ability, and, second, the skier should wear a pair of cut-off jeans or a short wet-suit. R.F. EDINOTON, MD, FRCs[C]
136 Durham St. S Sudbury, Ont.
Reference 1. L.smx JE, BEAUKNIGHT C, TWEEDALE P: in Collected Letters, International
Society of Obstetricians and Gynecologists, Lakeland, Fla., ser 15, Apr 15, 1974, p 61
The controversial internship To the editor: Dr. D. Laurence Wilson's editorial urging that medical graduates be made to serve a 3-year internship before entering general
practice is ridiculous (Can Med AsSoc J 118: 879, 1978). If medical schools cannot do an adequate job in the present 4- plus 1-year system, then we should look towards replacing large areas of so-called "basic" science training with clinical training. I believe, however, that the
present system is adequate. Lord save us from a 3-year internship. Cmus BLOUNT, MD,
blood loss into the amniotic cavity or per vaginam. It is necessary to note such details when one is trying to assess the potential causes of fetal bleeding, since clearly the problem posed in their first patient was remarkably different from the problem posed by their fourth patient. It would be useful and helpful to know whether there was any primary placental abnormality in patient 4 and whether the vessels in patients 1, 2 and 3 showed any of the changes described by others in spontaneous rupture of fetal vessels and placental surfaces.1 In a previous paper it was shown that a spontaneous subamniotic hematoma, as in patient 1 of Akhter and colleagues, was often associated with distinct abnormalities in the vessel wall, which suggested a relatively prolonged development of vascular lesions in the fetal circulation prior to rupture.1 These criticisms aside, Akhter and associates are to be congratulated for once more drawing our attention to the dangers posed by fetal blood loss. DJ. DESA, MB, D PHIL, MRC PATh
Department of pathology
Intern Dalhousie Family Medicine Centre Halifax, NS
Fetal exsanguination associated with antepartum hemorrhage To the editor: The paper by Dr. M.S.
McMaster University Hamilton, Ont.
Reference 1. DESA DJ: Rupture of fetal vessels on placental surface. Arch Dis Child 46: 495, 1971
Akhter and associates (Can Med Assoc J 118: 651, 1978) re-em-
cord. It would have been interesting to know the approximate volume of blood loss and its relation to the body weight of the infant, and whether the vessel wall showed any abnormalities near and away from the tear. Patients 2 and 3 had small ruptures of the cord vessels, but again no description of the cord vessels or the estimated size of the hematoma is provided. In patient 4 there was obvious evidence of feto-
maternal bleeding without frank fetal
highly effective in acute or recurrent cystitis, pyelitis and pyelonephritis
* bactericidal against major G.U. pathogens * double blockade activity discourages development of resistance * achieves therapeutic levels in both serum and urine * may be effective against sulfonamide-resistant strains * convenient b.i.d. dosage schedule * available in tablets or pleasant-tasting suspension * SEPTRA . Summary (Trimethoprim +Suttamethoxazole) INDICATIONS AND CLINICAL USES: Indicated for the following
infections when caused by susceptible organisms: URINARY TRACT INFECTtONS - acute, recurrent and chronic. GENITAL TRACT INFECTIONS - uncomplicated gonococcal urethritis. UPPER AND LOWER RESPtRATORY TRACT INFECTIONS particularly chronic bronchitis and acute and chronic otitis media. GASTROINTESTINAL TRACT INFECTIONS. SKIN AND SOFT TISSUE INFECTIONS SEPTRA is not indicated in intections caused by Pseudomonas, Mycoplasma or viruses. This drug has not yet been fully evaluated in streptococcal infections. CONTRAINDICATIONS: Patients with evidence of marked liver parenchymal damage, blood dyscrasias, known hypersensitivity to trimethoprim or sulfonamides, marked renal impairment where repeated serum assiys cannot be carried ouE premature or newborn babies during the first few weeks of life. For the time being SEPTRA is contraindicated during pregnancy. It pregnancy cannot be excluded, the possible risks should be balanced against the expected therapeutic effect. PRECAUTIONS: As with other sulfonamide preparations, critical appraisal of benefit versus risk should be made in patients with liver damage, renal damage, urinary obstruction, blood dyscrasias, allergies or bronchial asthma. The possibility of a superintection with a non-sensitive organism should be borne in mind.
DOSAGE AND ADMINISTRATION: Adults and children over 12
phasizes the importance of fetal Signing of absentee bleeding as a cause of perinatal medical certificates mortality and morbidity. If any criti- To the editor: I have read with incism can be leveled at their paper it terest the very appropriate editorial is the relative lack of histologic in- by Dr. N.P. Da Sylva (Can Med Asvestigation of the placenta in all Soc J 118: 881, 1978). I fully agree cases. with him that physicians should not The authors describe the first pa- be forced into becoming truant oftient as having a subamniotic hema- ficers - we caution them against toma around the insertion of the
SEPYRA
this.
One particular incident illustrates this very well. A couple of years ago, contrary to a labour contract, 13 workers walked out of a plant at 10 am. The company, as its part of the game, sent a telegram to each of the workers stating that they should not report back to work without a medical certificate. All the employees returned with a medical certificate and in only two instances was the same physician involved. Therefore, 12 physicians had signed
years. Standard dosage: Two Septra tablets or one Septra DS tablet twice daily (morning and evening). Minimum dosage and dosage for long-term treatment: One Septra tablet or one-half Septra OS tablet twice daily. Maximum dosage: Overwhelming infections: Three Septra tablets or one and one-half Septra OS tablets twice daily. Uncomplicated gonorrhea: Two Septra tablets or one Septra OS tablet tour times daily for 2 days. Children 12 years and under I Young children should receive a dose according to biological age: Children under 2 years: 2.5 ml pediatric suspension twice daily. Children 2 to 5 years: One to two pediatric tablets or 2.5 to 5 ml pediatric suspension twice daily. Children 6 to 12 years: Two to four pediatric tablets or 510 10 ml pediatric suspension or one adult tablet twice daily. (Septra OS tablets should not be used for children under 12 years.) tIn children this corresponds to an approximate dose of 6 mg trimethoprim/kg body weight/day, plus 30mg sulfamethoxazole/kg body weight/day, divided into two equal doses. DOSAGE FORMS: SEPTRA TABLETS, each containing 80 mg trimethoprim and 400 mg sultamethoxazole, and coded WELLCOME Y2B. Bottles of 100 and 500, and unit dose packs of .100. SEPTRA OS TABLETS, each containing 160 mg trimethoprim and 800 mg sulfamethoxazole, and coded WELLCOME 02C. Bottles of 50 and 250. SEPTRA PEDIATRIC SUSPENSION, each teaspoonful (5 ml) containing 40 mg trimethoprim and 200 mg sultamethoxazole. Bottles of 100 and 400 ml. SEPTRA PEDIATRIC TABLETS, each containing 20 mg trimethoprim and 100 mg sultamethoxazole, and coded WELLCOME H4B. Bottles of 100. Product monograph available on request.
. Burroughs Weilcome Ltd. LaSalle, 0u6. 'Trade Mark
W-6014
CMA JOURNAL/AUGUST 26, 1978/VOL. 119 311
136 Durham St. S Sudbury, Ont.
Reference 1. L.smx JE, BEAUKNIGHT C, TWEEDALE P: in Collected Letters, International
Society of Obstetricians and Gynecologists, Lakeland, Fla., ser 15, Apr 15, 1974, p 61
The controversial internship To the editor: Dr. D. Laurence Wilson's editorial urging that medical graduates be made to serve a 3-year internship before entering general
practice is ridiculous (Can Med AsSoc J 118: 879, 1978). If medical schools cannot do an adequate job in the present 4- plus 1-year system, then we should look towards replacing large areas of so-called "basic" science training with clinical training. I believe, however, that the
present system is adequate. Lord save us from a 3-year internship. Cmus BLOUNT, MD,
blood loss into the amniotic cavity or per vaginam. It is necessary to note such details when one is trying to assess the potential causes of fetal bleeding, since clearly the problem posed in their first patient was remarkably different from the problem posed by their fourth patient. It would be useful and helpful to know whether there was any primary placental abnormality in patient 4 and whether the vessels in patients 1, 2 and 3 showed any of the changes described by others in spontaneous rupture of fetal vessels and placental surfaces.1 In a previous paper it was shown that a spontaneous subamniotic hematoma, as in patient 1 of Akhter and colleagues, was often associated with distinct abnormalities in the vessel wall, which suggested a relatively prolonged development of vascular lesions in the fetal circulation prior to rupture.1 These criticisms aside, Akhter and associates are to be congratulated for once more drawing our attention to the dangers posed by fetal blood loss. DJ. DESA, MB, D PHIL, MRC PATh
Department of pathology
Intern Dalhousie Family Medicine Centre Halifax, NS
Fetal exsanguination associated with antepartum hemorrhage To the editor: The paper by Dr. M.S.
McMaster University Hamilton, Ont.
Reference 1. DESA DJ: Rupture of fetal vessels on placental surface. Arch Dis Child 46: 495, 1971
Akhter and associates (Can Med Assoc J 118: 651, 1978) re-em-
cord. It would have been interesting to know the approximate volume of blood loss and its relation to the body weight of the infant, and whether the vessel wall showed any abnormalities near and away from the tear. Patients 2 and 3 had small ruptures of the cord vessels, but again no description of the cord vessels or the estimated size of the hematoma is provided. In patient 4 there was obvious evidence of feto-
maternal bleeding without frank fetal
highly effective in acute or recurrent cystitis, pyelitis and pyelonephritis
* bactericidal against major G.U. pathogens * double blockade activity discourages development of resistance * achieves therapeutic levels in both serum and urine * may be effective against sulfonamide-resistant strains * convenient b.i.d. dosage schedule * available in tablets or pleasant-tasting suspension * SEPTRA . Summary (Trimethoprim +Suttamethoxazole) INDICATIONS AND CLINICAL USES: Indicated for the following
infections when caused by susceptible organisms: URINARY TRACT INFECTtONS - acute, recurrent and chronic. GENITAL TRACT INFECTIONS - uncomplicated gonococcal urethritis. UPPER AND LOWER RESPtRATORY TRACT INFECTIONS particularly chronic bronchitis and acute and chronic otitis media. GASTROINTESTINAL TRACT INFECTIONS. SKIN AND SOFT TISSUE INFECTIONS SEPTRA is not indicated in intections caused by Pseudomonas, Mycoplasma or viruses. This drug has not yet been fully evaluated in streptococcal infections. CONTRAINDICATIONS: Patients with evidence of marked liver parenchymal damage, blood dyscrasias, known hypersensitivity to trimethoprim or sulfonamides, marked renal impairment where repeated serum assiys cannot be carried ouE premature or newborn babies during the first few weeks of life. For the time being SEPTRA is contraindicated during pregnancy. It pregnancy cannot be excluded, the possible risks should be balanced against the expected therapeutic effect. PRECAUTIONS: As with other sulfonamide preparations, critical appraisal of benefit versus risk should be made in patients with liver damage, renal damage, urinary obstruction, blood dyscrasias, allergies or bronchial asthma. The possibility of a superintection with a non-sensitive organism should be borne in mind.
DOSAGE AND ADMINISTRATION: Adults and children over 12
phasizes the importance of fetal Signing of absentee bleeding as a cause of perinatal medical certificates mortality and morbidity. If any criti- To the editor: I have read with incism can be leveled at their paper it terest the very appropriate editorial is the relative lack of histologic in- by Dr. N.P. Da Sylva (Can Med Asvestigation of the placenta in all Soc J 118: 881, 1978). I fully agree cases. with him that physicians should not The authors describe the first pa- be forced into becoming truant oftient as having a subamniotic hema- ficers - we caution them against toma around the insertion of the
SEPYRA
this.
One particular incident illustrates this very well. A couple of years ago, contrary to a labour contract, 13 workers walked out of a plant at 10 am. The company, as its part of the game, sent a telegram to each of the workers stating that they should not report back to work without a medical certificate. All the employees returned with a medical certificate and in only two instances was the same physician involved. Therefore, 12 physicians had signed
years. Standard dosage: Two Septra tablets or one Septra DS tablet twice daily (morning and evening). Minimum dosage and dosage for long-term treatment: One Septra tablet or one-half Septra OS tablet twice daily. Maximum dosage: Overwhelming infections: Three Septra tablets or one and one-half Septra OS tablets twice daily. Uncomplicated gonorrhea: Two Septra tablets or one Septra OS tablet tour times daily for 2 days. Children 12 years and under I Young children should receive a dose according to biological age: Children under 2 years: 2.5 ml pediatric suspension twice daily. Children 2 to 5 years: One to two pediatric tablets or 2.5 to 5 ml pediatric suspension twice daily. Children 6 to 12 years: Two to four pediatric tablets or 510 10 ml pediatric suspension or one adult tablet twice daily. (Septra OS tablets should not be used for children under 12 years.) tIn children this corresponds to an approximate dose of 6 mg trimethoprim/kg body weight/day, plus 30mg sulfamethoxazole/kg body weight/day, divided into two equal doses. DOSAGE FORMS: SEPTRA TABLETS, each containing 80 mg trimethoprim and 400 mg sultamethoxazole, and coded WELLCOME Y2B. Bottles of 100 and 500, and unit dose packs of .100. SEPTRA OS TABLETS, each containing 160 mg trimethoprim and 800 mg sulfamethoxazole, and coded WELLCOME 02C. Bottles of 50 and 250. SEPTRA PEDIATRIC SUSPENSION, each teaspoonful (5 ml) containing 40 mg trimethoprim and 200 mg sultamethoxazole. Bottles of 100 and 400 ml. SEPTRA PEDIATRIC TABLETS, each containing 20 mg trimethoprim and 100 mg sultamethoxazole, and coded WELLCOME H4B. Bottles of 100. Product monograph available on request.
. Burroughs Weilcome Ltd. LaSalle, 0u6. 'Trade Mark
W-6014
CMA JOURNAL/AUGUST 26, 1978/VOL. 119 311
