The smallest dose of estrogen in any oral contraceptive in Canada today k.trodudng *
JIil.UfT.W1/2O each whtte tablet contains 1 mg norethindrone acetate and 20 mcg ethinyl estradiol
INDICATION-MinEstrin 1/20 is indicated for the control of conception. CONTRAINDICATIONS - Thrombophlebitis, thromboembolic disorders, cerebral apoplexy, or a past history of these conditions; markedly impaired liver function; known or suspected carcinoma of the breast or genital tract; known or suspected estrogen dependent neoplasia; undiagnosed abnormal genital bleeding; during the period a mother is breast feeding an infant; any ocular lesion such as partial or complete loss of vision, defect in visual fields or diplopia arising from ophthalmic vascular disease; when epiphysial closure is not complete; when pregnancy is suspected; classical migraine; history of cholestatic jaundice; coronary thrombosis. WARNINGS-If any thrombotic disorder occurs or is suspected, the drug should be discontinued immediately. Pretreatment and periodic physical examination should include special reference to breast and pelvic organs. Preexisting uterine fibromyomata may increase in size. Conditions influenced by fluid retention, such as epilepsy, asthma, cardiac or renal dysfunction, require careful observation. PRECAUTIONS-Among the precautions associated with oral contraceptive usage are the following: Endocrine, possibly liver function tests and thyroid function tests may be affected. Altered bleeding patterns may be induced. Diabetic patients or those with a familial history of diabetes should be carefully observed while receiving oral contraceptives. Oral contraceptives may mask the onset of the climacteric. Susceptible women may experience an increase in blood pressure. Patients with a history of jaundice should be given oral contraceptives with great care. ADVERSE REACTIONS- Possible adverse reactions include thrombophlebitis, pulmonary embolism, cerebral thrombosis, nausea, altered bleeding patterns, edema, breast soreness, changes in weight, headache, acne, depression, premenstrual tension, hirsutism, and neuro-ocular lesion. DOSAGE FORMS-MinEstrrn 1/20 is available in Simpak dispensers of 21 tablets (white) and Simpak dispensers of 28 tablets (21 white tablets and 7 lilac inert tablets). Each white tablet contains 1 mg of norethindrone acetate and 20 mcg of ethinyl estradiol. Full product informatIon available on request.
PARKE-DAVIS & Parke, Davis company, Ltd. Don Mills, Ontario M3C 2E9
sician. In fact my reason for writing about the TM method was to remove any such misconceptions that have been associated with the technique. Scientific research has substantiated the uniqueness of the TM technique with objective, repeatable psychophysiologic benefits. These results have been used effectively in numerous areas of medicine. The opinions of Dr. Town and a Christian publishing house can hardly be said to represent the entire Christian position. Ordained members of numerous established Christian denominations and believers of all major religions practise TM and find enhancement of their particular religious practices. TM is not a religion, defined as comprising belief, dogma, communal rituals, moral codes and scriptures, the last providing the foundation for all these. TM requires no faith, no set of beliefs that one must adhere to and no communal rituals one must practise as a means of worship, and it implies no moral dictates. There are no scriptures on which one is required to base all these aspects of institutionalized religion. If people of all faiths can practise this technique it is precisely because it is not a religion, but a technique. A clear perspective of the tradition behind TM and its position as a technique separate from the Eastern religions is provided by Dr. Louis J. West.1 Controversial aspects of TM are fully dealt with in the first two introductory lectures of the seven-step program prior to any commitment to start the course of instruction. I suggest that any individual with a serious desire to be informed will find teachers of TM most cooperative. While proposing to my fellow physicians that TM is an effective tool for decreasing anxiety, I can only apologize to Dr. Town for causing him such distress. E.B. TOANE, MD Central Peace Clinic Box 746 Spirit River, AB
Reference I. WEST U: Transcendental meditation and other nonprofessional psychotherapies, in Comprehensive Textbook of Psychiatry, vol 2, 2nd ed, FREEDMAN AM, KAPLAN HI, SADOCK BJ (eds), Baltimore, Williams & Wilkins, 1975, pp 2564-7
Measurement of blood pressure Ta the editor: Biron, Mongeau and Bertrand (Can Med Assoc J 114: 432, 1976) presented blood pressure standards for French-Canadian children established from readings obtained under home conditions. They correctly cautioned that blood pressures recorded in a doctor's office may be higher, thus indicating that their standards may be too low for office practice.
They compared their findings with those published for American children 6 to 11 years of age by Weiss, Hamill and Drizd,' and found that the latter reported higher median values. This led them to conjecture that this difference may result from the fact that American children weigh more than their Canadian peers and that, therefore, standards for blood pressure of American children cannot be used in Quebec. They may be right but such conclusions are not warranted. The authors recorded blood pressures at home, while the child was seated, and recorded as the diastolic pressure the point where the fourth Korotkoff sound was heard. Weiss and colleagues, however, measured pressures in supine children, outside the home, and recorded as the diastolic pressure the point where the sounds disappeared. Thus the differences in the values may be due to differences in method rather than in weight, although the latter may well be a factor. Nevertheless, the suggestion that American tables should not be used in Quebec may be justified. Indeed, there may be geographic differences in blood pressure, but more studies using similar methods are needed to clarify this question. SOL LONDE, MD Associate professor emeritus in clinical pediatrics Department of cardiology washington University School of Medicine St. Louis, MO
Reference I. wEIss
NS,
HAMILL PVV,
DRIZO T:
Blood
pressure levels of children 6-11 years, US Dept of Health, Education and welfare publ no (HRA) 74-1617, Rockville, MD, National Center for Health Statistics, vital and health statistics, series 11, no 135, 1973
To the editor: We appreciate Dr. Londe's comments about the possibility that differences in method may explain partly, but to an unknown extent, the lower blood pressure values found in French-Canadian children compared with American children. His comments are well taken. PIERRE BIRON, MD Universit6 de Montr6al Montreal, PQ
Gonococcal conjunctivitis: accidental infection To the editor: A case of accidental infection of the eye with Neisseria gonorrhoeae presented some interesting pathogenetic features. A laboratory technician with several years' experience with N. gonorrhoeae had injected mice intracerebrally with N. gonorrhoeae strain 188, human-virulent colony type (Ti). Seven days later, while examining the animals surviving the challenge, he was struck on the right eye by the strap of his sterile mask. For the re-
CMA JOURNAL/OCTOBER 9, 1976/VOL. 115
609
JIil.UfT.W1/2O each whtte tablet contains 1 mg norethindrone acetate and 20 mcg ethinyl estradiol
INDICATION-MinEstrin 1/20 is indicated for the control of conception. CONTRAINDICATIONS - Thrombophlebitis, thromboembolic disorders, cerebral apoplexy, or a past history of these conditions; markedly impaired liver function; known or suspected carcinoma of the breast or genital tract; known or suspected estrogen dependent neoplasia; undiagnosed abnormal genital bleeding; during the period a mother is breast feeding an infant; any ocular lesion such as partial or complete loss of vision, defect in visual fields or diplopia arising from ophthalmic vascular disease; when epiphysial closure is not complete; when pregnancy is suspected; classical migraine; history of cholestatic jaundice; coronary thrombosis. WARNINGS-If any thrombotic disorder occurs or is suspected, the drug should be discontinued immediately. Pretreatment and periodic physical examination should include special reference to breast and pelvic organs. Preexisting uterine fibromyomata may increase in size. Conditions influenced by fluid retention, such as epilepsy, asthma, cardiac or renal dysfunction, require careful observation. PRECAUTIONS-Among the precautions associated with oral contraceptive usage are the following: Endocrine, possibly liver function tests and thyroid function tests may be affected. Altered bleeding patterns may be induced. Diabetic patients or those with a familial history of diabetes should be carefully observed while receiving oral contraceptives. Oral contraceptives may mask the onset of the climacteric. Susceptible women may experience an increase in blood pressure. Patients with a history of jaundice should be given oral contraceptives with great care. ADVERSE REACTIONS- Possible adverse reactions include thrombophlebitis, pulmonary embolism, cerebral thrombosis, nausea, altered bleeding patterns, edema, breast soreness, changes in weight, headache, acne, depression, premenstrual tension, hirsutism, and neuro-ocular lesion. DOSAGE FORMS-MinEstrrn 1/20 is available in Simpak dispensers of 21 tablets (white) and Simpak dispensers of 28 tablets (21 white tablets and 7 lilac inert tablets). Each white tablet contains 1 mg of norethindrone acetate and 20 mcg of ethinyl estradiol. Full product informatIon available on request.
PARKE-DAVIS & Parke, Davis company, Ltd. Don Mills, Ontario M3C 2E9
sician. In fact my reason for writing about the TM method was to remove any such misconceptions that have been associated with the technique. Scientific research has substantiated the uniqueness of the TM technique with objective, repeatable psychophysiologic benefits. These results have been used effectively in numerous areas of medicine. The opinions of Dr. Town and a Christian publishing house can hardly be said to represent the entire Christian position. Ordained members of numerous established Christian denominations and believers of all major religions practise TM and find enhancement of their particular religious practices. TM is not a religion, defined as comprising belief, dogma, communal rituals, moral codes and scriptures, the last providing the foundation for all these. TM requires no faith, no set of beliefs that one must adhere to and no communal rituals one must practise as a means of worship, and it implies no moral dictates. There are no scriptures on which one is required to base all these aspects of institutionalized religion. If people of all faiths can practise this technique it is precisely because it is not a religion, but a technique. A clear perspective of the tradition behind TM and its position as a technique separate from the Eastern religions is provided by Dr. Louis J. West.1 Controversial aspects of TM are fully dealt with in the first two introductory lectures of the seven-step program prior to any commitment to start the course of instruction. I suggest that any individual with a serious desire to be informed will find teachers of TM most cooperative. While proposing to my fellow physicians that TM is an effective tool for decreasing anxiety, I can only apologize to Dr. Town for causing him such distress. E.B. TOANE, MD Central Peace Clinic Box 746 Spirit River, AB
Reference I. WEST U: Transcendental meditation and other nonprofessional psychotherapies, in Comprehensive Textbook of Psychiatry, vol 2, 2nd ed, FREEDMAN AM, KAPLAN HI, SADOCK BJ (eds), Baltimore, Williams & Wilkins, 1975, pp 2564-7
Measurement of blood pressure Ta the editor: Biron, Mongeau and Bertrand (Can Med Assoc J 114: 432, 1976) presented blood pressure standards for French-Canadian children established from readings obtained under home conditions. They correctly cautioned that blood pressures recorded in a doctor's office may be higher, thus indicating that their standards may be too low for office practice.
They compared their findings with those published for American children 6 to 11 years of age by Weiss, Hamill and Drizd,' and found that the latter reported higher median values. This led them to conjecture that this difference may result from the fact that American children weigh more than their Canadian peers and that, therefore, standards for blood pressure of American children cannot be used in Quebec. They may be right but such conclusions are not warranted. The authors recorded blood pressures at home, while the child was seated, and recorded as the diastolic pressure the point where the fourth Korotkoff sound was heard. Weiss and colleagues, however, measured pressures in supine children, outside the home, and recorded as the diastolic pressure the point where the sounds disappeared. Thus the differences in the values may be due to differences in method rather than in weight, although the latter may well be a factor. Nevertheless, the suggestion that American tables should not be used in Quebec may be justified. Indeed, there may be geographic differences in blood pressure, but more studies using similar methods are needed to clarify this question. SOL LONDE, MD Associate professor emeritus in clinical pediatrics Department of cardiology washington University School of Medicine St. Louis, MO
Reference I. wEIss
NS,
HAMILL PVV,
DRIZO T:
Blood
pressure levels of children 6-11 years, US Dept of Health, Education and welfare publ no (HRA) 74-1617, Rockville, MD, National Center for Health Statistics, vital and health statistics, series 11, no 135, 1973
To the editor: We appreciate Dr. Londe's comments about the possibility that differences in method may explain partly, but to an unknown extent, the lower blood pressure values found in French-Canadian children compared with American children. His comments are well taken. PIERRE BIRON, MD Universit6 de Montr6al Montreal, PQ
Gonococcal conjunctivitis: accidental infection To the editor: A case of accidental infection of the eye with Neisseria gonorrhoeae presented some interesting pathogenetic features. A laboratory technician with several years' experience with N. gonorrhoeae had injected mice intracerebrally with N. gonorrhoeae strain 188, human-virulent colony type (Ti). Seven days later, while examining the animals surviving the challenge, he was struck on the right eye by the strap of his sterile mask. For the re-
CMA JOURNAL/OCTOBER 9, 1976/VOL. 115
609
