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The aim of this study was to compare esophageal motor characteristics between diabetics and healthy individuals.Esophageal manometry was performed in 34 type 2 diabetics and 32 healthy individuals. Waves were evaluated in the 3 thirds of the esophagus (P1=upper, P2=middle, and P3=distal).In diabetics vs. controls, wave distribution was as follows: peristaltic waves, 83.5 ± 22.2% vs. 96.3 ± 4.4%, p0.002; simultaneous waves, 3.26 ± 5.8% vs. 0.53 ± 1.3%, p0.01; no transmitted waves, 10.62 ± 20.7% vs. 2.75 ± 3.0%, p0.002; and retrograde waves, 2.68 ± 4.0% vs. 0.31 ± 1.1%, p0.03. Wave amplitude was similar between groups. Average upstroke (mmHg/s) in diabetics vs. non-diabetics was P2, 33.8 ± 13.9 vs. 40.2 ± 17.7, p0.03; and P3, 29.8 ± 15.3 vs. 41.3 ± 14.0, p0.002.(1) Simultaneous waves, no transmitted waves, and retrograde esophageal waves were significantly more frequent in diabetics. (2) Average upstroke was significantly lower within the middle and distal esophagus of diabetic individuals. (3) Wave amplitude was similar in both groups.

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.

Introdução: O trânsito digestivo, na diabetes, pode estar alterado, mas a influência de alguns fatores é controversa. O objetivo deste trabalho é conhecer a influência da idade, sexo, duração da doença e controlo glicémico sobre o trânsito digestivo, nos diabéticos. População e método: Foram feitas 2 radiografias abdominais a 68 diabéticos tipo 2 entre 44-81 anos, 24 e 72 h após a ingestão de 25 partículas radiopacas. Analisou-se a relação entre o número de partículas no cólon direito, esquerdo, sigmoide-reto e cólon total com a idade, o género, a duração da doença e a hemoglobina glicosilada (HbA1c). Foi aplicado o teste t de Student. Os resultados apresentam-se como ¯X ±SD. Resultados: Às 24 h, o número de partículas no cólon foi significativamente maior nos indivíduos com HbA1c≤≤7% vs.> 7%, 18,6±6,3 vs. 13,1±8,5 p < 0,004. Às 72 h, a idade (≤60 anos vs.> 60 anos), o género e a HbA1 c não influenciaram significativamente o número de partículas no cólon. Nos diabéticos, com doença≤10 anos vs. > 10 anos, o número de partículas foi, no cólon direito 0,49±1,17 vs. 0,18±0,46, p > 0,05; cólon esquerdo 1,46±3,7 vs. 3,97±6,4, p < 0,05; cólon sigmoide e reto 1,26±2,2 vs. 3,39±2,5, p < 0,01; total 3,20±6,0 vs. 7,55±8,8, p < 0,02. Conclusões: 1 - O trânsito cólico, às 24 h, foi mais lento nos diabéticos com HbA1c ≤7%. 2 - Os doentes diabéticos há ≤10 anos tiveram um trânsito cólico significativamente mais lento. 3 - A idade, o género e a HbA1c não o influenciaram às 72 h. Introduction: In diabetes, the digestive transit may be altered. Nevertheless, the influence of some factors is controversial. The aim of this study is to examine the influence of age, gender, disease duration and HbA1c on the colonic transit of diabetic patients. Population and methods: Thirty eight type 2 diabetic patients, aged between 44 and 81, were enrolled. Two abdominal radiographs were conducted, 24 and 72 hours after the ingestion of 25 radiopaque particles. We examined the relationship between the number of particles in the right and left colon, sigmoid colon - rectum and total colon and age, gender, disease duration and glycosylated hemoglobin (HbA1c). t statistics were performed, and the results are in mean ± SD. Results: At 24 hours, the number of particles in the colon was significantly higher in patients with HbA1c ≤ 7%/l vs. > 7%, 18.6 ± 6.3 vs. 13.1 ± 8.5 p < 0.004, and, at 72 hours, the age (≤ 60 years vs. > 60 years), gender and HbA1c did not influence significantly the number of particles in the colon. In patients with disease duration ≤ 10 years vs> 10 years, the number of particles in the right and left colon were: 0.49±1.17 vs. 0.18±0.46, p > 0.05, 1.46±3.7 vs. 3.97±6.4, p < 0.05, respectively. In the sigmoid colon and rectum were: 1.26±3.39 vs. 2.2±2.5, p < 0.01, and total 3.20±6.0 vs. 7.55±8.8, p < 0.02. Conclusions: 1 - At 24 hours, patients with HbA1c ≤ 7% had significantly more particles in the colon. 2 - At 72hours, the patients with ≤ 10 years of disease had significantly less radiopaque particles in the colon. 3 - The age, gender, and the HbA1c did not have any effects, at 72 h.

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.