Consciousness: a neurobiological approach.

Consciousness and the disorders of consciousness can be more fully understood once they are integrated with the neurobiology of mental events. After a review of animal and human research, we found several anatomical structures in the central nervous system are required for consciousness. Identification of the critical structures, however, depends on what is meant by consciousness. In the general sense of mental responsivity, the reticular activating system must be intact. Consciousness has also been defined as the awareness of the sights, sounds, and feelings of everyday experience. In this sense, the system of sensory inputs and outputs of the anterior temporal cortex, amygdala, and the hippocampus must be functional. There is no neural evidence for "higher" consciousness.

Gaze-induced amaurosis from central retinal artery compression.

Color Doppler imaging was used to evaluate a patient with gaze-induced amaurosis caused by an intraconal orbital mass. The time-velocity waveform demonstrated abnormally high vascular resistance in the central retinal artery of the affected eye in the primary position. Abduction of the affected eye resulted in transient visual loss with an unreactive pupil. This same maneuver during color Doppler imaging resulted in a dramatic reduction of blood flow in the central retinal artery. Two months after surgical excision of the mass, the gaze-evoked amaurosis was no longer present, and color Doppler imaging demonstrated normal blood flow in the central retinal artery. This suggests that impaired retinal and optic nerve blood flow are responsible for gaze-induced amaurosis from compressive orbital lesions.

A comparison of two methods of punctal occlusion.

We performed punctal occlusion by thermal cautery on 23 patients (45 sides, 90 puncta). One punctum on the right side was randomly assigned to deep cauterization of the punctum and vertical canaliculus, and the other punctum assigned to cauterization of the punctum only. The two treatments were assigned to the opposite puncta on the left side. One month after cauterization, the puncta that received deep cauterization were significantly more likely to have remained closed than those that received superficial cauterization (P less than .01). Survival analysis over a period of follow-up that exceeded one year after surgery, using time to examination because of a reopened punctum as the endpoint, indicated a long-term advantageous effect of deep over superficial cauterization.

The development of physiatry before 1950.

The early development of physiatry as a specialty must be credited to a small group of men who were literally giants in the roles they played in the evolution of physiatry and of the American Academy of PM&R. Of those very early leaders, John S. Coulter, Frank H. Krusen, William Bierman, and Richard Kovacs stand out for their inspirational and conceptual leadership regarding the potentials of physiatry. The field will forever be indebted to Walter J. Zeiter for his administrative and executive abilities. Howard A. Rusk earned the approbation "Father of Rehabilitation Medicine" when he first demonstrated that rehabilitation of the ill and injured made it possible to restore meaning to life and at the same time reduce the duration and costs of disability. Finally, it is important that we appreciate the role George C. Deaver played as the progenitor, or perhaps "Grandfather" of physical medicine and rehabilitation. Although he was not an organization man--and in fact appears to have shunned them--he was the first physiatrist to use all the available tools of PM&R to rehabilitate the spinal cord injured, the patients with cerebral palsy, with the muscular dystrophies, with multiple sclerosis, and rheumatoid arthritis. At a time when these patients were being rejected and discarded as permanently disabled, Deaver was accepting them and patiently working with them to achieve the best possible outcomes through rehabilitation. And now, on to the 1950s. . .