Enseñanza de auscultación cardiaca a estudiantes y residentes de medicina mediante el uso de un simulador de ruidos cardiacos / A heart sound simulator as an effective aid in teaching cardiac auscultation to medical students and internal medicine residents

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[Permanent pacemaker implantation in patients with persistent left superior vena cava and absent right superior vena cava. Report of three cases]. / Implante de marcapaso definitivo en pacientes con vena cava superior izquierda persistente y ausencia de vena cava superior derecha. Caso clínico.

Persistent left superior vena cava and absent right superior vena cava is an uncommon anatomical association. This is a challenging situation for permanent pacemaker implantation. We report three patients with this anomaly and a permanent pacemaker successfully implanted through the left superior vena cava and coronary sinus, without acute or chronic complications.

[A 36 years experience with implantable pacemakers. A historical analysis]. / Experiencia de 36 años con marcapasos implantables. Un análisis histórico.

BACKGROUND: The implantation of pacemakers improves cardiac function and quality of life, in particular with dual chamber DDD and DDDR modes. AIM: To evaluate our clinical experience and results on pacemaker implantation, from 1963 to 1998. MATERIAL AND METHODS: Computerized data collected from 2,445 consecutive paced patients was reviewed. A total of 3,554 operative procedures were performed, including 412 procedures for complications and 697 pacemaker replacement. Patient survival was determined from clinical records, inquiry to pacemaker manufacturers and death certificates from Servicio de Registro Civil e Identificación de Chile (Chilean Civil and Identification Registry). RESULTS: Use of dual chamber (DDD and DDDR) pacemakers increased progressively up to 74% from 1988 to 1998. Complication rate was 42% in the 1963-1976 study period, it decreased to 10.6% in the 1977-1987 study period, and to 5.6% by 1988-1998. Only two patients died during surgery in the study period (0.08%). In the 1977-1987 period, pacemakers lasted 10.6 years. Survival rates were 52% at ten years, 33% at 15 years, and 21% at 20 years, with a median survival of 11.7 years, and 7.24 years in patients over 80 years old. CONCLUSIONS: Transvenous permanent pacing can be accomplished today with a low complication rate, mainly due to better technology and surgical procedures.

Aortitis de Takayasu y aneurisma torácico complicado por ruptura / Takayasu's arteritis complicated by a ruptured thoracic aortic aneurysm

Una mujer de 50 años, hipertensa antigua, es admitida por presentar un cuadro de dolor torácico, disnea y alteración de los pulsos periféricos. Los exámenes de laboratorio demostraron una marcada hipoxemia, anemia y velocidad de sedimentación aumentada. Los exámenes radiológicos comprobaron una arteritis de Takayasu tipo III complicada con la ruptura de un aneurisma secular de la aorta yuxtadiafragmática, el que no alcanzó a ser intervenido. La anatomía patológica comprobó las lesiones descritas. Se revisa la literatura encontrándose 2 casos similares, ambos fatales, y varios otros de formación aneurismática por arteritis en otros vasos. La arteritis de Takayasu es causa de aneurismas aórtico y periféricos, y se sospecha debe llevar al estudio panangiográfico. La demostración de estas lesiones requier de un seguimiento estrecho y dee su reparación electiva en especial si son de tipo sacular