Background: Tubular carcinoma of the breast is an uncommon and usually small tumour, and is thought to have a favourable prognosis. The present study examined the long‐term prognosis of patients with tubular breast carcinoma and the roles of axillary dissection and adjuvant therapy. Methods: Eighty‐six tubular cases were identified from a large worldwide database of 9520 breast carcinoma patients entered into randomized adjuvant therapy trials run by the International Breast Cancer Study Group from 1978 to 1999. These patients were followed for a median of 12 years. Results: Forty‐two (49%) cases were node‐positive, of which 33 (79%) had 1–3 nodes involved. Ten (32%) of the 31 smaller tumours (≤ 1 cm in size) were node‐positive. Patients with node‐positive tubular carcinoma had a significantly better 10‐year relapse‐free survival (P = 0.006) and survival (P < 0.0001) compared with non‐tubular node‐positive cases. Overall survival was similar for node‐positive and node‐negative tubular carcinoma. Overall, 71 patients (83%) received some form of adjuvant systemic therapy. Of the 86 cases, 43 (50%) received more than one course of chemotherapy. There was an 85% decrease in the risk of death for patients who received more than one course of chemotherapy compared to those who did not (hazard ratio 0.15, 95% confidence interval (CI): 0.03–0.82; P = 0.03). Conclusions: Compared to other histological types of breast cancer, tubular carcinoma has a better long‐term prognosis. Adjuvant chemotherapy may further improve prognosis and involvement of axillary nodes may not be an indicator for early death due to breast carcinoma.

The dynamics of mixing and entrainment induced by a steady turbulent boundary layer flow over a loose dust bed is studied with our second-order Godunov code. The problem considered models the late-time flow of explosions over soil surfaces, and extends previous shock-tube studies that focused on the early-time lofting of dust behind the shock front. As in our previous work, an equilibrium model was used for the dust-air mixture. The calculated boundary layer growth and mean-flow profiles are in reasonable agreement with wind-tunnel measurements. This suggests that our Convective Mixing Model is capable of simulating a wide variety of turbulent dusty flows.

The use of goserelin with or without tamoxifen was investigated in a randomised multicentre study involving 318 pre- and perimenopausal advanced breast cancer patients. With a median follow-up of 93 weeks, 31% of goserelin-treated patients had objective responses (UICC criteria) compared with 38% of goserelin plus tamoxifen-treated patients (P = 0.24). There was a modest benefit in favour of combination therapy in time to progression (P = 0.03) but not in survival (P = 0.25). Median follow-up for survival was 117.5 weeks. Median times for disease progression and survival were 23 and 127 weeks in the goserelin alone group and 28 and 140 weeks in the combination group, respectively. In 115 patients with skeletal metastases only, significant differences in favour of combination therapy were seen in response rate, time to progression and survival. Both treatments were well tolerated and no additional safety issues were associated with combination therapy.

A series of 139 patients who had a total mastectomy underwent breast reconstruction using the method of tissue expansion. In 127 patients a tissue expander was inserted at the time of mastectomy and in 12 patients this was done as a delayed procedure. The reconstruction was successfully completed in 87% of cases and the patient acceptance of this method of reconstruction has been high. We believe that tissue expansion should be offered to all women having immediate reconstruction after total mastectomy and that it also has a significant role in delayed breast reconstruction after mastectomy.

There is an increased incidence of colonic carcinoma in patients with breast carcinoma but colonic involvement secondary to breast carcinoma can also occur. The differentiation of the organ or origin (breast vs colon) of the abdominal tumour can be difficult and may benefit from the use of immunohistochemical staining with monoclonal antibodies that react preferentially with colon cancer (JGT) and breast cancer (3E1.2, BC2,BC3). Measurement of Mammary Serum Antigen (MSA) level as detected by the anti-breast monoclonal antibody (3E1.2) was also useful in the classification of tumours of uncertain origin.

A phase II trial of sequential oral medroxyprogesterone acetate (MPA) and epirubicin was performed in 12 postmenopausal women with advanced breast cancer. Patients received MPA at a dose of 500 mg twice daily by mouth for 25 days. Following a 3-day washout, epirubicin was administered in a dose of 75 mg/m2. After a 3-week hiatus, the cycle was recommenced with MPA. Responses were evaluated at the end of the first 25-day period of MPA and following the end of the first cycle. Partial responses were obtained in two patients (17%)--one after the first 25 days of MPA and the other at the end of the first cycle. One of the patients had chest wall disease and the other had hepatic involvement with ascites. Minimal toxicity was experienced from this regimen and the response durations were 2 and 7 months. The response rate reported here does not warrant the further development of sequential therapy. The dose intensity of both MPA and epirubicin are compromised and may be the cause of this low response rate.

Serum levels of mammary serum antigen (MSA), beta 2-microglobulin (beta 2M) and carcinoembryonic antigen (CEA) were evaluated in 186 subjects to assess their use in the diagnosis and monitoring of breast cancer, either singly or in combination. Raised MSA levels (greater than 300 I.U.) were detected in 79% of patients with Stage I/II breast cancer, compared with 25% for beta 2M (greater than 2000 micrograms/l) and 12% for CEA (greater than 5 ng/ml) levels respectively. Of 53 patients with Stage III/IV breast cancer, 98% (MSA), 55% (beta 2M) and 64% (CEA) had raised levels. In 25 patients followed over 3-9 months, the changes in MSA levels correlated with the clinical course of the disease in 23/25 (92%), compared with 7/25 (28%) using beta 2M, and 9/25 (36%) using CEA assays. The overall sensitivity, specificity and accuracy in detecting breast cancer were 88%, 95% and 99% for MSA; 39%, 90% and 96% for beta 2M; and 38%, 95% and 98% for CEA, respectively. MSA and beta 2M assays in combination enhanced the sensitivity in the detection of breast cancer (93%) especially early breast cancer, while maintaining specificity (90%). MSA seems to be superior to beta 2M or CEA as a tumour marker in breast cancer and its levels seem to correlate with tumour burden. While it appears that beta 2M or CEA measurements used alone are of little value in the current management of breast cancer, beta 2M may be a helpful adjunct to enhance the sensitivity of MSA assay especially in early breast cancer.

A 50-year-old patient with breast cancer was about to withdraw from her adjuvant chemotherapy regimen because of a long-standing phobia about being injected, which had been compounded by anxieties that were associated with the severe side-effects of adjuvant chemotherapy. She experienced a conditioned nausea response to hospital and medical situations. A psychological programme that incorporated relaxation training, systematic desensitization by way of the patient's visual imagination and videotape modelling, allowed her to complete the course of chemotherapy and to feel less anxious in hospital and medical settings.

In 54 patients with renal cell carcinoma, the angiographic T category of the International Union Against Cancer (UICC) classification correlated with the histopathologic (P) staging in only 44.4 per cent. Staging of the primary lesion in renal cell carcinoma must be based on the P category and not the angiographic appearances.

In order to evaluate the reliability of anthropometry in assessing protein stores we have compared, in 10 normal adults and 82 surgical patients with varying degrees of weight loss, measurements of weight/height, arm circumference, arm muscle circumference, and arm muscle area with direct measurements of body nitrogen using in vivo neutron activation analysis. Anthropometry is reliable for the assessment of protein nutrition in groups of patients (for 100 patients 95% confidence limits are +/- 30 g nitrogen) but the magnitude of variance shown makes it inappropriate for assessing the individual as a single measurement (95% confidence limits are +/- 300 g nitrogen). Repeat measurements were made after 2 weeks on 35 patients and there was no correlation between changes in body nitrogen and changes in the anthropometric measurements. Anthropometry is not reliable in following changes in body nitrogen in individual patients over short periods of time.

Eleven plasma proteins were compared for each of three groups of 10 closely matched patients before and 15 days after rectal excision who were receiving an addition to oral diets the following parenteral solutions by central venous catheter: 1) no hyperalimentation, 2) hypertonic glucose plus amino acids, or 3) amino acids alone. Plasma transferrin, prealbumin, and retinol-binding protein were normal before surgery in all but seven patients. Postoperatively, concentrations were decreased, but were restored to normal after full hyperalimentation whereas they were significantly less and lower than normal in controls and patients receiving amino acids. Acute phase proteins were higher than normal before surgery and also 15 days later. Lower values in patients receiving hyperalimentation were mainly due to hydration compared with higher values in the other groups caused by the higher incidence of sepsis. It is concluded that full hyperalimentation after major surgery restores "visceral" proteins more rapidly than by infusion of amino acids alone and is associated with fewer clinical complications.

The radioactivity induced in subjects by irradiation with 14 MeV neutrons is measured in a Whole-body Radiation Counter and analysed into its seperate activities. Total-body nitrogen is estimated from the annihilation spectrum after corrections for interfering reactions and the subject's body build. Total-body potassium is also derived from the spectrum following irradiation but using the contribution from its natural activity. The method is compared with that at another centre which uses the 14N (n,γ) 15N reaction. The procedure is being used to investigate nitrogen metabolism in critically-ill surgical patients and those receiving hyperalimentation.

A rapid, non-invasive method for the measurement of absolute amounts of fat, protein, minerals and water in the body has been developed which is applicable to very ill patients. The patient is weighed and skinfold thickness is measured with calipers. The body contents of potassium, nitrogen, sodium, chlorine, calcium and phosphorus are measured in a whole-body radiation counter after irradiation with fast neutrons. From these values absolute amounts of body fat, protein, minerals and water are calculated. The procedure, which takes about 40 min, is carried out with the patient lying supine on a couch. The errors in the absolute measurement of the components expressed as percentages of body weight are: for fat, 4.5 per cent; for protein, 1.6 per cent; for minerals, 0.8 per cent; and for water, 4.9 per cent. The radiation dose is equivalent to that of a chest radiograph (50 mrem). We have used this technique (a) to determine the tissue composition of the weight lost in 16 patients after excision of the rectum; (b) to establish that the weight gained by 16 patients receiving intravenous nutrition was mainly water; and (c) to show that in 10 patients who received a simple solution of amino acids for 2 weeks after rectal excision body protein was preserved as efficiently as in 10 similar patients who received a full course of intravenous nutrition. This is the first time body weights of living persons have been broken down into terms of fat, protein, minerals and water, and the method should help to solve a number of metabolic and nutritional problems in clinical surgery.

Fat-free body mass is an important component of body composition which is of particular interest to nutritionists and related workers. Fat-free mass has been determined from the simple measurement of skinfold thickness and it has been demonstrated that there is a close correlation with total body nitrogen even though the test subjects had a wide range of nutritional status.