Biomedical subjects
J G Sacks
Publications and source records attributed to J G Sacks.
The value of a new family practice center patient to the academic medical center.
BACKGROUND: Family practice centers are important contributors to the financial viability of academic health centers, although they often are not the direct beneficiaries of their own labor. The greater time commitment and lower costs of most primary care creates significant financial hardships for departments of family medicine in university centers. This study describes the use of inpatient and outpatient health care services by new patients at a university family practice center. METHODS: A sample of 215 new adult enrollees at a university family practice center were examined for a 1-year period after their initial visit to the center. Total billings by the university hospital, specialty services, and the family practice center were tabulated by insurance type. RESULTS: Medicare patients generated the highest average charges (+2501 per patient per year); self-indemnity patients generated the lowest average charges (+301 per patient per year). The largest portion of health services charges was generated by the university hospital inpatient service, which was responsible for approximately 60 cents of every dollar billed to patients in this study. Conversely, the Family Medicine Department billings generated only 17% of the total charges. CONCLUSIONS: The findings of this study indicate that university-based family practice centers are significant contributors to the financial and educational base of the academic health center. If family medicine and associated primary care centers are forced to reduce their size or services because of financial difficulties, the impact will be felt by the university hospitals and by other specialty departments.
Ophthalmologic screening of adults with mental retardation.
Ophthalmological screening was conducted on 113 clients in a work activity center for adults with mental retardation. Thirty-two percent had abnormalities that were neither refractive nor strabismic. We encountered no instance of neglect of current organic ocular disease. However, 37% of clients had at least one eye that either was not within one diopter of emmetropia or that was not corrected to within one diopter of their retinoscopic findings. Ophthalmologists should consider providing screenings in settings familiar to such clients, where they are more likely to be cooperative.
Treatment of exercise-induced transient visual events.
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Elevated intraocular pressure in dural shunt syndrome: a judgment on exercise.
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Suction ophthalmodynamometry in the diagnosis of carotid stenosis.
In a prospective evaluation of 39 patients who had arteriography for suspected carotid stenosis, suction ophthalmodynamometry correctly identified 86% of the patients who had radiographically demonstrable unilateral or asymmetric obstructions. This compares favorably with carotid compression tonography, oculoplethysmography, and Doppler flow studies. The false-positive rate was 27%, a figure higher than the latter two noninvasive tests.
Objective personality changes in residents of a therapeutic community.
The authors tested several groups of drug-abusing young adults who were residents of a drug-free therapeutic community. Three instruments were used: staff ratings, sociometric ratings by members of the community, and MMPI scores. All three measures showed objective evidence of decreasing psychopathology correlated with length of time in treatment, demonstrating the effectiveness of the therapeutic community in the rehabilitation of drug abusers. Individuals who left before completing treatment had MMPI scores indicating inability to develop social relationships; this elucidates a probable cause of the dropout phenomenon.
Basilar artery ectasia demonstrated by computed tomography.
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The pathogenesis of optic nerve drusen. A hypothesis.
Myriads of tiny perivascular drusen were found at histologic examination of the eyes of a 19-year-old patient who had pseudopapilledema and who died of a ruptured intracranial aneurysm. The possibility that they arose from constituents leaking from abnormal blood vessels prompted a review of 53 fluorescein retinal angiograms of patients with optic nerve drusen. As compared to a control group, many of these angiograms revealed the following abnormalities: (1) an abnormal branching pattern on the disc; (2) the presence of relatively large blood vessels connecting the superficial and deep disc circulations; and (3) increased disc capillarity. We believe that the tendency to develop optic nerve drusen results, at least in part, from a congenitally abnormal disc vasculature that allows transudation of plasma proteins that in turn serve as a nidus for the deposition of extracellular materials.
Cyst of the intraorbital optic nerve sheaths.
A 43-year-old woman had a history of gradual unilateral visual acuity loss and proptosis. A 2.5-cm cystic dilatation of the intraorbital dura mater was removed. Microscopic examination revealed a vascular proliferation within the leptomeninges. We inadvertently injected the lesion during orbitography, providing us with an unusual radiographic appearance.
Eye disorders: Looking at the eye for clues to systemic disease.
There are many systemic diseases in which eye signs detectable without an ophthalmoscope may be present. Examples are congenital glaucoma in neurofibromatosis, corneal involvement in mycosis fungoides, chloroma in leukemia, and uveitis and glaucoma in herpes zoster.
Transient eyelid retraction in myasthenia gravis.
Three patients with myasthenia gravis had transient retraction of the upper eyelids which usually followed prolonged upgaze and which persisted for many seconds. This could result from post-tetanic facilitation, myotonia, or a transient contracture. Retraction of this type is to be distinguished from both the long-standing unilateral retraction associated with ptosis of the contralateral eyelid and the fleeting lid twitch sign.
Bitemporal visual field defects in presumed multiple sclerosis.
Three patients with presumed multiple sclerosis had bitemporal hemianopia mimicking that caused by parasellar tumors; the visual loss was probably due to a plaque within the chiasm. The diagnosis of multiple sclerosis was made on the basis of a history of relapse and remission, signs and symptoms indicating involvement of different levels of the central nervous system, and normal neuroradiological studies. Extensive neuroradiological studies may be delayed or omitted in patients with established multiple sclerosis and nonprogressive bitemporal visual field defects if central visual acuity is not greatly reduced.
Letter: Third nerve palsy.
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