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Aims: Women previously treated for primary operable breast cancer are at increased risk of developing cancer in the contralateral breast. The purpose of this study was to assess the annual incidence of metachronous contralateral breast cancer (CBC) and to identify factors that predict for its development. Methods: A retrospective study was performed on 3211 women aged ≤70 years treated for primary operable breast cancer between 1975 and 1995. Results: Eighty-three developed CBC prior to locoregional or distant recurrence from the first primary. The clinical incidence of CBC was 6.4 per 1000 women years, three to four times the risk of occurrence of breast cancer in the general female population (or a risk of six to eight times to the remaining breast). Strong family history, age of onset <50 years and lobular histology were significant factors predicting for CBC in univariate and multivariate models. Other clinical factors (previous hormone therapy, chemotherapy, radiotherapy) or histological factors (DCIS, invasive tumour size, grade, vascular invasion, lymph node and oestrogen receptor status) were not significant predictors for CBC. Conclusions: In women previously treated for primary operable breast cancer, early age of onset and a strong family history are predictors for the subsequent development of metachronous CBC. Ipsilateral mastectomy with contralateral prophylactic mastectomy with or without immediate breast reconstruction is a reasonable option for a young woman diagnosed with breast cancer and who has a strong family history, particularly if the cancer has histological features suggesting a good prognosis. Copyright 1999 Harcourt Publishers Ltd

Using archival paraffin wax embedded tumour we have investigated histological grade, DNA ploidy, S phase fraction and prolifera live index in 74 patients with symptomatic ductal carcinoma in situ (DCIS) of the breast. Nine patients developed local recurrence, six invasive in character. No patients with the cribriform subtype of DCIS developed local recurrence. The cribriform subtype showed a significantly lower rate of DNA aneuploidy and a lower proliferative index than the other subtypes. Cribriform tumours were almost exclusively well differentiated in contrast with the comedo and solid variants. Our results suggest the cribriform variant is less aggressive than other subtypes of DCIS. This has possible implications for management of these lesions.

Summary The overexpression of the c-erbB-2 oncoprotein is now thought by most authors to be associated with adverse prognosis in breast carcinoma. In this study, we investigate the relationship between overexpression of the c-erbB-2 oncoprotein and nuclear size by morphometry in a series of 150 human breast carcinomas, comprising 65 cases of ductal carcinomain situ (DCIS) and 85 cases of invasive adenocarcinoma. The mean nuclear size for c-erbB-2 positive cases of DCIS was 54.8 µm2 and invasive carcinoma was 52.1 µm2 respectively, in contrast with 41.6 µm2 and 42.5 µm2 for c-erbB-2 negative cases of DCIS and invasive carcinoma respectively. Flow cytometric examination of DNA in a subset of 91 of these tumours showed no association between tumour cell aneuploidy and c-erbB-2 overexpression.

Increasing numbers of high-pressure high-temperature turbines are being subjected to frequent shutdowns, in many cases nightly. Designers and operators of these units must give careful consideration to the factors involved and by co-operative effort develop optimum techniques and procedures for starting and loading steam turbines. Suggestions are given in this paper of such procedures.

The purpose of this paper is to provide information concerning the performance of large steam-turbine-generator units of modern design, for modern steam conditions and ratings, and to show something of the background of experience from which the information is derived. A similar exposition was made in 1940, along somewhat different lines, and with no particular information on the reheat machines, which have become very much more popular in the last few years. The present paper shows the amount of test information obtained on complete turbine-generator units since the Warren-Knowlton paper was written, and also by comparing test results with guaranteed figures, shows the efficacy of the general performance-calculation method herein given.

This paper describes the essential design features of a 125,000-kw, 3600-rpm, tandem-compound, double-flow steam turbine designed for steam conditions of 4500 psig, 1150 F initial temperature, 1050 F at the first reheat, and 1000 F at the second reheat. The engineering objectives, problems, and solutions are emphasized more than the description of design details.