Sphincter Disorders Research Articles

Study of epidemiology, clinical features and early outcome in traumatic spine injuries at a tertiary hospital in Jammu region

Background: Traumatic Spinal Cord Injury (TSCI) is a devastating neurological injury, causing paralysis, sensory loss and sphincter disorder in different degrees and indirectly imposes a significant burden on the health care system. Present study was aimed to study epidemiology, clinical features and early outcome in traumatic spine injuries at a tertiary hospital in Jammu region. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients with traumatic spine injuries attending OPD or admitted in emergency. Results: Out of 282 patients, most of the patients were in the age group 51-60 (29.43%) and 41-50(29.08%). Mean age was 51.62 years. Male to female ratio was 2.4:1. Majority of traumatic spine injuries were due to road traffic accidents (54.96%), followed by fall from height (43.26%) and assault (1.77%). Majority of spine fractures occurred at cervical (41.84%) followed by Lumbar (27.30%) followed by thoracic (19.50%) vertebral level. 49.29% patients had neurodeficit. On pre -operative assessment 50.71% patients had ASIA score of E, 15.60 had ASIA score of C, 12.06% had ASIA score of D, 13.48% had ASIA score of A and 8.16% had ASIA score of B. Mean of SLICS score was 3.66 and mean duration of TLICS score was 3.8. Total deaths in our study were 30. Conclusion: Complication rates were higher in patients treated non-operatively. Leading causes in deaths at cervical level were due to respiratory failure and leading causes of deaths in thoracic and lumbar vertebral level were due to secondary complications of long-standing bed sores.

Diagnosis of Upper Esophageal Sphincter Disorder: A Study in Healthy Volunteers and Patients With Oropharyngeal Dysphagia

Diagnosis of Upper Esophageal Sphincter Disorder: A Study in Healthy Volunteers and Patients With Oropharyngeal Dysphagia

Urogenital disorders in women of reproductive age after radical surgeries about uterine myoma – optimization of diagnostic algorithm

The article presents an assessment and analysis of the most important medical and social risk factors for long-term postoperative urogenital disorders in women of reproductive age after radical surgical treatment for uterine fibroids. Radical operations for uterine fibroids cause an increase in the proportion of urogenital disorders, the clinical manifestations of which have a negative impact on the physical, psycho-emotional form and social significance of women in society. A survey of 80 women aged 40 to 50 years, the main group included 40 patients who underwent vaginal hysterectomy, the comparison group consisted of 40 patients with hysterectomy performed by abdominal access. Data on the assessment of pelvic floor condition and urogenital dysfunction using a standardized POP-Q system, both at the stage of preoperative observation and for 3 and 5 years after surgery. Сonducted surveys, filling diaries of pain, urination, physical examination and bimanual examination, determination of the pH of the vaginal contents, colposcopy, evaluated the index of the vaginal condition, the state of the microbiota of the mucous membranes, a comprehensive urodynamic examination, cystometry, ultrasound examination of the pelvic organs and assessment of ovarian structure.The most important risk factors are identified, which would allow to form groups of patients that require individualized approaches in the choice of surgical techniques and rehabilitation program. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth injuries, high birth parity); ovarian surgery, the use of gonadotropin-releasing hormone agonists. chronic diseases of the respiratory system and gastrointestinal tract, accompanied by increased intra-abdominal pressure; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. When choosing a method and access in case of surgical treatment for uterine fibroids, it is advisable to take into account the presence of pelvic prolapse and initial dysuric manifestations in women, the functional state of the sphincter apparatus and urethral hypermobility, obstetric and gynecological pathology and previous surgery on the organs of the uterus. the patient, her awareness of possible complications, the surgeon’s experience and his choice of surgical techniques.

Laparoscopic Heller Myotomy and Dor Fundoplication for the Treatment of Esophageal Achalasia After Sleeve Gastrectomy\u2014a Video Vignette

PurposeEsophageal dysmotility and disorders of the lower esophageal sphincter are well documented in morbidly obese patients. Esophageal achalasia has been reported in up to 1% of obese patients but the development of such esophageal motility disorder after laparoscopic sleeve gastrectomy (LSG) is extremely rare. The purpose of this video was to demonstrate the management of a type II esophageal achalasia diagnosed in a 46-year-old female patient 4-year after LSG.Materials and MethodsAn intraoperative video has been anonymized and edited to demonstrate the feasibility of laparoscopic Heller myotomy and anterior Dor fundoplication on the mentioned patient.ResultsThe operation started with the section of the perigastric adhesions. Proceeding in a clockwise direction, the esophagogastric junction, the anterior esophageal wall, and the His angle were freed. A residual slightly dilated fundus was found and isolated. After mobilization of the distal esophagus and identification of the anterior vagus nerve, a “hockey stick” myotomy was carried out for 6 cm on the esophagus and for 2 cm on the gastric side. An anterior Dor fundoplication was fashioned using the residual gastric fundus.ConclusionEsophageal achalasia in patients that previously underwent LSG is exceptional but should always be suspected in case of pathognomonic symptoms onset. In tertiary referral centers, laparoscopic Heller myotomy and, if technically feasible, an anterior Dor fundoplication seem safe and effective to relieve gastroesophageal outflow obstruction and prevent gastroesophageal reflux.

The Next EPISOD: Trends in Utilization of Endoscopic Sphincterotomy for Sphincter of Oddi Dysfunction from 2010-2019

For years, the endoscopic management of the disorder formerly known as Type III Sphincter of Oddi Dysfunction (SOD) had been controversial. In 2013, the results of the Evaluating Predictors and Interventions in Sphincter of Oddi Dysfunction (EPISOD) trial demonstrated that there was no benefit associated with endoscopic sphincterotomy for patients with Type III SOD. We aimed to assess the utilization of endoscopic sphincterotomy for patients with SOD in a large population database from 2010-2019. We searched a large electronic health record (EHR)-based dataset incorporating over 300 individual hospitals in the United States (Explorys, IBM Watson health, Armonk, NY). Using Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) we identified patients with a first-ever diagnosis of "disorder of Sphincter of Oddi" annually from 2010-2019. Subclassification of SOD types was not feasible using SNOMED-CT codes. Stratified by year, we identified the proportion of patients with newly-diagnosed SOD undergoing endoscopic sphincterotomy and those receiving newly-prescribed medical therapy. A total of 39,950,800 individual patients were active in the database with 7,750 index diagnoses of SOD during the study period. The incidence rates of SOD increased from 2.4 to 12.8 per 100,000 persons from 2010-2019 (P < .001). In parallel, there were reductions in the rates of biliary (34.3% to 24.5%) and pancreatic sphincterotomy (25% to 16.4%), respectively (P < .001). Sphincter of Oddi manometry (SOM) was infrequently utilized, <20 times in any given year, throughout the study duration. There were no significant increases in new prescriptions for TCAs, nifedipine, or vasodilatory nitrates. Among a wide range of practice settings which do not utilize routine SOM, a sudden and sustained decrease in rates of endoscopic sphincterotomy for newly-diagnosed SOD was observed beginning in 2013. These findings highlight the critical importance of high-quality, multi-center, randomized controlled trials in endoscopy to drive evidence-based changes in real-world clinical practice.

THU223 - The presence and outcome of biliary sphincter disorders in liver transplant recipients according to the Rome IV classification

THU223 - The presence and outcome of biliary sphincter disorders in liver transplant recipients according to the Rome IV classification

Dyssynergic Defecation and Anal Sphincter Disorders in Children in High-Resolution Anorectal Manometry Investigation.

Dyssynergic defecation is a common disorder in children with functional constipation (FC) because of relaxation disorders of the sphincter apparatus and intra-rectal pressure during defecation. The aim of the study was to determine frequency and type of dyssynergic defecation and to assess pressure in the anal canal poles during simulated evacuation and function of puborectalis muscle in defecation in children with FC. Three-dimensional (3D) high-resolution anorectal manometries (3D HRAM) were performed in 131 children with FC. In the manometric test, resting pressure measurements were assessed in 4 measuring poles of the anal canal. One hundred thirty-one children ages 5 to 17 years (mean age 10.2; SD ± 3.8; median 10) were involved in the study (69 girls and 62 boys). Dyssynergic defecation was shown in 106/131 (80.9%) examined children. A statistically significant difference between the age of examined children (P < 0.02) and intrarectal pressures at the anal canal measuring points (left P < 0.009, right P < 0.005, anterior P < 0.01) was found. Correlation between the residual pressure values in lateral anal canal measurement poles and intrarectal pressure was demonstrated in all types of dyssynergy (left: r = 0.69, P < 0.0005; right: r = 0.74, P < 0.0005). In a group of 53/131 (40.5%) children, 3D HRAM showed a rectal pressure increase during simulated defecation, because of the dysfunction of the puborectalis muscle. The increase in sphincter pressure in lateral and posterior poles in I and II types of dyssynergia and in lateral poles in other types of dyssynergia may depend on relaxation disorders of the puborectalis muscle during defecation.

Esophagogastric Junction Opening Parameters Are Consistently Abnormal in Untreated Achalasia

Achalasia is a disorder of impaired lower esophageal sphincter (LES) relaxation and failed peristalsis traditionally characterized by manometry.1 As impaired LES relaxation is a mechanism of reduced esophagogastric junction (EGJ) opening, abnormally reduced EGJ distensibility assessed with functional luminal imaging probe (FLIP) was reported among patients with untreated achalasia.2-5 Therefore, we aimed to describe the performance characteristics of EGJ opening parameters on FLIP panometry among a large cohort of treatment-naïve achalasia patients.

Factors influencing the severity of long-term sequelae in fishermen-divers with neurological decompression sickness.

Numerous studies have been conducted to identify the factors influencing the short-term prognosis for neurological decompression sickness (DCS). However, the long-term sequelae are rarely assessed. The purpose of this study to investigate the factors likely to influence the long-term prognosis. Twenty-seven Vietnamese fishermen-divers who on average 9 (SD 6) years beforehand had presented with neurological DCS and ongoing sequelae, were questioned and examined. The severity of the initial clinical profile was quantified using a severity score. The long-term sequelae were clinically evaluated by looking for a motor or sensory deficit or muscular spasticity, and by applying a severity score for the sequelae which focussed on gait and sphincter disorders. An initial severity score of ≥ 15 is significantly associated with a risk of serious long-term sequelae [OR = 13.7 (95% CI 2.4 to 79.5)]. Furthermore, certain treatment practices such as in-water recompression to depths > 17 metres' seawater breathing air are significantly associated with more serious sequelae. The practice of intensive non-standardised hyperbaric oxygen sessions over prolonged durations (median 30 days [IQR 19.5]) delayed after the initial accident (median 4 days [IQR 6]) also seems unfavourable. This study establishes a link between the initial DCS severity and the long-term sequelae causing severe gait disorders and sphincter incontinence. Furthermore, this work suggests that certain detrimental treatment practices should be modified. During this field study, we also found that it was possible to reduce sequelae of these divers by offering them an individual programme of self-rehabilitation.

Studying different aspects of quality of life in the system of neurorehabilitation of patients with neurodegenerative pathology

Breach of partnership signifi cantly worsens life satisfaction, leads to emotional disturbances, affects self-esteem, and ultimately is a quality of life problem. Erectile dysfunction (ED) continues to remain the most important problem of the health and quality of life of the male population. This problem in men with multiple sclerosis is detected in 50—90 % of cases. The article presents the result of isolating pathogenetic variants of erectile dysfunction in 73 men of the Eastern region of Ukraine with a remitting type of course of multiple sclerosis who were being treated at the Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine. At the time of the examination, all patients were in a post-debut period in a state of remission (full or partial). The clinical characteristics of the debut included the defeat of all functional systems: the optic nerve (in the form of retrobulbar neuritis), the pyramidal, cerebellar systems, impaired sensitivity and damage to the brain stem, sphincter disorders. Three pathogenetically different variants of ED were distinguished: with a predominant violation of suprasacral regu lation of erection, with a predominant violation of sacral regulation of erection, with a predominantly psychogenic ED. The predominant ED variants are the va riant with the predominant violation of suprasacral regulation of erection and the variant with predominantly psychogenic ED. The ED variant with a predominant violation of sacred regulation of erection was characterized by a moderate level of personal and reactive anxiety on the SpilbergerKhanin scale, positively correlated with damage to the function of the pelvic organs and was defined as prognostically unfavorable. The study confirmed the previously established clinical heterogeneity of ED in the remitting type of multiple sclerosis. The results of the study are supposed to be used in the development of rehabilitation programs for the remitting type of multiple sclerosis, taking into account regional specifics. Key words: quality of life, multiple sclerosis, remitting course, regional specificity, erectile dysfunction

Our Achalasia Surgery Experiences with the Achalasia Surgery Review

Objective: Achalasia means disorder and dysfunction of Lower Esophageal Sphincter. Achalasia treatment was two types: non-surgical treatments and surgical treatments. Heller myotomy is the best surgical method of achalasia. In our study, we want to present our achalasia surgical experiences and the post-operative follow-up status of the patients for contribution to the literature. Methods: After getting permission from ethics committee of our university, we collected data from patients who operated for achalasia between 2011 and 2019 retrospectively in Department of General Surgery, Van YuzuncuYil University Faculty of Medicine. Age and gender status, diagnosis process, presence of additional esophageal disease in the distal esophagus, surgical type, length of myotomy, presence of esophageal mucosal repair, duration of hospital stay and postoperative follow-up status of the patients were evaluated. Findings: In our study, there were 11 patients who underwent achalasia surgery. The mean age of patients was 31.6 (19-50) years. 63.63% (n = 7) of all cases were female and 36.37% (n = 4) were male. Apart from one case (case with hiatal hernia association) other cases were performed laparotomically. The mean myotomy length was calculated as 9.09 (8-15) cm. The mean duration of hospital stay was 5.18 (3-7) days. Among the patients only one patient had difficulty in swallowing in the first month control. But it was observed that the same patient did not have difficulty in swallowing in the third month control. Discussion: In our study, considering both our post-operative complication status and the patients' 1st and 3rd month controls; we saw that achalasia surgery was performed successfully in our clinic. An important deficiency is that laparoscopic surgery is not yet performed at our desired level in our clinic.

Atlantoaxoid subluxation by suboccipital Pott's disease: Arthrodesis using the Harms technique. About a case and review of the literature

Introduction: The suboccipital location of Pott′s disease is exceptional, and may be complicated by compression of the bulbomedullary junction. Case Report: We report the case of a young patient of 32 years of age, received in a table of spastic tetraplegia preceded by cervicalgia without associated sensory or sphincter disorders. Computed tomography and magnetic resonance imaging of the cervico-occipital hinge showed C1-C2 subluxation with osteolysis of the C1 arches, bone sequestration, and anterior compression of the bulbomedullary junction, requiring arthrodesis using the Harms technique. Diagnostic confirmation was obtained by pathological examination of bone fragments and epidural tissue removed per operation. Tuberculosis chemotherapy was started for 16 months. Progression was favorable with motor recovery allowing unaided walking. Conclusion: The surgical indication of these all tuberculosis localizations depends on the presence of bulbomedullary compression and/or cervico-occipital hinge instability.

Diagnostic and therapeutic approaches in rehabilitation correlated to a case of tetraparesis (with predominance of paraparesis) after severe CCT - bifronto - basal and bitemporal contusion.

Abstract Introduction. Cranio-cerebral trauma (CCT) can be defined as a brain damage caused by an external factor. It may or may not penetrate the skull. Examples of CCT causing sources can be: car accidents, falls (from height or same level), blows with blunt objects, shooting, etc. The diagnosis is generally easy to establish through anamnesis with the patient or witnesses, then by tomography. Having the patient’s consent and The Teaching Emergency Hospital “Bagdasar-Arseni” Ethic committee’s approval, N.O. 17464 per 14.06.2019, this article presents the evolution of a 32-year-old male, tetraparetic with predominance of paraparesis, bradylalia and cerebrastenia (with significant improvement) and disgraphy, following a severe CCT - bifronto-basal and bitemporal contusion. Operated temporo-parieto-occipital fracture (right parietal decompression flap) - all by falling off the horse (affirmative). Joint stiffness in the knees (by Pellegrin-Shida heterotopic periosteal calcifications). Total post-traumatic optic atrophy RE and partial optic atrophy LE. Multiple bedsores. Neurogenic bladder (carrier of indwelling urinary catheter). UTI with Proteus Mirabiris (etiologically treated) was admitted in the Neurorehabilitation Clinic of the Teaching Emergency Hospital”Bagdasar Arseni” (TEHBA) for tetraparesis motor deficit, retention sphincter disorders, locomotor and severe auto-care dysfunctions, specialized recovery and nursing treatment with favorable development. Discussion: The peculiarity of this case is the good evolution of a patient with severe CCT and multiple associated complications. Last but not least, we can highlight how the CCT was produced, namely by falling off the horse. This tells a lot about the importance of the precautions and equipment needed during a sport, in our case wearing a helmet. Key words: cerebral cranial trauma, tetraparesis, paraparesis, recovery,

44 Trends in ERCP Utilization for Sphincter of Oddi Dysfunction: The Real World Impact of EPISOD and Rome IV

INTRODUCTION: The widespread clinical adaptation of landmark clinical trials and practice guidelines is often unclear. The EPISOD trial, a randomized, sham-controlled trial, demonstrated that endoscopic sphincterotomy in patients with Type III Sphincter of Oddi dysfunction (SOD) did not result in clinical improvement. The results of this study were presented at the 2013 National Meeting of the American College of Gastroenterology and published in May 2014. Subsequently, the updated 2016 Rome IV criteria removed Type III SOD from the functional biliary disorder classification. Though patients with Type III SOD make up a minority of all SOD patients, we aimed to assess the utilization of ERCP for patients with SOD in a large population database from 2012–2017. METHODS: We searched electronic health record (EHR)-based disparate data from a cloud-based dataset which incorporates over 300 individual hospitals in the United States (Explorys Inc, Cleveland, OH). Using Systematized Nomenclature of Medicine (SNOMED) codes we identified patients with a first-ever diagnosis of “disorder of Sphincter of Oddi” or “spasm of Sphincter of Oddi” annually from 2012–2017. Because the dataset uses SNOMED codes, it was not feasible to sub-classify the types of SOD. Stratified by year, we identified the proportion of patients undergoing ERCP with sphincterotomy and those receiving tricyclic antidepressants (TCA). A Mantel-Haenszel test was used. RESULTS: The number of index cases of SOD and rates of ERCP utilization are outlined in Table 1. From 2013 (the presentation of EPISOD data) to 2016, there was a significant trend demonstrating lower rates of ERCP for newly-diagnosed SOD (P = 0.018). A divergent increase in TCA utilization was concomitantly seen from 2013–2015, but the trend was not statistically significant (P = 0.29). Following the publication of the ROME IV criteria, rates of ERCP utilization for newly-diagnosed SOD significantly increased (P = 0.048) (Figure 1). CONCLUSION: Following the presentation of the EPISOD data, there was a significant 3-year linear decrease in ERCP utilization for all-comers newly-diagnosed with SOD. Concomitantly, a divergent yet insignificant increase in TCA usage was observed. In 2016, after the Rome IV criteria narrowed the diagnosis of SOD, an expected increase in ERCP utilization was observed. These findings call for ongoing observation to see if these trends are durable.

A rare case of metastatic esthesioneuroblastoma

Olfactory neuroblastoma, also known as esthesioneuroblastoma (ENB), is a rare malignant tumour of the basal layer of the olfactory epithelium, which originally develops unilaterally, accounting for 3-6% of all intranasal tumours. We present the case of a patient with a voluminous ethmoidal lesion that invaded the left basal frontal lobe and left orbit. The biopsy revealed a stage C KADISH, grade III neuroblastoma. The patient followed a multimodal treatment with chemotherapy and radiation therapy to which he responded partially, then returned after 11 months for sphincter disorder and bilateral sciatic type pain. An MRI showed metastasis of the filum terminale, the anatomopathological exam identifying also neuroblastoma. CT and MRI imaging are required for a correct assessment of the regional extension of olfactory neuroblastoma, response to oncological treatment but also for the detection of secondary lesions found in a small number of cases.

Videofluoroscopic swallow study features of lower esophageal sphincter achalasia-like syndrome in dogs.

BackgroundMegaesophagus (ME) carries a poor long‐term prognosis in dogs. In people, lower esophageal sphincter (LES) disorders causing functional obstruction are rare causes of ME that may respond to targeted treatment. Functional LES disorders are reported rarely in dogs because of challenges in diagnostic methodologies.Hypothesis/ObjectivesTo identify dogs with videofluoroscopic swallow study (VFSS) features of LES achalasia‐like syndrome (LES‐AS). We hypothesized that dogs with LES‐AS could be distinguished from normal dogs using standardized VFSS criteria.AnimalsDogs with LES‐AS by VFSS (n = 19), healthy normal dogs (n = 20).MethodsRetrospective study. One‐hundred thirty dogs presented to the University of Missouri Veterinary Health Center (MU‐VHC) between April 2015 and December 2017 for a free‐feeding VFSS; 20 healthy dogs were included as controls. Swallow studies were evaluated for failure of the LES to relax during pharyngeal swallow (LES‐AS). Affected dogs subsequently were evaluated using standardized criteria to identify metrics important for identifying and characterizing dogs with LES‐AS.ResultsNineteen dogs with LES‐AS were identified out of 130 VFSS. Megaesophagus was present in 14 of 19 (73.7%) dogs with LES‐AS. A baseline esophageal fluid‐line and “bird beak” were present in 68.4% (95% confidence interval [CI], 47.5%‐89.3%) and 63.2% (95% CI, 41.5%‐84.8%) of affected dogs, respectively. The esophagus was graded as acontractile (8/19), hypomotile (8/19), or hypermotile (3/19).Conclusions and Clinical ImportanceDogs with LES‐AS may successfully be identified by VFSS using a free‐feeding protocol. These data are of critical clinical importance because a subpopulation of dogs with functional LES obstruction may be candidates for targeted intervention.

Invasive myxopapillary ependymoma of the lumbar spine: A case report

BACKGROUNDMyxopapillary ependymomas are rare spinal tumours. Although histologically benign, they have a tendency for local recurrence.CASE SUMMARYWe describe a patient suffering from extra- and intradural myxopapillary ependymoma with perisacral spreading. He was treated with subtotal resection and postoperative radiation therapy. After treatment, he experienced slight sphincter disorders and lumboischialgic pain with no motor or sensory disturbances. Eight months later, a tumour regression was documented. The patient is still followed-up regularly.CONCLUSIONLumbar myxopapillary ependymomas may present with lumbar or radicular pain, similar to more trivial lesions. Magnetic resonance imaging (MRI) is the primary modality for diagnosis. The treatment aim is to minimize both tumour and therapy-related morbidity and to involve different treatment modalities.

An odd and serious “disc bulging”!

Background and importanceCauda equina syndrome is a common acute medical condition, usually caused by large degenerative disc herniation or metastatic lumbar disease. We describe a patient who presented with a lesion featuring both discal and tumoral characteristics. Clinical presentationA 41-year-old woman presented with ongoing back pain, progressive lower-limb weakness and sphincter disorder. Magnetic resonance imaging showed a very odd-looking large anterior epidural lesion originating from the L3-L4 space and severely compressing the roots of the cauda equina. Partial surgical decompression was performed in emergency. At a later time, redo surgery was performed to maximize resection, and was unfortunately followed by several complications. After 6 surgical procedures including a ventriculo-peritoneal shunt insertion and intensive rehabilitation, the patient could walk independently with the aid of one crutch. Following collegial review, the diagnosis of low-grade chondrosarcoma of the intervertebral disc was suggested. ConclusionWe report on a very unusual and therapeutically challenging spinal tumor diagnosed as low-grade chondrosarcoma of discal origin, an entity never previously described.

Medullar Kock without Pott: 13 cases observed at the university hospital center of Conakry, Guinea

Background: The diagnostic certainty of medullar tuberculosis (TB) without Pott disease is difficult to establish in a tropical environment with the large group of infectious, parasitic, and systemic myelopathies, despite the increasing availability of magnetic resonance imaging (MRI) data and improvement of biological exploration platforms. Methods: We retrospectively analyzed the files of 186 patients hospitalized in the Department of Neurology and Neurosurgery of the University Hospital Center of Conakry, Guinea, between 2008 and 2016 for the management of non-compressive and compressive myelopathy. Biological evidence of TB infection was demonstrated for 13 (6.9%) patients. Results: Infectious clinical picture prior to the development of neurological signs was reported in 11 patients (84.6%). The neurological signs were summed up by the existence of a sensitivo-motor semiology of progressive evolution (100% of cases) with sphincter disorders in 11 patients (84.6%) and a medullary compression symptomatology with a lesion and under lesion syndrome from the outset in 4 patients (30.8%). Medullary MRI revealed an extensive intramedullary hypersignal in 9 patients with non-compressive myelopathy and in 4 cases, the lesions appeared in T1 hypersignal and T2 isosignal were localized. Lumbar puncture (LP) revealed lymphocytic pleocytosis, hypoglucorrhage (0.3 to 0.5 g/l), and leukocytosis. Conclusion: This study reveals a classic clinical, biological, neuroradiological, and evolutionary profile of compressive and non-compressive myelopathies. These results are important for the therapeutic and evolutionary discussion of TB myelopathies for good management.

Barium contrast evaluation of lower esophageal sphincter disorders with endoscopic correlation

Barium contrast evaluation of lower esophageal sphincter disorders with endoscopic correlation