Peter J. Stevens

TRANSFERRIN AND TRANSFERRIN RECEPTORS IN CARCINOMA OF THE BREAST

Breast tissues from 59 patients were immunohistologically studied for transferrin and transferrin receptors. None of the 8 normal breasts or 22 benign mastopathies, and only 1 of 7 fibroadenomas were reactive for transferrin, but 16 (72.7%) of 22 carcinomas were positive and parallel sections showed histopathologically that the rective areas were confined to tumour-cell membranes. That breast-tumour transferrin is probably receptor-bound in vivo was indicatd by its complete chemical removal in vitro and return to the same cells following reincubation with dilute solutions of transferrin. Similar bindig is found on certain normal or transformed cells and at the maternofetal interface of human placentae. It is suggested that this oncofetal receptor preferentially binds apotransferrin and may offer a novel approach to more specific therapy of certain breast cancers.

Transferrin Receptors, HLA-A,B,C, and Amnion Antigens in Breast Adenocarcinoma

Abstract The expression of transferrin receptors, HLA-A,B,C and amnion antigens on breast biopsies from 63 patients were studied by immunofluorescence. The majority of the 36 specimens from normal breast or benign mastopathy did not express transferrin receptors, but were reactive with antibodies to HLA-A,B,C and amnion antigens. Among the specimens from patients with adenocarcinoma, 54.5% of the biopsies expressed transferrin receptors, 78.3% were non-reactive with monoclonal antibodies to common determinant of HLA-A,B,C and 63.6% failed to react with heterologous antiserum to amnion antigens. These data showed that the inverse expression of these antigens between normal and adenocarcinoma may be used as an adjunct for diagnosis of breast adenocarcinoma.

THE IDENTIFICATION OF THE BODIES OF THE DEAD—I

This chapter presents the sociological and legal justification for the identification of the bodies of the dead that has been argued by several authors. The identification of the victims of any disaster is a public duty. Several types of evidence can help to establish the identity of a body; some are more reliable and specific than others. Essentially, personal characteristics such as fingerprints and the dental state are the most reliable evidence; circumstantial evidence such as the clothing on a body and the personal property found in the clothing is inherently less satisfactory and can, on occasions, be misleading. Considerable experience in this work has shown that, whenever possible, evidence of two or more kinds should be sought before the identity of a body is accepted; however, every case should be considered on its merits. Visual identification is the standard means used by the police to prove the identity of a body subject to a coroners inquiry.

THE IDENTIFICATION OF THE DEAD—III

This chapter presents the identification of the dead through forensic odontology. With the ever increasing numbers of casualties in a single air disaster, the task of the investigating pathologist is becoming so great that one person cannot cope with it alone. Therefore, it is logical that a dentist should be appointed to assist whenever large numbers of casualties occur. A large number in this context is over 50; those promoting forensic odontology as a specialty and pathologists disinterested in the subject would doubtless regard 10 as a large number. With the prospect of aircraft carrying 350–500 people in the near future, it appears that the example of the Scandinavian countries should be emulated in future practice in the Britain. Teams each including at least one pathologist and one dentist should be formed for the investigation of every mass air disaster when the casualties exceed a given number—that number being selected on the basis of the experience and competence of the personnel currently involved in aircraft accident investigation. Early in 1968, the Royal Air Force Dental Branch agreed to provide assistance with the identification of air crash victims whenever required by a Royal Air Force Pathologist.

NATURAL DISEASE IN THE PILOTS

This chapter presents a study of the natural disease in pilots killed in light aircraft accidents. The study presents that the occasional accidents occur because of illness in the pilot. There is no evidence from this study that the current practice in medical surveillance of private pilots is deficient or less efficient than that of commercial pilots. There is an indication that some cases where difficulty has been encountered in deciding whether a pilot with an adverse medical history should have his licence renewed might have been settled too leniently in favor of renewal. It might be that concealment of previous failure of flying training or of medical unfitness to fly is easy. The study reveals that there are many diseases that can cause acute incapacitation and, therefore, precipitate an accident and many others that can lower a pilots efficiency as to contribute to an error of skill. Any disease is of greater potential seriousness in a pilot who is flying solo or in a machine with only one set of controls than in the public transport aircraft with two or more pilots on board.

THE VARIOUS AUTHORITIES, OFFICIAL BODIES, AND GROUPS CONCERNED WITH THE INVESTIGATION OF AN ACCIDENT

This chapter highlights the importance of planning in advance for the tasks to be undertaken in the event of a large fatal aircraft accident investigation. The preparation of such plans should be made on a police regional basis, as the police are the cornerstone of the whole structure of a disaster plan. Any plan conceived if it is to be effective, should be fully discussed with and have the approval of coroners, pathologists, hospital and mortuary administrators, the fire brigade, the local Red Cross or other rescue organizations, and local undertakers. Many contingencies should be anticipated and provided for. Central stores of waterproof printed labels, blank labels, indelible crayons, wooden or metal stakes, body bags or polythene sheeting, small polythene bags, and similar items should be prepared. If this is done, the actions taken in the first few hours following an accident, pending the arrival of the expert investigators, will facilitate the subsequent investigations and not jeopardize them.

PATHOLOGICAL EVIDENCE OF EVENTS PRIOR TO AN ACCIDENT

This chapter focuses on the pathological evidence of events prior to an accident. The fourth amendment to the Air Navigation Order of 1960 made it mandatory for all jet aircraft over 12,500 lb. in weight and all piston-engined aircraft over 60,000 lb. in weight to carry a flight recorder so constructed and located in the aircraft as to make it likely to withstand the destructive forces encountered in an accident. At the current time, this equipment records altitude, air speed, magnetic heading, vertical acceleration, and pitch attitude against a time scale. It is, therefore, likely that a great deal of evidence will be available about what has happened to a modern aircraft during the minutes before a crash. Before the introduction of these flight recorders, a particular aircraft descended through cloud over mountainous terrain after the captain had declared his intention of staying at a safe altitude to await the expected improvement in local weather conditions. The aircraft struck the side of a mountain and was destroyed and all on board were killed. One of the problems presented to the Commission of Inquiry was to determine whether the descent was deliberate, or the result of sudden loss of control.

SURVIVAL AND SAFETY EQUIPMENT

This chapter discusses the survival and safety equipment. A glider is the most insubstantial of flying machines and there is little to protect the occupant or occupants from injury when an accident occurs. Escape in flight by parachute is possible; when a machine is to be flown higher than a few 100 feet, such a piece of equipment is obviously highly desirable. The only pieces of protective equipment available for those who crash in their gliders are harnesses and protective helmets. In 12 of the 14 gliding accidents investigated the occupants were in the glider when it crashed and 15 of the 17 people involved were killed. Fourteen of the 15 had their harnesses fully fastened as the two who survived. One only appeared not to have fastened the shoulder straps of his harness but the lap belt had been fastened. Although, the evidence in the wreckage did not suggest that a fully fastened harness would have saved his life. The effectiveness of a harness is limited by the strength of the structures to which it can be attached.

RECONSTRUCTION OF EVENTS DURING AN ACCIDENT

This chapter discusses the reconstruction of events during an accident. A pilot was flying in a glider that had been launched by an aircraft tug to 2500 ft. After being airborne for about two hours and fifteen minutes, the glider was seen to perform a rolling manoeuvre and to break up at an estimated altitude of 2500 ft. The pilot apparently either succeeded in getting out of the cockpit or fell out—but only at a low altitude; there was sufficient time for his parachute to stream but not to deploy and he died from the multiple lethal injuries he received at ground impact. There was one important clue at postmortem that helped in the reconstruction of the accident; there were marked bilateral subconjunctival petechial hemorrhages.

A NON-MEDICAL CAUSE FOR AN ACCIDENT

This chapter discusses the nonmedical cause for an accident. In different circumstances, the finding of raised carboxy-hemoglobin levels in the crew, and/or the passengers of an aircraft caused by contamination of the cockpit cabin atmosphere by a faulty heating system might point to some technical fault in the aircraft or the possibility of a fire in the air; although a radio distress signal would be expected if there were a fire in an aircraft in flight, the radio might be put out of action for some reason almost as soon as the fire commences. There have been at least 20 proved cases of sabotage to aircraft in flight and a further three accidents that resulted from other criminal acts. On 17 October, 1958, an aircraft engineer was killed when a bomb in his briefcase exploded in the airport buildings at Wichita, Kansas; it was believed that he intended to take the bomb with him onto an aircraft. The use of a time-bomb or other explosive device is the commonest form of sabotage. It occurred in all but one of the 20 cases presented in the chapter that were truly sabotage, that is, deliberate destruction or attempted destruction.