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[Avoidable deaths in the evaluation of the performance of health services. II. European Atlas of avoidable deaths: initial data and several reflections].

The second European Atlas of Avoidable deaths, which will be shortly issued, concerns the period 1979-83 for Italy. The causes of deaths included were: tuberculosis, neoplasms of the cervix uteri and those of the uterus with no specified site, Hodgkin's disease, chronic rheumatic heart disease, hypertensive and cerebrovascular disease, childhood respiratory infections, asthma, appendicitis, abdominal hernia, cholecystitis and cholelithiasis, maternal and perinatal deaths. In Italy marked excesses for cholecystitis-cholelithiasis, Hodgkin's disease, hypertensive and cerebrovascular disease and perinatal mortality were observed. A remarkable decrease was observed in comparison with the first Atlas (1974-78); but the European countries generally maintained the differences amongst them and their rank. Proposals to assess the causes of the observed differences are suggested (death certificate quality evaluation studies, case-reference studies, cohort studies) and the role of confidential enquiries is discussed.

Adolescent↗

Occipitoatlantoaxial malformation with duplication of the atlas and axis in a half Arabian foal.

An unusual occipitoatlantoaxial malformation is described in a 2-week-old male part Arabian foal that was unable to stand at birth and showed signs of spastic tetraparesis due to a cervical spinal cord compression. There were 2 atlases present. One was fused to the occipital bones. The other articulated with the first atlas and an axis which had a long dens that projected into the vertebral canal. Examination of the ossification centers of the axis indicated partial duplication of that bone.

Abnormalities, Multiple↗

A stereotaxic atlas for the telencephalon of the Siamese fighting fish (Betta splendens).

1. A stereotaxic technique for electrode positioning in the telencephalic nuclei of the Siamese Fighting fish (Betta splendens) is described. 2. The forebrain atlas was based on paraffin-embedded, in situ-sectioned, Nissl-stained material. Brain measurements were corrected for tissue shrinkage due to histological procedures. The atlas and methods have already been tested and have shown good accuracy and reproducibility.

Animals↗

A stereotaxic atlas of the medulla oblongata of the goat's brain.

A stereotaxic atlas has been prepared for the medulla oblongata of the adult goat's brain using the technique described previously (Tindal et al. 1968). The atlas consists of transverse stereotaxic planes passing caudally at 1 mm intervals from posterior 10 mm (P10) at the level of the junction between brainstem and cerebellum to posterior 20 mm (P20) at the level of the obex.

Anatomy, Artistic↗

[Atlas of head anatomy in the neuro-ocular plane].

The "Atlas of cross-sectional orbito-cephalic anatomy in the neuro-ocular plane" does exist (now in press). The authors submit the main clinico-anatomical correlations observed. We will remind you that the "neuro-ocular plane" (N.O.P.) is defined as the C.T. plane of cephalic orientation comprising "both lenses, optic nerve heads and optic canals in the primary position of gaze". The more informative anatomical, radiological and anthropological data that could derive from the N.O.P. are stressed; first, we will evaluate the validity of our work and the problems we had while building the atlas; then we will describe briefly the position of this cephalic orientation plane as compared to other planes (specifically the anthropological baseline, the orbito-meatal line, the vestibular orientation etc...) previously described. Finally, we will end our discussion by giving the anatomical correlations obtained in the N.O.P.: this plane would best include all the visual pathways starting "from the cornea to the calcarine fissure"; it would also reflect the same orientation of the temporal horn of the lateral ventricle as well as the orientation of the lateral fissure. Much more, the orthogonality of this cephalic orientation to the direction of the brainstem is demonstrated, enhancing the accuracy of the three dimensional approach in the evaluation of the orbito-cephalic anatomy and diseases, as actually completed with C.T. and N.M.R. imaging, at the Centre National d'Ophtalmologie des XV-XX in Paris.

Anatomy, Artistic↗

[First survey on polymorphism of 5 enzymes used as genetic markers in Moroccan cattle of the Brown Atlas type].

Electrophoretic studies about the polymorphism of phosphoglucomutase (PGM), soluble glutamic oxalacetic transaminase (GOT), mitochondrial malate dehydrogenase (MOR), mannose-6-phosphate isomerase (MPI) and nucleoside phosphorylase (NP) were performed on muscle samples of 40 moroccan bovines of the Brown Atlas type. The PGM, NP and MPI showed a polymorphism. The frequencies of the Alleles PGM3-A and NP-H were remarkably higher among the Brown Atlas cattle as compared to some other bovine breeds. This feature should be investigated regarding zootechnical abilities in the tropical areas.

Animals↗

Stereotactic neurosurgery in experimental animals. Use of intracerebral landmarks and an atlas of the cat brain.

A stereotactic method, based on the correlation of intracerebral radiological and anatomical landmarks, was developed for application in experimental animals. To make possible the use of this method, particularly in the cat, a stereotactic atlas was developed with an intracerebral coordinate system, as all currently available stereotactic atlases of experimental animals are based on extracranial landmarks. Advantages of the proposed method compared to the classical Horsley-Clarke method are discussed.

Animals↗

[Pelvic lymph node groups in computed tomography. Topographic atlas].

This atlas was prepared to facilitate the diagnosis of lymph mode enlargement in the pelvic region and to improve topographic diagnosis. Fifty computed tomographies were performed after lymphography using centimetric pelvic slices in order to select eight levels for reference. A statistical analysis was conducted to establish a diagram of the mean number of lymph nodes on the right and left side for each level. A table was established indicating the mean number and standard deviation for each group of nodes for the 8 different levels. In addition, a control slice (chosen among 50) accounts for the morphology of the iliac vessels, of the lymph nodes and psoas muscle most frequently encountered at each level. The distribution of the groups of nodes shows why interpretation can be difficult, particularly at vessel bifucations and confluents. Precise morphology based on effective opacification, especially in the pelvic area, is required for positive and especially topographic diagnosis. Finally, the description of the medial border of the psoas muscle and its close relations with certain groups of lymph nodes can cause some problems because of the similar densities. The atlas is of great help here.

Anatomy, Regional↗

[Interactive atlas with magnetic resonance on CD-ROM for Macintosh].

Computer assisted education in radiology has been increasingly used during the past ten years and now complements traditional learning resources. Magnetic Resonance Imaging (MRI) of musculoskeletal anatomy, and particularly of joints, lends itself naturally to learning modules on computer. This paper describes the design, development and use of an interactive computer assisted teaching module of MR joint anatomy on CD-ROM for Macintosh: to date, we have used this atlas for ankle and elbow anatomy. The atlas is divided into three main sections: MR anatomy, traditional anatomy and a quiz. On each MR image, any anatomical detail can be identified clicking on it with the mouse. Buttons allow to visualize cross-reference points and to go directly on the desired image. If the student wants to look at anatomical drawings of the last identified structure, a button retrieves all the cards in the traditional anatomy section containing that structure. Finally, the student can make his own self-assessment, verifying his learning immediately with the exam mode: the software makes a random selection of 10 MR images where an anatomical structure must be indicated: if the answer is wrong, the software gives the right one and shows the misinterpreted structure. Then, the student is given a total score for his performance. The computer assisted teaching modules present some advantages: the images can be viewed in a given sequence (like traditional learning resources) or in any self-paced, customized way; this possibility, together with the friendly interface of Macintosh computers could make learning more active and pleasant.

Anatomy↗

Parotid area swelling caused by a prominent transverse process of atlas.

Among 1,500 parotid sialography examinations, the diagnosis of a parotid mass caused by a prominent transverse process of the atlas was made in 18 patients. The diagnosis was confirmed in one patient who insisted on surgical exploration. The remaining 17 patients required no surgical procedure. Many head and neck surgeons have unwittingly operated on such cases with frustrating results. Hopefully, roentgenographic findings will assist in the confirmation of the diagnosis and eliminate the need for such operations.

Adolescent↗

[Fractures of the atlas].

The authors present details of 22 fractures of the atlas treated at the Orthopaedic Clinic of the University of Athens between 1970 and 1982. After a brief survey of the basis of classification of the four types of fracture, the mechanism of injury, the clinical and radiological presentation and the treatment of these injuries, the authors analyse their own cases and examine their results. Such fractures may go unrecognised because of more obvious associated injuries at other levels in the cervical spine. Neurological signs are uncommon. Treatment has always been orthopaedic and the results are usually excellent.

Adolescent↗

Fusion of the anterior arch of the atlas and dens.

Seven cases of fusion of the anterior arch of the atlas to the dens have been described in the English literature. This anomaly alone is stable. A new case of this rare anomaly incidentally discovered in a patient examined for trauma is presented.

Adolescent↗

Fracture of the anterior arch of the atlas associated with a congenital cleft of the posterior arch. Demonstration by CT.

A case of a vertical fracture of the anterior arch of the atlas associated with a congenital cleft of the posterior arch of the same vertebra is reported. Such an association has not previously been described in the literature. X-Ray computed tomography is an excellent exam for visualizing this region and for easily distinguishing between fractures and congenital clefts.

Adult↗

[Multiple fractures of the atlas with delayed fatal thrombosis of vertebral artery following "whiplash" injury of the neck (author's transl)].

Report of the case of a 62 year old male, who died in a car crash on his way home from duty, when he had a frontal collison with annother car at a speed of about 70 km per hour. After the collision, the car had completely turned over to its wheels. As the man had put on the seat belts, he had not been cast against the front window so that there were no head injuries. Following an unconsciousness of about ten minutes the patient recovered quickly and was already fully oriented when arrived at hospital. No neurological symptoms could be substantiated. He only suffered from pain of the neck and had a marked swelling of the left side of the neck. A burstin fracture of the atlas vertebra (Jefferson-fracture) was overlooked in routine X-rays of the craniovertebral region. Eight days after the accident, the hitherto "well improving" patient died suddenly and unexpectedly. The autopsy revealed an obstructing thrombosis of the left vertebral artery, less than 24 hours old. The wall of the artery showed numerous dissecting ruptures with intramural bleedings.

Accidents, Traffic↗

Actinomycotic osteomyelitis of the skull and atlas with late dissemination. A case of transient neurosurgical syndrome.

Actinomycosis of the skull and/or the vertebral column is extremely rare in previously healthy children and its diagnosis is difficult. A case is reported here involving the occipital bone and the atlas. The disease had started 4 years before diagnosis and presented as a neurosurgical affection in a 13-year-old-girl. The disease spread towards the retropharyngeal space and probably disseminated to the liver and the lung. Actinomyces israeli grew from cultures. Antibiotic treatment was successful.

Actinomyces↗