Currently used clinical and histopathological parameters imprecisely define the risk of distant recurrence in breast cancer, underscoring the need for more informative prognostic markers. In the present fluorescence in situ hybridization study of archived surgical specimens, we derived an algorithm for computing a prognostic index (PI) from DNA copy numbers of three genomic regions (CYP24, PDCD6IP, and BIRC5) for estrogen/ progesterone receptor-positive (ER/PR ؉ ) cancers and a distinct PI (based on NR1D1, SMARCE1, and BIRC5) for estrogen/progesterone receptor-negative (ER/PR ؊ ) cancers. Among independent test cases stratified by PI, recurrence rates were significantly higher among high-risk patients than low-risk patients for both ER/ PR ؉ (odds ratio ‫؍‬ 9.52, 95% confidence interval >2.12, P ‫؍‬ 0.0024) and ER/PR ؊ (odds ratio ‫؍‬ 12.3, 95% confidence interval >1.45, P ‫؍‬ 0.0188) cancers. Among the entire population, recurrences were significantly more prevalent for cases with PI above the medians for both ER/PR ؉ (Fisher's exact, P ‫؍‬ 1.19 ؋ 10 ؊5 ) and ER/PR ؊ (P ‫؍‬ 0.0025) patients and for the node-negative subsets (ER/PR ؉ node-negative, P ‫؍‬ 0.042 and ER/PR ؊ node-negative, P ‫؍‬ 0.039). In conclusion, these markers perform well in comparison with other criteria for recurrence risk assessment and can be used with routinely formalin-fixed, paraffin-embedded surgical specimens. (J Mol Diagn

This report is based on information obtainedfrom a questionnaire sent to major cardiac centres in the United Kingdom. This produced details of 39 pregnancies in 34 patients after valve replacement. The 39 pregnancies gave rise to 30 healthy babies. The small size of the series probably reflects both the increasing rarity ofyoung women with rheumatic heart disease in this country and the cautious attitude of their cardiologists. This makes it likely that these women represented the best end of the spectrum of cardiacfunction after valve replacement.Twenty-four pregnancies in 20 women who were not given anticoagulants produced 23 healthy babies and 1 spontaneous abortion. This group comprised 6 patients with free aortic homografts, 1 patient with a freefascia lata aortic valve, 2 with a Starr Edwards aortic valve, 7 with mounted mitral homografts, 1 with a fascia lata mitral valve, 1 with a Beall tricuspid prosthesis, 1 with a combined mitral homograft and Starr Edwards aortic prosthesis, and 1 with mitral and aortic frame-mounted fascia lata valves. There were no maternal deaths or thromboembolic complications in this group which included 5 patients who were in atrial fibrillation.Fifteen pregnancies in 14 women who received anticoagulants gave rise to 7 healthy babies. The fetal losses were one stillbirth, one intrauterine death at 34 weeks, and 3 spontaneous abortions; one surviving child has hydrocephalus as a result of blood clot and there were 2 maternal deaths. This group included 13 patients with Starr Edwards valves, 11 mitral and 2 aortic. A patient with a Hammersmith mitral valve was the only one to have been treated with heparin and her valve thrombosed. One patient with a mounted mitral homograft had a cerebral embolus. Nine of these patients were in atrialfibrillation.In 3 additional patients the valve replacement was carried out during pregnancy. Two of the patients survived operation. In one of these who was treated with warfarin the pregnancy gave rise to a congenitally malforned baby who died in the neonatal period. The baby born to the mother who did not receive anticoagulants has a hare-lip and talipes.Women with artificial valves can tolerate the haemodynamic load of pregnancy well, but there is an increased fetal wastage in patients taking oral anticoagulants. This is probably largely attributable to fetal haemorrhage but there is also a risk of malformation caused by a teratogenic effect of warfarin. Experience gained in non-pregnant patients suggests that withholding anticoagulants in pregnant patients with prosthetic valves would usually be undesirable but warfarin should be avoided. The advantages of biological valves were apparent in this series.Although rheumatic heart disease has become rare of child-bearing age who have had valve replaceamong our indigenous youth, its prevalence in many ments. These women need to know the risks of parts of the world remains unchanged and the pregnancy and the chances of having a healthy increasing frequency with which artificial valves are baby, but p...

This report is based on information obtainedfrom a questionnaire sent to major cardiac centres in the United Kingdom. This produced details of 39 pregnancies in 34 patients after valve replacement. The 39 pregnancies gave rise to 30 healthy babies. The small size of the series probably reflects both the increasing rarity ofyoung women with rheumatic heart disease in this country and the cautious attitude of their cardiologists. This makes it likely that these women represented the best end of the spectrum of cardiacfunction after valve replacement. Twenty-four pregnancies in 20 women who were not given anticoagulants produced 23 healthy babies and 1 spontaneous abortion. This group comprised 6 patients with free aortic homografts, 1 patient with a freefascia lata aortic valve, 2 with a Starr Edwards aortic valve, 7 with mounted mitral homografts, 1 with a fascia lata mitral valve, 1 with a Beall tricuspid prosthesis, 1 with a combined mitral homograft and Starr Edwards aortic prosthesis, and 1 with mitral and aortic frame-mounted fascia lata valves. There were no maternal deaths or thromboembolic complications in this group which included 5 patients who were in atrial fibrillation. Fifteen pregnancies in 14 women who received anticoagulants gave rise to 7 healthy babies. The fetal losses were one stillbirth, one intrauterine death at 34 weeks, and 3 spontaneous abortions; one surviving child has hydrocephalus as a result of blood clot and there were 2 maternal deaths. This group included 13 patients with Starr Edwards valves, 11 mitral and 2 aortic. A patient with a Hammersmith mitral valve was the only one to have been treated with heparin and her valve thrombosed. One patient with a mounted mitral homograft had a cerebral embolus. Nine of these patients were in atrialfibrillation. In 3 additional patients the valve replacement was carried out during pregnancy. Two of the patients survived operation. In one of these who was treated with warfarin the pregnancy gave rise to a congenitally malforned baby who died in the neonatal period. The baby born to the mother who did not receive anti-coagulants has a harelip and talipes. Women with artificial valves can tolerate the haemodynamic load of pregnancy well, but there is an increased fetal wastage in patients taking oral anticoagulants. This is probably largely attributable to fetal haemorrhage but there is also a risk of malformation caused by a teratogenic effect of warfarin. Experience gained in non-pregnant patients suggests that withholding anticoagulants in pregnant patients with prosthetic valves would usually be undesirable but warfarin should be avoided. The advantages of biological valves were apparent in this series. Although rheumatic heart disease has become rare of child-bearing age who have had valve replace-among our indigenous youth, its prevalence in many ments. These women need to know the risks of parts of the world remains unchanged and the pregnancy and the chances of having a healthy increasing frequency with which artificial valves are baby,...

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