VELOSEF 250 CAPSULES VELOSEF 500 CAPSULES Cophradine Capsules VELOSEF 125 FOR ORAL SUSPENSION VELOSEF 250 FOR ORAL SUSPENSION C.phradine for Oral Spopspnslon VELOSEF FOR INJECTION, 500 mg and 1.0 g C.phradine for Injection ACTION: Cephradine is a semi-synthetic, cephafbsporin antibiotic exhibiting bactericidal activity through inhibition of cell-wall synthesis. INDICATIONS: Infections in the respiratory and genitourinary tracts, and in the skin and soft tissues, due to susceptible organisms. Sensitivity tests should be performed: therapy may be instituted before receiving the results. CONTRANDICATIONS: Hypersensitivity to the cephafosporn group of antibiotics. WARNINGS: There is evidence of partial cross-allergenicity between the penicillins and the cephalosporins. Therefore, cephradine should be used with caution in patients with known hypersensitivity to

penicillins. Antibiotics, including cephradine, should be used cdutiously and only when absolutely necessary in patients with a history of allergies, particularly to drugs. Usage during pregnancy and lactation: Safety for use of this product during pregnancy has not been established. Cephradine is secreted in breast milk. PRECAUTIONS: Patients should be observed carefully during therapy. Allergic reactions require discontinuation of VELOSEF and appropriate treatment. Prolonged use of VELOSEF may result in overgrowth of nonsusceptible organisms: appropriate measures should be instituted. During long-term therapy, hematology, renal and hepatic functions should be monitored periodically. Patients with known or suspected renal impairment should be observed carefully since cephradine may accumulate in the serum and tissues unless dosage is suitably reduced. See DOSAGE AND ADMINISTRATION section. Indicated surgical procedures should be performed in conjunction with antibiotic therapy; e.g., the incision and drainage of abscesses. After treatment with cephalosporins, a false-positive reaction for glucose in the urine may occur, but not vith enzyme-based tests. A false-positive Coombs' test has also been reported. VELOSEF for Injection is physically compatible with most commonly used intravenous fluids and electrolyte solotions (e.g. Dextrose Injection, Sodium Chloride Injection or M/6 Sodium Lactate). However, it is not compatible with Lactated Ringer's Solution or other calcium-containing infusion fluids. ADVERSE REACTIONS: Usually limited to gastrointestinal disturbances and occasional hypersensitivity, but may include hematological and hepatobiliary disturbances, as well as elevated BUN, LDH and serum creatinine, superinfection, vaginitis and joint pains. Thrombophlebitis following I.V. injection and sterile abscesses after I.M. injection have occurred. Only occasionally have adverse.reactions been severe enough to warrant cessation of therapy. DOSAGE AND ADMNISTRATION: The presence of food in the gastrointestinal tract delays absorption and reduces the peak serum level but does not affect the total amount of cephradine absorbed. VELOSEF Capsules and VELOSEF for Oral Sospension. Adults: Respiratory tract infections: 250 mg, q6h or 500 mg q12h. Pneumococcal lobar pneumonia: 500 mg, q6h or 1 g ql2h. Genitourinary tract infections: 500 mg. q6h or 1 g q12h. Prolonged therapy is advisable for the treatment of prostatitis and epididymitis. Skin or soft tissue infections: 250 mg q6h or 500 mg q12h. Children: 25 to 50 mg/kg/day, in two or four equally divided and spaced doses, e.g.:

7. REINARZ JA, PIERCE AK, MAYS BB, et al: The potential role of inhalation therapy equipment in nosocomial pulmonary infection. J Clin Invest 44: 831, 1965 8. TINDEL J, CROWDER J: Septic arthritis due to Pseudomonas aeruginosa. JAMA 218: 559, 1971 9. SYKES G: Disinfection and Sterilization, 2nd ed, Philadelphia, Lippincott, 1965, p 449 10. SPALTER J, JACKSON M, MATZ R: Bacteria in medications. Growth during emergency resuscitation. NY State J Med 76: 693, 1976

w |i. iEIhIIIIE~~~~~~

IgD myeloma: a case report To the editor: Several syndromes that include hypogammaglobulinemia have been described; each is characterized by an increased susceptibility to infection. They are divided into primary and secondary immunodeficiency diseases.' The former are hereditary and idiopathic, whereas the latter may result from various disorders involving the reticuloendothelial system. In the cases of spontaneous fractures and bone pain, a neoplastic disease is suspected. If the erythrocyte sedimentation rate (ESR) is low and the heat test for Bence Jones protein is negative, a diagnosis of multiple myeloma may be difficult to make. The case reported below was first investigated as one of neoplastic disease. A 71-year-old woman was admitted to hospital with chest and back pain of 3 weeks' duration. Because of inability to walk and dyspnea she was bedridden. Physical findings were unremarkable except for small stature and dorsal kyphosis. Three years previously she had sustained a traumatic fracture of the right clavicle. The sternum was painful on pressure. Diffuse osteoporosis was noted on radiographs from a metastatic survey. Hemoglobin value was 11.8 g/dl; total

_ __IEEE-

FI. .-eut of .muolcrpoei __hua of noma seu:uprpnlo eac par ndptet' eum (oe pae)wt hefloigatiea -edn

frmtpt oto:plvletatsrm aniimngob niIA

!n,_t-IG wih ,aten'

at-.gM anti-gD, .nig

seu cocntae forfld atKan aniX atetsseu hwsanra reut_ ntstn_ihatiDwt eu cocnratdfufl,adwt

niX

VELOSEF for Oral Suspension 250 mg/5 ml _ 20 kg (44 lbs) % to I tsp. q6h or 1 to 2 tsp. ql 2h 1 to 2 tsp. q6h 40 kg (88 Ibs) or 2toi4tsp.ql2h Smaller doses than those indicated above should not be used. For otitis media due to H. influenzae, doses from 75 to 100 mg/kg/day are recommended. Maximum daily dose should not exceed 4 g. VELOSEF for Injection: For use in moderate, severe or life threatening infections or where oral therapy is not possible. Adut daily dose range is 2 - 4 g, depending on the infection. In children, a daily dose of 50 - 100 mg/kg is recommended. Aft patients; asl formulations: Largerdoses (upto 1 gq6h inadultsorupto25mg/kgq6hinchildren) may be given for severe or chronic infections: maximum daily dose should not exceed 4 g. Therapy should be continued for a mimimum of 48 to 72 hours after the patient becomes asymptomatic or evidence of bacterial eradication has been obtained. In infections caused by hemolytic streptococci, a minimum 10-day-treatment period is recommended. Stubbom infections may require treatment for several weeks with frequent bacteriological and clinical appraisal. A modified dosage schedule in patients with decreased renal function is necessary. Each patient should be considered individually: the following schedule is recommended as a guideline. Initial loading dose: 750 mg. Maintenance dose: 500 mg at the time intervals listed below:

Chi/ds Weight 10 kg (22 lbs)

125 mg/5 ml % to 1 tsp.q6h or 1 to 2 tsp. ql 2h 1 to 2 tsp. q6h or 2 to 4 tsp. ql 2h

Creatinine Clearance (ml/min/1 .73m2) > 20 ml/min 15-19 ml/min 10-14 ml/min 5-9 ml/min < 5 ml/min

Time Interval 6- 12 hours 12 - 24 hours 24 - 40 hours 40- 50 hours 50 - 70 hours

DOSAGE FORMS: Capsules of 250 mg and 500 mg in bottles of 50, and bottles of VELOSEF 125 and 250 for Oral Suspension which, after reconstitution, provide 100 ml of a pleasantly flavoured suspension containing 25 mg/ml and 50 mg/ml respectively. VELOSEF for Injection is provided as a sterile powder for reconstitution in vials containing 500 mg or 1.0 g. Consuft Product Monograph or Package insert for reconstitution procedure.. Product Monograph available to physicians and pharmacists on request.

I~E. R. SQUIBB & SONS LTD.

[^^]

2365 COTE DE LIESSE, MONTREAL, QUE. H4N 2M7

FIG. 1-Osteolytic lesions compatible with metastases or multiple myeloma.

CMA JOURNAL/JUNE 4, 1977/VOL. 116 1235

leukocyte and differential counts were normal. The ESR was 43 mm/h. Blood urea nitrogen and serum calcium concentrations were normal. Serum creatinine value was 1.03 mg/dl and serum alkaline phosphatase value, 18.7 King-Armstrong (KA) units (normal, 1 to 13 KA units). Serum concentrations of all fractions of immunoglobulin (Ig) were decreased as follows: IgG, 430 mg/dl (normal, 800 to 1800 mg/dl); IgA, 30 mg/dl (normal, 90 to 450 mg/dl); and IgM, 9 mg/dl (normal, 70 to 280 mg/dl). Radiographic examination disclosed osteolytic lesions of the skull (Fig. 1), diffuse osteoporosis of large bones and lumbar vertebrae, and several rib fractures. The presumptive diagnosis was metastatic bone lesions or multiple myeloma. A bone marrow aspirate showed 47% of the cells to be abnormal plasma cells. With the use of IgD antisera a homogeneous protein of Y mobility was identified immunoelectrophoretically as IgD, X type, and the IgD concentration in the serum was found to be 24 mg/dl (normal, 1.4 to 13 mg/dl). Bence Jones protein in the serum was also of X type (Fig. 2). The urine contained minimal protein, including Bence Jones protein, X type (Fig. 3). Melphalan and prednisone were given orally for 4 days at 28-day intervals. After two such courses of treatment self-mobilization was started; progression was steady and the patient was discharged free of

pain. Since the first case of IgD myeloma was reported in 1965 by Rowe and Fahey"3 numerous cases have been reported all over the world. This type of myeloma is relatively rare: according to Fishkin and colleagues4 the incidence varies between 0.6 and 3%. It is frequently associated with renal insufficiency, hypercalcemia, amyloidosis and several other diseases.57 Because the concentration of IgD in the serum is low a specific antiserum is necessary for its measurement. Now that such antisera are available commercially, cases of IgD myeloma should be recognized with greater facility. Neoplasia was suspected in our patient because of bone pain, osteolytic

FIG. 3-Results of immulnoelectrophoresis of normal human serum (upper panel of each pair) aDd concentrated urine of the patient (lower panel) with anti-K (top pair) and anti-X (bottom pair). Patient's urine shows abnormal arc with anti-X.

(levodopa and carbidopa combination) INDICATIONS Treatment of Parkinson's syndrome with exception of drug induced parkinsonism. CONTRAINDICATIONS When a sympathomimetic amine is contraindicated; with monoamine oxidase inhibitors, which should be discontinued two weeks prior to starting SINEMET*; in uncompensated cardiovascular, endocrine, hematologic, hepatic, pulmonary or renal disease; in narrowangle glaucoma; in patients with suspicious, undiagnosed skin lesions or a history or melanoma. WARNINGS When given to patients receiving levodopa alone, discontinue levodopa at least 12 hours before initiating SINEMET* at a dosage that provides approximately 20% of previous levodopa. Not recommended in drug-induced extrapyramidal reactions; contraindicated in management of intention tremor and Huntington's chorea. Levodopa related central effects such as involuntary movements may occur at lower dosages and sooner, and the 'on and off' phenomenon may appear earlier with combination therapy. Monitor carefully all patients for the development of mental changes, depression with suicidal tendencies, or other serious antisocial behaviour. Cardiac function should be monitored continuously during period of initial dosage adjustment in patients with arrhythmias. Safety of SINEMET* in patients under 18 years of age not established. Pregnancy and lactation: In women of childbearing potential, weigh benefits against risks. Should not be given to nursing mothers. Effects on human pregnancy and lactation unknown. PRECAUTIONS General: Periodic evaluations of hepatic, hematopoietic, cardiovascular and renal function recommended in extended therapy. Treat patients with history of convulsions cautiously. Physical Activity: Advise patients improved on SINEMET* to increase physical activities gradually, with caution consistent with other medical considerations. In Glaucoma: May be given cautiously to patients with wide angle glaucoma, provided intraocular pressure is well controlled and can be carefully monitored during therapy. With Antihypertensive Therapy:Assymptomatic postural hypotension has been reported occasionally, give cautiously to patients on antihypertensive drugs, checking carefully for changes in pulse rate and blood pressure. Dosage adjustment of antihypertensive drug may be required. With Psychoactive Drugs: If concomitant administration is necessary, administer psychoactive drugs with great caution and observe patients for unusual adverse reactions. With Anesthetics: Discontinue SINEMET* the night before general anesthesia and reinstitute as soon as patient can take medication orally. ADVERSE REACTIONS Most Common: Abnormal Involuntary Movements-usually diminished by dosage reduction-choreiform, dystonic and other involuntary movements. Muscle twitching and blepharospasm may be early signs of excessive

dosage. Othr Sorious Reactions: Oscillations in performance: diurnal variations, independent oscillations in akinesia with stereotyped dyskinesias, sudden akinetic crises related to dyskinesias, akinesia paradoxica (hypotonic freezing) and 'on and off' phenomenon. Psychiatric: paranoid ideation, psychotic episodes, depression with or without development of suicidal tendencies and dementia. Rarely convulsions (causal relationship not established). Cardiac irregularities and/or palpitations, orthostatic hypotensive episodes, anorexia, nausea, vomiting and dizziness.

1236 CMA JOURNAL/JUNE 4, 1977/VOL. 116

Other adverse reactions that may occur: Psychiatric: increased libido with serious antisocial behavior, euphoria, lethargy, sedation, stimulation, fatigue and malaise, confusion, insomnia, nightmares, hallucinations and delusions, agitation and anxiety. Neurologic: ataxia, faintness, impairment of gait, headache, increased hand tremor, akinetic episodes, "akinesia paradoxica", increase in the frequency and duration of the oscillations in performance, torticollis, trismus, tightness of the mouth, lips or tongue, oculogyric crisis, weakness, numbness, bruxism, priapism. Gastrointestinal: constipation, diarrhea, epigastric and abdominal distress and pain, flatulence; eructation, hiccups, sialorrhea; difficulty in swallowing, bitter taste, dry mouth; duodenal ulcer; gastrointestinal bleeding; burning sensation of the tongue. Cardiovascular: arrhythmias, hypotension, nonspecific ECG changes, flushing, phlebitis. Hematologic: hemolytic anemia, leukopenia, agranulocytosis. Dermatologic: sweating, edema, hair loss, pallor, rash, bad odor, dark sweat. Musculoskeletal: low back pain, muscle spasm and twitching, musculoskeletal pain. Respiratory: feeling of pressure in the chest, cough, hoarseness, bizarre breathing pattern, postnasal drip. Urogenital: urinary frequency, retention, incontinence, hematuria, dark urine, nocturia, and one report of interstitial nephritis. SpecialSenses: blurred vision, diplopia, dilated pupils, activation of latent Horner's syndrome. Miscellaneous: hot flashes, weight gain or loss. Abnormalities in laboratory tests reported with levodopa alone, which may occur with SINEMET*: Elevations of blood urea nitrogen, SGOT, SGPT, LDH, bilirubin, alkaline phosphatase or protein bound iodine. Occasional reduction in WBC, hemoglobin and hematocrit. Elevations of uric acid with colorimetric method. Positive Coombs tests reported both with SINEMET* and with levodopa alone, but hemolytic anemia extremely rare. DOSAGE SUMMARY In order to reduce the incidence of adverse reactions and achieve maximal benefit, therapy with SINEMET* must be individualized and drug administration continuously matched to the needs and tolerance of the patient. Combined therapy with SINEMET* has a narrower therapeutic range than with levodopa alone because of its greater milligram potency. Therefore, titration and adjustment of dosage should be made in small steps and recommended dosage ranges not be exceeded. Appearance of involuntary movements should be regarded as a sign of levodopa toxicity and an indication of overdosage, requiring dose reduction. Treatment should, therefore, aim at maximal benefit without dyskinesias. Therapy in Patients not receiving Levodopa: Initially '2 tablet once or twice a day, increase by '2 tablet every three days if desirable. An optimum dose of 3 to 5 tablets a day divided into 4 to 6 doses. Therapy in Patients receiving Levodopa: Discontinue levodopa for at least 12 hours, then give approximately 20% of the previous levodopa dose in 4 to 6 divided doses. FOR COMPLETE PRESCRIBING INFORMATION, PARTICULARLY DETAILS OF DOSAGE AND ADMINISTRATION, PLEASE CONSULT PRODUCT MONOGRAPH WHICH IS AVAILABLE ON REQUEST. HOW SUPPLIED Ca8804-TabletsSINEMET* 250, dapple-blue, oval, biconvex, scored, compressed tablets coded MSD 654, each containing 25 mg of carbidopa and 250 mg of levodopa. Available in bottles of 100.

CEl

MERCK

SHARP

*Trademark

&DOHME CANADA LIMITED POINTE CLAIRE. QUEBEC

(SNM-7-487-JA)

lesions, spontaneous rib fractures and decreased concentrations of immunoglobulin in the serum. The high proportion of abnormal plasma cells in the bone marrow aspirate was suspicious and light-chain disease was suspected. With the use of IgD antiserum in immunoelectrophoresis the diagnosis was confirmed; IgD, X type, was identified. Bence Jones protein, X type, was also detected in the serum and, in small quantity, in the urine. I thank Dr. W. Pruzanski, University of Toronto and Dr. E. Rioux, Laval University, for their help in confirming the diagnosis, and Dr. J. Mathieu for reviewing the manuscript. JIRI TOTH, MD Hematology service H6pital Christ-Roi

Quebec, PQ

consistently accurate predictor of liver damage, single plasma values are not as reliable in estimating prognosis. However, in the absence of a nomogram the clinician may use the following equations as a rough prognostic guide: Cl = antilog of (2.68 - 0.15t) C2 = antilog of (2.78 - 0.075t) where Cl and C2 are the theoretical plasma concentrations of acetaminophen calculated by substituting the value of t (number of hours after ingestion) in the two equations. If the observed plasma concentration at time t is less than C1 the patient is in the "safe zone" with no hepatotoxicity. An observed value greater than Cl but less than C2 indicates potential hepatotoxicity, and a value greater than C2 indicates hepatotoxicity. P.L. MADAN,

References

Assessment of acetaminophen toxicity from single plasma values To the editor: Acetaminophen (also known as paracetamol) has become increasingly popular in recent years. The drug is generally considered a safe and useful analgesic and antipyretic agent when taken in therapeutic doses' and is being advertised heavily to the consumer as "non-aspirin" and "safer than aspirin". However, some reports have cited hepatotoxicity with resulting death not only after an overdose' but also with as low a dose as 0.5 g.' This has prompted some investigators to take a closer look at the toxic potential of this drug, and various journals are publishing clinical reviews of the drug." In healthy individuals the elimination half-life of acetaminophen is usually 2 hours but it increases in patients with hepatotoxicity.7 Since liver damage can be expected to develop when the half-life of the drug exceeds 4 hours, nomograms have been constructed to assess the probability of liver damage according to the plasma concentration of acetaminophen.4 The plasma concentration of acetaminophen determined at time t after ingestion is often used as a guide in predicting whether hepatotoxicity exists. While the plasma half-life is the most

so.

J. HANS S. GEGGIE, MD Wakefield, PQ

PH D

St. John's University college of pharmacy and allied health professions Jamaica, NY

1. KAWAI T: Clinical Aspects of Plasma Proteins, Tokyo, Igaku Shoin Ltd, 1973, pp

393-414 2. ROWE DS, FAHEY JL: A new class of human globulins. I. A unique myeloma protein. J Exp Med 121: 171, 1965 3. Idem: A new class of human immunoglobulins. II. Normal serum IgD. Ibid, p 185 4. FISHKIN BC, GLASSY FJ, HA1TERSLEY PG, et al: IgD multiple myeloma: a report of five cases. Am I Clin Pathol 53: 209, 1970 5. FAHEY JL, CARBONE PP, ROWE DS, et al: Plasma cell myeloma with D-myeloma protein (IgD myeloma). Am J Med 45: 373, 1968 6. ALCALAY M, GOMBERT J, FROSCRAIN C, et al: Le myelome IgD. A propos d'un cas. Sem Hop Paris 51: 1227, 1975 7. KATZ A, PRUZANSKI W: IgD deposition in glomerulonephritis. Am J Clin Pathol 63: 291, 1975

Unlike Dr. Corrigan's men I never diverted - "organized" was the contemporary term - penicillin to use in animals! I did, however, "organize" some penicillin for a heroic Dutch doctor while stationed in Oss, Holland at the time of the Battle of the Bulge. It was a great pleasure to do ward rounds with Dr. Kris Fontein and see how well "our" patients were doing. In return Kris and his charming wife Freda entertained me New Year's Eve 1944. The Fonteins supplied the booze; I "organized" the food from the unit kitchen! So perhaps a few Germans and a few Dutch are living today due to my old commanding officer's humanity and my "organizing" ability - I hope

References 1. MIELKE CH JR, HEIDEN D, BRIITEN AF, et al: Hemostasis, antipyretics, and mild analgesics - acetaminophen vs aspirin. JAMA 235: 613, 1976 2. MATrrHEw H: Acute acetaminophen poisoning. Clin Toxicol 6: 9, 1973 3. MANOR E, MARMOR A, KAUFMAN S, et al: Massive hemolysis caused by acetaminophen. Positive determination by direct Coombs test. JAMA 236: 2777, 1976 4. MADAN PL: Acetaminophen toxicity. J Clin Pharnmacol (in press) 5. BOYER TD, ROUFF SL: Acetaminopheninduced hepatic necrosis and renal failure. JAMA 218: 440, 1971 6. KOCH-WESER J: Drug therapy. Acetaminophen. N Engl J Med 295: 1297, 1976 7. PREscoTr LR, RoscoE P, WRIGHT N, et al: Plasma paracetamol half-life and hepatic necrosis in patients with paracetamol overdosages. Lancet 1: 519, 1971

More vignettes of war To the editor: I am amused and stimulated by Dr. Corrigan's "Musings on Penicillium notatum" (Can Med Assoc J 116: 193 , 1977). While he commanded a surgical unit in Italy I was a junior medical officer in a field dressing station (FDS) in northwest Europe. I remember Major L.G. Alexander (Alec) of Calgary receiving an order down from corps denying penicillin to enemy wounded. With his inimitable and unforgettable panache he passed the offensive document across his backside and said "That's the only possible use for such a command." German wounded continued to get penicillin in six FDS. Never again did we hear of this infamous order. I first saw penicillin while on leave in Edinburgh in April 1944. At the Royal Infirmary we were shown a dozen milk bottles full of a green scum perched on a window sill. We were next introduced to the three patients receiving penicillin. I wonder if these were the first penicillin recipients in history?

1238 CMA JOURNAL/JUNE 4, 1977/VOL. 116

BOOKS This list is an acknowledgement of books received. It does not preclude review at a later date. ATLAS OF THE CENTRAL NERVOUS SYSTEM IN MAN. 2nd ed. Richard A. Miller and Ethel Burack. 126 pp. Illust. The Williams & Wilkins Company, Baltimore; Burns & MacEachern Limited, Don Mills, 1977. $18.45. ISBN 0-683-06127-5 ATLAS OF THE 'FACE IN GENETIC DISORDERS. 2nd ed. Richard M. Goodman and Robert J. Borlin. 584 pp. IIlust. The C.V. Mosby Company, Saint Louis, 1977. $60.40. ISBN 0-8016-1895-9 BLOOD TRANSFUSION FOR CLINICIANS. John Wallace. 351 pp. Churchill Livingstone, Edinburgh; Longman Canada Limited, Don Mills, 1977. $28. ISBN 0-443-01537-6 BURCKHARDT'S ATLAS AND MANUAL OF DERMATOLOGY AND VENEREOLOGY. 3rd ed. Edited by Peter J. Lynch and Stephan Epstein. 271 pp. Illust. The Williams & Wilkins Company, Baltimore; Burns & MacEachern Limited, Don Mills, 1977. $43.50. ISBN 0-683-01134-0 CLINICAL INTERVIEWING SKILLS. A Programmed Manual for Data Gathering, Evaluation, and Patient Management. 3rd ed. Robert E. Froelich and F. Marian Bishop. 203 pp. Illust. The C.V. Mosby Company, Saint Louis, 1977. $7.50. ISBN 0-80161702-2

COLOR ATLAS OF MEDICAL MYCOLOGY. Jean Delacretaz, Dode Grigoriu and Georges Ducel. 187 pp. lllust. Hans Huber Publishers, Bern; Year Book Medical Publishers, Inc., Chicago, 1976. $59.50. ISBN 0-8151-2422-8 COLOR ATLAS OF TROPICAL MEDICINE AND PARASITOLOGY. Wallace Peters and Herbert M. Gilles. 416 pp. Illust. Year Book Medical Publishers, Inc., Chicago, 1977. Price not stated. ISBN 0-8151-3475-4

ESSENTIAL HEPATOLOGY. Thomas S. Chen and Peter S. Chen. 360 pp. Illust. Butterworth (Publishers) Inc., Woburn; Butterworth & Co. (Canada) Ltd., Scarborough, 1977. $24.50. ISBN 0-409-95005-

x

HOMINID FOSSILS. An Illustrated Key. T.W. Phenice. 163 pp. Illust. Wm. C. Brown Company Publishers, Dubuque; Burns and MacEachern Limited, Don Mills, 1976. $4.50, paperbound. ISBN 0-697-03109-8 IMMUNOBIOLOGY OF BONE MARROW TRANSPLANTATION. A Transplantation Proceedings Reprint, September and December 1976. Edited by Bo Dupont and Robert A. Good. 346 pp. Charts. Grune & Stratton, Inc., New York; Longman Canada Limnited, Don Mills, 1976. $33. ISBN 0-80890982-7

continued on page 1242

IgD myeloma: a case report.

VELOSEF 250 CAPSULES VELOSEF 500 CAPSULES Cophradine Capsules VELOSEF 125 FOR ORAL SUSPENSION VELOSEF 250 FOR ORAL SUSPENSION C.phradine for Oral Spop...
1MB Sizes 0 Downloads 0 Views