designedtopenetrate wax. ov o - Europe PMC

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Indications. Depression: Neurotic or psychotic depressions including: reactive depression, endogenous depression, involutional melancholia, senile depression,.
larger doses; plasma values after sublingual and oral administration in their patients were very low at 1/2 and 1 hour, respectively. Therefore, although there may or may not be hepatic biotransformation of orally administered ISDN, as suggested by Needleman and colleagues,1'2 enough of the drug appears to escape degradation by the liver to produce plasma concentrations 7 times higher, and lasting 5 hours longer, than those produced by sublingual administration, or 15 times higher, and lasting 4 to 6 hours longer, than those produced by the oral administration of conventional doses (e.g., 10 mg tid and hs). The results of my study indicate that ISDN is more effective when administered orally and in larger doses than are conventional. This finding may be important in the rational medical management of coronary artery disease. S.J. SHANE, MD, FRCP[C] Sunnybrook Medical Centre Toronto, Ont.

References 1. NEEDLEMAN P, HuNItR FE JR: The transformation of glyceryl trinitrate and other nitrates by glutathione-organic nitrate reductase. Mol Pharmacol 1: 77, 1965 2. NEEDLEMAN P, KRANZ JC JR: The biotransformation of nitroglycerin. Biochem Pharmacol 14: 1225, 1965 3. SHANE SJ: High-dose oral isosorbide dinitrate and ischemic heart pain. A preliminary

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report. Can Fam Physician 19 (11): 61, 1973 4. RosSEEL MT, BOOAERT MG: GLC determination of nitroglycerin and isosorbide dinitrate in human plasma. J Pharm Sci 62: 754, 1973

Breast-feeding To the editor: In view of the recent comments on the value of breast-feeding1'2 as a means of protecting infants from common diseases as well as from such diverse and occasionally lifethreatening conditions as obesity, colonization of the gastrointestinal tract by Escherichia coli, recurrent rhinorrhea, bronchiolitis, bronchopneumonia, necrotizing enterocolitis and sudden infant death syndrome, the time has come to stop the sale of milk formulas except on prescription until their safety can be established. Surely any other drug suspected of causing such morbidity and mortality would be banned. I am not suggesting that formula foods should not be available, because they can be of great value when used properly and under the guidance of a physician who has decided "that the expected benefits outweigh the possible risks". Undoubtedly it will be argued by the companies marketing them that it is not the product itself that is dangerous but the manner in which it is used. However, the same argument could be applied to the use of heroin. The company should anticipate that the use of the product by the general public will be less than perfect.

The otitis drop designed to penetrate wax. ov o 0 The only "otic with thonzonium bromide to help the active ingredients aet riaht to the site of infection - even throuah cerumen and debris. DESTROYS COMMON PATHOGENS-Provides the broad-spectrum bactericidal actions of colistin sulphate and neomycin sulphate. REDUCES SWELLING, RELIEVES ITCHING-Also contains the proven benefits of hydrocortisone acetate. Composition: Each ml. contains - Colistin base activity 3.0 mg. (as the sulphate); neomycin base activity 3.3 mg. (as the sulphate); hydrocortisone acetate 10.0 mg.; thonzonium bromide 0.5 mg. Dosage: Instil 4 drops b.i.d. Precautions: If sensitivity or irritation occurs, medication should be discontinued promptly. Overgrowth of resistant organisms is possible. Use with care in cases

with perforated eardrum or in long standing otitis media because of the possibility of ototoxicity caused by neomycin. Contraindications: COLY-MYCIN OTIC is contraindicated if there is a history of sensitivity to any of its components, or in tubercular, fungal, and most viral lesions, especially herpes simplex, vaccinia and varicella. Supplied: 5 ml. bottles. Full information is avaliable on request. ME MBE1R

(PMAC 3

WARNER/CHILCOTT Laboratories Co. Limited Toronto, Canada

CMA JOURNAL/SEPTEMBER 6, 1975/VOL. 113 361

Entamoeba cysts were found that could not be identified with certainty as to species. The high percent recovery rates for Ascaris lumbricoides, E. histolytica and Giardia lamblia are not unexpected, for these parasites are dependent on low levels of hygiene for their transmission via food or water. On the other hand, Trichuris trichiura and Endolimax nana, the most common parasites detected by routine stool exT. HANCOCK, MB, BS aminations,2 were found in this series Chipman, NB in remarkably low numbers, even References though they are transmitted by routes similar to those of the others. Also un1. GERRARD JW: Breast milk: a neglected asset (E). Can Med Assoc 1 112: 1281, *1975 usual were the two cases of infection 2. MYRES AW: Obesity: is it preventable in due to Isospora belli. Infection by this infancy and childhood? Can Fam Physician 21 (4): 73, 1975 parasite and the related Isospora hominis is generally considered rare alParasites in orphans from though the parasites are found worldSouth Vietnam wide. The incidence in defined populations may be high,3'4 but difficulties in To the editor: Shortly after the arrival recovering these parasites from stool in Toronto recently of a number of specimens may account for their aporphans from South Vietnam, the To- parent scarcity in the general popularonto parasitology laboratory of the tion.5 While infections by these two Ontario Ministry of Health began re- species of Isospora are generally conceiving stool samples for screening sidered mild and self-limiting, Brandtests. This letter reports the parasites borg, Goldberg and Breidenbach' confound in the first 40 samples (36 pa- cluded that they can cause a variety of tients) to alert physicians and others symptoms, including malabsorption, who may care for these and other damage to and abnormalities of the children before and after adoption. intestinal mucosa, and steatorrhea. Unpreserved stool samples subThese children form a rather homomitted by mail, approximately 1 day geneous group, probably with similar old on arrival, were processed by our backgrounds of institutional living unroutine formalin/ ether concentration der hygienic conditions that were less method and examined by trained, ex- than ideal, so it is not surprising that perienced personnel. Because our dou- the overall rate of recovery of parasites ble-bottle collecting kit, which permits from them is much higher than that greater recovery and diagnostic ac- found in routine examinations in this curacy,' had not been used for this laboratory2 or in immigrants from Farinitial series of samples, simple saline East Asian countries.6 However, the mounts were also examined. rate in this group of children, high as Of the 40 samples (from 36 patients), it is, is probably well below the actual 34 (85%) contained 1 or more para- rate because the method of collecting sites; the total number of parasites re- the samples was less than ideal. As covered was 74 (2.2 per positive sam- shown by Scholten and Yang,' protople). Thirteen different species were zoan trophozoites cannot be recovered identified (Table I). In three instances from "fresh", unpreserved stools unless Mothers will also protest because they are so overwhelmed by advertising that they are unable to see the convenience of breast-feeding and its numerous benefits. Thus, a policy change would have to be accompanied by a massive educational campaign to inform them of the dangers of bottlefeeding and the advantages of breastfeeding.

Table I-Parasites found in Vietnamese orphans according to age Age of orphan (yr) Total Parasite 0-1 1-2 2-3 3-4 4+ Unknown parasites Entamoeba histolytica 1 2 2 5 Entamoeba hartmanni 1 1 3 5 Entamoeba coli 2 1 6 9 Endolimax nana 1 4 5 Iodamoeba buetschlii 1 1 2 Unidentified amebae 1 2 3 Giardia lamblia 1 1 1 2 2 5 12 Chilomastix mesnili 1 1 Isospora belli 1 2 3 Ascaris lumbricoides 1 3 1 3 2 12 22 Trichuris trichiura 1 1 Hookworm 2 2 1 Strongyloides stercoralis 1 2 Hymenolepis nana 1 1 2 None found 3 2 1 Total samples 6 6 3 5 3 = *Percent recovery rate number of parasites/total samples X 100

362 CMA JOURNAL/SEPTEMBER 6, 1975/VOL. 113

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Recovery rate (%)* 12.5 12.5 22.5 12.5 5.0 7.5 30.0 2.5 7.5 55.0 2.5 5.0 5.0 5.0 15.0

New Tofranil@-SD tablets of

75mg and 150mg one dose lasts from bedtime to bedtime Brief Prescribing Information Tofranli Geigy Antidepressant/Anti-Enuretic Indications Depression: Neurotic or psychotic depressions including: reactive depression, endogenous depression, involutional melancholia, senile depression, the depressive phase of manic-depressive psychosis, depression associated with organic diseases, depression associated with other psychiatric disorders (i.e.: schizophrenia, alcoholism, mental deficiency) Persistentfunctional childhood enuresis

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The following dosage recommendations should be used as a guide. Depression Except in elderly patients, adolescents or children: one tablet (25 mg) three times daily initially, increased up to six tablets daily, if necessary. Dosage in excess of eight tablets (200 mg) daily is not recommended for office patients. More severe and hospitalized cases may require up to 300 mg daily. In elderly patients and adolescents: 30-40 mg daily, initially, increased by 10 mg daily to a maximum of 100 mg in the elderly. In suitable subjects, the maintenance dose may be administered in a single dose before bedtime.

Enuresis

For persistent, functional enuresis which has not responded to other forms of management, a therapeutic trial with Tofranil may be considered for children between 5 and 15 years old, who are not mentally defective, and in whom organic causes of enuresis have been excluded. The recommended dosage for such a trial is 10-25 mg one hour before bedtime for children 5 years or over. If there is no response, the dosage may be increased up to 50 mg, in children 12-15 years old. The trial period should be 2-4 weeks. If there is a relapse, the treatment can be repeated but the

drug should not be given for more than two months without discontinuing its administration and assessing the need for further drug therapy. Because the margin of safety is lower in children, the recommended dose should not be exceeded and the minimum effective dose should be used at all times. Tofranil is not otherwise recommended in children.

Contraindicatdons

Concurrent use of monoamine oxidase inhibitors is an absolute contraindication. Two weeks should elapse before Tofranil is prescribed for patients who have received MAOI drugs.

Precautions

Utmost caution is recommended when Tofranil is used in patients with corcnary thrombosis, angina pectoris, congestive heart failure, disorders of cardiac rate or rhythm or conduction, prostatic disorders with potential urinary retention, and glaucoma. If any patient develops fever, sore throat, and stomatitis, the drug should be discontinued and a complete differential white cell count performed. As with any drug, Tofranil should not be used during the first trimester of pregnancy unless in the opinion of the prescribing physician, the potential benefits outweigh the possible risks. Side effects Most are related to its anticholinergic action, such as, xerostomia, disturbances of accommodation, tachycardia, constipation and sweating. Some cases of hypotension and changes in atrioventricular conduction time have been reported. Although rare, tremor, skin rashes and blood dyscrasias may occur.

Availability

Each coral sugar-coated round tablet branded * in white, contains 25 mg imipramine HCI Geigy Standard. In boffles of 100 and 1,000. Also supplied in 10 mg triangular and 50 mg round, coral sugar-coated tablets branded 09 in white. Available in bottles of 50 and 100. Also supplied in 75 mg and 150 mg round, coral, sugarcoated tablets branded * in white. Available in bottles of 30 and 500. Full information is available on request.

Geigy Dorval, Quebec H9S 1 Bi

Gt-4091