Arterial below the knee bypass grafts. Experience with the modified bovine heterograft

Fourteen patients underwent femoral-below the knee bypass grafting with the bovine heterograft with an initial patency rate of 64 per cent. If reopened grafts are included, the patency rate is 61 per cent. Therefore, it appears that the bovine graft is an excellent alternative when suitable saphenous vein is not available for below the knee grafts.     

Neuroanatomical correlates of selective downgaze paralysis

A 56-year-old woman had the sudden onset of a selective paralysis of downgaze associated with a partial third nerve paralysis on the right. On numerous examinations over the ensuing 3 and $\text{3}\text{4}$ years, these deficits were observed to persist. At autopsy, bilateral somewhat asymmetrical cavitated lesions were seen in the region of the thalamo-mesencephalic junction. Because this patient's selective downgaze paralysis was permanent, it is concluded that the supranuclear neural elements mediating downgaze are situated within the confines of these lesions. A consideration of the present case together with previous reports of selective vertical gaze paralysis permits the relevant region to be further localized to an area extending from the oculomotor nucleus to the rostral pole of the red nucleus and immediately dorsomedial to the latter. This is likely to be the location of the human analogue of the monkey “nucleus of the prerubral fields”, a supranuclear structure which is thought to mediate vertical gaze and especially downgaze.     

Inadequate behavior analysis: The achilles heel of outcome research in behavior therapy

In contrast to clinical practice, behavior analysis has figured but little in behavior therapy outcome research. Misconception-based fears have not been separated from those based on direct emotional (autonomic) conditioning, and in the latter category little attempt has been made to distinguish and separate cases with different antecedents of anxiety that might require different treatments. As a result, practically all outcome research comparisons have involved subject groupings of uncertain and non-uniform constitution, from which few valid deductions can be made.     

Osteomyelitis caused by Veillonella

Veillonella parvula and alcalescens are anaerobic gram-negative cocci that, when isolated from anaerobic cultures of clinical specimens, are usually regarded as commensal organisms. Occasionally they play a pathogenic role and require antibiotic therapy. Limited clinical experience and in vitro susceptibility studies suggest that penicillin G is the drug of choice for these organisms and that cephalosporins, clindamycin, chloramphenicol, and metronidazole may be acceptable therapeutic alternatives. Presented herein is a case report of a Veillonella infection, a discussion of the importance of these organisms when they occur in a clinical infection, and a discussion of the appropriate antibiotic therapy.     

Human Electropharmacology of Tocainide, a lidocaine congener

The electropharmacology of tocainide, an orally active congener of lidocaine, was evaluated in 10 patients with coronary artery disease. Electrophysiologic measurements including sinus nodal recovery time, sinoatrial conduction time, intraatrial conduction time, atrial, atrioventricular (A-V) nodal and ventricular refractory periods and intraventricular conduction time were obtained before and after intravenous infusion of tocainide. At blood levels shown to be effective against ventricular arrhythmias, tocainide produced no statistically significant changes in the electrophysiologic measurements, although occasional marked individual effects were observed. No side effects were observed during these studies. No adverse effects on A-V conduction were observed in patients with an intraventricular conduction disturbance or a prolonged control H-V interval. Thus, plasma tocainide concentrations effective in the therapy of ventricular arrhythmias exert no adverse effects on cardiac electrophysiologic properties in patients with coronary artery disease.     

An unusual case of pleural, epididymal and sternoclavicular tuberculosis

A patient with pleural, epididymal and sternoclavicular tuberculosis is described in whom the history suggests that primary infection occurred near the time when he was involved in a fight. Epididymal and sternoclavicular lesions represent infection of loci minoris resistentiae secondary to traumatic injuries sustained in the fight and provide evidence for the concept of tuberculous bacillaemia accompanying primary infection.