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Biomedical subjects

T S Harbin

Publications and source records attributed to T S Harbin.

At least 19 recordsLinked to original sources
PubMed1997

The relationship and tensions between vertical integrated delivery systems and horizontal specialty networks.

UNLABELLED: This activity is designated for physicians, medical directors, and healthcare policy makers. GOAL: To clarify the issues involved with the integration of single-specialty networks into vertical integrated healthcare delivery systems. OBJECTIVES: 1. Recognize the advantages that single-specialty networks offer under capitated medical care. 2. Understand the self-interests and tensions involved in integrating these networks into vertical networks of primary care physicians, hospitals, and associated specialists. 3. Understand the rationale of "stacking" horizontal networks within a vertical system.

Community Networks↗
PubMed1992

Asymmetric pigmentary glaucoma resulting from cataract formation.

Pigment dispersion syndrome usually manifests bilaterally, and asymmetric involvement is unusual. When asymmetry is present, the eye with greater involvement may have an additional exacerbating condition or the eye with less involvement may be protected. Analysis of such cases should further elucidate the mechanism of the disorder and its development and regression. We examined four patients in whom unilateral cataract formation or extraction was associated with reduced clinical signs of pigment dispersion syndrome in the affected eye. Cataract formation, by inducing relative pupillary block, appears to decrease or prevent the manifestation of pigment liberation.

Adult↗
PubMed1986

Postoperative suprachoroidal hemorrhage following filtration procedures.

We reviewed the charts of 500 patients who underwent filtration procedures and found ten patients who developed postoperative suprachoroidal hemorrhage (PSCH) following surgery. The incidence (2% overall) is especially high in those patients who were aphakic (6.6%) or who had high myopia (10%). Nine patients developed PSCH within the first four postoperative days. Pain, nausea, and vomiting were common presenting symptoms of PSCH although not invariably present. Postoperative suprachoroidal hemorrhage is related to prolonged hypotonia and inflammation; prevention centers on proper case selection and on avoiding a precipitous rise in postoperative intravascular pressure. Initial treatment consisted of anterior chamber reformation and drainage of suprachoroidal blood, often followed by vitrectomy and scleral buckling procedures. Four eyes (40%) obtained final visual acuities of 20/200 or better, four (40%) were reduced to counting fingers or hand motions, and two (20%) lost all light perception.

Adult↗
PubMed1986

Massive hemorrhage complicating age-related macular degeneration. Clinicopathologic correlation and role of anticoagulants.

Reported are 15 cases of age-related macular degeneration (AMD) complicated by massive subretinal and/or vitreous hemorrhage. Clinicopathologic correlation is presented in four of the seven cases studied histopathologically. Salient histologic findings include: subretinal and subretinal pigment epithelium (sub-RPE) fibrovascular scar in the posterior pole; discontinuities in Bruch's membrane with choroidal neovascularization; extensive hemorrhagic detachment of the RPE and sensory retina; and vitreous hemorrhage. In three cases, a choroidal artery, emerging from breaks in Bruch's membrane, had ruptured walls. The authors have reviewed the previously reported cases of AMD complicated by massive hemorrhage and found that 19% of the patients were taking Coumadin (warfarin) or aspirin treatment when the bleeding occurred. Forty percent had a positive history of systemic hypertension and cardiovascular diseases. Although the occurrence of hypertension is expected in the aged population with AMD, use of anticoagulants or antithrombotics by such patients may predispose them to serious ocular hemorrhagic complications.

Aged↗
PubMed1984

Corneal ulcer due to Achromobacter xylosoxidans.

We report a case of corneal ulcer caused by the opportunistic organism Achromobacter xylosoxidans which developed during chronic topical steroid treatment of an eye with neovascular glaucoma. A. xylosoxidans has probably been underreported as a cause of ocular infection because of confusion between this organism and other Gram-negative organisms, particularly pseudomonas. A. xylosoxidans is resistant to aminoglycosides and some cephalosporins but not carbenicillin. This difference in antibiotic sensitivity patterns between A. xylosoxidans and pseudomonas makes an accurate differentiation between the 2 organisms important. This case was successfully treated after substituting topical carbenicillin for topical gentamicin and amikacin.

Administration, Topical↗
PubMed1979

Applanation-Schiøtz disparity after retinal detachment surgery utilizing cryopexy.

Previous reports of applanation-Schiøtz disparity following retinal detachment surgery involved patients whose detachments were treated with diathermy and scleral buckling. In 73 patients with retinal detachments treated by cryopexy and scleral buckling, applanation and Schiøtz pressures were measured before and after surgery. In the postoperative period, applanation tension values were significantly higher than Schiøtz values in the operated eyes only; the mean disparity was 6 mm Hg, with a range of 0 to 14 mm Hg. Sex, age, surgical aphakia, and length of time after surgery did not influence the data. Placement of the buckle, rather than extent of cryopexy, appeared to be the main factor in producing this disparity. Ophthalmologists who utilize the Schiøtz tonometer should be aware of the various conditions, including retinal detachment surgery, which produce low ocular rigidity.

Adult↗
PubMed1978

Comparative intraocular pressure effects of adsorbocarpine and isoptocarpine.

Nine symmetrical ocular hypertensives used Adsorbocarpine in one eye and Isoptocarpine in the other. Each medication was given twice daily for one week, then Isoptocarpine was used 4 time daily. The 2 drugs were equally effective as twice daily medications while Isoptocarpine 4 times daily was significantly more effective than either given twice daily. The pH of the Adsorbocarpine may not have been optimal although commercially available solutions were used. The results indicated that pilocarpine in either vehicle can lower intraocular pressure when given less than 4 times daily; however, conclusive studies are needed before this can be recommended as a widespread clinical practice.

Clinical Trials as Topic↗
PubMed1977

Topical corticosteroid therapy complicating congenital glaucoma.

A 4-month-old infant with congenital glaucoma had been treated with a topical antibiotic-corticosteroid for three months. This fact complicated initial management, delaying definitive diagnosis and therapy. Topical steroid therapy in infants can produce a condition simulating congenital glaucoma. Since there is little rationale for using topical steroids to treat most infantile external disease processes, they are best avoided. When steroids are used for a prolonged period, some strategy for detecting glaucoma should be adopted.

Administration, Topical↗
PubMed1976

The effects of dipivalyl epinephrine on the eye.

We treated one eye each of ten patients with ocular hypertension with dipivalyl epinephrine (DPE), a congener of epinephrine. Pupil size and intraocular pressure were measured before and at intervals up to 240 minutes after instillation of a single drop of DPE in concentrations from 0.005 to 0.5%. Concentrations of 0.025% DPE and greater significantly reduced IOP, and mydriasis was induced by concentrations of 0.1% DPE or greater. Comcentrations of 0.1% DPE, instilled twice daily for one month, significantly reduced intraocular pressure during diurnal testing on days 2 and 31. No toxic side effects were noted. The DPE produced dose-related increases of cyclic adenosine monophosphate in the aqueous humor of rabbits.

Animals↗
PubMed1976

The Ocusert pilocarpine system: advantages and disadvantages.

Thirty-four patients with glaucoma were treated with the Ocusert pilocarpine system, a unique method of providing round-the-clock delivery of pilocarpine in the eye for seven-day periods. Advantages of the device include therapeutic effectiveness and continuous release rate, less effect on accommodation, less miosis, convenience for the patient, and reliability in patients who must rely on others for treatment (eg, children and the elderly). Some disadvantages encountered were need for instruction and encouragement of patients; retention difficulties, with some patients unaware when the device was lost; occasional side effects of a cutting sensation (as when the Ocusert sometimes doubles over), movement in the eye, and transient blurring of vision and miosis; and high cost. Overall, when compared to pilocarpine eyedrops, the Ocusert pilocarpine system presents many definite advantages and is a highly desirable method of therapy in selected cases of glaucoma.

Drug Evaluation↗
PubMed1975

Pilocarpine ocuserts. Long-term clinical trials and selected pharmacodynamics.

For up to one year, 22 patients with occular hypertension or glaucoma wore a seven-day sustained release device (Ocusert) containing pilocarpine with acceptable retention and no important side-effects. Comparison of prestudy medical regimens using eye drops with those defined as minimum controlling concentrations indicated a high rate of over-medication. The hypotensive effect of two Ocusert strengths was compared to four pilocarpine drop concentrations. Concurrent administration of epinephrine drops did not interfere with Ocusert action and had the anticipated additive effect. Further study indicated the need for continuous wearing and delimited the effective duration of action for single Ocuserts to seven days.

Aged↗
PubMed1975

Glaucoma in episcleritis.

Two patients had episcleritis and a secondary open angle glaucoma. Anterior uveitis was absent in three of the four eyes. The low facility of outflow suggests that increased episcleral venous pressure was not the mechanism of the glaucoma. The response of the intraocular pressure and, in one case, the outflow facility to steroid therapy suggests that inflammation of angle structures was the pathogenesis of the raised intraocular pressure.

Arthritis, Rheumatoid↗