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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The interaction between ophthalmology and society. History suggests strategy.
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The levator-trochlear muscle. A supernumerary orbital structure.
A supernumerary extraocular muscle was present in seven of 98 cadaver orbits. The muscle originates from the medial border of the levator palpebrae superioris and has a diaphanous insertion on the fascia in the region of the trochlea and other nearby structures. Innervation is from a branch of the superior division of the oculomotor nerve. The muscle has been called the tensor trochleae in the past, but since its action is not apparent, it is more appropriately named the levator-trochlear muscle. It could be the cause of otherwise poorly understood forms of ocular deviations.
Definitions of the quality of the medical care: a strategy for segmentation of the health care market.
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Hemorrhagic valsalva retinopathy in Leber's optic neuropathy.
A patient with acute Leber's optic neuropathy had a large splinter retinal hemorrhage noted after he had strained to install fire hydrants. The hemorrhage occurred at a site of peripapillary telangiectasia, which is a feature of this condition. The pathogenesis of the process is discussed.
The shape of the trochlea.
Dissections and serial sections of human orbits showed the shape of the trochlea to be more complex than has been previously described. A grooved cartilaginous flange extends posterolaterally from the front of the trochlea, guiding the reflected portion of the superior oblique tendon.
Peripheral innervation of extraocular muscles.
In order to avoid injury to the nerves supplying the extraocular muscles during orbital surgery, I studied the anatomy of these nerves in five human orbits that had been serially sectioned. Each of the nerves, except for the trochlear, exists as bundles of fascicles rather than as a discrete trunk. I made two other observations of surgical importance. First, the nerve to the inferior oblique muscle may pass through the belly of the inferior rectus muscle and then course beneath it before it reaches its normal position. Second, a fibrous septum at the orbital apex separates the abducent nerve from the other motor nerves.
Progressive visual loss in syphilitic optic atrophy.
A 62-year-old man had progressive visual loss from neurosyphilis while his optic disks appeared atrophic. At no time was there evidence of inflammation of the globe or of either optic disk. The presence of an extremely high IgG index and five oligoclonal bands in the cerebrospinal fluid indicated that the central nervous system was synthesizing antibody specific to Treponema pallidum. Recent investigations indicate that much larger doses of penicillin are necessary for adequate treatment of neurosyphilis than have been recommended previously.
Ophthalmodynamometry reveals retinal embolus.
Suction ophthalmodynamometry made an otherwise invisible retinal embolus appear by attenuating the overlying blood column. Observation of the entire posterior pole while the intraocular pressure is at diastole could enhance our ability to detect retinal emboli.
Late ocular hypotony following intracapsular cataract extraction: probable relation to premature resorption of polyglactin 910 sutures.
We have recently had a series of seven patients who developed late ocular hypotony, flat anterior chambers, and choroidal detachments following cataract surgery. In each case, there was evidence of premature dissolution of the polyglactin 910 sutures that were used for closure. From this experience we propose steps that can be taken to minimize such problems.
Recognition of carotid stenosis with bilateral simultaneous retinal fluorescein angiography.
In order to study the arm to retina circulation time (ARCT), we simultaneously photographed both fundi in patients with suspected or known carotid artery occlusive disease. Noninvasive carotid artery tests, selective carotid arteriography, or both, were performed on all of the patients. In the 11 patients with arteriographically proven significant carotid stenosis, or with noninvasive carotid tests demonstrating carotid occlusive disease, a triad of fluoroangiographic features (delayed ARCT, disparity of ARCT between eyes, and delayed ciliary circulation at the optic disc) was found. We believe that bilateral simultaneous retinal fluorescein angiography is a sensitive and accurate method for the recognition of patients with carotid artery occlusive disease.
Calcium emboli to the retinal artery in calcific aortic stenosis.
It is generally appreciated in the cardiovascular literature that calcium emboli to a central retinal artery or its branches may be the presenting feature of otherwise uncomplicated calcific aortic stenosis. The ophthalmologic literature provides good evidence for this point. Over a 7-month period, four such cases have come to our attention. Other potential sources of emboli were excluded by standard noninvasive and invasive diagnostic techniques, and two patients underwent successful aortic valve replacement. Previous studies of calcific aortic stenosis have demonstrated postmortem histologic evidence of calcium emboli to various organs, for example, heart, kidney, or brain. Since these emboli are small, their occurrence is clinically silent. The retinal circulation is unique in that its occlusion by a calcium microembolus results in loss of vision, and this symptom may be a clue to the presence of calcific aortic stenosis.
Transcranial enucleation for optic nerve tumor.
Tumors involving both the eye and the optic nerve present a special surgical problem. Conventional enucleation techniques neither permit the surgical exploration of the optic nerve nor assure the complete removal of tumor within the orbit, and they often involve transection through tumor-containing tissue. Transcranial enucleation permits the inspection of the tumor from the back of the globe to the chiasm and its en bloc removal.