languages from which we translate into English are Russian, German, Spanish, the Scandinavian languages and Japanese, but highly specialized materials also come to us in many other languages. We would appreciate having this need for specialized freelance translators brought to the attention of any of your readers who know foreign languages and are experts in their fields. G.A. MENDEL
Chief, multilingual services division Translation bureau Department of the Secretary of State Ottawa, Ont.
Therapeutic abortion
up" (Can Med Assoc J 112: 578, 1975) Cumming and colleagues state "Reported series correlating results of coronary angiography and exercise tests indicate that negative tests may occur in up to 75% of symptomatic patients with narrowing of only one major coronary artery, and in up to 50% of subjects with previous infarctions". This interpretation of work published by myself and associates1 is erroneous and misleading. We studied 84 patients by both exercise stress testing using multiple lead records, bearing close resemblance to standard scalar electrocardiography,2 and selective coronary arteriography. Thirty-seven of the 84 had typical angina pectoris; 6 were classified as having atypical angina pectoris because in the judgement of the clinicians their pain was probably ischemic myocardial pain but did not fulfil one or more criteria for typical angina pectoris. The remaining 41 patients were classified before the electrocardiographic stress testing or arteriography as "other", indicating that on clinical grounds their chest discomfort was not considered to be definitely due to coronary insufficiency. This gave us three simultaneous variables for comparison in each of the subjects: the clinical diagnosis of angina pectoris, the amount of ischemic ST-segment shift with exercise, and the degree of narrowing demonstrated by arteriography. The following criteria for arteriographic classes were used:3 0, no apparent narrowing; I, minimal narrowing; II, narrowing greater than 50% of the lumen of one artery; III, multiple severe narrowings; IV, one or more complete occlusions. Fig. 1 shows the amount of ST-segment shift for each of the 84 subjects in the single lead with greatest abnor-
To the editor: In his comments (Can Med Assoc J 112: 558, 1975) on my letter (Can Med Assoc J 112: 25, 1975) Dr. Wendell Watters suggests that I equate embryos with "helpless babies". If this were true Dr. Watters would have struck an effective blow against a proponent of the pro-life stance, showing him to be guilty of using an inane slogan. But what I said was in fact virtually the opposite: "(The pro-lifers) should credit those with views like Dr. Watters as being motivated by concern for the pregnant woman and not by a desire to destroy helpless babies to satisfy the whims of the mothers". Instead of espousing the "helpless baby" fatuity my statement actually condemns it. Dr. Watters's lack of perception is not limited to my letter. He also takes Dr. Heiko Baunemann to task, saying that he is "actually incorrect as to his facts. Between the end of World War I and Hitler's rise to power in 1933 there was a growing movement in Germany to liberalize abortion laws". Again, a serious indictment: a pro-lifer has his facts wrong. 9.01 QAtypecol Angina 0 But now read Dr. Baunemann's ac.4g..J tual statement on the subject: "As a 0 t..DO0 result of postwar hardships and the .2.0 subsequent depression, abortion on de0. mand or for nonmedical socioeconomic .Z5 reasons had been available in Germany C,) OEI. 8 since the end of World War I". Just ..E zo 0 what fact in this statement is incorrect? One almost wonders if Dr. Watters -E 1.5 read the whole letter before he an- E swered it. The debate can only improve 91.0 . o .o if it is kept free from misrepresenta0.5 .L.LsA L. L. fl tions. 0 JJ. KRAYENHOFF, MD r.z.fl 0 L.L.O 1120 Yates St. Victoria, BC
o
i
rr
.
Cinearteriographic Glosses
FIG. 1-Response of 84 subjects to ergometer stress test. Subjects classified according to coronary cinearteriograms To the editor: In the article "Electro- and clinical diagnosis. Reproduced from cardiographic changes during exercise Circulation1 by permission of The in asymptornatic men: 3-year follow- American Heart Association, Inc. 1388 CMA JOURNAL/JUNE 21, 1975/VOL. 112
Locasa len® for the treatment of chronic eczema Indications LOCASALEN is intendedfor thetreatment of subacute to hyperchronic inflammatory and/ordysplastic skin diseases, as well as hyperkeratotic conditions in particular. The indications tor LOCASALEN thus include chronic constitutional eczema or neurodermatitis; chronic exogenouseczema irrespectiveot origin, (e.g.: skin disorders dueto attrition, occupational eczema); chronic eczema ot microbial or mycotic origin; tylotic eczema; hyperkeratosis asencountered in ichthyosis or chronic dyshidrosis; pustulosis ot the palms and soles; lichen planus; chronic cutaneous lupus erythematosus; psoriasis.
Dosage and Administration
Ass rule LOCASALEN should be applied once or twice dailywhen dressings are not used and once dailywhen employed under occlusive dressing. It is not usually necessaryto coverthe treated area. Thethickness of the layer should vary depending on the nature andseverity otthe skindisorder, since in thisway, it is possibleto regulate moisture retention. In cases in which transitoryexudative must be anticipated, LOCASALEN should be applied in a verythin layer, thereby allowing largerquantitiesof moistureto be released through the filmof ointment. LOCASALEN can alsoexert an occlusive effect but only if applied in a thick layer. It panetrates well into the skin and when rubbed in thoroughly, leaves onthe skins transparent, oily film that can be removed with soap and water or a skin cleanser. Excess film can be removed relativelywell with papertissue, scarcely leaving any perceptible sheen.
Adverse Reactions
The local tolerabilityof LOCASALEN proved to be very goodOases in which local irritation made it advisableto discontinuethe medication accounted for less than 2% of thetotal number of patientatreated. Adverse reactions consists mainly of local reddening of the skin, desquamation, pruritis and smarting. LOCASALEN contains no preservatives, odour correcting agents, emulsifiers, stabilizers or antibiotic supplements which have been recognized as potential sensitizers. Hypersensitivity to salicylic acid canoccur; however, the incidence in the population asa whole is approximately 0.2%. Systemic side effectsattributable to the transcutaneous abeorplion of salicylic acid or flumethasone pivalate have not been reported. Absorption of salicylic acid does occur; however, investigations have shown that irrespective of the amount of LOCASALEN employed, and even applied under occlusive dressings, plasma concentrations of salicylic acid did not exceedordinary therapeutic levels as a result of transcutaneous absorption. Investigations have shownthat under extreme conditions-where 40 to60 grams of ointment were applied daily to80-90% of the body surface under occlusive dressings-plasma cortisol and urinary steroids have been obeerved to decrease below normal levels. This decrease proved transitoryand was not accompanied by anyclinical symptoms.
Warnings
LOCASALEN is not indicated in acute weeping or subacute exudetive stages. Astranscutaneous absorption of the salicylic acid component may give rise to systemic effects, LOCASALEN should not be applied toextensive areasof the skin in small children or pregnant women. Likewise corticosteroidsare known to be abeorbed percutaneously, therefore in patients requiring applications of LOCASALEN to extensive areas or for prolonged periods, adrenal function should be carefully monitored. All contact of the drug with theeyes, mouth, mucous membraneashould be avoided.
Precautions
If sensitivity or idiosyncratic reactions occu.LOCASALEN should be discontinued and appropriate measures taken. The safety of the use of topical corticosteroids in pregnant females has not been established. Therefore they should not be used extensively on pregnant patients in large amountsor for prolonged periodsof time. Patients should be advised to inform subsequent physicians of the prior useof corticosteroids. In the presence of an infection, the use of an appropriate antifungal or antibacterial agent should be instituted, If a favourable response does not occur promptly, LOCASALEN should be discontinued until the infection has been adequately controlled.
Contraindications
Tuberculosis of the skin, syphilitic skin affections, viral and acute fungal infectionsof the skin. Systemic fungal infections. This preparation is not for ophthalmic use. LOCASALEN is contraindicated in individualawith a history of hypersensitivityto its components.
Supplied
Flumethasone Pivalate 0.02% and salicylic acid 3.0% ointmentintubesof 15gm and 50 gin.
ECG changes during exercise
CIBA Dorval, P.Q.
Chief, multilingual services division Translation bureau Department of the Secretary of State Ottawa, Ont.
Therapeutic abortion
up" (Can Med Assoc J 112: 578, 1975) Cumming and colleagues state "Reported series correlating results of coronary angiography and exercise tests indicate that negative tests may occur in up to 75% of symptomatic patients with narrowing of only one major coronary artery, and in up to 50% of subjects with previous infarctions". This interpretation of work published by myself and associates1 is erroneous and misleading. We studied 84 patients by both exercise stress testing using multiple lead records, bearing close resemblance to standard scalar electrocardiography,2 and selective coronary arteriography. Thirty-seven of the 84 had typical angina pectoris; 6 were classified as having atypical angina pectoris because in the judgement of the clinicians their pain was probably ischemic myocardial pain but did not fulfil one or more criteria for typical angina pectoris. The remaining 41 patients were classified before the electrocardiographic stress testing or arteriography as "other", indicating that on clinical grounds their chest discomfort was not considered to be definitely due to coronary insufficiency. This gave us three simultaneous variables for comparison in each of the subjects: the clinical diagnosis of angina pectoris, the amount of ischemic ST-segment shift with exercise, and the degree of narrowing demonstrated by arteriography. The following criteria for arteriographic classes were used:3 0, no apparent narrowing; I, minimal narrowing; II, narrowing greater than 50% of the lumen of one artery; III, multiple severe narrowings; IV, one or more complete occlusions. Fig. 1 shows the amount of ST-segment shift for each of the 84 subjects in the single lead with greatest abnor-
To the editor: In his comments (Can Med Assoc J 112: 558, 1975) on my letter (Can Med Assoc J 112: 25, 1975) Dr. Wendell Watters suggests that I equate embryos with "helpless babies". If this were true Dr. Watters would have struck an effective blow against a proponent of the pro-life stance, showing him to be guilty of using an inane slogan. But what I said was in fact virtually the opposite: "(The pro-lifers) should credit those with views like Dr. Watters as being motivated by concern for the pregnant woman and not by a desire to destroy helpless babies to satisfy the whims of the mothers". Instead of espousing the "helpless baby" fatuity my statement actually condemns it. Dr. Watters's lack of perception is not limited to my letter. He also takes Dr. Heiko Baunemann to task, saying that he is "actually incorrect as to his facts. Between the end of World War I and Hitler's rise to power in 1933 there was a growing movement in Germany to liberalize abortion laws". Again, a serious indictment: a pro-lifer has his facts wrong. 9.01 QAtypecol Angina 0 But now read Dr. Baunemann's ac.4g..J tual statement on the subject: "As a 0 t..DO0 result of postwar hardships and the .2.0 subsequent depression, abortion on de0. mand or for nonmedical socioeconomic .Z5 reasons had been available in Germany C,) OEI. 8 since the end of World War I". Just ..E zo 0 what fact in this statement is incorrect? One almost wonders if Dr. Watters -E 1.5 read the whole letter before he an- E swered it. The debate can only improve 91.0 . o .o if it is kept free from misrepresenta0.5 .L.LsA L. L. fl tions. 0 JJ. KRAYENHOFF, MD r.z.fl 0 L.L.O 1120 Yates St. Victoria, BC
o
i
rr
.
Cinearteriographic Glosses
FIG. 1-Response of 84 subjects to ergometer stress test. Subjects classified according to coronary cinearteriograms To the editor: In the article "Electro- and clinical diagnosis. Reproduced from cardiographic changes during exercise Circulation1 by permission of The in asymptornatic men: 3-year follow- American Heart Association, Inc. 1388 CMA JOURNAL/JUNE 21, 1975/VOL. 112
Locasa len® for the treatment of chronic eczema Indications LOCASALEN is intendedfor thetreatment of subacute to hyperchronic inflammatory and/ordysplastic skin diseases, as well as hyperkeratotic conditions in particular. The indications tor LOCASALEN thus include chronic constitutional eczema or neurodermatitis; chronic exogenouseczema irrespectiveot origin, (e.g.: skin disorders dueto attrition, occupational eczema); chronic eczema ot microbial or mycotic origin; tylotic eczema; hyperkeratosis asencountered in ichthyosis or chronic dyshidrosis; pustulosis ot the palms and soles; lichen planus; chronic cutaneous lupus erythematosus; psoriasis.
Dosage and Administration
Ass rule LOCASALEN should be applied once or twice dailywhen dressings are not used and once dailywhen employed under occlusive dressing. It is not usually necessaryto coverthe treated area. Thethickness of the layer should vary depending on the nature andseverity otthe skindisorder, since in thisway, it is possibleto regulate moisture retention. In cases in which transitoryexudative must be anticipated, LOCASALEN should be applied in a verythin layer, thereby allowing largerquantitiesof moistureto be released through the filmof ointment. LOCASALEN can alsoexert an occlusive effect but only if applied in a thick layer. It panetrates well into the skin and when rubbed in thoroughly, leaves onthe skins transparent, oily film that can be removed with soap and water or a skin cleanser. Excess film can be removed relativelywell with papertissue, scarcely leaving any perceptible sheen.
Adverse Reactions
The local tolerabilityof LOCASALEN proved to be very goodOases in which local irritation made it advisableto discontinuethe medication accounted for less than 2% of thetotal number of patientatreated. Adverse reactions consists mainly of local reddening of the skin, desquamation, pruritis and smarting. LOCASALEN contains no preservatives, odour correcting agents, emulsifiers, stabilizers or antibiotic supplements which have been recognized as potential sensitizers. Hypersensitivity to salicylic acid canoccur; however, the incidence in the population asa whole is approximately 0.2%. Systemic side effectsattributable to the transcutaneous abeorplion of salicylic acid or flumethasone pivalate have not been reported. Absorption of salicylic acid does occur; however, investigations have shown that irrespective of the amount of LOCASALEN employed, and even applied under occlusive dressings, plasma concentrations of salicylic acid did not exceedordinary therapeutic levels as a result of transcutaneous absorption. Investigations have shownthat under extreme conditions-where 40 to60 grams of ointment were applied daily to80-90% of the body surface under occlusive dressings-plasma cortisol and urinary steroids have been obeerved to decrease below normal levels. This decrease proved transitoryand was not accompanied by anyclinical symptoms.
Warnings
LOCASALEN is not indicated in acute weeping or subacute exudetive stages. Astranscutaneous absorption of the salicylic acid component may give rise to systemic effects, LOCASALEN should not be applied toextensive areasof the skin in small children or pregnant women. Likewise corticosteroidsare known to be abeorbed percutaneously, therefore in patients requiring applications of LOCASALEN to extensive areas or for prolonged periods, adrenal function should be carefully monitored. All contact of the drug with theeyes, mouth, mucous membraneashould be avoided.
Precautions
If sensitivity or idiosyncratic reactions occu.LOCASALEN should be discontinued and appropriate measures taken. The safety of the use of topical corticosteroids in pregnant females has not been established. Therefore they should not be used extensively on pregnant patients in large amountsor for prolonged periodsof time. Patients should be advised to inform subsequent physicians of the prior useof corticosteroids. In the presence of an infection, the use of an appropriate antifungal or antibacterial agent should be instituted, If a favourable response does not occur promptly, LOCASALEN should be discontinued until the infection has been adequately controlled.
Contraindications
Tuberculosis of the skin, syphilitic skin affections, viral and acute fungal infectionsof the skin. Systemic fungal infections. This preparation is not for ophthalmic use. LOCASALEN is contraindicated in individualawith a history of hypersensitivityto its components.
Supplied
Flumethasone Pivalate 0.02% and salicylic acid 3.0% ointmentintubesof 15gm and 50 gin.
ECG changes during exercise
CIBA Dorval, P.Q.
