&
The value of needling
To the editor: In describing his experience with needling (Can Med Assoc J 112: 558, 1975), Dr. McKone asks for an explanation of his unexpected success with "McKonapuncture". Since no theories on the subject have appeared in the Journal to date I have decided to outline my concept of the mechanism involved. The Chinese mythologically derived foci of favourable responses elicited by needling frequently correspond with the dermatologic distribution of sensory bodies within the confines of the dermatomes or Head's zones. Needles varying in diameter and length are inserted into the most painful and sensitive areas for varying periods of time. Often the most tender points are found only by minute stabbings into the epidermis of the afflicted area. There are two basic methods of performing this treatment: (a) one can leave the needle in situ for several minutes or (b) one can move the needle in a fan-like pattern under the epidermis, shoving the needle forward then retracting it towards the centre while twirling it between the thumb and index finger. I suggest that this microtraumatization of cells releases minute amounts of histamine, which softens cell membranes in the vicinity of the needle, thus facilitating lymph flow in sclerotic and keloid-like scar tissues. When I practised in a northern mining town in the SOs and early 60s I found that 0.1 ml of a 0.004% histaContributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and should not exceed 1½ pages in length.
mine solution injected into selected pain spots brought relief. Only patients who had tried all recognized forms of therapy without success were chosen for the needling. The resultant wheals were impressive; they felt warm and were itchy. Patients had almost immediate relief from pain. A strong liniment will produce the same effect on sensitive skins. Liniment, however, has little esthetic appeal, so one can conclude that the oriental miracle treatment will remain with us for some time. FRANK B. SMALL, MD
823 Royal Ave. SW Calgary, Alta.
Self-medication with proprietaries To the editor: Peter Michaelson's excellent article on the new federal regulations affecting proprietary selfmedication products (Can Med Assoc J 112: 1229, 1975) will do much to dispel professional uncertainty about the use of these products. Modern self-medication with proprietaries of proved safety and efficacy, fully labelled as to active ingredients, uses and precautions, fairly advertised, subject to both a code administered by the Canadian Advertising Advisory Board and federal government preclearance, readily available and competitively priced, will benefit the consumer and the physician. By providing symptomatic relief from common ailments, proprietaries relieve an already overburdened medical community from minor, time-consuming and unnecessary chores. Furthermore, they form an important "first line of defence" to prevent needless access to the higher cost elements of the health care system.
They have been likened by Fry1 to the base of the medical care pyramid the family caring for itself is the foundation of the total medical care system. It has been stated that without proprietaries our health care system would simply collapse under an unbearable and unnecessary patient load.2 Individual physicians or medical associations desiring additional information on the various aspects of selfmedication should feel free to contact us at any time. J. DONALD HARPER
The Proprietary Association of Canada 1819 Yonge St. Toronto, Ont.
References 1. FRY J: Address to the first general assembly of the world Federation of Proprietary Medicine Manufacturers, London, Nov 1971 2. MoRRIsoN AB: Self-medication - an important aspect of health care. Address to 78th annual meeting, Proprietary Association of Canada, Sept 1974
Medical charge card To the editor: With the introduction of "universal" medicare in Canada, most physicians have little choice at the present time but to bill the provincial paying agency for medical services rendered. Inevitably the old adage that he who pays the piper calls the tune has proved to be true; as a consequence, government is now dictating to physicians in respect of fees and schedules of benefits, extra billing and in one province the minimum amount of time that must be spent when examining a patient. While there are many advantages in a health care system in which the majority of patients have insurance coverage, the economic and political
CMA JOURNAL/AUGUST 23, 1975/VOL. 113 275
consequences of the provision of a government monopoly health plan are potentially disastrous. The medical profession in Canada is becoming subservient to government bureaucracy, and one way to escape from the trap is to deal directly with patients. In many medical offices it is impracticable to invoice individual patients for services rendered. With the increasing use of credit cards I see no reason why a group of physicians who are determined to deal directly with their patients should not take advantage of Chargex, Master Card, American Express, etc. I should be interested to hear from physicians who support the concept of the medical charge card, or who favour entering some form of association with established credit card organizations in Canada.
well as the patient's own tumour cells. The patient responded rapidly to antitumour therapy with prednisone, vincristine and cyclophosphamide, and is doing well after 8 months of therapy. To our knowledge, this is the first reported case of reticulum cell sarcoma associated with antinucleolar antibodies. J.H. JONCAS, MD, PH D P. ROBITAILLE, MD
P. BENOIT, MD Department of pediatrics Sainte-Justine Hospital Montreal, Que.
References I. RITCHIE RF: Antinucleolar antibodies: their frequency and diagnostic association. N Engi J Med 282: 1174, 1970 2. TAN EM, NORTHWAY JD, PINNAs JL: Clinical significance of antinuclear antibodies.
Postgrad Med 54: 143, 1973
3. PINNAS JL, NORTHWAY JD, TAN EM: Antinucleolar antibodies in human sera. J finmunol 111: 996, 1973 4. BECK JS, ANDER5ON JR, MCELHINNEY AJ,
A. GEOFFREY DAWRANT, MD, B CR Box 7692, Station A Edmonton, Alta.
et al: Antinucleolar antibodies. Lancet 2: 575, 1962 5. Bowa JM, ANGERMAN 3, McBama CM, et al: Antinucleolar antibodies in sera of patients with melanoma (abstr no 338). Cancer Res 12: 85, 1971
Antinucleolar antibodies in reticulum cell sarcoma
Therapeutic abortion
To the editor: Antinucleolar antibodies are one type of antinuclear antibody rarely found in human serum.1'2 They have been reported in patients with scleroderma and Sj6gren's syndrome,3'4 melanoma,5 and undiagnosed illnesses or syndromes manifesting Raynaud's phenomenon.3 We have recently studied a patient with reticulum cell sarcoma whose serum had a titre of 1/128 for antinucleolar antibodies. A 6-year-old boy was admitted to hospital with fever and an inguinal mass that had enlarged over a month. While the child was in hospital the mass invaded the overlying skin, which became purplered, and generalized adenopathy developed. After 2 weeks another subcutaneous mass formed over a rib in the right midposterior thorax, and a minimal right pleural effusion developed. The only notable laboratory finding was a serum 1gM value of 1120 mg/dl. Infectious and other causes for the lesions were excluded. Two successive biopsies of the inguinal nodes and invaded skin disclosed reticulum cell proliferation with numerous atypical mitotic figures, compatible with the features of reticulum cell sarcoma. A diagnosis of Hodgkin's disease could not be made in the absence of Reed-Steinberg cells, among other criteria. Epstein-Barr virus (EBV) antibody studies showed absent viral capsid (VCA), early (EA) and nuclear (NA) antibodies but revealed antinucleolar antibodies on Molt 4 cells used as controls in the EB-NA tests. The same antinucleolar pattern was demonstrated in a variety of cells, including lymphoblastoid cells of Raji and HRlK types; lymphoblastoid cells in culture from patients with infectious mononucleosis and healthy individuals; human embryo fibroblasts; primary monkey and rat kidney cells; as
To the editor: In the abortion issue I believe that our only concern as physicians is in regard to how we define "therapeutic abortion". By this term surely we mean abortion carried out to prevent or treat a condition associated with pregnancy, or as a direct result of pregnancy, that threatens the woman's life or health. As a psychiatrist I have examined many patients who were referred for emotional or psychological assessment and, where appropriate, I have recommended that the pregnancy be terminated. Such a recommendation has also been made when the presenting disorder was in the category of a psychosocial condition; this allows a variety of conditions to be included within an ethical medical framework. While I am prepared to agree that in this area there may be dispute, nevertheless it is quite different from the so-called "abortion on demand", which has no ethical medical basis. Therapeutic abortion is adequately covered by current legislation, if not by health service facilities (and there are indeed great differences and gaps between medical and health services). However, I do not believe that the solution lies in changing the law. Rather, it seems that those who wish abortion on demand would like the law to be altered so that physicians would in fact be altering the ethical medical basis on which they practise; the procedure could then no longer be considered a therapeutic abortion. If society wishes to sanction abortion on demand, then the law could
276 CMA JOURNAL/AUGUST 23, 1975/VOL. 113
'Demulen® ethynodiol diacetate ethinyl estradiol Indication - Oral Contraception Contraindications - Malignant tumors ot the breast or genital tract, estrogen dependent neoplasia, signiticant liver dystunction, history ot cholestatic jaundice, during breast teeding, undiagnosed vaginal bleeding, history ot CVA, coronary thrombosis, classical migraine, thrombophlebitis or thromboembolic disease, ocular lesions such as partial or complete loss ot vision: detect in visual tields, diplopia: suspect pregnancy. Warnings - Discontinue medication at the earliest manitestation ot: thromboembolic disorders such as thrombophlebitis, cerebrovascular disease, pulmonary embolism, myocardial ischemia, retinal thrombosis: visual defects, proptosis, diplopia, undiagnosed severe headache, classical migraine, papilledema, ophthalmic vascular lesions, psychiatric disturbances. Rule out pregnancy alter two consecutive periods are missed or alter the first missed period it the prescribed regimen has not been followed. Demulen may cause metabolic imbalance: observe carefully in epilepsy, asthma, cardiac and renal dysfunction. Precautions - Before use, a thorough history should be taken and a thorough physical examination performed, including the breasts and pelvic organs and a Papanicolaou smear. Follow up examination should be within six months and at least yearly thereafter. Liver, thyroid and other endocrine function teats should not be considered accurate unless therapy has been discontinued. Withdrawal of medication for 2 to 4 months is necessary before alteration in thyroxine binding reverts to normal. Similar precautions apply to liver function studies and other tests of protein binding (e.g. plasma cortisol). Follow diabetic patients or those with a family history of diabetes closely for decrease in glucose tolerance. Persistent irregular vaginal bleeding requires investigation. In metabolic or endocrine disease and when metabolism of calcium and phosphorus is involved, careful clinical evaluation should precede medication. Possible influence of prolonged therapy on pituitary, ovarian, adrenal, thyroid, hepatic or uterine function awaits further study. Risks of complications due to adrenocortical insufficiency appear to be minimal, but may occur. Treatment may mask the onset of the climacteric. Advise the pathologist of therapy with Demulen with relevant specimens. Uterine fibroids are subject to the same complications as may occur in pregnancy. Sudden enlargement, pain or tenderness require discontinuance of medication. Patients with a history of emotional disturbance, especially the depressive type, are prone to recurrence. If this occurs, discontinue medication. Discontinue medication in patients who develop transient aphasia, paralysis, or loss of consciousness. Give Demulen to patients with signs of essential hypertension only under close supervision. Elevation of blood pressure may occur at any time and even if asymptomatic necessitates cessation of medication. Give with great care and under close supervision to patients with a history of jaundice. Do not prescribe to those with a history of cholestatic jaundice, especially associated with pregnancy. In those patients who develop severe generalized pruritus or icterus, consider hepatic dysfunction and withdraw medication. If the jaundice is of the cholestatic type, do not resume medication. Considering the. oversuppression syndrome patients may be advised to discontinue medication after approximately two years and resume only after normal ovulatory cycles have been re-established. Avoid prescribing to patients with a history of prolonged episodes of amenorrhea or infertility. Assess adolescent patients for adequate skeletal development prior to medication. Oral contraceptives may accelerate epiphyseal closure. After discontinuing Demulen, the patient should await the resumption of normal ovulating cycles before attempting to become pregnant. Use special judgment in prescribing to women with recurrent fibrocystic disease of the breast. Estrogen-progestogen combinations may increase plasma lipoproteins. Use with caution in women with pre-existent hyperlipoproteinemia. Adverse Effects - The following have been noted with varying incidence: nausea, vomiting, other GI symptoms, breakthrough bleeding, spotting, change in menstrual flow, amenorrhea, edema, suppression of lactation, migraine, cholestatic jaundice, rash (allergic), rise in blood pressure and mental depression. Disturbances in bleeding patterns are usually most pronounced during the first cycle and usually disappear after several cycles. The following have been reported, although no cause and effect relationship has been established: anovulation posttreatment, premenstrual-like syndrome, changes in libido and appetite, cystitis-like syndrome, headache, nervousness, hemorrhagic eruption, and itching. Thrombophlebitis, pulmonary embolism and neuro-ocular lesions have been observed, although a cause and effect relationship has neither been established nor disproved. Various laboratory results may be altered particularly BSP. coagulation factors, tests of thyroid function, metapyrone. pregnanediol and corticosteriod determinations. Dosage - Demulen 21 - One tablet daily. Cyclic administration 3 weeks on tablets and one week off. Demulen 28 One tablet daily. Continuous administration 21 active tablets followed by 7 inert tablets. Availability - Each white, round tablet with Searle' on one side and 71 on the other contain ethynodiol diacetate 1.D mg.. and ethinyl estradiol 0.05 mg. Available in 21 and 28 day Compack dispensers (on green foil).
Searle Pharmaceuticals OakviIIe, Ontario L6H 1M5
The value of needling
To the editor: In describing his experience with needling (Can Med Assoc J 112: 558, 1975), Dr. McKone asks for an explanation of his unexpected success with "McKonapuncture". Since no theories on the subject have appeared in the Journal to date I have decided to outline my concept of the mechanism involved. The Chinese mythologically derived foci of favourable responses elicited by needling frequently correspond with the dermatologic distribution of sensory bodies within the confines of the dermatomes or Head's zones. Needles varying in diameter and length are inserted into the most painful and sensitive areas for varying periods of time. Often the most tender points are found only by minute stabbings into the epidermis of the afflicted area. There are two basic methods of performing this treatment: (a) one can leave the needle in situ for several minutes or (b) one can move the needle in a fan-like pattern under the epidermis, shoving the needle forward then retracting it towards the centre while twirling it between the thumb and index finger. I suggest that this microtraumatization of cells releases minute amounts of histamine, which softens cell membranes in the vicinity of the needle, thus facilitating lymph flow in sclerotic and keloid-like scar tissues. When I practised in a northern mining town in the SOs and early 60s I found that 0.1 ml of a 0.004% histaContributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and should not exceed 1½ pages in length.
mine solution injected into selected pain spots brought relief. Only patients who had tried all recognized forms of therapy without success were chosen for the needling. The resultant wheals were impressive; they felt warm and were itchy. Patients had almost immediate relief from pain. A strong liniment will produce the same effect on sensitive skins. Liniment, however, has little esthetic appeal, so one can conclude that the oriental miracle treatment will remain with us for some time. FRANK B. SMALL, MD
823 Royal Ave. SW Calgary, Alta.
Self-medication with proprietaries To the editor: Peter Michaelson's excellent article on the new federal regulations affecting proprietary selfmedication products (Can Med Assoc J 112: 1229, 1975) will do much to dispel professional uncertainty about the use of these products. Modern self-medication with proprietaries of proved safety and efficacy, fully labelled as to active ingredients, uses and precautions, fairly advertised, subject to both a code administered by the Canadian Advertising Advisory Board and federal government preclearance, readily available and competitively priced, will benefit the consumer and the physician. By providing symptomatic relief from common ailments, proprietaries relieve an already overburdened medical community from minor, time-consuming and unnecessary chores. Furthermore, they form an important "first line of defence" to prevent needless access to the higher cost elements of the health care system.
They have been likened by Fry1 to the base of the medical care pyramid the family caring for itself is the foundation of the total medical care system. It has been stated that without proprietaries our health care system would simply collapse under an unbearable and unnecessary patient load.2 Individual physicians or medical associations desiring additional information on the various aspects of selfmedication should feel free to contact us at any time. J. DONALD HARPER
The Proprietary Association of Canada 1819 Yonge St. Toronto, Ont.
References 1. FRY J: Address to the first general assembly of the world Federation of Proprietary Medicine Manufacturers, London, Nov 1971 2. MoRRIsoN AB: Self-medication - an important aspect of health care. Address to 78th annual meeting, Proprietary Association of Canada, Sept 1974
Medical charge card To the editor: With the introduction of "universal" medicare in Canada, most physicians have little choice at the present time but to bill the provincial paying agency for medical services rendered. Inevitably the old adage that he who pays the piper calls the tune has proved to be true; as a consequence, government is now dictating to physicians in respect of fees and schedules of benefits, extra billing and in one province the minimum amount of time that must be spent when examining a patient. While there are many advantages in a health care system in which the majority of patients have insurance coverage, the economic and political
CMA JOURNAL/AUGUST 23, 1975/VOL. 113 275
consequences of the provision of a government monopoly health plan are potentially disastrous. The medical profession in Canada is becoming subservient to government bureaucracy, and one way to escape from the trap is to deal directly with patients. In many medical offices it is impracticable to invoice individual patients for services rendered. With the increasing use of credit cards I see no reason why a group of physicians who are determined to deal directly with their patients should not take advantage of Chargex, Master Card, American Express, etc. I should be interested to hear from physicians who support the concept of the medical charge card, or who favour entering some form of association with established credit card organizations in Canada.
well as the patient's own tumour cells. The patient responded rapidly to antitumour therapy with prednisone, vincristine and cyclophosphamide, and is doing well after 8 months of therapy. To our knowledge, this is the first reported case of reticulum cell sarcoma associated with antinucleolar antibodies. J.H. JONCAS, MD, PH D P. ROBITAILLE, MD
P. BENOIT, MD Department of pediatrics Sainte-Justine Hospital Montreal, Que.
References I. RITCHIE RF: Antinucleolar antibodies: their frequency and diagnostic association. N Engi J Med 282: 1174, 1970 2. TAN EM, NORTHWAY JD, PINNAs JL: Clinical significance of antinuclear antibodies.
Postgrad Med 54: 143, 1973
3. PINNAS JL, NORTHWAY JD, TAN EM: Antinucleolar antibodies in human sera. J finmunol 111: 996, 1973 4. BECK JS, ANDER5ON JR, MCELHINNEY AJ,
A. GEOFFREY DAWRANT, MD, B CR Box 7692, Station A Edmonton, Alta.
et al: Antinucleolar antibodies. Lancet 2: 575, 1962 5. Bowa JM, ANGERMAN 3, McBama CM, et al: Antinucleolar antibodies in sera of patients with melanoma (abstr no 338). Cancer Res 12: 85, 1971
Antinucleolar antibodies in reticulum cell sarcoma
Therapeutic abortion
To the editor: Antinucleolar antibodies are one type of antinuclear antibody rarely found in human serum.1'2 They have been reported in patients with scleroderma and Sj6gren's syndrome,3'4 melanoma,5 and undiagnosed illnesses or syndromes manifesting Raynaud's phenomenon.3 We have recently studied a patient with reticulum cell sarcoma whose serum had a titre of 1/128 for antinucleolar antibodies. A 6-year-old boy was admitted to hospital with fever and an inguinal mass that had enlarged over a month. While the child was in hospital the mass invaded the overlying skin, which became purplered, and generalized adenopathy developed. After 2 weeks another subcutaneous mass formed over a rib in the right midposterior thorax, and a minimal right pleural effusion developed. The only notable laboratory finding was a serum 1gM value of 1120 mg/dl. Infectious and other causes for the lesions were excluded. Two successive biopsies of the inguinal nodes and invaded skin disclosed reticulum cell proliferation with numerous atypical mitotic figures, compatible with the features of reticulum cell sarcoma. A diagnosis of Hodgkin's disease could not be made in the absence of Reed-Steinberg cells, among other criteria. Epstein-Barr virus (EBV) antibody studies showed absent viral capsid (VCA), early (EA) and nuclear (NA) antibodies but revealed antinucleolar antibodies on Molt 4 cells used as controls in the EB-NA tests. The same antinucleolar pattern was demonstrated in a variety of cells, including lymphoblastoid cells of Raji and HRlK types; lymphoblastoid cells in culture from patients with infectious mononucleosis and healthy individuals; human embryo fibroblasts; primary monkey and rat kidney cells; as
To the editor: In the abortion issue I believe that our only concern as physicians is in regard to how we define "therapeutic abortion". By this term surely we mean abortion carried out to prevent or treat a condition associated with pregnancy, or as a direct result of pregnancy, that threatens the woman's life or health. As a psychiatrist I have examined many patients who were referred for emotional or psychological assessment and, where appropriate, I have recommended that the pregnancy be terminated. Such a recommendation has also been made when the presenting disorder was in the category of a psychosocial condition; this allows a variety of conditions to be included within an ethical medical framework. While I am prepared to agree that in this area there may be dispute, nevertheless it is quite different from the so-called "abortion on demand", which has no ethical medical basis. Therapeutic abortion is adequately covered by current legislation, if not by health service facilities (and there are indeed great differences and gaps between medical and health services). However, I do not believe that the solution lies in changing the law. Rather, it seems that those who wish abortion on demand would like the law to be altered so that physicians would in fact be altering the ethical medical basis on which they practise; the procedure could then no longer be considered a therapeutic abortion. If society wishes to sanction abortion on demand, then the law could
276 CMA JOURNAL/AUGUST 23, 1975/VOL. 113
'Demulen® ethynodiol diacetate ethinyl estradiol Indication - Oral Contraception Contraindications - Malignant tumors ot the breast or genital tract, estrogen dependent neoplasia, signiticant liver dystunction, history ot cholestatic jaundice, during breast teeding, undiagnosed vaginal bleeding, history ot CVA, coronary thrombosis, classical migraine, thrombophlebitis or thromboembolic disease, ocular lesions such as partial or complete loss ot vision: detect in visual tields, diplopia: suspect pregnancy. Warnings - Discontinue medication at the earliest manitestation ot: thromboembolic disorders such as thrombophlebitis, cerebrovascular disease, pulmonary embolism, myocardial ischemia, retinal thrombosis: visual defects, proptosis, diplopia, undiagnosed severe headache, classical migraine, papilledema, ophthalmic vascular lesions, psychiatric disturbances. Rule out pregnancy alter two consecutive periods are missed or alter the first missed period it the prescribed regimen has not been followed. Demulen may cause metabolic imbalance: observe carefully in epilepsy, asthma, cardiac and renal dysfunction. Precautions - Before use, a thorough history should be taken and a thorough physical examination performed, including the breasts and pelvic organs and a Papanicolaou smear. Follow up examination should be within six months and at least yearly thereafter. Liver, thyroid and other endocrine function teats should not be considered accurate unless therapy has been discontinued. Withdrawal of medication for 2 to 4 months is necessary before alteration in thyroxine binding reverts to normal. Similar precautions apply to liver function studies and other tests of protein binding (e.g. plasma cortisol). Follow diabetic patients or those with a family history of diabetes closely for decrease in glucose tolerance. Persistent irregular vaginal bleeding requires investigation. In metabolic or endocrine disease and when metabolism of calcium and phosphorus is involved, careful clinical evaluation should precede medication. Possible influence of prolonged therapy on pituitary, ovarian, adrenal, thyroid, hepatic or uterine function awaits further study. Risks of complications due to adrenocortical insufficiency appear to be minimal, but may occur. Treatment may mask the onset of the climacteric. Advise the pathologist of therapy with Demulen with relevant specimens. Uterine fibroids are subject to the same complications as may occur in pregnancy. Sudden enlargement, pain or tenderness require discontinuance of medication. Patients with a history of emotional disturbance, especially the depressive type, are prone to recurrence. If this occurs, discontinue medication. Discontinue medication in patients who develop transient aphasia, paralysis, or loss of consciousness. Give Demulen to patients with signs of essential hypertension only under close supervision. Elevation of blood pressure may occur at any time and even if asymptomatic necessitates cessation of medication. Give with great care and under close supervision to patients with a history of jaundice. Do not prescribe to those with a history of cholestatic jaundice, especially associated with pregnancy. In those patients who develop severe generalized pruritus or icterus, consider hepatic dysfunction and withdraw medication. If the jaundice is of the cholestatic type, do not resume medication. Considering the. oversuppression syndrome patients may be advised to discontinue medication after approximately two years and resume only after normal ovulatory cycles have been re-established. Avoid prescribing to patients with a history of prolonged episodes of amenorrhea or infertility. Assess adolescent patients for adequate skeletal development prior to medication. Oral contraceptives may accelerate epiphyseal closure. After discontinuing Demulen, the patient should await the resumption of normal ovulating cycles before attempting to become pregnant. Use special judgment in prescribing to women with recurrent fibrocystic disease of the breast. Estrogen-progestogen combinations may increase plasma lipoproteins. Use with caution in women with pre-existent hyperlipoproteinemia. Adverse Effects - The following have been noted with varying incidence: nausea, vomiting, other GI symptoms, breakthrough bleeding, spotting, change in menstrual flow, amenorrhea, edema, suppression of lactation, migraine, cholestatic jaundice, rash (allergic), rise in blood pressure and mental depression. Disturbances in bleeding patterns are usually most pronounced during the first cycle and usually disappear after several cycles. The following have been reported, although no cause and effect relationship has been established: anovulation posttreatment, premenstrual-like syndrome, changes in libido and appetite, cystitis-like syndrome, headache, nervousness, hemorrhagic eruption, and itching. Thrombophlebitis, pulmonary embolism and neuro-ocular lesions have been observed, although a cause and effect relationship has neither been established nor disproved. Various laboratory results may be altered particularly BSP. coagulation factors, tests of thyroid function, metapyrone. pregnanediol and corticosteriod determinations. Dosage - Demulen 21 - One tablet daily. Cyclic administration 3 weeks on tablets and one week off. Demulen 28 One tablet daily. Continuous administration 21 active tablets followed by 7 inert tablets. Availability - Each white, round tablet with Searle' on one side and 71 on the other contain ethynodiol diacetate 1.D mg.. and ethinyl estradiol 0.05 mg. Available in 21 and 28 day Compack dispensers (on green foil).
Searle Pharmaceuticals OakviIIe, Ontario L6H 1M5
