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Spondylodiskitis is a rare condition in adults but with high index of morbidity and mortality due to difficult diagnosis. The insidious evolution and the unspecificity of symptoms interfere with prompt treatment, being the diagnosis based primarily on a high index of suspicion. There are two major groups of spondylodiskitis: pyogenic, being Staphylococcus aureus the most frequent etiological pathogen, and granulomatous, caused mainly by Mycobacterium tuberculosis and Brucella melitensis, both endemic in Portugal. The authors describe two clinical cases of spondylodiskitis, where the etiological investigation proved a challenge. In both cases the combination of clinical and imagiological data contributed to the appropriate empirical treatment, with a favorable clinical outcome.

Many diabetic patients report symptoms of incomplete defecation. We aimed to clarify the recto-anal manometric characteristics related to these symptoms.A questionnaire regarding gastrointestinal symptoms was distributed to 35 diabetics (19 women and 16 men) aged between 39 and 81 years. Nineteen reported incomplete defecation sensation (WS) and 16 did not (NS). Recto-anal manometry was performed for all patients. Data are presented as mean±SD.Resting rectal pressure was 14.4±10.1 mmHg and 8.8±3.9 mmHg, p.03; first sensation was 61.0±27.8 ml and 83.1±35.7 ml, p.04; and maximum tolerable volume was 174.2±81.5 ml and 235.0±89.5 ml, p.04 for WS and NS, respectively. The WS group was further divided into 2 groups according to symptom severity (less severe and very severe). Significant differences were found in resting external anal sphincter pressure (50.4±15.6 and 34.3±17.4, p.04) and the recto anal inhibitory reflex (48.6±19.8 and 26.3±23.2, p.03) between the less severe and very severe groups, respectively.(1) Resting rectal pressure was significantly higher in symptomatic individuals. (2) First sensation and maximum tolerable volume were higher in asymptomatic diabetics. (3) In diabetics with more severe symptoms, the resting external anal sphincter pressures were significantly lower. (4) The degree of relaxation in the recto-anal inhibitory reflex was significantly higher in individuals without complaints.