Thyroglobulin (TG) is a normal constituent of serum detectable by radioimmunoassay in 75% to 90% of healthy adults. Levels are altered in a number of physiological and pathological conditions. Although the indications for serum TG measurements have not been clearly established, it is simple, inexpensive, and presents no risk of radiation exposure. Problems include variable sensitivity and reproducibility of assays, interference by TG autoantibodies, and changes induced by certain diagnostic or therapeutic interventions. Serum TG measurements is primarily used as a tumor marker in thyroid carcinoma. Values are almost invariably high with disseminated metastases. After total ablation of thyroid tissue, serum TG determination is useful in separating patients in remission from those with residual metastatic disease. Serial measurements in the same patients are useful in monitoring the effect of treatment of nonfunctioning thyroid metastases. It is of no proved value in the initial diagnosis of thyroid carcinoma. Controversy still exists regarding the advantages of measuring TG during hormonal therapy. The assay may aid in the diagnosis of thyrotoxicosis factitia, painless subacute thyroiditis, and neonatal hypothyroidism.

Twenty-one (100%) Haitians and 42 (21.5%) of 192 native black Americans autopsied in a 33-month period at Jackson Memorial Hospital, Miami, were included in this review. All autopsied materials were examined. Among the Haitians autopsied, infectious diseases accounted for 11 (52%) of 21 deaths. Toxoplasma encephalitis was the leading cause of death (five cases). Other infectious causes of death included disseminated cryptococcosis (one), disseminated cytomegalovirus diseases (one), Pneumocystis carinii pneumonia (one), chronic active hepatitis B (two), and bacterial pneumonia (one). Malignant neoplasms were also found to be causes of death and these included a single cases of each of the following: adenocarcinoma of the lung, multiple myeloma, diffuse histiocytic lymphoma, hepatoma, and Kaposi's sarcoma. Deaths of the remaining cases were due to hypertensive cardiovascular diseases (two), rheumatic heart disease (one), glomerulonephritis (one), and intimal fibroplasia of coronary arteries (one). Seven Haitian cases fulfilled the Centers for Disease Control case definition for the acquired immune deficiency syndrome (AIDS). For comparison, autopsies of black Americans were chosen from conditions that would most likely predispose them to opportunistic infections. Among the autopsies on black Americans there were no cases of opportunistic infections or Kaposi's sarcoma that were considered to be consistent with the AIDS.

The esophageal obturator airway (EOA) has been considered a beneficial ventilatory technique for use in cardiopulmonary resuscitation (CPR). At present, seven studies in the literature compare the EOA with other means of ventilation in humans; only one is an actual field study of its effectiveness. We reviewed the available literature dealing with the device to define clearly its role in the ventilatory treatment of patients who require CPR. There appears to be no current evidence of the EOA's effectiveness for ventilation in prehospital cardiac arrest, and fatal complications have been reported with its use. The use of the EOA to replace endotracheal intubation in airway management is not substantiated in the literature.

A retrospective analysis of 56 button (miniature) battery ingestions was conducted. This represents the largest series in the literature studying this problem. Impaction of these foreign bodies, most frequently in the esophagus (five cases), was a uniform predictor of severe morbidity. In the remaining 51 cases, the battery traversed the esophagus without incident; only four of these ingestions produced symptoms, and there was only one case with any severe complications. In 33 asymptomatic patients, the battery passed spontaneously through the gastrointestinal tract. Fourteen patients underwent endoscopic or operative procedures or both despite the absence of symptoms. Unanticipated mucosal erosions were noted in seven of these patients, although no symptoms or sequelae developed. Initial chest roentgenogram and observation for symptoms will detect ingestors at risk of complications. Operative or endoscopic intervention should be withheld in the absence of these clinical indicators. Button batteries can routinely be allowed to pass spontaneously.

The role of emergency room thoracotomy in the management of trauma remains poorly defined despite an increase in its use. Most authors agree that the procedure is effective in the treatment of penetrating thoracic injuries, while its benefit in penetrating injuries below the diaphragm and in blunt trauma has not been established. The best outcome can be expected in patients who have sustained penetrating cardiac and thoracic injuries. Penetrating abdominal wounds that are severe enough to require thoracotomy in the emergency room fare less well; those patients who suffer from blunt thoracoabdominal injuries are least fortunate. The anatomic location and mode of injury greatly influence the outcome of these patients and are useful in determining when to perform this procedure.

Asystole can be the presenting ECG finding of accidental hypothermia when the core temperature is less than 28 degrees C. Even two hours of persistent asystole does not represent irreversible cardiac compromise. With cardiopulmonary support and active rewarming, resuscitation and survival without serious sequelae can be achieved. Case reports and electrophysiology studies suggest that asystole is a primary manifestation of hypothermia potentiated by carbon dioxide retention. However, ventricular fibrillation in this setting is probably a secondary complication of resuscitation efforts, being precipitated by hypocapnic alkalosis, physical manipulation of the heart, and rewarming.

Absolute deficiency of insulin no longer is considered the principal cause of ketoacidosis. A combination of pathogenic mechanisms includes (1) relative insulin deficiency, (2) stress hormone excess, (3) fasting, and (4) dehydration. Prevention of any one or more of these mechanisms will reverse or lessen the rate of metabolic decompensation. Several important metabolic parameters must be monitored at frequent intervals to permit rational, preventive therapy. The flow sheet to be maintained by the patient should include body weight, temperature, respiratory rate, level of consciousness, degree of ketonuria, and degree of glycosuria. If the patient exhibits decreased mental status, more than 5% loss of body weight, or respirations more than 36/min, hospitalization is indicated.

(1) Radiotherapy after definitive surgery for breast cancer has not been proved to have a deleterious effect on patient survival. (2) The beneficial effect of radiation therapy is to decrease significantly local recurrences (P less than .001), which are very difficult to control once they develop. (3) In the hands of experienced radiotherapists, the incidence of complications is quite low. (4) Adjuvant chemotherapy effects on the prevention of local recurrence are most encouraging but still experimental and should at this stage be used mainly in study situations. (5) Until more detailed information is obtained, radiation therapy remains the most effective, least toxic method for the control of local disease.