Assistant Professor, Department of Emergency Medicine
Department of Emergency Medicine
Bronx Lebanon Hospital Center
1650 Selwyn Ave
Milstein Bldg, Suite 8C
Bronx, New York
Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY 10461, USA.
In academic institutions, radiology residents are often relied on for providing preliminary reports of imaging studies done in the ED. We examined the prevalence of discrepant interpretations of body computed tomographic (CT) scans in our institution.
We conducted a retrospective study on a consecutive series of body CT scans at an urban ED. We compared the preliminary interpretation by radiology residents with the final interpretation by radiology attending physicians. An interpretation was characterized as having no discrepancy, minor discrepancy, or major discrepancy. A major discrepancy was defined as a discrepancy that resulted in a change in diagnosis, treatment, or disposition.
Two hundred three body CT scans were identified during the study period. Of these CT scans, 20 had major discrepancies (10%), 40 had minor discrepancies (20%), and 143 had no discrepancy (70%). Major discrepancies included missed appendicitis, normal appendix, missed bowel obstruction, and missed colon cancer. Computed tomographic scans with abnormal findings were more likely to contain major discrepancies (relative risk = 6.0; 95% confidence interval = 1.8-2.0).
Discrepancies between radiology residents and radiology attending physicians were common at our institution. Emergency department physicians should exercise caution when relying on residents' interpretation of body CT scans
Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA.
Androgens, diet, race and obesity are thought to play some roles in the pathogenesis of prostate cancer. We wanted to evaluate if there were any inter-relationships between prostate specific antigen (PSA), serum testosterone, serum cholesterol, HDL, triglycerides, body mass index (BMI) and race, in older patients with and without prostate cancer (CaP). We evaluated 308 patients referred to urologists in private practice offices and clinics with and without prostate cancer with regard to race, serum PSA, age, serum testosterone, full lipid profile, height and weight, and stage of cancer. We used multivariate analysis, Fisher's exact test and t-tests as well as logistic regression analysis. Data was analyzed using SPSS computer software, and P-values<0.05 were considered statistically significant. Significantly higher levels of serum testosterone were found in black men with CaP than black men without CaP (526+/-28 vs 404+/-19, respectively.) We also found significantly higher levels of serum testosterone in white men with CaP than white men without CaP (409+/-20 vs 302+/-14, respectively, P<0.05). HDL was higher in black men than white men, and triglycerides were higher in white men than black men. Cholesterol was similar across all groups, but BMI was highest in white men with CaP. We also found a significant association between BMI and pathological stage of prostate cancer patients among both black and white men (P<0.05). Our study demonstrated that black men who developed CaP had higher serum testosterone levels, on average, than white men who developed CaP. Furthermore, BMI was highest in white men developing CaP compared to black men, but we found a significant association between pathological stage and BMI in both black and white patients. Although it is controversial whether obesity is considered to be a risk factor for prostate cancer, this small pilot study suggests that BMI may play a role in the progression of the disease once it is established.Prostate Cancer and Prostatic Diseases (2001) 4, 101-105
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Bronx-Lebanon Hospital Center
1650 Selwyn Avenue
Milstein Building, Room 8C
Bronx, NY 10457