Microbiota of the Oropharynx and Endoscope Compared to the Esophagus.

The role of the microflora in the development of esophageal disease is still largely unknown and is being investigated in more detail. Our goal was to determine how the microbiota levels of endoscope and uvular swabs compared to the levels of tissue biopsies along various points of the esophagus. 17 patients with Barrett's esophagus agreed to participate in the study. Biopsies of esophageal mucosa were taken from the (1) proximal esophagus, (2) mid-esophagus, (3) distal esophagus, and (4) Barrett's esophagus. Swabs were also taken from the uvula and the endoscope. Throughout the esophagus, 17 bacterial genera were detected from the samples. The microflora pattern obtained from the uvula and endoscopic swabs did not correlate well with mucosal biopsies along any aspect of the esophagus. There were statistically significant differences in the levels and proportions of bacteria found when comparing the uvula swab to the esophageal biopsies and when comparing the endoscope swab to the esophageal biopsies. Obtaining a simple swab of the uvula or endoscope itself appears to be a poor substitute for tissue biopsy of esophageal mucosa when evaluating microflora patterns. When performing microflora studies of the esophagus, mucosal biopsies should be used for analysis.

Ultrasonographic examination of the synovial fold of the radiohumeral joint.

This report describes the anatomy of the synovial fold of the radiohumeral joint and assesses its visibility by ultrasonography. Forty-nine fresh cadaver radiohumeral joints were examined by ultrasonography before and after intraarticular saline injection and then dissected. Digital photos were taken before and after the joint capsule was excised. The relative coverage of the radial head by the fold was calculated. Synovial folds were observed in all specimens. Forty-three had anterior and posterior lobes. The synovial fold covered an average of 28% of the radiocapitellar joint surface of the radial head. The sensitivity of the ultrasonography was 81%, 46%, and 85% from the anterior, lateral, and posterior aspects of the radiohumeral joint, respectively. Intraarticular saline injection improved the sensitivity to 96%, 67%, and 94%, respectively. The synovial fold is a consistent anatomic structure, and ultrasonography can be a useful preoperative diagnostic tool.