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Background The nasogastric tube syndrome is a potentially life-threatening complication of an indwelling nasogastric (NG) tube. The syndrome is thought to result from ulceration and infection of the posterior cricoid region with subsequent dysfunction of vocal cord abduction. This dysfunction may present as complete loss of vocal cord abduction manifested as serious airway compromise. Reports of this syndrome are infrequent, with only 29 cases published to date. Methods Two additional cases of nasogastric tube syndrome diagnosed at the University of Iowa Hospitals and Clinics over a 2-year period are presented. A search of MEDLINE (1966 through February 1999), including review of those articles' references identified seven previous publications, including 29 case reports. These 29 cases are reviewed and the findings summarized. Results Twenty-nine cases of NG tube syndrome are identified, with 16 of these occurring in the preantibiotic period. Including the two cases presented here, 15 contemporary patients are examined. Among these 15 cases, 10 required tracheostomy, on average 8.5 days after NG tube placement. Conclusion Although the fully manifested syndrome presents quite dramatically, we suspect that a clinical spectrum of severity exists with less severe cases going unrecognized. Consistent with previous reports, we found that direct visualization of the postcricoid region is required to rule out the diagnosis and recommend such action be taken whenever the diagnosis is suspected. Treatment should include establishment of a safe airway, removal of the tube whenever possible, antibiotic therapy, and antireflux therapy. © 2000 John Wiley & Sons, Inc. Head Neck 23: 59–63, 2001.

In humans, a portion of the duodenum is often at risk for radiation-induced complications following intraoperative radiation therapy for pancreatic carcinoma. To determine experimentally the prevalence and severity of late effects in the normal mammalian duodenum, 190 rats received single doses of 0, 15, 20, 25, 30, or 40 Gy orthovoltage X rays to temporarily exteriorized 3 cm circumferential segments of duodenum. The animals were killed 2, 6, 8, or 10 months later. Actuarial survival, change in body weight, and a radiation injury score based on eight histopathologic alterations were used as endpoints. Epithelial atypia, intestinal wall fibrosis, serosal thickening, and vascular sclerosis were the dominant histopathologic alterations at all dose levels throughout the 10-month observation period. The prevalence and severity of histologic radiation injury showed sigmoidal dose-response relationships with the plateaus starting at 20 Gy. Doses of 20 Gy or greater also resulted in a substantial loss of body weight and a high level of early deaths (20–80 days). All endpoints indicate that intraoperative doses of 20 Gy or greater are associated with unacceptable risks of late and irreversible complications.

One hundred and four patients with bilateral breast cancers, detected clinically, were studied. Patients with synchronous lesions experienced the worst survival. Lymph node metastases in the second mastectomy had obvious adverse effect on survival. The development of scirrhous carcinoma in the second breast did not alter survival. A maximum of 21 patients might have been adversely affected by the development of a second cancer because of lymph node metastases in the second breast only. Survivorship data suggest the adequacy of treatment of contralateral breast cancers when they become detectable by clinical means alone.

Primary gastrointestinal carcinoid tumors rarely metastasize to the orbit, but an aggressive approach is warranted for any patient with a history of carcinoid tumor and ocular complaints. The diagnosis can be established only by obtaining tissue for histologic examination. Treatment, usually with radiation, can result in symptomatic improvement and should be considered after confirmation of the diagnosis.

A new human breast cancer cell line (Ia-270) has been isolated from a malignant pleural effusion from a woman with metastatic infiltrating ductal carcinoma of the breast. This cell line contains cytoplasmic estrogen (ER) and progesterone (PR) receptors. Following estradiol (E2) administration, PR synthesis is augmented and a higher level of saturation density is reached. In an athymic mouse, the cell line produced a tumor morphologically similar to the primary tumor. The results of isoenzyme and karyotype analyses demonstrate Ia-270 to be of human origin and free of HeLa cell contamination. The cell line has been maintained in continuous culture since April 1982 and may provide a useful in vitro system for studying the biology of human breast cancer.

During intraoperative radiation therapy for carcinoma of the head of the pancreas in humans, a portion of duodenum is often at risk for radiation-induced complications because of its fixed anatomical position within the treatment field. This study was undertaken to determine the feasibility of using the rat as a model to determine the radiotolerance of normal mammalian duodenum. The procedures used to exteriorize and irradiate a selected segment of duodenum are described. Histopathologic changes in 5-cm segments of midduodenum were studied 14 and 28 days after 0, 30, 40, or 50 Gy X-radiation. Complete denudation of the epithelium and thickening of the muscularis and serosal layers occurred in all irradiated segments by day 14. By day 28, even though crypt and villus architectures were atypical, large areas of epithelial regeneration were seen in rats receiving 30 Gy. In contrast, complete denudation of the epithelium were still evident along most of the length of the irradiated segments in rats receiving 40 or 50 Gy. Serosal fibrosis was prominent in all irradiated animals, regardless of dose. These results indicate that radiation doses above 30 Gy carry high risks of complications. The rat is considered a suitable animal model.

This report reviews the results of treatment of hepatic malignancies by intra-arterial infusional chemotherapy and hepatic artery ligation. Seventy-nine patients with liver metastases or primary hepatomas were treated by this technique between the years 1970 and 1982. The majority of patients had metastatic disease from colon and rectal cancers. The median and mean survivals in the total group was 10 and 14 months, respectively (including operative deaths). Patients with metastatic disease from colon and rectal cancers had better survival than those with metastases from other primaries. Patients with synchronous liver malignancy had better survival than those with metachronous disease. Length of survival correlated positively with the duration of chemotherapeutic infusions, the latter being frequently (in 42% of patients) interrupted because of catheter complications. A new technique utilizing implantable pumps can be expected to further improve the results by reducing catheter malfunction and prolonging treatment courses.

The occurrence of bilateral breast cancers in three members of one family is reported. In two members, evidence of a distinct primary lesion in each breast was verified. The occurrence of unilateral breast cancer and other cancers in other members of the family was surveyed. Recommendations for early detection and surveillance in familial breast cancer at the present time should be by aggressive and close follow-up of the affected members. Absence of reliable markers preclude effective surveillance for early detection or susceptibility.

• The records of 916 trauma victims transported by an emergency helicopter service were reviewed to evaluate its impact on patient outcome. According to strict criteria, the service was classified as essential, helpful, or "not a factor" in the preservation of life and/or limb in each case. The helicopter service was essential in 14.0%, helpful in 12.9%, and "not a factor" in 56.6% of patients. A fourth category included patients who, despite the delivery of maximal emergency medical care, died as a result of their injuries (16.5%). With the available initial information, it was impossible to determine prospectively which patients would benefit from air transport. We believe that the rapid evaluation of potentially serious injuries and the number of patients for whom the service proved beneficial justify its use, particularly in rural areas. (Arch Surg1987;122:992-996)

Two cases of massive hemoperitoneum secondary to spontaneous rupture of hepatic metastases are presented. This devastating complication of hepatic malignant disease is difficult to diagnose preoperatively. However, the diagnosis should be considered in patients with known malignant disease who present with unexplained blood loss, shock, or signs consistent with an acute surgical abdomen. The presence of fever and leukocy-tosis with these signs and symptoms may also be part of the clinical picture. Treatment by hepatic resection is never curative. Review of the literature indicates that local control of the bleeding site by suture ligature, packing with topical hemostatic agents, or hepatic artery ligation offers the best chances of obtaining hemorrhage control and some degree of palliation in these desperately ill patients.

A retrospective review of 312 hospitalized patients with cervical spine injuries was conducted to identify presenting signs, symptoms, and coexisting conditions, and to determine if any injuries were not diagnosed in the emergency department. Of the 257 (82%) patients who were alert on ED evaluation, 215 (84%) complained of neck pain or tenderness. Of the remaining 42 alert patients without neck pain, 34 had sensory or motor symptoms or signs suggestive of cervical spine injury, and eight had significantly painful other injuries. Of the 284 patients presenting within the first 48 hours after injury, 23 were not diagnosed initially, 21 because radiographs were initially read as negative and two because no radiographs were taken. A significant number of patients had more than one fracture of the spinal column. A stepwise approach to rational ordering of cervical spine radiographs in blunt trauma is proposed.

Three methods of treatment of the donor kidney or its vascular pedicle during the surgical excision and the period of ischemia in renal transplantation have been evaluated. The methods evaluated were: 1. 1. Prevention of renal intravascular collapse. 2. 2. Infiltration of the renal pedicle with procaine plus intraarterial injection of papaverine or acetylcholine. 3. 3. Flush of the kidney with a balanced salt solution at 5°C. Renal blood flow and function of a kidney treated in one of the described methods was compared to its untreated contralateral mate over a two-hour period while both were maintained in identical ex vivo perfusion systems. When the renal ischemia time was 15 minutes no consistent change in the blood flow or renal function was observed in kidneys treated by any of the three described methods. It is concluded therefore that when the period of renal ischemia is kept short these procedures are of no value in preventing immediate posttransplantation renal failure.

Conclusion“High liquid glucose” drink, if tolerated by a patient in renal failure, is an excellent agent for increasing carbohydrate and caloric intake. This decreases the rate of rise of BUN by decreasing protein catabo-lism and thus reduces the incidence of hemo-dialysis.

A xeromammogram led to the surgical excision of a calcified breast lesion on a 66-year-old female. Before specimen mammography was performed, the excised tissue was oriented with tattoo pigment. The specimen mammogram then revealed multiple calcifications caused by unsuspected radio-opaque material in the tattoo pigment, and the original calcifications were obscured. This case demonstrates the hazards involved utilizing tattoo powders for orienting xeromammographically discovered specimens.

Two patients became pregnant while receiving adjuvant chemotherapy for breast cancer following mastectomy. These cases suggest that the significant prolongation of disease-free survival seen in young premenopausal patients may not be ascribable to ovarian failure alone. While the degree to which these patients will benefit from adjuvant therapy is unknown, it is clear that the agents used did not affect fertility. The need to instruct such patients in the necessity for using nonoral contraceptive techniques is stressed. ( JAMA 1981;245:1660-1661)

CLINICALLY significant malabsorption states after gastric resection are uncommon, but occasionally produce various types of nutritional anemias. These anemias are now recognized more frequently than formerly, because physicians are more aware of their occurrence, and the development of more precise laboratory techniques allows greater precision in their diagnosis. Iron deficiency is known to be a frequent sequela of partial gastric resection, but vitamin B 12 deficiency thereafter is thought to be rare. A patient with clinical and laboratory evidence of combined vitamin B 12 and iron deficiencies occurring 15 years after partial gastrectomy was recently seen at the University of Minnesota Hospitals and prompts this report. Report of Case A 78-year-old white man (UMH 796785), was admitted to the University of Minnesota Hospitals on Jan 6, 1965, because of complaints of weight loss, anorexia, and severe weakness of six months' duration. He had had an excision of a gastric ulcer