evolución precisó la utilización de la vía parenteral, por lo que se le administró una perfusión subcutánea de morfina. A las 12 horas desarrolló un cuadro de enrojecimiento y prurito en hemitórax superior, cuello y cabeza con somnolencia y desorientación. Ante la sospecha de un cuadro de toxicidad local de la morfina, dado que la clínica era localizada, y al comprobar que el lugar de punción fue en el brazo derecho, se retiró la perfusión cediendo la sintomatología. Al reiniciarse la perfusión en el abdomen no volvieron a aparecer los efectos secundarios Conclusiones: En pacientes con Síndrome de Vena Cava Superior que precisen tratamiento con morfina por vía parenteral, debe evitarse el acceso en miembros superiores y tórax, ya que puede aparecer un cuadro de toxicidad local del opiáceo (AU)