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M J Carmichael

Publications and source records attributed to M J Carmichael.

At least 19 recordsLinked to original sources
PubMed1995

Deoxyribonucleic acid ploidy analysis as a predictor of recurrence following radical prostatectomy for stage T2 disease.

Deoxyribonucleic acid (DNA) ploidy image analysis was used postoperatively to predict recurrence of 112 clinically localized adenocarcinomas of the prostate. All men underwent radical retropubic prostatectomy between 1978 and 1991. Patients with positive lymph nodes or positive seminal vesicles were excluded because progression is nearly inevitable in these men. The minimum followup for men without progression was 5 years (range 5 to 15). Patients were considered to have clinically evident disease progression based on local recurrence (8%), distant metastases (4%) and/or an isolated elevation of serum prostate specific antigen (87%). Of the tumors 43% were diploid and 57% were nondiploid. In a multivariate analysis comparing grade, ploidy, capsular penetration and surgical margins, Gleason sum was the best predictor of progression (p < 0.0001). Nevertheless, a subset of patients remained with well to moderately differentiated Gleason grade tumors (Gleason sum 6 or less) who failed. DNA ploidy was able to predict recurrence in this particular group (p = 0.034). In addition, we compared different methods of tissue preparation to determine which best predicted progression. We found that ploidy analysis on tissue sections was more predictive than ploidy performed on disaggregated tissue. In summary, our study revealed that DNA ploidy analysis can offer additional prognostic information following radical prostatectomy for men with low grade prostatic adenocarcinoma.

Actuarial Analysis↗
PubMed1995

Pathological features of hereditary prostate cancer.

The aim of this study was to characterize the pathological features of hereditary prostate cancer, a recently recognized variant of prostate cancer with an autosomal dominant inheritance of a rare highly penetrant gene associated with early onset of disease. We compared the histology at radical prostatectomy of clinical stage T2 prostate cancer, including its relationship to prostatic intraepithelial neoplasia, in men with a family history of prostate cancer to those without a family history of prostate cancer. Three cohorts (hereditary, familial and sporadic) were identified based on pedigree analysis. A hereditary subgroup (28 patients) met 1 of the following 3 criteria: 1) cluster of greater than 3 affected relatives within the nuclear family, 2) occurrence of prostate cancer in each of 3 generations in either the proband paternal or maternal lineage, or 3) a cluster of 2 relatives affected at an early age of less than 55 years. This subgroup was compared to an age-matched subgroup with family history of prostate cancer (26 patients) yet the aforementioned conditions for inclusion within the hereditary subgroup were not met and to a sporadic subgroup without a family history of prostate cancer (27 patients). All parameters were statistically similar among the groups except that hereditary and familial group multifocal tumors were of lower grade (p = 0.0001), sporadic cases had a greater proportion of small multifocal cancers associated with prostatic intraepithelial neoplasia (p = 0.02) and the familial group had a weaker correlation between total tumor volume and grade. In conclusion, our analysis failed to demonstrate substantial pathological differences among hereditary, familial and sporadic forms of prostate cancer. Rather, our data are remarkable for the wide range of all parameters studied in each group. Even the sporadic cases had features, such as increased numbers of precursor lesions and tumor multifocality, which in other organs are commonly associated with either hereditary cancer or cancer arising in a field effect due to diffuse exposure to a carcinogen.

Adenocarcinoma↗
PubMed1993

Influence of capsular penetration on progression following radical prostatectomy: a study of 196 cases with long-term followup.

We studied 196 radical prostatectomy cases performed for clinical stage B prostate cancer with capsular penetration; in all cases seminal vesicles and lymph nodes were free of tumor. The mean followup in patients who showed no evidence of progression was 5 years. Focal capsular penetration was seen in 93 cases. There was no difference in progression in this group, irrespective of whether margins were negative or positive. High grade tumors (Gleason score 7 or more) had a significantly higher risk of progression compared to lower grade tumors (p = 0.0002). Established capsular penetration was seen in 103 tumors. Cancers with established capsular penetration had a higher risk of progression than those with focal capsular penetration. Established capsular penetration tumors were stratified into 3 groups with increasing risks of progression: 1) margins were negative and grade was low, 2) margins were positive or grade was high yet both adverse features were not present or 3) margins were positive and grade was high. The differences in progression among these 3 groups were statistically significant. Because of the negligible influence of positive margins in patients with focal capsular penetration the status of capsular margins should not influence the decision on whether to administer immediate postoperative adjuvant therapy. To evaluate the efficacy of adjuvant therapy following radical prostatectomy, tumors with capsular penetration should be stratified into groups having similar risks of progression according to the extent of capsular penetration, surgical margins of resection and grade.

Humans↗
PubMed1993

Does high grade prostatic intraepithelial neoplasia result in elevated serum prostate specific antigen levels?

Prior studies have evaluated high grade prostatic intraepithelial neoplasia on biopsy material when undiagnosed carcinoma or benign prostatic hyperplasia (BPH) may have been associated with elevated serum prostate specific antigen (PSA) levels. We studied 65 totally embedded radical prostatectomy specimens with minimal carcinoma (tumor volume 0.5 cc or less) and relatively minimal BPH (gland weight less than 65 gm.). Even for these relatively small glands, PSA showed a significant correlation with gland volume (r = 0.64). To account for BPH, PSA density (PSA divided by gland volume) was also calculated. In these specimens with trivial tumor the tumor volume did not correlate with PSA (r = 0.12) or PSA density (r = 0.23). The volume of high grade prostatic intraepithelial neoplasia also showed no correlation with PSA (r = 0.16) or PSA density (r = 0.14). The 11 cases with extensive high grade prostatic intraepithelial neoplasia (0.50 cc or more) had PSA density values of 0.03 to 0.14, with 10 less than 0.1. Of the 6 cases with PSA density values of 0.1 or more only 1 had a high grade prostatic intraepithelial neoplasia volume of 0.5 cc or more. These results indicate that high grade prostatic intraepithelial neoplasia in and of itself does not account for elevated serum PSA levels. In a patient with high grade prostatic intraepithelial neoplasia on biopsy material and elevated serum PSA values, BPH may account for the elevated serum PSA levels. More likely, because of the association between high grade prostatic intraepithelial neoplasia and carcinoma these patients have undiagnosed carcinoma as the source of the elevated serum PSA values.

Humans↗
PubMed1988

Prevention of postoperative pericardial adhesions with hydrophilic polymer solutions.

Pericardial adhesions subject patients requiring cardiac reoperation to potential injuries of the heart, great vessels, and extracardiac grafts during resternotomy. We evaluated polyvinylpyrrolidone (PVP) and a methlycellulose derivative (MCD) as intraoperative irrigating solutions in the prevention of postoperative pericardial adhesions. Fifteen dogs weighing 15 to 20 kg were divided into three equal cohorts and subjected to left thoracotomy with pericardiotomy. Prior to surgical manipulation, the pericardial cavity was irrigated with either PVP, MCD, or Ringer's lactate (RL). Serosal injury stimulating intraoperative trauma was induced by gauze sponge abrasion of the epicardium and inner surface of the pericardium and by allowing desiccation of serosal surfaces for 30 min. The pericardial cavity was evaluated for adhesion formation 6 weeks postoperatively by reoperation. Two independent observers, unaware of the study solution, evaluated the extent and severity of pericardial adhesions on a 0-4 scale. All dogs in the RL control group had surgically significant adhesions and a mean adhesion score of 3.2 +/- 1.1. In contrast, no PVP- or MCD-treated dog had surgically significant adhesions. The mean adhesion scores were 0.2 +/- 0.4 for PVP and 0.5 +/- 0.7 for MCD. Our results indicate that PVP (P less than 0.004) and MCD (P less than 0.024) significantly reduce pericardial adhesion formation when compared to RL. Clinical application of PVP or MCD for the prevention of pericardial adhesions should reduce morbidity and mortality of cardiac reoperation.

Animals↗
PubMed1987

Preoperative evaluation of the thoracic aorta using MRI and angiography.

The ability of ECG-gated magnetic resonance imaging (MRI) to evaluate disease of the thoracic aorta compared with angiography was prospectively assessed in 28 patients. MRI identified abnormalities in all patients, with confirmation at operation in 22 (79%) and by angiography alone in all 28. In 20 of the patients, MRI correctly diagnosed 20 of 21 aneurysms of the thoracic aorta (6 dissecting, 4 saccular, 10 fusiform), but 1 surgically proven fusiform aneurysm was categorized as an enlarged aortic dissection based on both MRI and angiographic findings. One dissection and 1 fusiform aneurysm were shown by MRI only. Coarctation of the aorta was identified in 4 patients. Ascending aortic enlargement and left ventricular hypertrophy were identified by MRI in 4 patients with aortic stenosis. In 7 patients (25%), MRI provided additional important information not shown by angiography and in 1 patient, the MRI findings resulted in a change in the surgical approach. In 14 of 28 patients (50%), angiography was necessary for definitive preoperative evaluation of the aortic valve, the coronary arteries, or the brachiocephalic vessels. MRI was a useful noninvasive supplement to angiography for the preoperative assessment of thoracic aortic disease.

Aorta, Thoracic↗
PubMed1986

Carcinoma of the superior pulmonary sulcus treated with surgery and/or radiation therapy.

This is a retrospective analysis of 50 patients with carcinoma of the superior pulmonary sulcus, treated with curative intent at the University of Florida between October 1964 and October 1981. Treatment groups included preoperative radiation therapy and surgery (40 patients), radiation therapy alone (7 patients), and surgery with postoperative radiation therapy (3 patients). There was a minimum 2-year follow-up. Local control was obtained in 8 of 26 evaluable patients (31%) treated with preoperative radiation therapy and surgery, 2 of 6 patients treated with radiation therapy alone, and 0 of 2 patients treated with surgery and postoperative radiation therapy. Twelve (30%) of 40 patients receiving planned preoperative radiation therapy did not undergo definitive surgery. Absolute survival free of disease at 5 years by treatment group for patients at risk was 3 of 30 (10%) with preoperative radiation therapy and surgery, 0 of 3 with surgery and postoperative radiation therapy, and 2 of 7 with radiation therapy alone. Since one third of the patients who received low- to moderate-dose preoperative radiation therapy did not undergo definitive surgery, and since there is a small but significant survival with radiation therapy alone, it seems unwise to give moderate-dose preoperative radiation therapy, which implies an unfavorable radiation technique for the unresectable cases. The recommendation is to treat patients with lesions believed to be resectable by initial surgical resection followed by high-dose radiation therapy in selected patients with questionable margins or positive lymph nodes. Those patients with borderline or apparently unresectable lesions are recommended to be treated with radiation therapy alone.

Adenocarcinoma↗
PubMed1986

Coronary angioplasty at the time of initial cardiac catheterization.

Following initial diagnostic cardiac catheterization in 20 patients with unstable angina, percutaneous transluminal angioplasty (PTCA) was successfully performed either immediately (15 patients) or later in the day (five patients). This approach offers certain clinical and financial advantages. PTCA immediately following diagnostic catheterization should probably only be performed by experienced operators and only when excellent cooperation with cardiovascular surgeons is possible.

Adult↗
PubMed1986

Salvage coronary angioplasty for symptoms refractory to medical therapy.

Coronary angioplasty was used without surgical back-up in eight patients with angina refractory to medical therapy. After careful evaluation, none of these patients was felt to be a candidate for elective or emergent bypass surgery. Angioplasty provided a reasonable means of coronary revascularization. In each patient, extenuating clinical circumstances and reduced left ventricular function led to this approach. Angioplasty was angiographically and clinically successful in each patient.

Aged↗
PubMed1985

Cardiac operation for congenital heart disease in children of Jehovah's Witnesses.

We reviewed the perioperative courses of 110 children of members of the Jehovah's Witness faith who underwent 112 operations for complete repair of congenital heart disease with cardiopulmonary bypass. Operations were performed over a 20 year period, ending June, 1983. The children ranged in age from 6 months to 12 years and weighed 5.2 to 42.3 kg. Thirty-nine (34.8%) of the patients weighed less than 15 kg, 36 (32.1%) were polycythemic preoperatively, and 26 (23%) had previous thoracic operations. All operations were performed during normothermic cardiopulmonary bypass with a glucose crystalloid prime. No patient received any blood or blood products during hospitalization. Perioperative mortality was 5.4%. Only one of the deaths could be attributed to blood loss. Complications occurred in 10 patients, and none of these could be attributed to failure to transfuse. The results demonstrate that cardiac operations can be safely performed in children denied transfusion and suggest that hemodilution techniques might be used more extensively in children undergoing cardiac operations.

Body Weight↗
PubMed1984

Unusual sequelae of colon interposition for esophageal reconstruction: late obstruction requiring reoperation.

Colon interposition has become a favored technique for esophageal reconstruction. Late morbidity is generally related either to technical problems associated with the procedure or to the development of new disorders in the transposed segment. Two patients are discussed who were seen with obstruction of colon interposition grafts ten and five years after esophageal reconstruction. In the first patient, a volvulus of the interposed colon associated with a chronically narrowed area distal to the looped segment resulted in obstruction. In the second patient, the redundant intrathoracic segment of the colon interposition became kinked at the diaphragmatic hiatus leading to dilatation and incomplete emptying. Both patients underwent successful reoperations and are doing well 10 and 12 months later. The causes and possible prevention of these and other late complications of colon interposition are discussed.

Adult↗
PubMed1982

Increased incorporation of an infused labelled amino acid into plasma proteins as a means of assessing the severity of injury or activity of disease in surgical patients.

Following injury there is increased synthesis of several plasma proteins. During a constant rate infusion of 1-(1-14C) leucine some of the labeled amino acid became incorporated into plasma proteins, the amount being readily determined after precipitation with perchloric acid. This value was correlated with the clinical state of the patient to see if an index of severity of injury could be derived. Before operation 6.7 +/- 0.5% (mean +/- SD, n = 16) of the infused labeled amino acid was incorporated in asymptomatic patients, irrespective of their dietary intakes, while in the presence of symptomatology this value rose, correlating with tumor staging in patients with colorectal neoplasia (r = 0.988, p = 0.001). It returned to normal following tumor resection, but was elevated in the presence of recurrence or residual disease. After operation it also rose, being maximal in the early postoperative period and following the more major surgical procedures, the increase correlating with the change in cortisol level in patients following cholecystectomy (r = 0.84, p less than 0.01; n = 8). The pattern of distribution of the label among the plasma proteins did not change with increased incorporation. The increase in incorporation of 1-(1-14C) leucine into plasma proteins would appear to offer a good index for severity of injury of activity of a disease state.

Blood Proteins↗