Prescribing Information Summary
Diverticulitis of the sigmoid colon in young adults
of the diseased bowel segment at 24 years of age.2 We have also found five cases of diverticulitis and associated adenocarcinoma of the sigmoid colon. The ages of the patients at the time of operation ranged from 55 to 86 years (mean 71 years).
To the editor: We report a case and study that illustrate that, while diverticulitis of the colon develops primarily in the elderly, it can also develop in young adults. A 30-year-old man with a 20month history of recurrent urinary NORMAN ISENSTEiN, B SC A. NElL CROWSON tract infection presented with pneuROGERS, MD, M SC, FRCP[C] maturia. A barium enema revealed ARNOLD G.Misericordia General Hospital a colovesical fistula and multiple Winnipeg, Man. sigmoid diverticula. In spite of the presence of diverticular disease it References was believed that Crohn's colitis was a more likely cause of the cob- 1. EuSEBIo EB, EISENBERG MM: Natural history of diverticular disease vesical fistula in view of the paof the colon in young patients. Am J tient's age. Surg 125: 308, 1973 During operation acute sigmoid 2. KIM U, DREILING DA: Problems in the diagnosis of diverticulitis in the diverticulitis was diagnosed and a young. Am J Gastroenterol 62: 109, primary sigmoid colon resection 1974 with end-to-end anastomosis was performed. A study was carried out of the Malfunction of anesthesia age and sex distribution of 70 pa- equipment tients with diverticulitis (29 men To the editor: Drs. G.R. Sellery and 41 women) who underwent sur- (Can Med Assoc J 120: 901, 1979) gical procedures at the Misericordia and John W.R. McIntyre (120: General Hospital, Winnipeg be- 923, 1979) have rendered a valutween January 1965 and March able service by defining the prob1979 (Table I). The mean age of the lem of anesthesia equipment malpatients was 61 years (standard function and providing current deviation 13.5 years); 3% of the measures to prevent subsequent dispatients were less than 40 years of asters. My letter makes no attempt age. This finding is consistent with to de-emphasize equipment malthat of Eusebio and Eisenberg,1 function. I wish only to emphasize who found that 2% to 4% of pa- the significance of human error in tients admitted to hospital for di- tragedies related to anesthesia. verticular disease were less than 40 The recently published report of years of age. The youngest person Cooper and colleagues1 indicts huwith histologically proven sigmoid man error in 82% of preventable diverticulitis we have found first incidents associated with anesthesia, experienced symptoms at 19 years and overt equipment failure in 14% of age and underwent a resection of these retrospectively analysed situations. In an as yet unpublished analysis of liability claims related to anesthesia, Drs. M.H. Harmel, Table I-Age and sex distribetlon of 70 patients undergoing operation for acute Joseph D. Buckley and I have assiginold colon .v*.tilt.s signed human error the main role in 86% of these cases. While we Age No. Ito. can learn much by focusing on its Cyr) of men of women Total tip, let us not forget the rest of the 26-30 ,1 0 1 iceberg. 31-35 1 0 1 36-40 0 1 1 DAVID A. DAVIS, MD 41-45 5 2 7 Professor of anesthesiology 4640 2 2 4 Duke University Medical Center 51-55 4 5 9 Durham, North Carolina 5640 7 5 12 6145 4 6 10 66-70 2 3 5 Reference 7145 2 5 7 7640 1 7 8 81-65 0 4 4 1. COOPER JB, NEWBOWER RS, LONG 86-96 0 1 1 CD, et al: Preventable anesthesia misTatal 29 41 70 haps: a study of human factors. Anesthesiology 49: 399, 1978
LANOXIN*(d. DESCRIPTION: Digoxin, a cardiotonic glycoside obtained from the leaves of Digitalis lanata, was discovered and developed in 1930 at the Wellcome Research Laboratories. ACTION: The digitalis glycosides have qualitatively the same therapeutic effect on the heart. They increase the force of myocardial contraction, increase the refractory period of the atrioventricular (A-V) node,and to a lesser degree, affect the sinoatrial (S-A) node and conduction system via the parasympathetic and sympathetic nervous systems. INDICATIONS: Congestive heart failure. Congestive failure of all degrees is the primary indication. Atrial fibrillation with rapid ventricular response, atrial flutter, paroxysmal atrial tachycardia, cardiogenic shock. CONTRAINDICATIONS: The presence of toxic effects induced by any digitalis preparation is a contraindication to all of the cardiac glycosides. Allergy, though rare, does occur. It may not extend to all preparations and another may be tried. Ventricular fibrillation. WARNINGS: Dosage must be carefully titrated. Monitoring of the electrocardiogram and serum digoxin levels may be necessary to avoid intoxication. PRECAUTIONS: Atrial arrhythmias associated with hypermetabolic and febrile states are particularly resistant to digitalis treatment. Care must be taken to avoid digitalis toxicity if digoxin is used to help control the arrhythmia. Potassium depletion sensitizes the myocardium to digitalis and toxicity is apt to develop even with usual dosage. Magnesium deficiency also predisposes the heart to digoxin intoxication. TREATMENT OF TOXIC EFFECTS PRODUCED BY OVERDOSE: Digitalis is discontinued until after all signs of toxicity are abolished. CAUTION: Potassium should not be used and may be dangerous for severe or complete heart block due to digitalis and not related to any tachycardia. DOSAGE AND ADMINISTRATION: Recommended doses are practical average figures which may require considerable modification as dictated by individual sensitivity or associated conditions. The following recommended doses can merely serve as guidelines and should be adjusted according to the circumstances. Infants: Recommended digitalization dosage with normal renal function is: Newborn: (normal) up to 1 month; 0.04-0.06 mg/kg Infants: 1 month to 2 years; 0.06-0.08 mg/kg. Children 2 to 10 Years of Age: The total dose of LANOXIN Digoxin for complete digitalization of children from 2 to 10 years of age is 0.04 to 006 mg/kg body weight. Children OverlO Years of Age: Children over 10 years require adult proportions by weight. Adults:The average digitalizing dose (i.e., amount accumulated) with digoxin tablets is 1.0 to 1.5 mg. The usual daily oral maintenance dose is Q125 to 0.50 mg (usually 025 mg). In elderly patients, 0.125 to 0.25 mg should be considered the average maintenance dose. SUPPLIED: LANOXIN TABLETS: 0.125 mg yellow tablet; code: Wellcome y3B 0.25 mg white tablet; code: Wellcome X3A LANOXIN PEDIATRIC ELIXIR: A stable, lime-flavoured solution for oral administration containing 0.05 mg digoxin in each ml. Available in 100 ml bottles with calibrated dropper. LANOXIN INJECTION: Contains 0.5 mg digoxin in each 2 ml ampoule (0.25 mg per ml). LANOXIN PEDIATRIC INJECTION: Contains QOS mg digoxin in each 1 ml ampoule. Additional product information available on request.
.
Weilcome Medical Division Burroughs Welicome Ltd. LaSalle, Que.
PAAB
.Trade Mark
L.L.tJ
W-8002
Diverticulitis of the sigmoid colon in young adults
of the diseased bowel segment at 24 years of age.2 We have also found five cases of diverticulitis and associated adenocarcinoma of the sigmoid colon. The ages of the patients at the time of operation ranged from 55 to 86 years (mean 71 years).
To the editor: We report a case and study that illustrate that, while diverticulitis of the colon develops primarily in the elderly, it can also develop in young adults. A 30-year-old man with a 20month history of recurrent urinary NORMAN ISENSTEiN, B SC A. NElL CROWSON tract infection presented with pneuROGERS, MD, M SC, FRCP[C] maturia. A barium enema revealed ARNOLD G.Misericordia General Hospital a colovesical fistula and multiple Winnipeg, Man. sigmoid diverticula. In spite of the presence of diverticular disease it References was believed that Crohn's colitis was a more likely cause of the cob- 1. EuSEBIo EB, EISENBERG MM: Natural history of diverticular disease vesical fistula in view of the paof the colon in young patients. Am J tient's age. Surg 125: 308, 1973 During operation acute sigmoid 2. KIM U, DREILING DA: Problems in the diagnosis of diverticulitis in the diverticulitis was diagnosed and a young. Am J Gastroenterol 62: 109, primary sigmoid colon resection 1974 with end-to-end anastomosis was performed. A study was carried out of the Malfunction of anesthesia age and sex distribution of 70 pa- equipment tients with diverticulitis (29 men To the editor: Drs. G.R. Sellery and 41 women) who underwent sur- (Can Med Assoc J 120: 901, 1979) gical procedures at the Misericordia and John W.R. McIntyre (120: General Hospital, Winnipeg be- 923, 1979) have rendered a valutween January 1965 and March able service by defining the prob1979 (Table I). The mean age of the lem of anesthesia equipment malpatients was 61 years (standard function and providing current deviation 13.5 years); 3% of the measures to prevent subsequent dispatients were less than 40 years of asters. My letter makes no attempt age. This finding is consistent with to de-emphasize equipment malthat of Eusebio and Eisenberg,1 function. I wish only to emphasize who found that 2% to 4% of pa- the significance of human error in tients admitted to hospital for di- tragedies related to anesthesia. verticular disease were less than 40 The recently published report of years of age. The youngest person Cooper and colleagues1 indicts huwith histologically proven sigmoid man error in 82% of preventable diverticulitis we have found first incidents associated with anesthesia, experienced symptoms at 19 years and overt equipment failure in 14% of age and underwent a resection of these retrospectively analysed situations. In an as yet unpublished analysis of liability claims related to anesthesia, Drs. M.H. Harmel, Table I-Age and sex distribetlon of 70 patients undergoing operation for acute Joseph D. Buckley and I have assiginold colon .v*.tilt.s signed human error the main role in 86% of these cases. While we Age No. Ito. can learn much by focusing on its Cyr) of men of women Total tip, let us not forget the rest of the 26-30 ,1 0 1 iceberg. 31-35 1 0 1 36-40 0 1 1 DAVID A. DAVIS, MD 41-45 5 2 7 Professor of anesthesiology 4640 2 2 4 Duke University Medical Center 51-55 4 5 9 Durham, North Carolina 5640 7 5 12 6145 4 6 10 66-70 2 3 5 Reference 7145 2 5 7 7640 1 7 8 81-65 0 4 4 1. COOPER JB, NEWBOWER RS, LONG 86-96 0 1 1 CD, et al: Preventable anesthesia misTatal 29 41 70 haps: a study of human factors. Anesthesiology 49: 399, 1978
LANOXIN*(d. DESCRIPTION: Digoxin, a cardiotonic glycoside obtained from the leaves of Digitalis lanata, was discovered and developed in 1930 at the Wellcome Research Laboratories. ACTION: The digitalis glycosides have qualitatively the same therapeutic effect on the heart. They increase the force of myocardial contraction, increase the refractory period of the atrioventricular (A-V) node,and to a lesser degree, affect the sinoatrial (S-A) node and conduction system via the parasympathetic and sympathetic nervous systems. INDICATIONS: Congestive heart failure. Congestive failure of all degrees is the primary indication. Atrial fibrillation with rapid ventricular response, atrial flutter, paroxysmal atrial tachycardia, cardiogenic shock. CONTRAINDICATIONS: The presence of toxic effects induced by any digitalis preparation is a contraindication to all of the cardiac glycosides. Allergy, though rare, does occur. It may not extend to all preparations and another may be tried. Ventricular fibrillation. WARNINGS: Dosage must be carefully titrated. Monitoring of the electrocardiogram and serum digoxin levels may be necessary to avoid intoxication. PRECAUTIONS: Atrial arrhythmias associated with hypermetabolic and febrile states are particularly resistant to digitalis treatment. Care must be taken to avoid digitalis toxicity if digoxin is used to help control the arrhythmia. Potassium depletion sensitizes the myocardium to digitalis and toxicity is apt to develop even with usual dosage. Magnesium deficiency also predisposes the heart to digoxin intoxication. TREATMENT OF TOXIC EFFECTS PRODUCED BY OVERDOSE: Digitalis is discontinued until after all signs of toxicity are abolished. CAUTION: Potassium should not be used and may be dangerous for severe or complete heart block due to digitalis and not related to any tachycardia. DOSAGE AND ADMINISTRATION: Recommended doses are practical average figures which may require considerable modification as dictated by individual sensitivity or associated conditions. The following recommended doses can merely serve as guidelines and should be adjusted according to the circumstances. Infants: Recommended digitalization dosage with normal renal function is: Newborn: (normal) up to 1 month; 0.04-0.06 mg/kg Infants: 1 month to 2 years; 0.06-0.08 mg/kg. Children 2 to 10 Years of Age: The total dose of LANOXIN Digoxin for complete digitalization of children from 2 to 10 years of age is 0.04 to 006 mg/kg body weight. Children OverlO Years of Age: Children over 10 years require adult proportions by weight. Adults:The average digitalizing dose (i.e., amount accumulated) with digoxin tablets is 1.0 to 1.5 mg. The usual daily oral maintenance dose is Q125 to 0.50 mg (usually 025 mg). In elderly patients, 0.125 to 0.25 mg should be considered the average maintenance dose. SUPPLIED: LANOXIN TABLETS: 0.125 mg yellow tablet; code: Wellcome y3B 0.25 mg white tablet; code: Wellcome X3A LANOXIN PEDIATRIC ELIXIR: A stable, lime-flavoured solution for oral administration containing 0.05 mg digoxin in each ml. Available in 100 ml bottles with calibrated dropper. LANOXIN INJECTION: Contains 0.5 mg digoxin in each 2 ml ampoule (0.25 mg per ml). LANOXIN PEDIATRIC INJECTION: Contains QOS mg digoxin in each 1 ml ampoule. Additional product information available on request.
.
Weilcome Medical Division Burroughs Welicome Ltd. LaSalle, Que.
PAAB
.Trade Mark
L.L.tJ
W-8002
