The recurrence score has been validated as quantifying the likelihood of distant recurrence in tamoxifen-treated patients with node-negative, estrogen-receptor-positive breast cancer.

Trastuzumab (Herceptin) provides clinical benefits for patients diagnosed with advanced breast cancers that have overexpressed the HER2 protein or have amplified the HER2 gene. The National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-31 is designed to test the advantage of adding Herceptin to the adjuvant chemotherapeutic regimen of doxorubicin and cyclophosphamide followed by paclitaxel (Taxol) in the treatment of stage II breast cancer with HER2 overexpression or gene amplification. Eligibility is based on HER2 assay results submitted by the accruing institutions. We conducted a central review of the first 104 cases entered in this trial on the basis of immunohistochemistry (IHC) results. We found that 18% of the community-based assays, which were used to establish the eligibility of patients to participate in the B-31 study, could not be confirmed by HercepTest IHC or fluorescence in situ hybridization (FISH) by a central testing facility. This report provides a snapshot of the quality of HER2 assays performed in laboratories nationwide.

To determine the effects of prolonged exercise on systolic and diastolic left ventricular function, we studied 21 athletes before, at the finish (within 11 5 min), and during recovery (28 + 9 hr) after the Hawaii Ironman Triathlon (2.4 mile swim, 112 mile bike, 26.2 mile run). Twodimensionally guided M mode echocardiograms were digitized for wall thickness, cavity dimension, fractional shortening, and peak rates of cavity enlargement and wall thinning. Pulsed Doppler left ventricular inflow recordings were analyzed for peak early and late velocities and their ratio. Left ventricular diastolic dimension was reduced at race finish (5.4 0.6 to 5.1 + 0.6 cm) and remained reduced after 1 day of recovery (5.2 ± 0.6 cm, p<.05). Fractional 19 cm/sec) and a reduced ratio of early to late velocities (1.9 + 0.6 to 1.5 ± 0.6). In contrast, peak rates of cavity enlargement and wall thinning were unchanged. All functional variables returned to prerace values during recovery. We conclude that prolonged exercise may result in alterations in systolic and diastolic left ventricular performance. The rapid reversal of all changes suggests cardiac "fatigue." Circulation 76, No. 6, 1206No. 6, -1213No. 6, , 1987 EXTREME EXERCISE is widely known to pose a variety of health hazards, although myocardial dysfunction is not often considered among them. However, with increasing participation in ever-more grueling, ultraendurance racing events, clear delineation of the cardiac response becomes important to athlete safety. Existing data suggest that the effects of prolonged exhaustive exercise on left ventricular systolic performance may be deleterious.'-6The effects of exercise on diastolic performance have not been examined, although depression of inotropic state could affect active relaxation as well as systolic contraction. Accordingly, we sought to determine the effects of prolonged, competitive exercise on left ventricular systolic and diastolic performance. Echocardiography, Doppler velocimetry, electrocardiography, and bio- MethodsSubjects. The study population consisted of 21 ultraendurance athletes with a mean age of 34 + 9 years (range 19 to 55 years) and included 13 men and eight women. Environmental conditions during the race included humidity ranging from 40% to 85%, ambient temperatures ranging from 240 to 420 C, and water temperature of 260 C. During the race the athletes chose their own speed and rest periods, and had liberal access to fluids and foods. Subjects were weighed nude and dry immediately before and after the race.Echocardiograms. All subjects underwent three echocardiographic and Doppler studies: 2 to 4 days before the race, immediately upon finishing the race (average time from finish to recording was 11 + 5 min, range 3 to 23 min), and after 1 to 2 days of recovery (28 ± 9 hr). Two-dimensionally guided M mode echocardiograms of the left ventricle were recorded at the chordal level with an ATL Ultramark 8 equipped with a 3.0 MHz transducer and strip-chart recorder. Imaging location and gain settings...

Triathlons (races involving consecutive swimming, bi cycling, and running) have become commonplace in the United States. These races may involve from 30 min utes to 36 hours of continuous exercise, usually in warm or hot environments. Little has been published regarding the medical and physiological aspects of these events. This paper represents the first large study to date on the subject, including both an analysis of medical complications at six triathlons as well as a prospective electrolyte study conducted at two of these races. Medical records were kept and examined for all ath letes requiring treatment during a typical United States Triathlon Series (USTS) race in 1986 (1,000 starters; finish times, 2 to 4 hours), a typical Ironman Qualifier (IQ) race in 1986 (622 starters; finish times, 4 to 8 hours), and the 1982 through 1985 Hawaii lronman World Championships (4,583 starters; finish times, 9 to 17 hours). At the USTS race, fewer than 2% (17/1,000) of the starters required aid, at the IQ, approximately 10% (61 /622) of the starters were treated, and at the Ironman, an average of 17% (794/4,583) received med ical attention. The most common diagnoses at the USTS and IQ were dehydration and heat exhaustion. At the lronman, dehydration and heat problems were complicated by hyponatremia. Because hyponatremia has been reported as a com plication of ultraendurance events, a prospective study was performed on 36 athletes during a USTS race and 64 athletes at the 1984 lronman race. Prerace and postrace blood samples showed that no athletes were hyponatremic following the shorter USTS race, but 27% (17/64) of the athletes studied were hyponatremic fol lowing the lronman race. Medical personnel should be prepared to treat a minimum of 2% and up to 10% of the athletes in races lasting up to 4 hours, 10% to 20% of those in races lasting 4 to 8 hours, and at least 20% of starters in races lasting between 9 and 17 hours. For races less than 4 hours, the IV fluid of choice should be D5 1/2 NSS (normal saline solution). For races longer than 4 hours, D5NSS should be used for IV resuscitation.