PurposeThe aim of this study was to retrospectively compile normative data on the anterior cruciate ligament (ACL) in the paediatric population with magnetic resonance imaging, emphasizing the differences between men and women. MethodsIn this retrospective study, musculoskeletal radiologists evaluated length, area, coronal and sagittal inclination of the ACL and inclination of the intercondylar notch. A total of 253 MR examinations (130 males and 123 females between 6 and 18 years of age) were included. The association between measurements, sex and age was considered. Linear and fractional polynomial regression models were used to evaluate the relationships between measurements. ResultsACL length showed significant progressive growth (p < 0.001) with age in men and women, without characterization of growth peaks. ACL area in women showed more pronounced growth up to 11 years, stabilized from 11 to 14 years and then sustained a slight reduction. In men, ACL area showed more pronounced growth up to 12 years, stabilized from 12 to 15 years and then sustained slight reduction. Coronal and sagittal inclination of the ACL showed a significant progressive increase (p < 0.001) with age in both sexes, progressively verticalizing. The intercondylar roof inclination angle showed significant progressive reduction (p < 0.001) with age in both sexes. ConclusionThe area of the ACL does not accompany skeletal maturation, interrupting its growth around 11–12 years. Progressive verticalization of the ACL as well as of the intercondylar notch roof in the evaluated ages was also observed. The clinical relevance of this study is that the ACL presents different angular and morphologic changes during growth in the paediatric population. Since ACL repair is now being performed on younger children, recognition of the normal developmental changes of the ACL is of utmost importance for successful ACL graft placement. Level of evidenceIII.
SumárioO diabetes melito, especialmente quando descompensado, pode culminar em várias complicações neurológicas, sendo o desenvolvimento de movimentos involuntários uma das formas mais raras. O estado hiperglicêmico não cetótico em pacientes idosos, que se apresentam com movimentos tipo balismo-coreia associados a alterações nos exames de imagem cerebral (tomografia computadorizada e/ou ressonância magnética), constitui uma síndrome de caracterização recente e de poucos relatos na literatura. Apresentamos o caso de um paciente admitido com história de movimentos involuntários do tipo hemibalismo-hemicoreia à esquerda associado a estado hiperglicêmico com hemoglobina glicada de 14,4%. O exame tomográfico de crânio revelou área hiperdensa em topografia de gânglios da base à direita. Após controle glicêmico adequado, houve melhora progressiva e recuperação do quadro neurológico, com desaparecimento completo da lesão hiperdensa inicial. Arq Bras Endocrinol Metab. 2010;54(3):335-8 SummaryDiabetes mellitus, especially when not under control, can lead to several neurological complications being the development of involuntary movements one of the rarest presentations. Nonketotic hyperglycemia in aged patients who present with ballismus-chorea movements and cerebral image alterations in computerized tomography (CT) and magnetic resonance constitute a syndrome of recent characterization and few cases in literature. We present a case of a 75 year-old male patient admitted with history of hemiballismus-hemichorea movements, hyperglycemia, glycated hemoglobin of 14.4% and CT with a hyperdense area in the topography of the right basal ganglia. After glycemic control, the neurological signs resolved completely and the initial hyperdense lesion disappeared. Arq Bras Endocrinol Metab. 2010;54(3):335-8 B alismo e coreia são distúrbios do movimento hipercinético diferenciados pela amplitude e distribuição de grupos musculares, evidentes no repouso ou na ação, e que tendem a desaparecer durante o sono (1). Acometem mais frequentemente um lado do corpo, sendo assim denominados hemibalismo ou hemicoreia.Geralmente resultam de lesões estruturais no núcleo subtalâmico e estriado contralateral, podendo ser de várias etiologias, principalmente secundários a eventos vasculares (2). Na ausência de lesão vascular focal, alterações metabólicas, neoplasia cerebral e infecções do sistema nervoso central (SNC) devem ser consideradas (3).Existem raros relatos na literatura. Estima-se que a incidência de hemibalismo seja 1 caso para 500 mil na população geral (2).O estado hiperosmolar hiperglicêmico (EHH) representa uma das complicações mais graves do diabetes melito (DM), mais frequentemente observado em dia-
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