Rare association of anatomical variations of the atlas and the occipital in a case with cranial deformation.

The paracondylar process is an exostosis, situated lateral to the occipital condyles, which expands towards the transverse process of the atlas. The epitransverse process of the atlas is a bony outgrowth that extends from the transverse process towards the occiput. Ponticulus posterior is a bony bridge that spans from the lateral mass of the atlas towards the posterior extremity of the vertebral artery groove. They are important anatomical variations. In this article, we analyze a rare situation of concomitant presence of ponticulus posterior, foramen arcuate, paracondylar process and epitransverse process, all of them situated on the right side of an individual with artificial cranial deformation from the fifth century AD. The paracondylar process and the epitransverse process form an accessory atlantooccipital joint. The expression of these variations, though under genetic influence, might have also been influenced by artificial cranial deformation. To our knowledge, this association has not been reported. The epitransverse process and the ponticulus posterior are important because of the positional relationship with the vertebral artery on which they may exert compression effects generating blood flow disorders. The paracondylar process is located at the insertion of rectus capitis lateralis, an important surgical landmark, which could be affected by the presence of the paracondylar process, thus leading to possible difficulties in orientation and iatrogenic trauma. This case contributes to extending the knowledge regarding anatomical variations, being of great use to the contemporary medical field, especially surgery.

A Study of Risk Factors and T- Score Variability in Romanian Women with Postmenopausal Osteoporosis.

BACKGROUND: The purpose of this study was to analyse the prevalence of postmenopausal osteoporosis risk factors and to analyse the T-score variability in spine and hip according to the associated risk factors. METHODS: This is a retrospective study (2003-2007) including 177 female patients with postmenopausal osteoporosis. The patients were separated in seven groups according to the number of risk factors per case. The T-score was compared between this groups using unpaired t-Student test. RESULTS: The most frequent risk factor was early menopause (44.63%), followed by low consumption of dairy products (37.29%), coffee consumption (25.99%), sedentary lifestyle (20.9%), smoking (19.21%), delayed menarche (15.25%), low body mass index (10.71%), nulliparity (7.91%), alcohol consumption (0.56%). The maximum number of risk factors per case was six. The T-score decreased with increasing number of risk factors. T-score differences are statistically significant when comparing cases with 6 risk factors to cases with 5 risk factors (P=0.0315 in spine; P=0.0088 in hip), 4 risk factors (P=0.0076 in spine; P=0.043 in hip), 3 risk factors (P<0.0001 in spine; P=0.0205 in hip), 2 risk factors (P=0.0012 in spine; P<0.0001 in hip), a single risk factor (P<0.001 in spine and hip) and no risk factor (P=0.0075 in spine; P=0.0006 in hip). CONCLUSION: Association of several risk factors leads to decrease of T-score so being able to avoid any such factors may contribute to a better bone mineral density. This could be achieved by the education of female population regarding postmenopausal osteoporosis risk factors, followed by adopting an appropriate lifestyle and diet.