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.

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.

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.

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.

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.

Short posterior ciliary artery insufficiency with hyperthermia (Uhthoff's symptom).

Transient visual blurring with heart or exercise (Uhthoff's symptom) is associated with multiple sclerosis. To our knowledge, this is the first report of its occurrence in cases of documented vascular disease. Two patients had insufficiency of the short posterior ciliary circulation. In one it was caused by a carotid occlusion and in the other by cranial (giant-cell, temporal) arteritis. The monocular blurring may have occurred during periods of relative arterial hypotension.

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.

Computed tomographic findings in cerebral arterial ectasia.

The computed tomographic findings in 15 patients with angiographically documented cerebral arterial ectasia are reported. In addition to demonstrating the majority of pathologic arterial segments, computed tomography also documents the presence and extent of associated intracranial abnormalities. In this study these included cerebral atrophy (10 patients), infarction (three patients), and subarachnoid hemorrhage (one patient).

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.

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.

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.

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.