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Biomedical subjects

I M Muir

Publications and source records attributed to I M Muir.

10 recordsLinked to original sources
PubMed2000

Prospective analysis of a scoring system to predict choledocholithiasis.

BACKGROUND: The management of choledocholithiasis in the laparoscopic era remains debatable. A common policy is to perform preoperative endoscopic retrograde cholangiopancreatography (ERCP) on patients suspected of having common bile duct (CBD) stones, using standard risk criteria. The aim of this study was to evaluate prospectively a scoring system designed to improve the accuracy of CBD stone prediction before laparoscopic cholecystectomy. METHODS: Known clinical, biochemical and radiological risk factors for CBD stones were analysed retrospectively in 233 patients. The presence (n = 77) or absence (n = 156) of CBD stones was determined by preoperative ERCP and/or laparoscopic cholangiography. Using multivariate analysis, the significant risk factors for CBD stones were identified and a new preoperative scoring system was developed. A score of 3 or more was taken as the cut-off point to suggest CBD stones and the need for preoperative ERCP. This scoring system was then tested prospectively in 211 consecutive patients with symptomatic gallstones requiring surgery. Patients whose bile ducts could not be demonstrated by ERCP or operative cholangiography were excluded. RESULTS: Fifty-five patients scored 3 or more (predicted ERCP rate of 29 per cent), of whom 23 (42 per cent) had proven CBD stones. Intraoperative cholangiography was successful in 87 per cent. Five patients (4 per cent) who scored less than 3 had small stones (less than 5 mm) demonstrated at operative cholangiography. The overall sensitivity and specificity of this scoring were 82 and 80 per cent respectively. CONCLUSION: Formal risk assessment of the presence of CBD stones using this scoring system is simple and may be used for preoperative selection of patients for biliary tract imaging by magnetic resonance cholangiography or ERCP.

Analysis of Variance↗
PubMed1998

Laparoscopic cholangiography: a prospective study.

BACKGROUND: The place of cholangiography has been controversial in the conventional and now in the laparoscopic setting. The aim of this study was to evaluate laparoscopic cholangiography and compare use of a portable C-arm image intensifier with conventional radiography. METHODS: One hundred and ninety-seven consecutive patients undergoing laparoscopic cholecystectomy were randomized before operation to cholangiography by either C-arm image intensifier or conventional radiography. Data were collected on a pro forma completed immediately after the operation. RESULTS: Cholangiography was successful in 93.0 per cent of patients. Cholangiography with an image intensifier was significantly faster. In 19 patients the ductal system was obscured by a cannula; in 17 of these cases a metal cannula was used. In 31.6 per cent of patients the clip on the cystic duct was within 1 cm or less of the common bile duct (CBD). CONCLUSION: Laparoscopic cholangiography is a safe procedure. Use of an image intensifier should be the preferred method of obtaining images. Metal cannulas are more likely to obscure the ductal system. The proximity of the clip on the cystic duct to the CBD highlights the potential for injury caused by electrocautery or erroneous clip application.

Adolescent↗
PubMed1991

The prognostic value of immunoperoxidase staining with monoclonal antibodies NCRC-11 and 3E1.2 in breast cancer.

The variation in survival of women with clinically similar breast cancers may lead to difficulty in clinical management so it is important to recognise factors which indicate the prognosis. Immunoperoxidase staining patterns of primary breast tumours using monoclonal antibody NCRC-11 have been shown to relate to overall survival (Ellis et al., 1985) but the results have not been reproducible in other centres. In this study paraffin sections of 483 primary breast cancers were stained with NCRC-11 and 3E1.2 using an immunoperoxidase system. The tumour staining patterns were compared with overall survival using life tables and tested for relative prognostic significance by Cox's multivariate analysis. NCRC-11 related to survival in all 483 cases (chi 2 5.8, P = 0.02) but both antibodies achieved maximum prognostic significance in lymph node negative patients (chi 2 9.4, P less than 0.002 and chi 2 10.7, P less than 0.001) in whom no other factor was more significant. Immunoperoxidase staining patterns produced by monoclonal antibodies NCRC-11 and 3E1.2 are important prognostic factors in breast cancer.

Antibodies, Monoclonal↗
PubMed1989

Predicting survival in bilateral breast carcinoma.

Survival in 38 patients with bilateral breast cancer has been studied. The tumours were synchronous in 14 patients and metachronous in 24. Survival was less than that predicted for either tumour on the basis of a previously developed index involving lymph node status, oestrogen receptor content, progesterone receptor content, and patient age. Simple addition of the indices for the two tumours gave better predictor although this also overstated the prospects for survival for both synchronous and metachronous tumours. This experience suggests, therefore, that the prospects for survival for patients with suggests, therefore, that the prospects of survival for patients with synchronous or metachronous bilateral breast carcinoma is poor, and worse than might reasonably be anticipated.

Breast Neoplasms↗
PubMed1988

The prognostic importance of steroid receptors in endometrial carcinoma.

Three hundred forty-nine cases of primary endometrial carcinoma (endometrioid, adenosquamous, and clear-cell) were studied to investigate the relative prognostic importance of age, menopausal status, stage, histology, myometrial invasion, and estrogen and progesterone receptor content. Excluding menopausal status, all of these variables had a significant relationship to overall survival in a univariate analysis. Using a Cox multivariate regression analysis, stage, age, and an estrogen receptor value of more than 70 fmol/mg protein, combined with a progesterone receptor value of more than 30 fmol/mg protein, were independently associated with survival. The results demonstrate that for maximum prognostic information, both estrogen and progesterone content of tumors should be measured. Maximum prognostic information is obtained by using cutoff levels that are much higher than those traditionally accepted. This has particular relevance for patient stratification in clinical trials investigating receptor information and response to adjuvant or therapeutic treatment.

Adenocarcinoma↗
PubMed1987

Validation of a prognostic index in breast cancer.

The validation of a prognostic index for patients with primary breast cancer is described. The actual survival data in a group of 383 patients was compared with expected survival predicted by an index based on axillary lymph node status, oestrogen receptor, progesterone receptor and age. There was no significant difference between actual and predicted deaths for five ranges of index value at 2 years and for the three highest ranges of index value at 5 years. However, in the two lowest ranges, the index significantly underpredicted deaths at 5 years. The Cox proportional hazards model was used to determine if there was any significantly better combination of coefficients and covariates to predict survival in the test group. The original index--1 = N + E + P + A, where N = 0 if no nodes are involved, 13 if one to three nodes are involved, and 31 if more than three nodes are involved; E = 15 if oestrogen receptor value is less than 10 fmol/mg cytosol protein and 0 otherwise; P = 12.5 if progesterone receptor value is less than 10 fmol/mg cytosol protein and 0 otherwise; and A = number of years over age 65--was as good as any competing model in ranking survival prospects in the test group. However, it was a less sensitive predictor in this group than in the original set of patients. A second index based on tumour size, hormone receptor status and age, for use when lymph node status was unavailable, was tested by the same method and validated.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1986

Carcinoma of the gallbladder.

Gallbladder carcinoma is the fourth commonest gastrointestinal malignancy. Its growth is insidious and the majority of cases are advanced at the time of diagnosis. The recognized radiological features occur only in those with advanced disease. Cholecystectomy may be curative when carcinoma is confined to the gallbladder but the place of extensive surgery, chemotherapy or radiotherapy is unproven.

Adenocarcinoma↗