Double contrast upper gastrointestinal barium examination with biopsy versus endoscopy with biopsy in dyspeptic patients.

RATIONALE AND OBJECTIVES: The financial restrictions of the managed care environment require reconsideration of the barium upper gastrointestinal examination as a diagnostic tool for gastritis patients. However, a greater sensitivity and specificity for gastritis is needed. A prospective study was performed comparing barium examinations with gastric biopsies to endoscopy with biopsy. METHODS: Forty adult patients underwent upper gastrointestinal barium examination with gastric biopsies obtained under fluoroscopy through a nasogastric tube. Twenty-seven patients gave consent for subsequent endoscopy with biopsy. Both sets of biopsies were compared, as were the interpretations of the radiographs and visual appearances. RESULTS: For barium examinations with gastric biopsies, sensitivity for gastritis was 94% and specificity was 100%, using endoscopic biopsies as the gold standard. CONCLUSIONS: In addition to endoscopy with biopsy, the upper gastrointestinal barium examination with biopsy is another option of sufficient sensitivity and specificity for consideration by clinicians in their workup of patients with gastritis.

Nonendoscopic gastric mucosal biopsy to augment double-contrast upper gastrointestinal barium examination.

The authors present a gastric mucosal biopsy technique with use of a nasogastric catheter and biopsy forceps after double-contrast upper gastrointestinal fluoroscopy in patients with clinical symptoms of dyspepsia. In 51 patients (18 men and 33 women, aged 27-73 years [mean, 46 years]), 136 aggregates (specimens composed of the two pieces of mucosal tissue obtained in each region) ranged from 0.1 to 0.6 cm in diameter. All but three specimens were of adequate mucosal depth. No complications secondary to bleeding resulted.

Does magnesium play a role in the hypokalemia of Bartter's syndrome?

A patient with Bartter's syndrome manifested hypomagnesemia in addition to hypokalemia. Under conditions of maximal free water production, he had a fractional distal solute reabsorption of 0.65, a value consistent with a renal defect in sodium chloride reabsorption in the thick ascending limb of the loop of Henle. This is also the site of 65% to 70% of urinary magnesium reabsorption. With magnesium supplementation and amiloride, the urinary potassium decreased and the serum potassium increased. Atrial natriuretic peptide concentrations in the plasma were low. Evaluation of family members showed five of nine offspring had hypokalemia with no disorder in the parents, an apparent autosomal recessive mode of inheritance. This is a US government work. There are no restrictions on its use.

Delayed pleuropulmonary complications following coronary artery revascularization with the internal mammary artery.

We have seen four cases of delayed postoperative pleuro-pulmonary complications associated with use of the internal mammary artery (IMA) conduit. In each case the left IMA was used as a bypass conduit to the left anterior descending (LAD) coronary artery. In two of the instances the complications were life-threatening to the patients. Each patient was left with symptomatic residual roentgenographic changes. The IMA is becoming the graft of choice for coronary artery revascularization. The potential for delayed pleuropulmonary complications associated with use of this graft is not well recognized.