The effect of enucleation on orbital growth in patients with retinoblastoma.

PURPOSE: To measure orbital volume using serial magnetic resonance imaging (MRI) scans to determine the effect of enucleation on orbital growth over time. METHODS: The medical records of patients who underwent unilateral enucleation for retinoblastoma with a minimum of 2 MRIs were retrospectively reviewed. Orbital asymmetry was calculated using MRI measurements. Nonlinear and linear mixed effect regression models were used to predict the effect of age at time of enucleation on degree of orbital asymmetry. RESULTS: A total of 27 patients were included (mean age at enucleation, 2 years; range, 2.5 months to 5 years). Age at scan (P = 0.046) and age at enucleation (P = 0.0006) were found to have a significant effect on orbital asymmetry. Change in orbital asymmetry over time was more pronounced after enucleation in children enucleated at <1 (P < 0.0001) or <2 years of age (P = 0.0109). Younger age at enucleation was associated with a greater degree of asymmetry over time, although this effect was extinguished for patients enucleated after the age of 3 years. CONCLUSIONS: In patients with retinoblastoma, enucleation with orbital implant before 3 years of age has a significant effect on orbital volume asymmetry. After the age of 3, this effect appears to be less detrimental to the degree of orbital asymmetry.

Using extended cognitive behavioral treatment and medication to treat dependent smokers.

OBJECTIVES: We evaluated smoking-cessation efficacy of an extended course of sustained-release bupropion (bupropion SR) and cognitive-behavioral treatment (CBT). METHODS: Participants who smoked at least 10 cigarettes per day and who smoked within 30 minutes of arising (n = 406) completed a 12-week smoking-cessation treatment including group counseling, nicotine-replacement therapy, and bupropion SR. Participants were then randomly assigned to 1 of 5 conditions: (1) no further treatment, (2) active bupropion SR for 40 weeks, (3) placebo for 40 weeks, (4) active bupropion SR and 11 sessions of CBT for 40 weeks (A-CBT), or (5) placebo and 11 sessions of CBT for 40 weeks. Participants were assessed at baseline and at weeks 12, 24, 52, 64, and 104. RESULTS: A-CBT was not superior to the other 3 extended treatments. From weeks 12 through 104, all extended treatment conditions were superior to standard treatment. At weeks 64 and 104, the 2 CBT conditions produced significantly higher abstinence rates than did the other 3 conditions. CONCLUSIONS: Brief contact with providers can increase abstinence during treatment. CBT may increase long-term abstinence after extended treatment is terminated.

Extended treatment of older cigarette smokers.

AIMS: Tobacco dependence treatments achieve abstinence rates of 25-30% at 1 year. Low rates may reflect failure to conceptualize tobacco dependence as a chronic disorder. The aims of the present study were to determine the efficacy of extended cognitive behavioral and pharmacological interventions in smokers > or = 50 years of age, and to determine if gender differences in efficacy existed. DESIGN: Open randomized clinical trial. SETTING: A free-standing, smoking treatment research clinic. PARTICIPANTS: A total of 402 smokers of > or = 10 cigarettes per day, all 50 years of age or older. INTERVENTION: Participants completed a 12-week treatment that included group counseling, nicotine replacement therapy (NRT) and bupropion. Participants, independent of smoking status, were then assigned randomly to follow-up conditions: (i) standard treatment (ST; no further treatment); (ii) extended NRT (E-NRT; 40 weeks of nicotine gum availability); (iii) extended cognitive behavioral therapy (E-CBT; 11 cognitive behavioral sessions over a 40-week period); or (iv) E-CBT plus E-NRT (E-combined; 11 cognitive behavioral sessions plus 40 weeks nicotine gum availability). MEASUREMENTS: Primary outcome variable was 7-day point prevalence cigarette abstinence verified biochemically at weeks 24, 52, 64 and 104. FINDINGS: The most clinically important findings were significant main effects for treatment condition, time and the treatment x time interaction. The E-CBT condition produced high cigarette abstinence rates that were maintained throughout the 2-year study period [(week 24 (58%), 52 (55%), 64 (55%) and 104 (55%)], and was significantly more effective than E-NRT and ST across that period. No other treatment condition was significantly different to ST. No effects for gender were found. CONCLUSIONS: Extended cognitive behavioral treatments can produce high and stable cigarette abstinence rates for both men and women. NRT does not add to the efficacy of extended CBT, and may hamper its efficacy. Research is needed to determine if these results can be replicated in a sample with a greater range of ages, and improved upon with the addition of medications other than NRT.