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PEG is a safe, effective and widely used modality for nutritional andpharmacological enteral support in children. Rupture of the gastrostomy button during replacement is a very infrequent complication that may be avoided by choosing the adequate tube.

We report the case of a six-year-old girl who suffer an isolated sternal fracture due to hyperflexion of the thorax (while she was playing on a jumping-bed). On clinical examination, only slight tenderness and pain with compression of sternum was found. Chest X-ray demonstrated a fracture of the body of the sternum without other findings. The patient was admitted, observed during 12 hours with ECG monitoring and discharged because no cardiac or pulmonary pathology appeared. We present this case because fracture of the sternum in a child is rare, especially if road-traffic accident with seat belt injury is not implicated as a cause.

Basis: The objectives of the study are: 1. Know the grade of satisfaction of the parents of children operated in a program of surgery without admission (CSI). 2. Compare it with another program of surgery with admission (CCI). 3. Know the outputs of reentry and complications of both programs., Material and Method: 95 children were operated in a program of CSI. They were elected 95 children operated with CCI of similar characteristic. A questionnaire in a type Likert scale was sent for mail to the parents to value diverse looks of the satisfaction: Information, deal, perceived control, security, hostelry and global satisfaction. The questionnaire also picked up social-demographics and cultural data., Outputs: The rate of the answer was from the 83% in the program of CSI and 82% in the CCI. The global satisfaction was over 90% in both programs. They met differences significant in the sensation of insecurity, more frequent in the parents of children operated with CSI (30%) that with CCI (11%). The reentry and complications rate of the evaluated program are similar to other programs of CSI.

The treatment of infection and obstruction in totally implantable central venous access catheters is based on the administration of medication into the system. Injected medication may be diluted in the portal which acts as a dead space in the line. We have studied the dynamic of fluids in the Low Profile Port-a-Cath, and developed an infusion-suction technique with double syringe to achieve high concentrations in the system with minimum repercussion in the vascular space. This procedure can be applied both in the treatment of infection with high-dose local antibiotics and in total or partial obstructions.