The femoral head-neck contour varies as a function of physeal development.

OBJECTIVES: The purpose of this study was to investigate whether the femoral head-neck contour, characterised by the alpha angle, varies with the stage of physeal maturation using MRI evaluation of an asymptomatic paediatric population. METHODS: Paediatric volunteers with asymptomatic hips were recruited to undergo MRI of both hips. Femoral head physes were graded from 1 (completely open) to 6 (completely fused). The femoral head-neck contour was evaluated using the alpha angle, measured at the 3:00 (anterior) and 1:30 (anterosuperior) positions and correlated with physeal grade, with gender sub-analysis performed. RESULTS: A total of 43 asymptomatic paediatric volunteers (26 male, 17 female) with mean age 13.0 years (eight to 18) were included with review of bilateral hip MRIs. Correlation between the physeal grade and alpha angle was moderate in males at both the 3:00 (r = 0.477, p < 0.001) and 1:30 (r = 0.509, p < 0.001) positions, whereas there was no significant correlation in females. A significant difference was found between the alpha angles of all the physeal grades (3:00, p = 0.030, 1:30, p = 0.005), but only in males, with the angle increasing with higher grades. For physeal grading, the inter-reader reliability was substantial (intraclass correlation coefficient (ICC) = 0.694), and the intra-reader reliability was also substantial (ICC = 0.788). CONCLUSION: The femoral head-neck contour varies and correlates with the stage of physeal development, but only in males, with the alpha angle increasing with progressive physeal maturation. This suggests that gender differences exist in the natural physiological growth, development or remodelling of femoral head-neck junction. In males, pre-physeal fusion may be a critical period of vulnerability for development of morphologic abnormalities of the femoral head-neck junction. Cite this article: Bone Joint Res 2015;4:17-22.

[Neurocryptococcosis caused by nonencapsulated Cryptococcus neoformans]. / Neurocriptococose por Cryptococcus neoformans não capsulado.

The case of a patient with meningoencephafalitis due to a nonencapsulated strain of Cryptococcus neoformans is reported; he had no risk factors for the disease or AIDS. Clinical examination showed a chronic meningoencephalitis first diagnosed as tuberculosis. In the second cerebrospinal fluid (CSF) examination after a week from admission yeasts appeared inside macrophage cells. CSF culture in Sabouraud medium disclosed nonencapsulated Cryptococcus neoformans (biochemical identification). Sample inoculation in mouse (intraperitoneal) evidenced a capsule that disappeared in several consecutive cultures. The morphology of the yeast was studied by electronic microscopy. After treatment with amphotericin B and 5-fluorocytosine the patient had a favorable evolution. The significance of capsular material is discussed.

Neurocriptococose por Cryptococcus neoformans näo capsulado / Neurocryptococcosis due to non capsulated Cryptococcus neoformans

Os autores registram um caso de neurocriptococose em paciente HIV-positivo, por Cryptococcus neofarmans acapsulado ou deficiente em cápsula. O quadro neurológico era de meningoencefalite subaguda, compatível ao diagnóstico de neurotuberculose, pelo exame do líquido cefalorraqueano (LCR). Estruturas leveduriformes foram encontradas no interior de macrófagos, ao exame citomorfológico do LCR. Cultivo do sedimento do LCR revelou a presença de Cryptococcus neoformans näo capsulado (identificaçäo bioquímica). A inoculaçäo da amostra em camundongo, por via intraperitoneal, permitiu a produçäo de cápsula que desaparecia em cultivos. Foi estudada a micromorfologia do fungo à microscopia eletrônica de varredura. A evoluçäo foi favorável com o emprego da anfotericina B associada a 5-fluoreocitosina. Näo foi caracterizada a variedade de Criptococcus neoformans agente do processo