The large-scale provision of programmes for imprisoned sex offenders: issues,dilemmas and progress

Serious sexual offending almost invariably attracts a custodial sentence, but sexual deviancy is among the most obviously interpersonal disorders, and the target or victim often very specific. In this context, many doubts have been expressed about the possibility of adequate assessment and treatment of sex offenders when in an institution, divorced from ordinary life, and generally also from the real objects of their desire. Since 1991 the prison service in England and Wales has progressively implemented a systematic strategy for the treatment of imprisoned sex offenders. At the heart of this is a structured group work programme designed to be delivered by para-professional staff. The programme includes elements that, far from allowing the offender to `escape’ into the institution and its routine, bring him face to face with his cognitive distortions with respect to sexual interests and activity, possibly for the first time. By April 1994 over 700 sex offenders will have completed this programme, about half of those approached, demonstrating that such a programme is possible within a closed instituition. This paper considers issues arising in relation to the large-scale delivery of this programme in such a setting, with particular reference to treatment integrity, selection of offenders for the programme and factors affecting offenders acceptance or refusal of the programme. The dangers of institutional reinforcement of attitudes in treatment refusers are also considered.     

Urachal carcinoma: CT findings

The computed tomographic (CT) appearance of urachal carcinoma in ten patients was studied and compared with the pathologic findings. Magnetic resonance images were available in one case. All tumors were mucinous adenocarcinomas; four were solid, three were cystic, and three were mixed. The tumor had a characteristic location along the expected midline course of the urachus directly behind the anterior abdominal wall. The main tumor mass was supravesical in eight patients. Seven tumors contained calcification. CT correctly depicted bladder wall involvement and supravesical extent of tumor in all cases. CT provided incorrect information about invasion of the perivesical fat in three patients and about bladder mucosal invasion in two patients.     

Impact of Young Age at Diagnosis on Survival in Patients with Surgically Treated Renal Cell Carcinoma: a Multicenter Study

The prognostic significance of age in renal cell carcinoma (RCC) is a subject of debate. The aim of the present multi-institutional study was to evaluate the impact of age on clinicopathological features and survival in a large cohort of patients with RCC. A total of 5,178 patients who underwent surgery for RCC at eight institutions in Korea between 1999 and 2011 were categorized into three groups according to age at diagnosis as follows: young age (< 40 years, n = 541), middle-age (≥ 40 and < 60 years, n = 2,551), and old age (≥ 60 years, n = 2,096) groups. Clinicopathological variables and survival rates were compared between the three groups. Young patients had lower stage tumors with a low Fuhrman grade, a lower rate of lymphovascular invasion than patients in the other age groups. Regarding histologic type, the young age group had a lower percentage of clear cell histology and a greater incidence of Xp11.2 translocation RCC. Kaplan-Meier estimates showed that cancer-specific survival was significantly better in the young age group than in the other groups (log rank test, P = 0.008). However, age at diagnosis was not an independent predictor of survival in multivariate analysis. In conclusion, young age at diagnosis was associated with favorable pathologic features, although it was not an independent prognostic factor for survival in patients with surgically-treated RCC. Age itself should not be regarded as a crucial determinant for the treatment of RCC.