Prospective evaluation of endorectal magnetic resonance imaging to detect tumor foci in men with prior negative prostastic biopsy: a pilot study.

PURPOSE: Prostate cancer foci have a characteristic appearance on endorectal magnetic resonance imaging (MRI) which might be useful for prostate cancer detection. In this pilot study the ability of endorectal MRI to detect prostate cancer foci prospectively in men at risk for a malignant prostatic neoplasm is assessed. MATERIALS AND METHODS: Endorectal MRI was performed in 33 consecutive men with 1 or more prior negative prostatic biopsies. All studies were read by 2 MRI dedicated study radiologists in consensus before and after receiving patient clinical data. Areas of interest on endorectal MRI were mapped as low, moderate or high suspicion for carcinoma on a prostate model. Directed needle biopsy cores of the prostate were obtained based on this model, and the histopathological findings were compared with MRI results. RESULTS: Carcinoma was detected in 7 of 33 men (21.2%) on post-MRI biopsy, including 1 of 18 (5.6%) with low, 1 of 8 (12.5%) with moderate and 5 of 7 (71.4%) with high suspicion MRI. The site of positive biopsy correlated correctly with the area of suspicion on MRI in 85.7% of cases. Overall, endorectal MRI had 40% positive predictive value (moderate or high suspicion), 94.4% negative predictive value (low suspicion) and 69.7% accuracy. On multivariate analysis positive endorectal MRI was associated with an 11.3-fold risk of positive biopsy. CONCLUSIONS: Endorectal MRI may effectively stratify patients with prior negative prostatic biopsy into low, moderate and high risk groups for a malignant prostatic neoplasm, and may improve our ability to identify prostatic tumor foci prospectively.

Thermally activated escape rates of uniaxial spin systems with transverse field: uniaxial crossovers.

Classical escape rates of uniaxial spin systems are characterized by a prefactor differing from and much smaller than that of the particle problem, since the maximum of the spin energy is attained everywhere on the line of constant latitude: theta =const, 0 < or= phi < or = 2 pi. If a transverse field is applied, a saddle point of the energy is formed, and high, moderate, and low damping regimes (similar to those for particles) appear. Here we present the first analytical and numerical study of crossovers between the uniaxial and other regimes for spin systems. It is shown that there is one HD-Uniaxial crossover, whereas at low damping the uniaxial and LD regimes are separated by two crossovers.

Physicians' self-reports of reactions to malpractice litigation.

The authors devised a survey as a first step in assessing physicians' perceptions of the impact of medical malpractice litigation on their professional practice and personal lives. Subjects were a sample of physicians in Cook County, Ill., who had been sued during 1977-1981. Many respondents reported changes in how they practiced their profession. Two clusters of self-reported symptoms in reaction to the litigation also emerged. Further studies, including clinical interviews, are needed to clarify the impact of medical malpractice suits on the sociological reality of medical practice.

Clinical assessment of a profession: Roman Catholic clergymen.

The present study investigated the personality of the American Catholic priest by means of clinical procedures. It is based on a national, randomly selected, representative sample. Recorded 2-hour clinical interview plus a battery of standardized as well as specially designed psychological tests were administered to 271 Ss. A clinical report was written for each priest based on all the interview data. Four categories or types of classification were devised to describe and to distinguish the priests along a continuum of soci-psychological development: maldeveloped (8%), underdeveloped (57%), developing (29%), and developed (6%).