The internal mammary vein: an alternate route for central venous access with an implantable port.

Central venous catheterization in pediatric patients has, among other risks, flebitis and thrombosis, and finally occlusion of the superior and inferior venae cavae, making long-term catheterization and multiple venous cutdown more difficult. Use of the internal mammary vein might be an alternative procedure to provide sure and easy access to the central venous circulation. The authors report on a patient with multiple venous cutdown and thrombosis of the inferior vena cava, in whom the internal mammary vein was used for placement of a vascular device.

[Achalasia of the esophagus: modified Heller's esophagomyotomy and floppy Nissen fundoplication, via the abdomen].

Six patients with achalasia of the esophagus were submitted to an abdominal esophagomyotomy which extended two centimeters in width and six to eight centimeters in length, descending one or two centimeters from the esophagealgastric union without having to remove the mucosa in 50% of the esophageal circumference while also performing total funduplication of the floppy Nissen type. The clinical evaluation showed the disappearance of all symptoms. Both the endoscopic as well as the X-rays studies showed the obsence of obstructive symptoms or reflux of any sort.