Background
Esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder characterized by a lack of relaxation of the esophagogastric junction (EGJ), with preserved esophageal body peristalsis. We propose new terminology for the coexistence of EGJOO with hypercontractile esophagus and distal esophageal spasm as a major mixed motility disorder (MMMD), and normal peristalsis or a minor disorder of peristalsis such as ineffective esophageal motility with EGJOO as isolated or ineffective EGJOO (IEGJOO).
Methods
We reviewed prior diagnoses of EGJOO, stratified diagnoses as IEGJOO or MMMD, and compared their symptomatic presentations, high‐resolution manometry (HRM) and endoluminal functional lumen imaging probe (EndoFLIP) metrics, and treatment responses at 2–6 months of follow‐up.
Results
Out of a total of 821 patients, 142 met CCv3 criteria for EGJOO. Twenty‐two were confirmed by CCv4 and EndoFLIP as having EGJOO and were clinically managed. Thirteen had MMMD, and nine had IEGJOO. Groups had no difference in demographic data or presenting symptoms by Eckardt score (ES). HRM showed MMMD had greater distal contractile integral, frequency of hypercontractile swallows, and frequency of spastic swallows, and greater DI by EndoFLIP. Patients with MMMD showed greater reduction in symptoms after LES‐directed intervention when measured by ES compared with IEGJOO (7.2 vs. 4.0).
Conclusion
Patients with MMMD and IEGJOO present similarly. Detectable differences in HRM portend different responses to endoscopic therapy. Because patients with MMMD have greater short‐term prognosis, they should be considered a different diagnostic classification to guide therapy.
Giant cell tumor of tendon sheath is a benign soft tissue lesion most commonly found in the flexor aspect of the hand and wrist. Being uncommon in the foot and ankle, the unusual appearance of this lesion can at times imitate other lesions such as lipoma, synovial sarcoma, malignant fibrous histiocytoma, synovial cyst, and ganglion. Thus, it is vital to include this lesion in differential diagnoses, especially if the lesion is found to be anchored to any of the surrounding tendons. This article describes the unusual occurrence of giant cell tumor of the tendon sheath of extensor digitorum brevis of great toe anchored to the capsule of metatarsophalangeal joint, which is rarely described in the literature.
Introduction: Chronic lumbo-sacral pain is a common and challenging clinical entity in pain management centre. The most commonly involved surgical indication are intractable leg or back pain and significant functional impairment that have been unresponsive to conservative measures. This is a level 2 evidence study where we have studied results of endoscopic discectomy and compared it to conventional discectomy procedure. Material and Methods: We selected 40 patients with severe low back pain radiating to one or both lower limbs, which has failed to resolve after prolonged conservative treatment and have less than level 3 disc prolapse. Oswestry Disability Index (For Low Back Pain) was recorded with questionnaire response and used as clinical tool for assessment. Results: Mean age of 40 patients was found to be 42.9 year with 80% patients having paracentral disc protrusion. Average operative time for endoscopic discectomy was 103 minutes which was higher than conventional discectomy (78 minutes). However, there was minimal blood loss compared to conventional discectomy. Based on ODI score, both endoscopic and conventional discectomy offered similar results in all grades. Conclusion: Endoscopic discectomy is a novel, safe and effective method that minimizes invasiveness of the surgical approach. Results achieved with this method are comparable to those achieved with open discectomy in terms of relief of symptoms on longer follow up, and is significantly better in terms of early mobilisation and morbidity as there is minimal tissue trauma.
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