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Biomedical subjects

J W Harbison

Publications and source records attributed to J W Harbison.

At least 19 recordsLinked to original sources
PubMed1992

Ticlopidine versus aspirin for the prevention of recurrent stroke. Analysis of patients with minor stroke from the Ticlopidine Aspirin Stroke Study.

BACKGROUND AND PURPOSE: Ticlopidine has not been formally compared with aspirin in patients with a completed stroke. We therefore performed an analysis on a subgroup of patients from the Ticlopidine Aspirin Stroke Study (TASS) with a recent minor completed stroke as the qualifying ischemic event. METHODS: This was a multicenter, double-blind, randomized trial of patients with a recent history of cerebral ischemia. Eligible patients had a qualifying minor stroke within 3 months of study entry. All patients received either 650 mg aspirin twice daily or 250 mg ticlopidine twice daily for up to 5.8 years. The primary study end point was the first occurrence of nonfatal stroke or death from any cause. A secondary end point was the first occurrence of a fatal or nonfatal stroke. RESULTS: Minor stroke was the qualifying ischemic event in 927 patients (463 received ticlopidine and 464 received aspirin). The cumulative event rate at 1 year for nonfatal stroke or death was 6.3% for patients receiving ticlopidine and 10.8% for patients receiving aspirin, a 42% risk reduction in favor of ticlopidine. For fatal or nonfatal stroke, the cumulative event rate at 1 year was 4.8% for patients receiving ticlopidine and 7.5% for those receiving aspirin, a risk reduction of 36% for ticlopidine relative to aspirin. The overall risk reductions were 22.1% for nonfatal stroke or death and 19.9% for fatal or nonfatal stroke. Adverse reactions were reported in 58% of the ticlopidine patients and 51% of the aspirin patients. CONCLUSIONS: The results in this subgroup are consistent with the overall TASS results and show that ticlopidine is somewhat more effective than aspirin for reducing the risk of stroke in patients with a completed minor stroke.

Adult↗
PubMed1989

The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke.

The Canadian American Ticlopidine Study (CATS) is a randomised, double-blind, placebo-controlled trial to assess the effect of ticlopidine (250 mg twice daily) in reducing the rate of subsequent occurrence of stroke, myocardial infarction, or vascular death in patients who have had a recent thromboembolic stroke. Twenty-five centres entered 1072 patients into the study between 1 week and 4 months after their qualifying stroke. The patients were treated and followed for up to 3 years (mean 24 months). In the efficacy analysis, the event rate per year for stroke, myocardial infarction or vascular death, considered together, was 15.3% in the placebo group and 10.8% in the ticlopidine group, representing a relative risk reduction with ticlopidine of 30.2% (95% confidence interval 7.5-48.3%; p = 0.006). Ticlopidine was beneficial for both men and women (relative risk reductions 28.1%, p = 0.037, and 34.2%, p = 0.045, respectively). Analysis by intention-to-treat gave a smaller estimate of risk reduction (23.3%, p = 0.020) for stroke, myocardial infarction, or vascular death. Adverse experiences associated with ticlopidine included neutropenia (severe in about 1% of cases) and skin rash and diarrhoea (severe in 2% of cases each); all were reversible. This study provides evidence of a beneficial effect of ticlopidine in both men and women with a recent thromboembolic stroke.

Aged↗
PubMed1989

Perceptions of housestaff stress and dysfunction within the academic medical center.

Stress, emotional dysfunction, and work impairment are seen as accelerating phenomena in residency training, and have received increased attention in the medical literature. The authors review relevant literature in this area, and note continued deficiencies in programs for prevention and intervention. The present study focuses on the perceptions of key members of the academic hierarchy regarding housestaff stress and impairment. Chairmen, program directors, and chief residents in all specialties were asked to estimate the prevalence of several impairment syndromes, to describe any existing policies or programs to assist residents, and to express their opinions about developing such intervention strategies. The results are compared by respondent group, by resident postgraduate year, and by groupings of surgical and non-surgical programs. Suggestions for further research in this area are then offered.

Academic Medical Centers↗
PubMed1988

The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke. Design, organization, and baseline results.

The Canadian American Ticlopidine Study is a randomized, placebo-controlled, double-blind, multicenter study to assess the efficacy and safety of ticlopidine hydrochloride in patients who have suffered a thromboembolic stroke no less than 1 week and no more than 4 months before entry into the study. The primary assessment of efficacy will be based on the cluster of outcome events recurrent stroke, myocardial infarction, or vascular death. Twenty-five clinical centers, 12 in Canada and 13 in the United States, entered a total of 1,072 patients during a 3-year recruitment period; these patients were randomly allocated to receive either 250 mg ticlopidine or identical-appearing placebo tablets twice daily for up to 3 years. Patient recruitment was completed in December 1986. Patients were followed for a maximum of 3 years or until the close of the study in December 1987; at that time an average follow-up of 25 months had been achieved. We summarize the protocol and organization of the study and document the methods of execution and analysis, with corresponding criteria, before disclosure of the treatment code to any of the study investigators. We also provide a clinical description of the patients at entry into the study.

Aged↗
PubMed1985

Papilledema after acute head injury.

Low grade papilledema after acute, severe head injury was identified in 15 (3.5%) of 426 patients. Papilledema was recognized immediately after head injury in 1 patient, during the 1st week in 10 patients, and in the 2nd week or after in 4 patients. Initial computed tomographic scans showed evidence of brain injury in 11 of these patients. The intracranial pressure (ICP) was monitored continuously for 3 or more days in 9 patients; it was mildly elevated (20 to 40 mm Hg) in 7 patients and moderately elevated (40 to 60 mm Hg) in 2 patients. Intracranial hypertension was controllable in each patient. A sudden, severe, but transient increase in ICP best explained the immediate development of papilledema and survival of 1 patient. Sustained but mild to moderately elevated ICP accounted for papilledema appearing in the 1st week. Papilledema in the 2nd week or after occurred from impaired cerebrospinal fluid absorption and consequent communicating hydrocephalus or delayed focal or diffuse cerebral swelling. A lesser degree of head injury in patients with posttraumatic papilledema was suggested by a higher Glasgow coma score, milder and controllable elevations in ICP, and the absence of any fatality in this group. The favorable outcome was significant compared to the mortality of the more severely injured patients (chi square-4.327; P less than 0.04). Papilledema did not occur in 6 patients with sustained, severely elevated ICP (greater than 60 mm Hg) for 3 or more days. Each of these patients died. The severity of the trauma apparently accounts for the failure of papilledema to develop, possibly by arresting axoplasmic production and transport in retinal nerve fibers.

Acute Disease↗
PubMed1984

Clinical significance of transient visual phenomena in the elderly.

To evaluate the significance of transient visual phenomena in the elderly patient, a retrospective study of 43 patients over 40 years of age (mean, 58) presenting between 1971 and 1982 was conducted. Historical, clinical and diagnostic features were collated and analyzed by computer. The study revealed that 31 patients were diagnosed as migraine and 12 as vertebrobasilar insufficiency based on features identified in this review. Follow-up was obtained in 90% of the patients with a mean follow-up of 2.4 years. In general, prognosis proved to be excellent, with two deaths of cardiac origin and an 81% incidence of remission or symptomatic improvement of the visual events. No retinal or cerebral strokes were observed and TIAs occurred in only 9% of the population. This study suggests that transient visual phenomena in the elderly are benign.

Adult↗
PubMed1984

Neuro-ophthalmology of sphenoid sinus carcinoma.

Three cases of sphenoid sinus carcinoma observed personally and 39 identified in the English language publications are reviewed. Sphenoid carcinoma constitutes only 0.3 per cent of sinus cancer. Its symptoms and signs are nonspecific until the sinus wall is penetrated. Once breached, specific neuro-ophthalmological symptoms and signs ensue, resulting from involvement of anatomically contiguous structures. These are characterized most commonly by the sphenocavernous syndrome and less frequently by isolated sixth nerve palsies and visual loss. Identified best by plain radiography, polytomography and computerized tomography, diagnosis of sphenoid carcinoma requires direct biopsy. Treatment, principally with radiotherapy supplemented by chemotherapy, has been disappointing with most patients dead by three years. The authors believe that in rapidly evolving neuro-ophthalmological syndromes of basal origin, accompanied by intractable headache, sphenoid sinus cancer must be considered.

Blepharoptosis↗
PubMed1978

Dural arteriovenous fistula and spontaneous choroidal detachment: new cause of an old disease.

A case is presented in which bilateral spontaneous choroidal detachments appear to be the direce result of bilateral dural arteriovenous fistula of the cavernous sinus region. Rapid resolution of the clinical signs followed bilateral orbital decompression via the transfrontal approach. Similarities in clinical presentation of both entities are reviewed and a premise for their cause-and-effect relationship elaborated. A literature search for similar unrecognised cases is discussed. The paper suggests that this association may be more frequent than published reports would imply.

Aged↗
PubMed1978

Blue-domed cyst with optic nerve compression.

A patient presenting with persistent headache of vascular quality and an intermittently progressive chiasmal syndrome had a blue-domed haemorrhagic cyst beneath the right optic nerve and underwent surgical drainage with good results. As prompt surgical intervention may proivde significant return of visual function, detailed diagnostic evaluation of similar cases is recommended.

Adult↗
PubMed1977

Amaurosis fugax from disease of the external carotid artery.

Three patients with proved internal carotid artery occlusion and diseased external carotid artery or common carotid artery had amaurosis fugax. Evidence for retinal embolization through external carotid collaterals is retinal emboli and infarction after carotid artery manipulation, amaurosis during external carotid angiography, and relief of amaurosis by endarterectomy of this vessel. The abundance of external carotid collaterals, their size, and natural incidence are discussed. Reports clinically support embolization to the central retinal artery and ophthalmic artery through these collaterals.

Arteriosclerosis↗
PubMed1977

Smith-Lemli-Opitz syndrome: neuropathological and ophthalmological observations.

The case of a three-year-old boy with the Smith-Lemli-Opitz syndrome is reported. In addition to the constellation of skeletal and genital anomalies classically described in this syndrome, this patient had spontaneous opsoclonus-like eye movements, strabismus, lack of visual following responses and of opticokinetic reflexes. At autopsy the cerebellar vermis was found to be absent. There were retinal hemangiomas. Microscopical examinations showed loss of Purkinje cells and extensive neuronal degeneration within dentate nuclei, associated with patchy demyelination of cerebellar peduncles and central white matter. These findings may contribute to the explanation of the pathophysiology of opsoclonus and some of the neuro-ophthalmological findings.

Abnormalities, Multiple↗
PubMed1975

Embolic posterior cerebral artery occlusion secondary to spondylitic vertebral artery compression. Case report.

The authors report a case of isolated homonymous hemianopsia secondary to embolic occlusion of the posterior cerebral artery. The cause of embolism was demonstrated to be spondylitic vertebral artery compression. The importance of arteriography is emphasized since the clinical syndrome may be nonspecific and myelographic or plain x-ray changes may be minimal. Surgical therapy is also discussed.

Adult↗