Educational impact of a clinical anatomy workshop on 1st-year orthopedic and rheumatology fellows in Mexico City.

We aim to study the educational impact of a clinical anatomy workshop in 1st-year orthopedic and rheumatology fellows. First-year rheumatology fellows (N = 17) and a convenience sample of 1st-year orthopedic fellows (N = 14) from Mexico City in the 9th month of training participated in the study. The pre- and the post- workshop tests included the same 20 questions that had to be answered by identification or demonstration of relevant anatomical items. The questions, arranged by anatomical regions, were asked in five dynamic stations. Overall, the 31 participants showed an increase of correct answers, from a median of 6 (range 1 to 12) in the pre-workshop test, to a median of 14 (range 7 to 19) in the post-workshop test. In the pre-workshop test, the correct median answers were 7 (range 2 to 12) in the orthopedic fellows and 5 (range 1 to 10) in the rheumatology fellows (p = 0.297). Corresponding scores in the post-workshop were 15 (range 10 to 19) and 12 (range 7 to 18) (p = 0.026) showing a significant difference favoring the orthopedic group. Our clinical anatomy workshop was efficacious, in the short term, as a teaching instrument for 1st-year orthopedic and rheumatology fellows. The post-workshop scores, although significantly improved in both groups, particularly in the orthopedic fellows, were still suboptimal. Further refinements of our workshop might yield better results.

Localización del electrodo de marcapasos definitivo en el tracto de salida del ventrículo derecho mediante tomografía axial computarizada / Determinating the location of the permanent pacemaker lead in the right ventricle outflow tract by computed tomography

Introducción: Precisar la ubicación del electrodo de marcapasos en el tracto de salida del ventrículo derecho (TSVD) es difícil mediante las técnicas convencionales (fluoroscopia y electrocardiografía). La tomografía permite determinar de forma tridimensional la relación del electrodo en el TSVD. Objetivo: Determinar la localización del electrodo de marcapasos mediante la tomografía axial computarizada y comparar los resultados con la localización electrocardiográfica y fluoroscópica. Material y métodos: Se incluyeron 36 pacientes portadores de marcapasos definitivo VVI con el electrodo localizado en el TSVD, a quienes se les tomó un electrocardiograma de 12 derivaciones, proyecciones fluoroscópicas convencionales y tomografía multicorte para determinar la posición del electrodo en el TSVD. Resultados: Mediante el electrocardiograma se localizó el electrodo septal en 58.3% y en pared libre en 41.7%. Por fluoroscopia en oblicua anterior izquierda (OAI) a 35° se localizó el electrodo en pared anterior 5.6%, en pared libre en 38.9% y septal en 55.6%; en OAI a 45° en pared anterior en 2.8%, en pared libre 44.4% y septal en 52.8%. Mediante tomografía se documentó la posición anterior del electrodo en 39%, pared libre en 48% y septal en 13%. El coeficiente Kappa de las 3 pruebas mostró una concordancia muy baja. Conclusión: La tomografía es un mejor método para determinar la posición del electrodo en TSVD comparado contra la fluoroscopia y el electrocardiograma.

Introduction: Determination of the location of the lead of the permanent pacemaker in the right ventricle outflow tract (RVOT) it's difficult with the conventional techniques (fluoroscopic images and electrocardiography). The computed tomography (CT) allows to determinate in three dimensions the relation between the lead and the RVOT. Objective: Determine the location of the electrode lead by computed tomography and compare the results with electrocardiographic and fluoroscopy images localization. Material and methods: 36 patients were included with VVI permanent pacemaker with the lead in the RVOT. A 12-lead electrocardiogram, fluoroscopy images and CT were performed to determine the position of the lead in the RVOT. Results: By electrocardiogram, we located the lead in septal wall 58.3% and free wall 41.7%. By fluoroscopy images in left anterior oblique (LAO) 35° the lead was located on the anterior wall 5.6%, free wall 38.9% and septal 55.6%; in LAO 45° anterior wall 2.8%, free wall 44.4% and septal 52.8%. By Tomography the lead was positioned on anterior wall in 39%, free wall 48% and septal 13%. The Kappa coefficient of the 3 tests showed very low concordance. Conclusion: CT is a better method for determining the position of the lead on the RVOT compared to fluoroscopy images an electrocardiogram.