Biomedical subjects

James Babb

Publications and source records attributed to James Babb.

14 recordsLinked to original sources

PubMed2006

Abdominal aortic aneurysm: can the arterial phase at CT evaluation after endovascular repair be eliminated to reduce radiation dose?

PURPOSE: To retrospectively determine if arterial phase computed tomographic (CT) imaging is necessary for follow-up imaging of patients who have undergone endovascular stent-graft therapy for abdominal aortic aneurysm. MATERIALS AND METHODS: This HIPAA-compliant study was exempt from institutional review board approval; informed patient consent was waived. Eighty-five patients (66 men, 19 women; mean age, 66 years; range, 45-81 years) underwent 110 multidetector CT examinations after endovascular repair of abdominal aortic aneurysms. Nonenhanced CT images were obtained. Intravenous contrast material was then injected at 4 mL/sec, and arterial and venous phase (60 seconds) CT images were obtained. The nonenhanced and venous phase images were evaluated to determine if an endoleak was present. Subsequently, arterial phase images were analyzed. The effective dose was calculated. Ninety-five percent confidence intervals as indicators of how often arterial phase imaging would contribute to the diagnosis of endoleak were determined. RESULTS: Twenty-eight type II endoleaks were detected by using combined nonenhanced and venous phase acquisitions. Twenty-five of the 28 endoleaks were also visualized during the arterial phase. Three type II endoleaks were seen only during the venous phase. The arterial phase images depicted no additional endoleaks. Seventy-eight CT examinations performed in 67 patients revealed no endoleak during the venous phase. The arterial phase images also depicted no endoleaks at these examinations. Thus, for no more than 3.1% of all examinations, there was 95% confidence that arterial phase imaging would depict an endoleak missed at venous phase imaging. Arterial phase imaging contributed to a mean of 36.5% of the effective dose delivered. CONCLUSION: Study results indicate that arterial phase imaging may not be necessary for the routine detection of endoleaks. Radiation exposure can be decreased by eliminating this phase.

Aged↗

PubMed2005

A randomized pilot study of cognitive-behavioral therapy versus basic health education for smoking cessation among cancer patients.

BACKGROUND: Previously, we have linked theoretically based cognitive and emotional variables to the ability of cancer patients to quit smoking. PURPOSE: In this study, we evaluated the impact of cognitive-behavioral therapy (CBT), which addressed these theoretically derived cognitive and emotional variables linked to tobacco use in this population, for promoting smoking cessation in a sample of cancer patients and assessed longitudinal predictors of smoking cessation. METHODS: Cancer patients (N=109) were randomized to either the theoretically based CBT intervention or to a general health education (GHE) condition, and all patients received nicotine replacement therapy. RESULTS: Contrary to our expectation, no significant difference in 30-day point-prevalence abstinence between the CBT and GHE conditions was detected at either a 1-month (44.9 vs. 47.3%, respectively) or 3-month (43.2% vs. 39.2%, respectively) follow-up evaluation. Higher quit motivation and lower cons of quitting were related to smoking cessation. CONCLUSIONS: Implications for the implementation of smoking cessation behavioral treatments in the oncologic context are discussed, as are directions for future research in this area.

Cognitive Behavioral Therapy↗

PubMed2005

Diffuse FDG shoulder uptake on PET is associated with clinical findings of osteoarthritis.

OBJECTIVE: Our objective was to examine the degree and pattern of (18)F-FDG uptake within the shoulder as a potential marker of joint inflammation or injury. SUBJECTS AND METHODS: Twenty-four patients undergoing (18)F-FDG PET for clinical oncologic assessment completed questionnaires regarding history of shoulder disease, trauma, pain, and/or functional impairment. Thorough physical examination of the shoulder was performed. A clinical diagnosis of specific shoulder derangement or normal was established for each patient. PET scans were evaluated blindly by a nuclear medicine physician and a musculoskeletal radiologist qualitatively for location, distribution, and intensity of shoulder uptake. Standardized uptake values (SUV) were measured. RESULTS: Twenty-one patients had shoulder PET findings. Fourteen had clinical findings consistent with a specific diagnosis in the PET-positive shoulder. The remaining seven PET-positive patients were clinically normal. Three recognizable patterns of uptake were appreciable. Eight of 10 patients with diffuse uptake had findings of osteoarthritis (n = 7) or bursitis (n = 1). Two of four patients with focal greater tuberosity uptake had findings of rotator cuff injury. Two of four patients with focal glenoid uptake had findings of frozen shoulder. SUV showed a positive correlation with subject age (p < 0.01), but no association with clinical findings was identified. CONCLUSION: The pattern of FDG uptake within the shoulder may point to specific clinical entities. While focal uptake is less reliably related to clinical findings, diffuse uptake is associated with signs and symptoms of osteoarthritis or bursitis.

Adult↗

PubMed2004

Colorectal polyps and cancers in asymptomatic average-risk patients: evaluation with CT colonography.

PURPOSE: To compare thin-section multi-detector row computed tomographic (CT) colonography with conventional colonoscopy in the evaluation of colorectal polyps and cancer in asymptomatic average-risk patients. MATERIALS AND METHODS: Sixty-eight asymptomatic men (age > 50 years) scheduled to undergo screening colonoscopy were enrolled in this study. CT colonography was followed by conventional colonoscopy, performed on the same day. Supine and prone CT colonography were performed after colonic insufflation with room air. A gastroenterologist measured all polyps, which were categorized as 1-5, 6-9, or over 10 mm. Biopsy and histologic evaluation were performed of all polyps. CT colonography and colonoscopy results were compared for location, size, and morphology of detected lesions. Point estimates and 95% CIs were provided for specificity and sensitivity of CT by using results at conventional colonoscopy as the reference standard. RESULTS: At colonoscopy, 98 polyps were identified in 39 patients; 21 (21.4%) of 98 were detected at CT colonography. Sensitivity was 11.5% (nine of 78) for polyps 1-5 mm, 52.9% (nine of 17) for polyps 6-9 mm, and 100% (three of three) for polyps over 10 mm. Results at colonoscopy were normal in 29 (42.6%) of 68 patients; at CT colonography, results were correctly identified as normal in 26 of these 29 patients. In one of these patients, a lesion larger than 10 mm was detected at CT colonography. The per-patient specificity of CT was 89.7% (26 of 29; 95% CI: 72.7%, 97.8%). The mean time for CT image interpretation was 9 minutes. CONCLUSION: In patients at average risk for colorectal cancer, CT colonography is a sensitive and specific screening test for detecting polyps 10 mm or larger; the sensitivity for detecting smaller polyps is decreased. Examination findings can be interpreted in a clinically feasible amount of time.

Animals↗

PubMed2004

Measuring blood volume and vascular transfer constant from dynamic, T(2)*-weighted contrast-enhanced MRI.

Dynamic, contrast-enhanced MRI (deMRI) is increasingly being used to evaluate cerebral microcirculation. There are two different approaches for analyzing deMRI data. Intravascular indicator dilution theory has been used to estimate blood volume (and perfusion), usually from T(2)- or T(2) (*)-weighted images of the first pass of the bolus. However, the theory assumes that the tracer (i.e., contrast agent) remains intravascular, which is often not the case when the blood-brain barrier (BBB) is damaged. Furthermore, the method provides no information on the vascular transfer constant. Pharmacokinetic modeling analyses of T(1)-weighted images after first pass do give values of the vascular transfer constant and the volume of the extravascular, extracellular space (EES), but they generally are unable to give estimates of blood volume. In this study we apply pharmacokinetic modeling to dynamic T(2) (*)-weighted imaging of the first pass of a tracer bolus. This method, which we call first-pass pharmacokinetic modeling (FPPM), gives an estimate of the blood volume, vascular transfer constant, and EES volume. The method was applied to a group of 26 patients with surgically proven tumors (10 glioblastomas multiforme (GBMs), six lymphomas, and 10 meningiomas). The measurements of the blood volume and transfer constant were consistent with the known physiology of these tumors.

Blood Volume↗

PubMed2004

Psychoeducational group intervention for wives of men with prostate cancer.

OBJECTIVE: The effects of a 6-week psychoeducational group intervention on the distress, coping, personal growth, and marital communication of wives of men diagnosed with prostate cancer were evaluated using a randomized clinical trial. METHODS: Sixty wives completed measures prior to random assignment to either the psychoeducational group intervention or a no-treatment control group, and 1 month after completion of the group. RESULTS: No differences with regard to wives' general distress or cancer-specific distress were noted. In comparison with the control group, participants receiving the intervention perceived that having a spouse with prostate cancer had made positive contributions to their lives, reported gains in the use of positive reappraisal coping and reductions in denial coping. CONCLUSION: Although the psychoeducational intervention did not result in changes in psychological distress, improvements in adaptive coping and indicators of psychological growth were found. The utility of group interventions for spouses of men with prostate cancer is discussed.

Activities of Daily Living↗

PubMed2004

Significance of missed polyps at CT colonography.

OBJECTIVE: Our purpose was to determine the clinical significance of polyps missed on CT colonography using histologic analysis and the natural history of colorectal polyps and to propose guidelines for follow-up colon surveillance based on CT colonographic findings. SUBJECTS AND METHODS. One hundred eighty-six men (age range, 40-87 years; mean, 62.3 years) underwent CT colonography immediately before conventional colonoscopy. All polyps detected on CT colonography were measured and imaged, and their segmental location was documented. All polyps detected on colonoscopy were measured, photographed, biopsied, and histologically analyzed. Results of CT colonography and conventional colonoscopy were compared with the final pathology reports. Conventional colonoscopy was used as the gold standard unless CT colonography showed a lesion measuring 10 mm or more that was not detected on conventional colonoscopy and had characteristics of a polyp. In these cases, follow-up conventional colonoscopy was offered. RESULTS: One hundred ninety-one polyps were detected on conventional colonoscopy. CT colonography prospectively detected 53 polyps. Histologic analysis of the polyps not detected on CT colonography showed that of those 5 mm or smaller, 58.1% were not adenomas, and of those measuring 6-9 mm, 42.8% were not adenomas. Both missed polyps at CT colonography of 10 mm or more were adenomas. Of the 22 polyps measuring 10 mm or more, three were not detected on conventional colonoscopy. Of these three, CT colonography showed a lesion having characteristics of a polyp, follow-up endoscopy confirmed the presence of the lesion, and histologic analysis showed a villous adenoma, a tubulovillous adenoma, and a tubular adenoma. CONCLUSION: If CT colonography shows no abnormality, follow-up screening in 5 years is recommended. If CT colonography detects a lesion smaller than 5 mm, follow-up imaging in 3-5 years is recommended. If CT colonography detects a lesion measuring 6 mm or more, endoscopy and polypectomy should be offered unless contraindicated.

Colonic Polyps↗

PubMed2003

CT colonography data interpretation: effect of different section thicknesses--preliminary observations.

PURPOSE: To evaluate if differences exist in the interpretation of thin- and thick-section reconstructions at computed tomographic (CT) colonography. MATERIALS AND METHODS: Twenty-five patients underwent multi-detector row CT colonography prior to colonoscopy. CT images were reconstructed with two methods: 1.25-mm sections reconstructed every 1 mm (thin) and 5-mm sections reconstructed every 2 mm (thick). Two independent readers interpreted thin sections, then waited a minimum of 15 days before interpreting thick sections. With colonoscopy as the reference standard, comparisons were made between interpretation of thin and thick sections, including sensitivity, specificity, and number of false-positive observations. Interpretation times were recorded, and comparisons were made by using repeated measures analysis of variance. For all tests, P <.05 indicated a statistically significant difference. RESULTS: At colonoscopy, 10 patients had 12 polyps (< or =5 mm, n = 7; 6-9 mm, n = 2; > or =10 mm, n = 3). Sensitivity for polyp detection was statistically indistinguishable for thin and thick sections. Reader 1 had three false-positive findings with thin sections and six with thick sections. Reader 2 had six false-positive findings with thin sections and 11 with thick sections. For both readers, the number of false-positive findings was significantly lower for thin sections than for thick sections (P =.035). Specificity was 93.3% with thin sections and 80.0% with thick sections for reader 1 and 80.0% with thin sections and 73.3% with thick sections for reader 2. Mean interpretation time for reader 1 was significantly longer with thin sections (P <.001). Mean interpretation time for reader 2 was 13.0 minutes for both thin and thick sections. CONCLUSION: Specificity improved for both readers with thin sections, with no difference in sensitivity.

Aged↗

PubMed2003

Understanding intention to undergo colonoscopy among intermediate-risk siblings of colorectal cancer patients: a test of a mediational model.

BACKGROUND: There is a need for research to identify factors influencing intentions to undergo colorectal cancer (CRC) screening among family members at risk for CRC. This study tested a mediational model primarily guided by Ronis' elaboration of the Health Belief Model in predicting intention to have colorectal cancer screening among siblings of individuals diagnosed with colorectal cancer prior to age 56 years. METHODS: Data were collected from 534 siblings of individuals diagnosed with CRC. A baseline survey was administered by telephone. Measures included perceived susceptibility, CRC severity, physician and family support for CRC screening, cancer-specific distress, the closeness of the relationship with the affected sibling, and future intention to have a colonoscopy. Participant age, gender, and number of prior colonoscopies, as well as the stage of the affected patient's cancer and time from the patient's diagnosis to the interview, were controlled for in the analyses. RESULTS: The proposed model was not a good fit to the data. A respecified model was fit to the data. In this model, physician support, family support, and sibling closeness were significantly associated with both perceived benefits and barriers. Perceived severity was associated with barriers. Benefits and barriers, as well as cancer-specific distress, were directly associated with colonoscopy intentions. Results were consistent with a mediational role for benefits and barriers in the associations of sibling closeness and with a mediational role for barriers in the association between perceived severity and colonoscopy intentions. Family and physician support impacted intentions both directly and indirectly through effects on benefits and barriers. Perceived risk was not associated with benefits, barriers, or colonoscopy intentions. CONCLUSION: Intervention efforts to increase colonoscopy intentions may benefit from targeting family influences, particularly the affected proband in the family, as well as physician influence, cancer-related distress, perceived CRC severity, and perceived benefits and barriers to colonoscopy.

Colonoscopy↗

PubMed2003

Psychosocial correlates of intention to undergo prophylactic oophorectomy among women with a family history of ovarian cancer.

BACKGROUND: The purpose of this study was to examine sociodemographic and psychosocial correlates of intention to undergo prophylactic oophorectomy among women with a family history of ovarian cancer. METHODS: Participants were 76 women enrolled in a familial cancer risk assessment program. Psychosocial assessments were collected upon entry into the program and included measures of perceived risk of developing ovarian cancer, perceived benefits and limitations of prophylactic oophorectomy, and psychological distress. In addition, respondents were asked whether they intended to undergo prophylactic oophorectomy in the following 12 months. RESULTS: Thirty-four percent reported intention to have surgery within 12 months. Logistic regression analyses indicated that intention to undergo surgery was associated with several psychosocial factors including greater perceived risk of developing ovarian cancer and greater perceived benefits of surgery. CONCLUSIONS: Women who have heightened risk perceptions and who perceive there to be many benefits of surgery may be more inclined to undergo the procedure, possibly without fully considering the potential limitations and consequences of surgery. These findings suggest the need for education and risk counseling designed to facilitate informed decision making among not only high-risk women, but also women who perceive themselves to be at increased risk.

Adult↗

PubMed2003

Psychological issues related to the use of spiral CT for lung cancer early detection.

Although the NCI is presently investigating whether enhanced detection of lung tumors via spiral CT reduces lung cancer mortality, use of this technology for lung cancer screening is already widespread in the US. Few data are available concerning level of interest in, or awareness of, spiral CT for lung cancer screening, correlates of participation in screening, or potential reactions to screening results (i.e. smoking cessation) among high-risk individuals. One-hundred-and-seventy-two current or former smokers with no personal cancer history were queried about their awareness of spiral CT for lung cancer screening, received information about the procedure, and completed a survey that assessed interest in screening, correlates of screening interest (i.e. demographic, health, psychological), and expected effects of screening results on smoking. Seventy-seven percent of respondents were unaware of spiral CT for lung cancer screening and 62% expressed high interest in screening. Screening interest was positively related to screening self-efficacy, knowledge of asymptomatic illness, and perceived lung cancer risk. In the face of a positive scan, 52% of smokers said that they would quit, 43% said they would consider quitting, and 3% would continue smoking. If the scan was negative, 19% of smokers said that they would quit, 61% said they would consider quitting, and 20% would continue smoking. Finally, 59% of smokers were interested in smoking cessation counseling, with screening. These findings can help guide the design of psychological interventions to promote the utilization of spiral CT for early lung cancer detection as well as the development of protocols to promote behavior change within lung cancer screening programs, should future studies indicate that spiral CT screening can effectively reduce the overall lung cancer mortality rate.

Adult↗

PubMed2003

Longitudinal predictors of continued tobacco use among patients diagnosed with cancer.

Even though continued smoking by cancer patients adversely affects survival and quality of life, about one third of patients who smoked prior to their diagnosis continue to smoke after their diagnosis. The implementation of smoking cessation treatments for cancer patients has been slowed by the lack of data on correlates of tobacco use in this population. Thus, this longitudinal study assessed demographic, medical, addiction, and psychological predictors of tobacco use among 74 head, neck, and lung cancer patients. Multivariable binary logistic regression analyses, with outcome categorized as smoker or nonsmoker, indicated that the likelihood that patients would be a smoker was associated with lower levels of perceived risk and a higher level of quitting cons. Multivariable nominal logistic regression, with outcome classified as continuous smoker, continuous quitter, relapser, or follow-up quitter, indicated that: (a). patients categorized as continuous smokers reported significantly lower quitting self-efficacy than follow-up quitters and continuous quitters, (b). relapsers reported a significantly lower level of quitting self-efficacy than either follow-up quitters or continuous quitters, and (c). continuous smokers exhibited a significantly lower level of risk perceptions than continuous abstainers. These findings can be useful for the development and evaluation of treatments to promote smoking cessation among cancer patients.

Adult↗

PubMed2003

Intestinal ischemia versus intramural hemorrhage: CT evaluation.

OBJECTIVE: We evaluated the capability of CT to depict findings that allowed differentiation of small-bowel ischemia from intramural hemorrhage. MATERIALS AND METHODS: Findings of 35 CT examinations (19 patients with small-bowel ischemia and 16 patients with intramural hemorrhage) were analyzed by two abdominal radiologists for the degree of wall thickening, location and length of involvement (short, 30 cm), presence of hemoperitoneum, and pattern of attenuation. Patency and caliber of the superior mesenteric artery and vein were noted. Diagnosis was confirmed by laboratory findings, clinical parameters, and follow-up examinations, or at surgery. A Mann-Whitney U or Fisher's exact test was used to compare the two conditions for the following features: wall thickening, location and length of involvement, presence of hemoperitoneum, and appearance of the target sign. RESULTS: Among the 35 examinations, 18 abnormal segments with intramural hemorrhage and 19 abnormal segments with ischemia were identified. (Two patients with intramural hemorrhage each had two segments involved.) Mean bowel wall thickness was 11.7 mm (range, 4-25 mm) in patients with intramural hemorrhage and 4.0 mm (range, 1-9 mm) in patients with ischemia. Length of involvement was short in 14 segments with intramural hemorrhage and medium in four segments with intramural hemorrhage; none of the segments with intramural hemorrhage had long involvement. Among the segments with ischemia, length of involvement was medium in three and long in 16; none of the ischemic segments had short involvement. Fifteen (94%) of 16 segments with intramural hemorrhage and six (32%) of 19 segments with ischemia had hemoperitoneum. Seven of the 18 segments with intramural hemorrhage and nine of the 19 with ischemia had a target sign. Segments with intramural hemorrhage exhibited a higher statistically significant degree of wall thickening (p < 0.001), a shorter length of involvement (p < 0.0001), and a higher incidence of hemoperitoneum (p < 0.001) than did segments with ischemia. The two groups were not statistically different in location of involvement (p = 0.12) or in the incidence of the target sign (p = 0.18). CONCLUSION: Although some of the CT features overlap, a short segment involvement with wall thickening of 1 cm or greater is typical of intramural hemorrhage; a long segment involvement with wall thickening of less than 1 cm is typical of ischemia.

Aged↗

PubMed2002

Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer.

Concepts from the health belief, transtheoretical, and dual process models were used to examine how siblings of individuals diagnosed with colorectal cancer (CRC) before age 56 made decisions about CRC screening. Siblings (N = 504) were assessed for CRC screening practices and intentions, pros, cons, processes-of-change, perceived risk of CRC, perceived severity of CRC, preventability of CRC, cancer-related distress, and sibling relationship closeness. Physician and family recommendation and knowledge were also assessed. Fifty-seven percent of participants (n = 287) were compliant with CRC screening. Logistic regression indicated that perceived pros and cons, perceived risk, commitment to screening, health care avoidance, and sibling closeness were associated with screening compliance. Physician and family recommendation were also strong correlates. A similar set of factors was associated with stage of adoption of CRC screening.

Adoption↗