Delay in delivery of the Journal To the editor: On Jan. 21, 1977 I received two journals. One was the CMA Journal, published Jan. 8, 1977; the other was the New England Journal of Medicine, published Jan. 20, 1977. Why do I get a Canadian journal 2 weeks after publication and an American journal 1 day after publication? H.E. EMSON, MA, MD, FRcP[c] Department of pathology University Hospital Saskatoon, Sask.
[The answer to Dr. Emson's question is as follows: The Journal is mailed by third-class mail on the day of publication; NEJM is mailed by second-class mail - the newspaper rate - 1 week before the publication date. The Jan. 8, 1977 issue of the Journal was mailed to Dr. Emson from Montreal on Jan. 7, 1977 and took 2 weeks, which is reasonable for third-class delivery; the Jan. 20, 1977 issue of NEJM was mailed from Waseca, MN - relatively close to Canada - on Jan. 14, 1977 and took 1 week. The point made by Dr. Emson is a good one and the Journal would welcome information from readers concerning dates on which issues of the Journal are received. - Ed.]
one still has to add an increment required to accommodate an expanding population. The very evident shortages in some provinces must be considered as well. Dr. McKendry's statement in the last paragraph - to the effect that the disparity between my estimate and that of the original report relating to the needed number of ophthalmologists deserves prompt study - is very much to the point. The last sentence in his last paragraph shows how little he understands ophthalmology, the practice of ophthalmology, ophthalmologists and their capabilities. It is to be hoped more studies of this nature will serve to educate those who have influence in the decision-making that seems to be upon us. This much is owed the Canadian people. On the clearly hypothetical and invalid supposition that there may be an "ongoing overproduction" of ophthalmologists, Dr. McKendry outlines the difficulty of "retreading" ophthalmologists. What does he mean? Does he look upon the ophthalmologist as some sort of exclusive specialist, or technician, or possibly a form of optometrist with a courtesy medical degree? How uninformed can one be? We are basically physicians and surgeons with certain special technical skills, and no different from any other specialist.
Physician manpower requirements To the editor: May I reply to Dr. J.B.R. McKendry's comments (Can Med Assoc J 115: 983, 1976) relative to my criticism of the special report by Milan Korcok and D.A. Geekie on manpower requirements (Can Med Assoc J 115: 265, 1976)? In my original letter I said there are many imponderables in making medical manpower estimates. For instance, for some occult reason it is difficult to arrive at the exact number of practising ophthalmologists in Canada today; the number probably is at least 100 less than the figure of 780 given in the original article. (By ophthalmologists I do not mean physicians practising ophthalmology, but fully qualified ophthalmologists.) Included among the 780 mentioned in the report are some qualified ophthalmologists in administrative or semiadministrative positions, and some in semiretirement. The estimate of one ophthalmologist per 28 000 persons, as suggested by the committee report of the Council of Ontario Faculties of Medicine (COFM) (Boone report) had reference to full-time, fully qualified ophthalmologists. Dr. McKendry suggests that only 100 over and above the 780 will be required by 1981. On the above basis it is clear that a great many more than this, possibly twice as many, will be required, and
JOHN V.V. NICHOLLS, MD, FRCs[C] Clinical professor of ophthalmology University of Western Ontario London, Ont.
Found: alternative to the "Compendium of Pharmaceuticals and Specialties" (CPS) To the editor: After reading the letter by Dr. Warren Bell on the CPS (Can Med Assoc J 116: 349, 1977) I searched my cluttered desk to find an alternative to the CPS. I finally found one - The Medical Letter. According to Goodman and Gilman,1 "A very useful source of information on new drugs and therapeutics is the biweekly publication, The Medical Letter. Its distinguished board of editors provides a distinct service to medicine and to physicians by furnishing prompt, unbiased, pointed assessment of new drugs." The integrity of the Letter cannot be doubted. It is a nonprofit publication. Those familiar with the Letter may wonder how it is produced. Usually an expert in the field writes a draft. Then the draft is reviewed by the Letter's editors and advisers and by as many consultants as necessary, sometimes more than 30. When opinions differ, a consensus is arrived at. There are now laudable imitations of the Letter: Great Britain has the Drugs and
720 CMA JOURNAL/APRIL 9, 1977/VOL. 116
Pro-BanthTne for more than peptic ulcer INDICATIONS Pro-Banthine is indicated in peptic ulcer, functional gastrointestinal disturbances, ulcerative colitis, biliary dyskinesia, chronic hypertrophic gastritis, pylorospasm, acute and chronic pancreatitis, hypermotility of the small intestine not associated with organic change, ileostomies, irritable colon syndrome, diverticulitis, ureteral and urinary bladder spasm, hyperhidrosis. CONTRAINDICATIONS Glaucoma Obstructive disease of the gastrointestinal tract Obstructive uropathy due to prostatism Intestinal stony of elderly or debilitated patients Toxic megacolon complicating ulcerative colitis Hialal hernia associated with ref lux esophagitis Unstable cardiovascular adjustment in acute hemorrhage PRECAUTIONS Patients with severe cardiac disease should be given this medication with caution if even a slight increase in heart rate is undesirable. Fever and heat stroke may occur due to anhidrosis. Varying degrees of urinary hesitancy may occur in elderly patients with prostatic hypertrophy. In such patients urinary retention may be avoided if they are advised to micturate at the time of taking the medication. A decrease in bronchial secretion may lead to inspissation by these secretions and formation of mucus plugs especially in the elderly or debilitated with chronic pulmonary disease. ADVERSE EFFECTS Varying degrees of drying of salivary secretions may occur as well as mydriasis and blurred vision. In addition the following adverse reactions have been reported: nervousness, drowsiness, dizziness, insomnia, headache, loss of the sense of taste, nausea, vomiting, constipation, impotence and allergic dermatitis. Some of these effects are dose related. DOSAGE AND ADMINISTRATION Oral: Dosage should be individualized Pro-Banthine tablets (7.5 mg and 15 mg): the usual adult dosage is 7.5 mg to 15 mg of propantheline bromide with meals and 15 mg to 30 mg at bedtime. Patients with severe manifestations may require increased dosage up to 30 mg four times a day. Pro-Banthine P.A. (30 mg): the usual adult dosage is one tablet in the morning and one at night. Occasionally patients may require one tablet every 8 hours. Parenteral: Initial parenteral dose may be 30 mg or more every 6 hours intramuscularly or intravenously, depending on the condition for which it is administered and the requirements for prompt action. IM. solution - prepared by sterilizing the rubber cap with alcohol and injecting 1 ml of U.S.P. sterile water for injection into the ampoule. IV. solution - recommended that the contents of the 30 mg ampoule be dissolved in 10 ml of U.S.P. sodium chloride injection. COMPOSITION AND AVAILABILITY Pro-Banthine 7.5 mg: each white, round, convex, sugar-coaled tablet imprinted "Searle" on one side and "611 on the other contains 7.5 mg of propantheline bromide.
In bottles of 100 tablets. Pro-Banthlne 15 mg: each peach-coloured, sugar-
coated tablet imprinted "Searle" on one side and "601' on the other contains 15 mg of propantheline bromide. In bottles of 100, 1000 and 2500 tablets.
Pro-Banthlne P.A. (Prolonged ActIng): the core of each capsule-shaped, compression-coated, peach-coloured tablet, impressed "Searle" on one side and "651' on the other contains 30 mg of propantheline bromide in the form of sustainedrelease beads, about half being released within one hour of ingestion and the remainder released slowly as earlier increments are metabolized. In bottles of 50 and 500 tablets. Pro-Banthine VIALS: each vial contains 30 mg of propantheline bromide as a dry sterile powder for parenteral therapy following reconstitution. In boxes of 10 vials. Full prescribing information available on request
or in C.P.S.
Searle Pharmaceuticals Oakvglle, Ontario
INTERNATIONAL SYMPOSIUM ON GRAIN DUST AND HEALTH University of Saskatchewan Saskatoon, Canada November 7-9, 1977 CALL FOR ABSTRACTS This symposium will be held at the University of Saskatchewan, Saskatoon, Canada from November 7-9, 1977. Its purpose is to summarize current information related to the effects of grain dust on health, and to provide a framework to discuss future research in this area. Sessions will be devoted to 1) the pathophysiological mechanisms of grain dustinduced pulmonary disease; 2) the epidemiology of occupational pulmonary disease; 3) physiological changes with emphasis on early identification; and 4) the physical and biological characteristics of grain dust including methods of environmental monitoring. Both original and previously published material will be considered. Abstracts should be in English: 1. Approximately 150 words in length, typed and double spaced. Please provide an original and 6 copies. 2. Presentations will be limited to 10 minutes with 5 minutes for discussion. 3. Include the title of the paper, the authors, the full address and institution of the person presenting the paper. 4. Mail abstracts to: The International Symposium on Grain Dust and Health, Division of Pulmonary Medicine, University of Saskatchewan, University Hospital, Saskatoon, Saskatchewan, 57N OWS. 5. DeadlIne for Abstracts is July 15, 1977. If accepted, a full text of the presentation will be required for publication in the Proceedings of the Symposium. Financial assistance to help defray the cost of air fare and lodging is available. An estimate of air fare costs should be submitted with abstract. For non-participants, there will be a registration fee of $100.00. This symposium is sponsored by the University of Saskatchewan, Heal. and Welfare Canada, The Saskatchewan Workers' Compensation Board, The Saskatchewan Anti-TuberculosIs League and the Western Grain Elevators AssocIation. Chairman - J. A. DOSMAN Co-Chalmian - D. J. COtTON
Therapeutics Bulletin and France, La Lettre Mt.dicale d'Information, for example, but none has such a well organized network of consultants. There are now two Canadian physicians on the advisory board. According to marketing departments in the drug industry, The Medical Letter is a nuisance. Yet there have been of late some "favourable" assessments of new drugs. For example, dopamine (Desberger's Intropin) was approved with little restriction and labelled "an important new drug" in the treatment of shock, having "the advantage over previously available catecholamines of a direct beneficial effect on renal blood flow".2 Who can ask for a better rating? The new nonsteroid anti-inflammatory drugs were labelled as "useful in treatment of rheumatoid arthritis" in the last September issue.3 The new antiseptic chlorhexidine (Hibitane-Ayerst) was also well rated last October.4 The scope of the Letter is no longer restricted to providing information just on drugs. There have recently been articles on colonoscopy, aortocoronary bypass, food additives, surgery for obesity, cardiac pacemakers, frostbite, surgery for colitis, influenza vaccination, water fluoridation, elastic stockings, high-fibre diet, ultrasound, radiographic therapy, mammography, cyclamates, allergy tests, poison ivy, intravenous fluid filters, intrauterine devices, pregnancy tests, treatment of hemorrhoids and mineral supplements. There is something for everyone. The Medical Letter covers areas of medical practice where decisions about whether to use a procedure are difficult to make. The Medical Letter on Medical Procedures might be a more appropriate name. New information on old and new drugs is now produced at such a rate that textbooks become obsolete, and the only alternative to reading the Letter would be to read all drug reviews appearing in the major medical journals. The Medical Letter requires 1 minute a day (15 minutes to read the few pages issued every other week). The presentation is tailored to the busy practitioner; it is usually limited to 4 pages, short paragraphs, concise sentences and few references. There is no equivalent in other areas of medical literature. A practitioner who does not have the time to read The Medical Letter does not have the time to read - in that case, may God help his patients. PIERRE BIRON, MD Department of pharmacology Faculty of medicine University of Montreal Montreal, PQ
References 1. GOODMAN LS, GILMAN A (eds): Pharmaco-
724 CMA JOURNAL/APRIL 9, 1977/VOL. 116
logical Basis of Therapeutics, 5th ed, Riverside, NJ, Macmillan, 1975 2. Dopamine for treatment of shock. Med Leit Drugs Ther 17: 13, 1975 3. New drugs for arthritis. Med Lea Drugs Ther 18: 77, 1976 4. Chiorhexidine and other antiseptics. Ibid, p 85
Tribute to AD. Kelly To the editor: Among the many tributes to the late A.D. Kelly that must be reaching your desk, the undersigned wish to include a record of the modest obsequies celebrated in Vancouver in memory of this charming doyen of contemporary Canadian medical literature. The ceremonies were conducted with decorous good humour, as Art himself would have arranged them, and with a sense of gratitude for the good fortune of knowing him through his pen and in person. ERNEST J. BOWMER, MD, MB, CH B, rRCP[c] KENNETH G. CAMBON, MD KENNETH M. LEIGHTON, MD, FRCP[C] University of British Columbia Vancouver, BC
Urticarial rash, periorbital edema following influenza (bivalent) vaccination To the editor: I report a case of urticanal rash and periorbital edema following influenza vaccination in a nonallergic young adult. A 23-year-old man, previously healthy, received 0.5 ml of bivalent influenza virus vaccine in each deltoid area on Oct. 26, 1976. The next day he noted puffiness around his eyes and a generalized itchy, red rash. The itching was relieved by the administration of oral and parenteral diphenhydramine hydrochloride (Benadryl). Because of persisting symptoms and signs he attended hospital on Dec. 6, 1976. He gave no history of allergies to egg, and no family history of allergic disorders. He was afebrile. Findings included urticarial lesions over the entire body, peniorbital edema, small, discrete lymph nodes in the cervical area, liver enlargement to 2 cm below the right costal margin and splenk enlargement to 2 cm below the left costal margin. Total leukocyte count was 5.6 x 10'! 1 (56% segmented forms and 33% lymphocytes); no eosinophils were seen. Results of blood chemistry studies, chest radiography and urinalysis were normal. VDRL testing and the differential slide test for infectious mononucleosis gave negative results. The patient was treated with hydroxyzine hydrochloride (Atarax) orally. The skin lesions and periorbital edema disappeared in about 7 days. Hepatosplenomegaly persists and follow-up is being continued in the outpatient clinic. U. NANDA KUMBAR, MD, FRCP[C] BASIL VARKEY, MD, FRcP[c] Department of medicine Veterans Administration Centre 5000 West National Ave. Wood (Milwaukee), WI
[The answer to Dr. Emson's question is as follows: The Journal is mailed by third-class mail on the day of publication; NEJM is mailed by second-class mail - the newspaper rate - 1 week before the publication date. The Jan. 8, 1977 issue of the Journal was mailed to Dr. Emson from Montreal on Jan. 7, 1977 and took 2 weeks, which is reasonable for third-class delivery; the Jan. 20, 1977 issue of NEJM was mailed from Waseca, MN - relatively close to Canada - on Jan. 14, 1977 and took 1 week. The point made by Dr. Emson is a good one and the Journal would welcome information from readers concerning dates on which issues of the Journal are received. - Ed.]
one still has to add an increment required to accommodate an expanding population. The very evident shortages in some provinces must be considered as well. Dr. McKendry's statement in the last paragraph - to the effect that the disparity between my estimate and that of the original report relating to the needed number of ophthalmologists deserves prompt study - is very much to the point. The last sentence in his last paragraph shows how little he understands ophthalmology, the practice of ophthalmology, ophthalmologists and their capabilities. It is to be hoped more studies of this nature will serve to educate those who have influence in the decision-making that seems to be upon us. This much is owed the Canadian people. On the clearly hypothetical and invalid supposition that there may be an "ongoing overproduction" of ophthalmologists, Dr. McKendry outlines the difficulty of "retreading" ophthalmologists. What does he mean? Does he look upon the ophthalmologist as some sort of exclusive specialist, or technician, or possibly a form of optometrist with a courtesy medical degree? How uninformed can one be? We are basically physicians and surgeons with certain special technical skills, and no different from any other specialist.
Physician manpower requirements To the editor: May I reply to Dr. J.B.R. McKendry's comments (Can Med Assoc J 115: 983, 1976) relative to my criticism of the special report by Milan Korcok and D.A. Geekie on manpower requirements (Can Med Assoc J 115: 265, 1976)? In my original letter I said there are many imponderables in making medical manpower estimates. For instance, for some occult reason it is difficult to arrive at the exact number of practising ophthalmologists in Canada today; the number probably is at least 100 less than the figure of 780 given in the original article. (By ophthalmologists I do not mean physicians practising ophthalmology, but fully qualified ophthalmologists.) Included among the 780 mentioned in the report are some qualified ophthalmologists in administrative or semiadministrative positions, and some in semiretirement. The estimate of one ophthalmologist per 28 000 persons, as suggested by the committee report of the Council of Ontario Faculties of Medicine (COFM) (Boone report) had reference to full-time, fully qualified ophthalmologists. Dr. McKendry suggests that only 100 over and above the 780 will be required by 1981. On the above basis it is clear that a great many more than this, possibly twice as many, will be required, and
JOHN V.V. NICHOLLS, MD, FRCs[C] Clinical professor of ophthalmology University of Western Ontario London, Ont.
Found: alternative to the "Compendium of Pharmaceuticals and Specialties" (CPS) To the editor: After reading the letter by Dr. Warren Bell on the CPS (Can Med Assoc J 116: 349, 1977) I searched my cluttered desk to find an alternative to the CPS. I finally found one - The Medical Letter. According to Goodman and Gilman,1 "A very useful source of information on new drugs and therapeutics is the biweekly publication, The Medical Letter. Its distinguished board of editors provides a distinct service to medicine and to physicians by furnishing prompt, unbiased, pointed assessment of new drugs." The integrity of the Letter cannot be doubted. It is a nonprofit publication. Those familiar with the Letter may wonder how it is produced. Usually an expert in the field writes a draft. Then the draft is reviewed by the Letter's editors and advisers and by as many consultants as necessary, sometimes more than 30. When opinions differ, a consensus is arrived at. There are now laudable imitations of the Letter: Great Britain has the Drugs and
720 CMA JOURNAL/APRIL 9, 1977/VOL. 116
Pro-BanthTne for more than peptic ulcer INDICATIONS Pro-Banthine is indicated in peptic ulcer, functional gastrointestinal disturbances, ulcerative colitis, biliary dyskinesia, chronic hypertrophic gastritis, pylorospasm, acute and chronic pancreatitis, hypermotility of the small intestine not associated with organic change, ileostomies, irritable colon syndrome, diverticulitis, ureteral and urinary bladder spasm, hyperhidrosis. CONTRAINDICATIONS Glaucoma Obstructive disease of the gastrointestinal tract Obstructive uropathy due to prostatism Intestinal stony of elderly or debilitated patients Toxic megacolon complicating ulcerative colitis Hialal hernia associated with ref lux esophagitis Unstable cardiovascular adjustment in acute hemorrhage PRECAUTIONS Patients with severe cardiac disease should be given this medication with caution if even a slight increase in heart rate is undesirable. Fever and heat stroke may occur due to anhidrosis. Varying degrees of urinary hesitancy may occur in elderly patients with prostatic hypertrophy. In such patients urinary retention may be avoided if they are advised to micturate at the time of taking the medication. A decrease in bronchial secretion may lead to inspissation by these secretions and formation of mucus plugs especially in the elderly or debilitated with chronic pulmonary disease. ADVERSE EFFECTS Varying degrees of drying of salivary secretions may occur as well as mydriasis and blurred vision. In addition the following adverse reactions have been reported: nervousness, drowsiness, dizziness, insomnia, headache, loss of the sense of taste, nausea, vomiting, constipation, impotence and allergic dermatitis. Some of these effects are dose related. DOSAGE AND ADMINISTRATION Oral: Dosage should be individualized Pro-Banthine tablets (7.5 mg and 15 mg): the usual adult dosage is 7.5 mg to 15 mg of propantheline bromide with meals and 15 mg to 30 mg at bedtime. Patients with severe manifestations may require increased dosage up to 30 mg four times a day. Pro-Banthine P.A. (30 mg): the usual adult dosage is one tablet in the morning and one at night. Occasionally patients may require one tablet every 8 hours. Parenteral: Initial parenteral dose may be 30 mg or more every 6 hours intramuscularly or intravenously, depending on the condition for which it is administered and the requirements for prompt action. IM. solution - prepared by sterilizing the rubber cap with alcohol and injecting 1 ml of U.S.P. sterile water for injection into the ampoule. IV. solution - recommended that the contents of the 30 mg ampoule be dissolved in 10 ml of U.S.P. sodium chloride injection. COMPOSITION AND AVAILABILITY Pro-Banthine 7.5 mg: each white, round, convex, sugar-coaled tablet imprinted "Searle" on one side and "611 on the other contains 7.5 mg of propantheline bromide.
In bottles of 100 tablets. Pro-Banthlne 15 mg: each peach-coloured, sugar-
coated tablet imprinted "Searle" on one side and "601' on the other contains 15 mg of propantheline bromide. In bottles of 100, 1000 and 2500 tablets.
Pro-Banthlne P.A. (Prolonged ActIng): the core of each capsule-shaped, compression-coated, peach-coloured tablet, impressed "Searle" on one side and "651' on the other contains 30 mg of propantheline bromide in the form of sustainedrelease beads, about half being released within one hour of ingestion and the remainder released slowly as earlier increments are metabolized. In bottles of 50 and 500 tablets. Pro-Banthine VIALS: each vial contains 30 mg of propantheline bromide as a dry sterile powder for parenteral therapy following reconstitution. In boxes of 10 vials. Full prescribing information available on request
or in C.P.S.
Searle Pharmaceuticals Oakvglle, Ontario
INTERNATIONAL SYMPOSIUM ON GRAIN DUST AND HEALTH University of Saskatchewan Saskatoon, Canada November 7-9, 1977 CALL FOR ABSTRACTS This symposium will be held at the University of Saskatchewan, Saskatoon, Canada from November 7-9, 1977. Its purpose is to summarize current information related to the effects of grain dust on health, and to provide a framework to discuss future research in this area. Sessions will be devoted to 1) the pathophysiological mechanisms of grain dustinduced pulmonary disease; 2) the epidemiology of occupational pulmonary disease; 3) physiological changes with emphasis on early identification; and 4) the physical and biological characteristics of grain dust including methods of environmental monitoring. Both original and previously published material will be considered. Abstracts should be in English: 1. Approximately 150 words in length, typed and double spaced. Please provide an original and 6 copies. 2. Presentations will be limited to 10 minutes with 5 minutes for discussion. 3. Include the title of the paper, the authors, the full address and institution of the person presenting the paper. 4. Mail abstracts to: The International Symposium on Grain Dust and Health, Division of Pulmonary Medicine, University of Saskatchewan, University Hospital, Saskatoon, Saskatchewan, 57N OWS. 5. DeadlIne for Abstracts is July 15, 1977. If accepted, a full text of the presentation will be required for publication in the Proceedings of the Symposium. Financial assistance to help defray the cost of air fare and lodging is available. An estimate of air fare costs should be submitted with abstract. For non-participants, there will be a registration fee of $100.00. This symposium is sponsored by the University of Saskatchewan, Heal. and Welfare Canada, The Saskatchewan Workers' Compensation Board, The Saskatchewan Anti-TuberculosIs League and the Western Grain Elevators AssocIation. Chairman - J. A. DOSMAN Co-Chalmian - D. J. COtTON
Therapeutics Bulletin and France, La Lettre Mt.dicale d'Information, for example, but none has such a well organized network of consultants. There are now two Canadian physicians on the advisory board. According to marketing departments in the drug industry, The Medical Letter is a nuisance. Yet there have been of late some "favourable" assessments of new drugs. For example, dopamine (Desberger's Intropin) was approved with little restriction and labelled "an important new drug" in the treatment of shock, having "the advantage over previously available catecholamines of a direct beneficial effect on renal blood flow".2 Who can ask for a better rating? The new nonsteroid anti-inflammatory drugs were labelled as "useful in treatment of rheumatoid arthritis" in the last September issue.3 The new antiseptic chlorhexidine (Hibitane-Ayerst) was also well rated last October.4 The scope of the Letter is no longer restricted to providing information just on drugs. There have recently been articles on colonoscopy, aortocoronary bypass, food additives, surgery for obesity, cardiac pacemakers, frostbite, surgery for colitis, influenza vaccination, water fluoridation, elastic stockings, high-fibre diet, ultrasound, radiographic therapy, mammography, cyclamates, allergy tests, poison ivy, intravenous fluid filters, intrauterine devices, pregnancy tests, treatment of hemorrhoids and mineral supplements. There is something for everyone. The Medical Letter covers areas of medical practice where decisions about whether to use a procedure are difficult to make. The Medical Letter on Medical Procedures might be a more appropriate name. New information on old and new drugs is now produced at such a rate that textbooks become obsolete, and the only alternative to reading the Letter would be to read all drug reviews appearing in the major medical journals. The Medical Letter requires 1 minute a day (15 minutes to read the few pages issued every other week). The presentation is tailored to the busy practitioner; it is usually limited to 4 pages, short paragraphs, concise sentences and few references. There is no equivalent in other areas of medical literature. A practitioner who does not have the time to read The Medical Letter does not have the time to read - in that case, may God help his patients. PIERRE BIRON, MD Department of pharmacology Faculty of medicine University of Montreal Montreal, PQ
References 1. GOODMAN LS, GILMAN A (eds): Pharmaco-
724 CMA JOURNAL/APRIL 9, 1977/VOL. 116
logical Basis of Therapeutics, 5th ed, Riverside, NJ, Macmillan, 1975 2. Dopamine for treatment of shock. Med Leit Drugs Ther 17: 13, 1975 3. New drugs for arthritis. Med Lea Drugs Ther 18: 77, 1976 4. Chiorhexidine and other antiseptics. Ibid, p 85
Tribute to AD. Kelly To the editor: Among the many tributes to the late A.D. Kelly that must be reaching your desk, the undersigned wish to include a record of the modest obsequies celebrated in Vancouver in memory of this charming doyen of contemporary Canadian medical literature. The ceremonies were conducted with decorous good humour, as Art himself would have arranged them, and with a sense of gratitude for the good fortune of knowing him through his pen and in person. ERNEST J. BOWMER, MD, MB, CH B, rRCP[c] KENNETH G. CAMBON, MD KENNETH M. LEIGHTON, MD, FRCP[C] University of British Columbia Vancouver, BC
Urticarial rash, periorbital edema following influenza (bivalent) vaccination To the editor: I report a case of urticanal rash and periorbital edema following influenza vaccination in a nonallergic young adult. A 23-year-old man, previously healthy, received 0.5 ml of bivalent influenza virus vaccine in each deltoid area on Oct. 26, 1976. The next day he noted puffiness around his eyes and a generalized itchy, red rash. The itching was relieved by the administration of oral and parenteral diphenhydramine hydrochloride (Benadryl). Because of persisting symptoms and signs he attended hospital on Dec. 6, 1976. He gave no history of allergies to egg, and no family history of allergic disorders. He was afebrile. Findings included urticarial lesions over the entire body, peniorbital edema, small, discrete lymph nodes in the cervical area, liver enlargement to 2 cm below the right costal margin and splenk enlargement to 2 cm below the left costal margin. Total leukocyte count was 5.6 x 10'! 1 (56% segmented forms and 33% lymphocytes); no eosinophils were seen. Results of blood chemistry studies, chest radiography and urinalysis were normal. VDRL testing and the differential slide test for infectious mononucleosis gave negative results. The patient was treated with hydroxyzine hydrochloride (Atarax) orally. The skin lesions and periorbital edema disappeared in about 7 days. Hepatosplenomegaly persists and follow-up is being continued in the outpatient clinic. U. NANDA KUMBAR, MD, FRCP[C] BASIL VARKEY, MD, FRcP[c] Department of medicine Veterans Administration Centre 5000 West National Ave. Wood (Milwaukee), WI
