were formulated that related to growth, nutrition and mental development. Our intention was to assess office practice routines for infants and children in age groups from birth to 15 years. From the results of our survey we prepared a preliminary report entitled A Survey of the Quantity and Quality and Documentation of Primary Care Given by the Paediatricians of Canada. The main purpose of our study was to stimulate interest in producing a similar survey by family practice physicians. Representatives from the Canadian Paediatric Society, the College of Family Physicians of Canada, and the various provincial and federal public health departments would then be able to use these results in formulating recommendations for comprehensive child care. An informed medical consensus for treatment of acute appendicitis exists, but there is no informed consensus as to what constitutes an adequate health examination. There should be a basic statkdard of primary medical care available to all Canadian children. For those interested in learning the details of our survey a limited quantity of reprints is available and can be obtained by writing to any of the undersigned. J.B.J. MCKENDRY, MD, PRCP[C] C.S. ANGLIN, MD B. LAsIU, MD, PRCP[c] Hospital for Sick Children 555 University Ave. Toronto, Ont. M5G 1X8
References 1. ANDERSON EP: Evaluation of the routine physical examination of infants in the first year of life. Pediatrics 45: 950, 1970 2. GoRoIs L, MARKOWITZ M: Evaluation of the effectiveness of comprehensive and continuous pediatric care. Pediatrics 48: 766, 1971 3. HOEKELMAN RA: Primary care: we need all the help we can get. Pediatrics 59: 315, 1977 4. BERGMAN AR, DAssEL SW, WEDOWOOD RJ: Time-motion study of practicing pediatricians. Pediatrics 38: 254, 1966 5. . JE, MILLER 3D: The preparation, utilization and evaluation of a registered nurse trained to give telephone advice in private pediatric office. Pediatrics 47: 1051, 1971 6. ALPERT JJ, RoaaRTsoN LS, KosA 3, et al: Delivery of health care for children: report of an experiment. Pediatrics 57: 917, 1976 7. Committee on standards of child health care, American Academy of Pediatrics: Standards of Child Health Care, Evanston, III, 1977 8. SHAH CP: The Canadian pediatrician: a dilemma in child health. Can Med Assoc I 105: 1059, 1971
Suicide and attempted suicide among the aged To the editor: I have read Dr. Sendbuehler's editorial (Can Med Assoc J 117: 418, 1977) with interest, but I note that he failed to mention the concept of normal pressure hydrocephalus as a cause of dementia and confusional states in the aged. For the past tew years it has been standard neurosurgical practice when seeing such patients to exclude first the dementia associated with thyroid disease and the dementia associated with
vitamin B12 deficiency. Following this it is a simple matter to inject the specific isotope into the lumbar theca. Repeated daily scans thereafter may show no perfusion over the cerebral hemispheres and a reflux of the isotope into the ventricular system. It is important to recognize this syndrome in view of the increase in numbers of our ageing population. It has been emphasized that 50% of the patients affected will show dramatic improvement when treated with ventricular-peritoneal shunting (H. Barnett: personal communication, 1977). WILLIAM W. BLUE, MB 145 Queenston St. St. Catharines, Ont.
To the editor: Normal pressure hydrocephalus was not mentioned in my editorial simply because it was not my intention to list and discuss the causes of dementia and confusional states in the aged. Dr. Blue's comment brings into focus the concept of dementia and confusional states in the aged and the great variation in the clinical picture that these persons present. A number of cases that have been brought to my attention recently have illustrated the rapidity with which the confusional state may be overcome. It may change from one day to the next after the individual has attempted suicide. Other confusional states may persist over a period of months. It is encouraging to note that the medical profession is recognizing this syndrome and that when the situation is due to organic brain disease the outlook is not as hopeless as it was in the past. J.M. SENDBUEHLER, MD Royal Ottawa Hospital Ottawa, Ont.
Petriellidium boydil (Allescheria boydil) endocarditis associated with porcine valve replacement To the editor: Fungal endocarditis associated with cardiovascular surgery, narcotic addiction and prolonged intravenous therapy has been reviewed recently.1'2 Candida albicans and Aspergillus sp. have been the most common fungi isolated from patients following cardiac valve replacement. A number of reports3'4 have incriminated other fungi but we have not found any reported cases of endocarditis caused by Petriellidium boydji (Allescheria boydii). We present a case of a patient with endocarditis caused by this organism. A 48-year-old Indian man with mitral stenosis underwent mitral valvulotomy in 1961 and subsequently porcine valve insertion on Apr. 3, 1975 for restenosis. His postoperative course was uneventful
1250 CMA JOURNAL/DECEMBER 3, 1977/VOL. 117
.oAct'fe6 Tablets/Syrup! Expectorant Antitussive-ExpectorantDecongestant Indications: Syrup/Tablets. For the treatment of all types of cough, especially cough associated with the common cold and acute bronchitis. CoActifecl Expectorant. Same indications as for CoActifed Cough Syrup and Tablets: also for conditions where a definite expectorant action is necessary in cases of accumulated secretion in the trachea and bronchi. Precautions: Use with caution in patients with hypertension and in patients receiving MAO inhibitors. Patients should be cautioned not to operate vehicles or hazardous machinery until their response to the drug has been determined. Since the depressant effects of antih istami nes are additive to those of other drugs affecting the central nervous system, patients should be cautioned against drinking alcoholic beverages or taking hypnotics. sedatives, psychotherapeutic agents or other drugs with ONS depressant effects during antih istami nic therapy. Rarely, prolonged therapy with antihistaminecontaining preparations can produce blood dyscrasias. Side effects: Certain patients may exhibit mild stimulation or mild sedation. Overdose: Treatment: Prompt gastric lavage. using sodium bicarbonate 1% solution, oxygen and artificial respiration. Caffeine as a stimulant. Keep patient warm. Methamphetamine HCI 10 to 15 mg is an effective antagonist to codeine to maintain blood pressure, paraldehyde for excitement and convulsions. Dosage:Adults and children over 12 years: 2 tsp. or 1 Tablet 4 times daily. Children 6-12 years: tsp. or ./2 Tablet 4 times daily. infants and children up to 6 years: ./2 tsp. 4 ti mesdai ly. If a more frequent dosage schedule is desired, one-half of the appropriate dose recommended above may be given every 3 hours. Supplied: Expectorant: Each 5 ml of orange syrup with a mixed fruit odor contains: triproildine HCI 2mg, pseudoephedrine HCI 30 mg, gualfenesln 100 mg, codeine phosphate 10mg. Available In 100 ml and 1 litre bottles. Syrup: Each 5 ml of dark-red syrup with a black currant flavor contains: triprolidine HCI 2 mg, pseudoephedrine HCI 30 mg, codeine phosphate 10 mg. Available In 100 ml and 1 lltrebottles. Tablets: Each white, biconvex tablet 10.2 mm in diameter, code number WELLCOME P48 on same side as diagonal .score mark, contains: trlprolidine HCI 4 mg, pseudoephedrine HCI 60 mg, codeine phosphate 20 mg. Each tablet Is equivalent to 2 teaspoonfuls of syrup. Bottles of 10 and 50 tablets. Additional prescribing information available upon request.
. Burroughs Welicome Ltd. LaSalle, Qu6. Trade Mark
.
W-6022
References 1. ANDERSON EP: Evaluation of the routine physical examination of infants in the first year of life. Pediatrics 45: 950, 1970 2. GoRoIs L, MARKOWITZ M: Evaluation of the effectiveness of comprehensive and continuous pediatric care. Pediatrics 48: 766, 1971 3. HOEKELMAN RA: Primary care: we need all the help we can get. Pediatrics 59: 315, 1977 4. BERGMAN AR, DAssEL SW, WEDOWOOD RJ: Time-motion study of practicing pediatricians. Pediatrics 38: 254, 1966 5. . JE, MILLER 3D: The preparation, utilization and evaluation of a registered nurse trained to give telephone advice in private pediatric office. Pediatrics 47: 1051, 1971 6. ALPERT JJ, RoaaRTsoN LS, KosA 3, et al: Delivery of health care for children: report of an experiment. Pediatrics 57: 917, 1976 7. Committee on standards of child health care, American Academy of Pediatrics: Standards of Child Health Care, Evanston, III, 1977 8. SHAH CP: The Canadian pediatrician: a dilemma in child health. Can Med Assoc I 105: 1059, 1971
Suicide and attempted suicide among the aged To the editor: I have read Dr. Sendbuehler's editorial (Can Med Assoc J 117: 418, 1977) with interest, but I note that he failed to mention the concept of normal pressure hydrocephalus as a cause of dementia and confusional states in the aged. For the past tew years it has been standard neurosurgical practice when seeing such patients to exclude first the dementia associated with thyroid disease and the dementia associated with
vitamin B12 deficiency. Following this it is a simple matter to inject the specific isotope into the lumbar theca. Repeated daily scans thereafter may show no perfusion over the cerebral hemispheres and a reflux of the isotope into the ventricular system. It is important to recognize this syndrome in view of the increase in numbers of our ageing population. It has been emphasized that 50% of the patients affected will show dramatic improvement when treated with ventricular-peritoneal shunting (H. Barnett: personal communication, 1977). WILLIAM W. BLUE, MB 145 Queenston St. St. Catharines, Ont.
To the editor: Normal pressure hydrocephalus was not mentioned in my editorial simply because it was not my intention to list and discuss the causes of dementia and confusional states in the aged. Dr. Blue's comment brings into focus the concept of dementia and confusional states in the aged and the great variation in the clinical picture that these persons present. A number of cases that have been brought to my attention recently have illustrated the rapidity with which the confusional state may be overcome. It may change from one day to the next after the individual has attempted suicide. Other confusional states may persist over a period of months. It is encouraging to note that the medical profession is recognizing this syndrome and that when the situation is due to organic brain disease the outlook is not as hopeless as it was in the past. J.M. SENDBUEHLER, MD Royal Ottawa Hospital Ottawa, Ont.
Petriellidium boydil (Allescheria boydil) endocarditis associated with porcine valve replacement To the editor: Fungal endocarditis associated with cardiovascular surgery, narcotic addiction and prolonged intravenous therapy has been reviewed recently.1'2 Candida albicans and Aspergillus sp. have been the most common fungi isolated from patients following cardiac valve replacement. A number of reports3'4 have incriminated other fungi but we have not found any reported cases of endocarditis caused by Petriellidium boydji (Allescheria boydii). We present a case of a patient with endocarditis caused by this organism. A 48-year-old Indian man with mitral stenosis underwent mitral valvulotomy in 1961 and subsequently porcine valve insertion on Apr. 3, 1975 for restenosis. His postoperative course was uneventful
1250 CMA JOURNAL/DECEMBER 3, 1977/VOL. 117
.oAct'fe6 Tablets/Syrup! Expectorant Antitussive-ExpectorantDecongestant Indications: Syrup/Tablets. For the treatment of all types of cough, especially cough associated with the common cold and acute bronchitis. CoActifecl Expectorant. Same indications as for CoActifed Cough Syrup and Tablets: also for conditions where a definite expectorant action is necessary in cases of accumulated secretion in the trachea and bronchi. Precautions: Use with caution in patients with hypertension and in patients receiving MAO inhibitors. Patients should be cautioned not to operate vehicles or hazardous machinery until their response to the drug has been determined. Since the depressant effects of antih istami nes are additive to those of other drugs affecting the central nervous system, patients should be cautioned against drinking alcoholic beverages or taking hypnotics. sedatives, psychotherapeutic agents or other drugs with ONS depressant effects during antih istami nic therapy. Rarely, prolonged therapy with antihistaminecontaining preparations can produce blood dyscrasias. Side effects: Certain patients may exhibit mild stimulation or mild sedation. Overdose: Treatment: Prompt gastric lavage. using sodium bicarbonate 1% solution, oxygen and artificial respiration. Caffeine as a stimulant. Keep patient warm. Methamphetamine HCI 10 to 15 mg is an effective antagonist to codeine to maintain blood pressure, paraldehyde for excitement and convulsions. Dosage:Adults and children over 12 years: 2 tsp. or 1 Tablet 4 times daily. Children 6-12 years: tsp. or ./2 Tablet 4 times daily. infants and children up to 6 years: ./2 tsp. 4 ti mesdai ly. If a more frequent dosage schedule is desired, one-half of the appropriate dose recommended above may be given every 3 hours. Supplied: Expectorant: Each 5 ml of orange syrup with a mixed fruit odor contains: triproildine HCI 2mg, pseudoephedrine HCI 30 mg, gualfenesln 100 mg, codeine phosphate 10mg. Available In 100 ml and 1 litre bottles. Syrup: Each 5 ml of dark-red syrup with a black currant flavor contains: triprolidine HCI 2 mg, pseudoephedrine HCI 30 mg, codeine phosphate 10 mg. Available In 100 ml and 1 lltrebottles. Tablets: Each white, biconvex tablet 10.2 mm in diameter, code number WELLCOME P48 on same side as diagonal .score mark, contains: trlprolidine HCI 4 mg, pseudoephedrine HCI 60 mg, codeine phosphate 20 mg. Each tablet Is equivalent to 2 teaspoonfuls of syrup. Bottles of 10 and 50 tablets. Additional prescribing information available upon request.
. Burroughs Welicome Ltd. LaSalle, Qu6. Trade Mark
.
W-6022
