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At least 577 records · Page 32Linked to original sources
PubMed2001

Cervical cord compression due to a hypoplastic atlas. Case report.

The authors report the case of a 66-year-old man with progressive, nontraumatic, C-1 cord compression who presented with a complete but hypoplastic atlas. They review six cases found in the literature. Symptoms usually develop in the late adulthood; the sagittal diameter of the canal measures 10 mm or less. The treatment requires a posterior decompression. Opening of the dura is sometimes necessary. There is no pressing need for a primary stabilization device.

Aged↗
PubMedDate not supplied

Partial aplasia of the posterior arch of the atlas with an isolated posterior arch remnant: findings in three cases.

We report the imaging findings in three symptomatic cases of partial aplasia of the posterior arch of the atlas with an isolated posterior remnant of the arch. These cases are instructive in illustrating the mechanism of cord impingement produced by the posterior arch remnant during extension of the cervical spine. Additionally, focal increased T2 signal was observed within the cord at the level of the anomaly in two of the patients.

Adult↗
PubMed2003

High- versus low-dose angiotensin converting enzyme inhibitor therapy in the treatment of heart failure: an economic analysis of the Assessment of Treatment with Lisinopril and Survival (ATLAS) trial.

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors reduce heart failure death and hospitalization. Prescribed doses often are lower than randomized clinical trial (RCT) targets and practice guideline recommendations. OBJECTIVE: To assess the cost-effectiveness of high- versus low-dose ACE inhibitor therapy in the ATLAS trial. STUDY DESIGN: A 19-nation RCT of high-dose (32.5-35.0 mg/day) versus low-dose (2.5-5.0 mg/day) lisinopril in 3164 patients with class II-IV heart failure and left ventricular ejection fraction < or = 30%. METHODS: Data on clinical outcomes and major cost events (hospitalizations and drug utilization) were collected prospectively. Hospital costs were estimated using Medicare and representative managed care diagnosis-related group reimbursement rates. ACE inhibitor drug costs were estimated using US average wholesale prices. Costs were discounted at 3% annually. RESULTS: Patients in the high-dose lisinopril group had fewer hospitalizations (1.98 vs 2.22, P = .014) and hospital days (18.28 vs 22.22, P = .002), especially heart failure hospitalizations (0.64 vs 0.80, P = .006) and heart failure hospital days (6.02 vs 7.45, P = .028) compared with the low-dose group. The high-dose lisinopril group also had lower heart failure hospital costs (dollars 5114 vs dollars 6361, P = .006) but higher ACE inhibitor drug costs (dollars 1368 vs dollars 855, P = .0001). Total hospital and drug costs were similar between high- and low-dose lisinopril groups (mean difference dollars -875, 95% CI dollars -2613 to dollars 884). Sensitivity analyses confirmed these findings. CONCLUSIONS: Cost savings from fewer heart failure hospitalizations offset higher ACE inhibitor costs in the high-dose group. The improved clinical outcomes were achieved without increased treatment costs.

Aged↗
PubMed2003

[On the artful, yet pernicious body. A cultural-historical interpretation of Bidloo's anatomical atlas].

Among historians of science and medicine it is well known that early modern anatomical representations, in addition to illustrating ideas on the body, also teach a moral lesson. The anatomical cabinets of Frederik Ruysch (1638-1731) are exemplary. His exhibits show 1) the divine design of the body and 2) the fragility of life and man's dependence on God for his existence. Govard Bidloo (1649-1713), in his anatomical atlas, the Anatomia humani corporis (1685), does not seem to answer this standard view on the 'moral teaching' of anatomy. It has been argued that his depictions of dead and mutilated (parts of) bodies indicate a more realistic way of representation, devoid of metaphor and morality. Yet, taking the fierce controversy between Bidloo and Ruysch as my starting point, I show that in fact there is a moral lesson in Bidloo's anatomy. It reflects two important aspects of Bidloo's Mennonite faith, i.e. the aversion against beautiful decoration and the fascination with suffering and death found in martyr stories.

Anatomy↗
PubMed2003

A vertebral artery tortuous course below the posterior arch of the atlas (without passing through the transverse foramen). Anatomical report and clinical significance.

A vertebral artery (VA) coursing below the posterior arch of the atlas (C1) without passing through the transverse foramen of C1, combined with a tortuous course within the spinal canal has rarely been reported in the literature. This article describes a case encountered during an anatomical study of the far-lateral approach, and reviews its embryonic development and clinical significance. The suboccipital triangle was filled with numerous venous plexures. After exiting from the transverse foramen of C2, instead of passing upwards through the transverse foramen of C1, the VA turned directly medially towards the spinal canal. At the spinal canal, it first formed an angle downwards, then turned upwards, piercing and entering the lateral part of the dura at C1 level. The diameter of this VA seemed to be within its normal limits. The course of the contralateral (right) VA was normal but with a small caliber and mainly supplied the posterior inferior cerebellar artery (PICA); after PICA, it became much thinner and dysplastic, the basilar artery was mainly supplied by the left VA. The bilateral posterior communicating arteries were large in diameter but there was dysplasia of the P1 segment of the posterior cerebral arteries bilaterally. Marked tortuosity of the bilateral intracavernous internal carotid artery (ICA) was also found. We did not find any osseous abnormality in the occipito-axial region or of C1-C2 joint. An abnormal course of the VA should be kept in mind during exposure of the craniocervical junction, especially in the variety of lateral approaches; due to compression of the nerve roots or the spinal cord, this abnormal course of the VA could give rise to clinical symptoms, which could be resolved by microvascular decompression technique.

Aged↗
PubMed2006

Lhermitte sign during yawning associated with congenital partial aplasia of the posterior arch of the atlas.

We describe the case of a 26-year-old man who presented with symptoms compatible with Lhermitte sign that occurred during yawning. It was associated with congenital partial aplasia of the posterior arch of the atlas. Cervical multisection-detector CT myelography during yawning showed compression of the upper cervical cord due to the inward mobility of the isolated posterior tubercle. The symptoms completely disappeared following removal of the isolated posterior tubercle.

Adult↗
PubMedDate not supplied

Getting the most out of your practice--the Practice Health Atlas and business modelling opportunities.

BACKGROUND: The Practice Health Atlas (PHA) is a decision support tool for general practice, designed by the Adelaide Western Division of General Practice (AWDGP). OBJECTIVE: This article describes the features of the PHA and its potential role in enhancing health care. DISCUSSION: In developing the PHA, the AWDGP utilises a range of software tools and consults with a practice to understand its clinical data management approach. The PHA comprises three sections: epidemiology, business and clinical modelling systems, access to services. The objectives include developing a professional culture around quality health data and synthesis of aggregated de-identified general practice data at both practice and divisional level (and beyond) to assist with local health needs assessment, planning, and funding. Evaluation occurs through group feedback sessions and from the general practitioners and staff. It has demonstrated its potential to fulfill the objectives in outcome areas such as data quality and management, team based care, pro-active practice population health care, and business systems development, thereby contributing to improved patient health outcomes.

Adolescent↗
PubMedDate not supplied

Fracture of the posterior arch of the atlas.

The authors analyzed the results obtained in 10 fractures of the posterior arch of the atlas treated nonsurgically. There was consolidation in all of the cases at the end of treatment. According to the authors the element which most characterizes this fracture is constituted by its radiological diagnosis which principally makes use of lateral projection. In particular cases, when patients are characterized by multiple trauma, the fracture may go unrecognized.

Adolescent↗
PubMed1991

Imaging of the atlas (C1) and axis (C2).

In imaging the atlantoaxial region in injured patients, the initial modality is plain radiography. The lateral C-spine as well as the open-mouth view are essential in this regard. On these views, it is not only important to examine the bony contour but also to look for indirect signs of injury such as prevertebral soft-tissue swelling, air in the prevertebral space, an increased width of the anterior atlantodental interval, and overriding of the C1-C2 joint on one side (the so-called wink sign of atlantoaxial rotatory subluxation). In patients in whom there is a high index of suspicion for occult trauma, but without fractures suggested or adequately visualized on routine films, or in those with severe cranial trauma, further studies should be pursued. CT scan is the modality of choice in optimally imaging the bony contours of the axis and atlas. It has limitations in visualizing transversely oriented fractures such as high dens fractures, transverse fractures of the facet joints (although widening of the facet joint is an indirect indication of facet fracture), or transverse arch fractures. Plain tomography may better demonstrate such transverse fractures but has several disadvantages. Plain tomography is often not as readily available as CT; it requires that the patient be placed in lateral decubitus position to obtain lateral tomograms, which may be contraindicated in such clinical circumstances; and it is not as easy to appreciate three-dimensional relationships on plain tomography as it is on CT. CT clearly defines the location of displaced bone fragments in relationship to the spinal canal as well as often demonstrating disc injuries. Ligamentous injury, though potentially visualized directly on MR imaging, is more commonly addressed with flexion-extension films. Flexion-extension studies should, obviously, be performed only in awake, oriented patients who are without neurologic deficit, and the studies should be done with close physician supervision and stopped at the first onset of pain. MR imaging may be helpful in demonstrating soft-tissue injuries such as hemorrhage, disc herniation, nerve root impingement, and direct spinal cord damage.

Adult↗
PubMed1991

Fractures of the atlas.

Thirty-four patients who had fractures of the atlas (the first cervical vertebra) were reviewed at an average follow-up of 4.5 years. Seventeen patients had bilateral fracture of the posterior arch of the first cervical vertebra. Eight were treated with immobilization in a cervical orthosis, with no long-term problems secondary to the injury. Nine of these patients had additional fractures in the first and second cervical vertebral complex, complicating the management of the fractures of the posterior arch. Two of the nine patients died, and the treatment of the other seven was dependent on the additional fractures. A second group of six patients had a fracture in the area of the lateral mass, with one fracture just anterior to or within the anterior portion of the lateral mass of the first cervical vertebra and a second fracture posterior to the lateral mass of the first cervical vertebra on the same side; resultant asymmetrical displacement of the lateral masses was seen on the open-mouth roentgenogram that was made for each patient. A third group of eleven patients sustained a Jefferson, or burst, fracture of the first cervical vertebra. These patients had either four fractures (two in the anterior arch and two in the posterior arch) or three fractures (one in the anterior arch and two in the posterior arch). Spreading of the lateral masses was relatively symmetrical on the open-mouth roentgenogram. Patients who had fractures with displacement of two to seven millimeters were treated with immobilization in a halo vest. Patients who had fractures with severe spreading of the lateral masses (more than seven millimeters) were treated with reduction of the lateral masses by axial traction until healing of the arch had occurred. No atlanto-axial instability was evident in any patient at follow-up.

Adolescent↗
PubMed1990

A review of fractures of the atlas vertebra.

From 48 consecutive cases of atlas fractures presenting over a 12.5-year period, two groups are apparent that differ in age, presentation, mechanism of injury, and treatment given. Jefferson fractures were, on average, 42 years of age. Displaced Jefferson fractures were treated by traction. At final review, those that had been reduced and those that were initially undisplaced did better than the displaced group. Inadequate reduction was often obtained due to insufficient traction. Patients sustaining a posterior arch fracture were generally more elderly and were, on average, 17 years older than those with a Jefferson fracture. Patients with a posterior arch fracture had marked degenerative changes in the mid- to distal cervical spine and almost invariably had another cervical spine fracture. Treatment was usually directed to the other cervical spine injury. Injury in the elderly usually followed low velocity trauma.

Accidents↗
PubMed1989

Osteometry by computer-aided image analysis: application to the human atlas.

Computer-assisted image-analysis having almost not been applied to macroscopical anatomy, particularly to osteometry, we used it for the automatic measurement of 8 osteological parameters on a series of 150 human atlases. From these measured parameters, 5 parameters have been directly calculated. The values obtained by image analysis and by measurement with vernier calliper are identical and similar to the data of the literature. The accuracy, the sources of error, and the great advantages of the image analysis method are then discussed.

Calibration↗
PubMed1989

[Usefulness of dual-energy digital radiography in detecting atlas and axis].

Cranial dual-energy digital radiography was applied to three patients. The anatomy of the atlas and axis was clearly recognized without utilizing the open-mouth view. We consider it a very effective technique when applied to the patient who experiences difficulty in opening the mouth, like severe traumatic or infantile patients. In addition, it is a useful examination for patients with suspected anomalies of cranio-vertebral junction.

Axis, Cervical Vertebra↗
PubMed1988

Fractures of the atlas vertebra. The two-part burst fracture of Jefferson.

Burst fractures of the atlas are usually diagnosed and treated as four-part fractures as described by Jefferson in 1920. Review of the literature, roentgenogram, computed axial tomography (CAT) scans, and laboratory studies, indicates that the burst fracture is usually, if not always, a two-part fracture. These findings are contrary to the accepted concept of burst fractures, and indicate that routine roentgenograms are not adequate for proper diagnosis. Also, with disclosure of the true nature of these injuries, there is indication for further consideration and study relating to treatment of these injuries.

Cervical Atlas↗
PubMed1987

Anterior extraoral approach to the atlas and axis.

A transcervical extraoral approach was utilized to achieve exposure to the upper cervical spine in five patients, four of whom required bone graft placement. Excellent exposure was achieved in all patients, and the postoperative course was uncomplicated. The anterior extraoral approach is a reliable technique in treatment of pathology of the atlas and axis.

Axis, Cervical Vertebra↗