[Catheter in the superior vena cava for hemodialysis as a last resort in superior hemithorax]. / Catéter en vena cava superior para hemodiálisis entre los últimos recursos en hemitórax superior.

We report four patients with chronic kidney disease undergoing haemodialysis therapy, which had exhausted conventional venous access (internal jugular, subclavian) and non-conventional access (axillary, innominate) in the upper hemithorax for haemodialysis. This was primarily due to thrombosis of these veins caused by previous catheterisation. These patients did not qualify for peritoneal dialysis. Using the technique recommended by Archundia et al., 4 indwelling catheters were implanted directly in the superior vena cava in each of the patients with subsequent subcutaneous tunneling. The catheters operated correctly and are currently permeable after being used for an average of 19 months.

[Implanting haemodialysis catheters in the brachiocephalic vein: a little-used approach]. / Implantación de catéteres para hemodiálisis en vena innominada, una ruta poco utilizada.

We report three patients with chronic renal failure in hemodialysis therapy, which had exhausted conventional venous access in the upper hemitórax (internal jugular, subclavian, axillary) for hemodialysis, primarily due to thrombosis of these veins by previous catheterization. We chose the technique of Rao et al. and cols for puncture of innominate vein, resulting in the implantation of catheters and their subsequent subcutaneous tunneling. Permanent catheters3 work properly and are permeable to the date after a period averaging 8 months.

Manejo de la miastenia gravis en el nino. / Management of myasthenia gravis in children

1. Se presenta la experiencia del Departamento de Pediatria, Seccion Neurologia Infantil del Hospital Universitario de Caracas, en miastenia gravis, forma infantil, en 5 pacientes cuyas edades fluctuaron entre 2 anos y 14 anos, con predominio entre 2 y 3 anos de edad. 2. La evolucion clinica y respuesta terapeutica fue la descrita en las diferentes formas infantiles de miastenia gravis. No tuvimos experiencia en formas congenitas familiares. 3. Sugerimos que la evaluacion del paciente miastenico debe ser completa e integral y debe insistirse en el estudio inmunologico completo, que constituye la base terapeutica y de pronostico en esta enfermedad