Achalasia is a motor disorder characterized by esophageal aperistalsis and failure of lower esophageal sphincter relaxation. The cardinal symptoms are dysphagia, food regurgitation and weight loss. The most effective treatments are pneumatic dilation (PD) of the cardia and Heller esophageal myotomy with partial fundoplication. There is still controversy regarding which treatments should be initially done. The aims of this study were to evaluate clinical response and the variables related to good results in both treatments. Ninety-two patients with achalasia diagnosed by esophageal manometry were randomized to receive either PD or laparoscopic Heller myotomy with partial fundoplication. After the procedure, patients were followed up clinically and submitted to esophageal manometry and pH monitoring. Three months after treatment, 73% of the patients from PD group and 84% of the surgery group had good results (P = 0.19). After 2 years of follow-up, 54% of the PD group and 60% of the surgery group (P = not significant) were symptom free. Variables related to a good response to PD were a 50% drop in lower esophageal sphincter pressure (LESP) or a LESP <10 mmHg after treatment. Patients over 40 years old with LESP ≤32 mmHg before treatment and a drop in LESP >50% after treatment significantly achieved better responses after surgical treatment when compared with PD. The reflux rate was significantly higher in the PD group (27.7%) compared with the surgery group (4.7%), P = 0.003. We concluded that surgical treatment and PD for achalasia are equally effective even after 2 years of follow-up. The choice of treatment for achalasia should be based on the following parameters: treatment availability, rate of good results, complication rates, variables related to good responses and also the patient's wish.

The learning of geometric concepts by Visually Impaired People (VIP) is a huge challenge. This paper presents a new dynamic computer-based environment for the learning of geometric concepts through adaptive technology. A case study on learning of geometric concepts in VIP classrooms using the proposed environment is detailed. Several experiments carried out with signed subjects (control group) and VIP subjects (experimental group) using the proposed method is also discussed. The results of this case study have shown that: i. the learning of geometric concepts by the VIP students was done through a peremptory and autonomous way; ii. the VIP students improved their ability to learn, retain and apply obtained concepts in other contexts; iii. the environment innovated the VIP geometry learning and increased their logical reasoning iv. the continuous use of the environment have enabled them to improve their spatial positioning and motions; v. the environment exhibited a superior performance than the classical geometry teaching in VIP classrooms. The main result of the experiments is that VIP students required (in average) only 20% of the time that was required in classical classes for solve correctly all proposed exercises.