Tussionex a(resin complexes of hydrocodone and phenyltoloxamine)

.The. , antitussive that

goes further.Composition: Each capsule, tea­spoonful (5 ml.) or tablet contains 5 mg. hydrocodone (Warning: may be habit-forming), and 10 mg. phenyltoloxamine as cationic resin complexes.Effects: An effective antitussive which acts for approximately 12 hours.Dosage: Adults: 1 teaspoonful (5 ml.),capsule or tablet every 8-12 hours. May be adjusted to individual requirements.Children: From 1-5 years: Yi tea­spoonful every 12 hours. Over 5 years: 1 teaspoonful every 12 hours.Side E ffects: May include mild constipation, nausea, facial pruritus, or drowsiness, which disappear with adjustment of dose or discontinuance of treatment.Precaution: In young children the respiratory center is especially susceptible to the depressant action of narcotic £ough sup­pressants. Benefit to risk ratio should be carefully considered especially in children with respiratory embarrassment. Estimation of dosage relative to the age and weight of the child is of great importance.Overdosage: Immediately evacuate the stomach. Respira­tory depression, if any, can be counteracted by respiratory stimulants. Convulsions, some­times seen in children, can be controlled by intravenous administration of short-acting barbiturates.How Supplied: Tussionex Capsules, green and white.Bottles of 50. Tussionex Suspen­sion, neutral in taste, golden color; 16 oz. and 900 ml. bottles. Tussionex Tablets, light brown, scored; bottles of 100. A pre­scription for 2 oz. of the Suspen­sion, or 12 Tablets or Capsules, constitutes a 6-day supply in the average case.References:1. Cass LJ, Frederik WS: The prolonged use of a sustained release antitussive. Cambridge, Mass, University Health Services, Harvard University, 1959.2. Cass LJ: The clinical evaluation of a new sustained-release antitussive of low narcotic content. Curr Ther Res 3:355-359, 1961.3. Chan YT, Hays EE: A resin complex for prolonged antitussive effects.Am J Med Sci 234:207-212, 1957.

DIVISION

S P enwaltROCHESTER NEW YORK 14623

Book Reviews

Cope's Early Diagnosis of the Acute Abdomen (15th Edition). William Silen. Oxford University Press, New York, 1979, 280 pp., $13.95 (cloth), $6.95 (paper).

This is the first edition of this book by Dr. Silen, although it seems to have been a well-loved work in Great Britain through 14 previous editions. It has the de­lightfully dignified style char­acteristic of many British publica­tions, and the new editor has couched his additions and modifi­cations in language so similar that one is hard put to discover them. The text is written in a highly per­sonal manner, with anecdotes from the experience of Dr. Cope some­times leading to conclusions that sound rather speculative.

I would like to have had this book at hand during my surgical clerkship and Emergency Room ro­tations. It presents the differential diagnosis of the acute abdomen in a comprehensive and interesting manner, and should prove invalu­able to students and residents. Any practicing physician who encounters patients with acute abdominal symp­toms will profit from the review af­forded by reading this volume, which includes excellent sections on problems encountered in pediatric and gynecological offices as well as in family practice. It reiterates— indeed, Cope may have been the first

to formulate— many of the old aphorisms concerning abdominal diagnosis.

Some clarity could have been gained by the addition of arrows to point out positive findings on the x-ray film reproductions and by translating a few terms, such as "#1 needle” and “ Stirling’s gen­tian violet" into American usage. Perhaps this will be done if Dr. Silen continues as editor and the book becomes popular in this coun­try, as it should.

Collin Baker, MD University o f South Carolina

Columbia

Handbook of Endocrine Tests in Adults and Children (2nd Edition).Robert N. Alsever, Ronald W. Got- lin. Year Book Medical Publishers, Chicago, 1978, 238 pp., $17.95.

This handbook seeks to outline the proper performance (collection techniques and clinical variables, not laboratory procedure perform­ance) of endocrine tests and their normal responses. It is aimed at clinicians at all levels of training and expertise from student to

Continued on page 126

123

Gantrisinsulfisoxazole/RocheB e fo re p re s c r ib in g , p le a s e c o n s u lt c o m p le te p ro d u c t in fo rm a tio n , a s u m m a ry o f w h ic h fo llo w s : In d ic a t io n s : N o n o b s tru c te d u r in a ry tra c t in fe c tio n s (m a in ly c y s tit is , p y e lit is , p y e lo n e p h r it is ) d u e to s u s ­c e p t ib le o rg a n is m s (u s u a lly E. co li, K le b s ie lla - A e ro b a c te r, s ta p h y lo c o c c u s , P m ira b ilis , P v u lg a r is ) A c u te o titis m e d ia d u e to H. in f lu e n z a e (c o n c o m i­ta n t ly w ith a d e q u a te d o s e s o f p e n ic illin ) . IM P O R T A N T N O TE : In v itro s e n s it iv ity te s ts no t a lw a y s re liab le ; m u s t b e c o o rd in a te d w ith b a c te r io lo g ic a l a n d c lin ic a l re sp o n se . A d d a m in o b e n z o ic a c id to fo llo w -u p c u l­tu re m e d ia . In c re a s in g f re q u e n c y o f re s is ta n t o r­g a n is m s lim its u s e fu ln e s s o f a n tib a c te r ia l a g e n ts , e s p e c ia l ly in c h ro n ic a n d re c u rre n t u r in a ry in fe c tio n s . M a x im u m s a fe to ta l s u lfo n a m id e b lo o d leve l, 2 0 m g / 100 m l; m e a s u re le ve ls as v a r ia t io n s m a y o ccu r. C o n tra in d ic a tio n s : H y p e rs e n s it iv ity to su lfo n a m id e s ; in fa n ts le ss th a n 2 m o n th s o f a g e ; p re g n a n c y at te rm a n d d u r in g th e n u rs in g p e rio d .W a rn in g s : S a fe ty in p re g n a n c y no t e s ta b lis h e d . D o no t u s e fo r g ro u p A b e ta -h e m o ly tic s t re p to c o c c a l in fe c tio n s , as s e q u e la e (rh e u m a tic feve r, g lo m e ru ­lo n e p h r it is ) a re no t p re v e n te d . D e a th s re p o r te d from h y p e rs e n s itiv ity re a c tio n s , a g ra n u lo c y to s is , a p la s tic a n e m ia a n d o th e r b lo o d d y s c ra s ia s . S o re th ro a t, fever, pa llo r, p u rp u ra o r ja u n d ic e m a y b e e a r ly in d ic a ­tio n s o f s e r io u s b lo o d d is o rd e rs , C B C a n d u r in a lys is w ith ca re fu l m ic ro s c o p ic e x a m in a t io n s h o u ld b e p e r­fo rm e d freq uen tly .P re c a u tio n s : U s e c a u t io u s ly in p a tie n ts w ith im ­p a ire d re na l o r h e p a t ic fu n c tio n , s e ve re a lle rg y o r b ro n c h ia l a s th m a . H e m o lys is , f re q u e n tly d o s e - re la te d , m a y o c c u r in g lu c o s e -6 -p h o s p h a te d e h y d ro g e n a s e -d e f ic ie n t p a tie n ts . M a in ta in a d e q u a te f lu id in ta k e to p re v e n t c ry s ta llu r ia a n d s to n e fo rm a tio n .A d v e rs e R e a c tio n s : B lo o d d y s c ra s ia s : A g ra n u ­lo cy to s is , a p la s tic a n e m ia , th ro m b o c y to p e n ia , le u k o p e n ia , h e m o ly tic a n e m ia , p u rp u ra , h y p o p ro - th ro m b in e m ia a n d m e th e m o g lo b in e m ia ; A lle rg ic re a c ­t io n s : E ry th e m a m u ltifo rm e (S te ve n s -J o h n s o n s y n ­d ro m e ), g e n e ra liz e d s k in e ru p tio n s , e p id e rm a l n e ­c ro ly s is , u r tic a r ia , s e ru m s ic k n e s s , p ru r itu s , e x fo lia tiv e d e rm a tit is , a n a p h y la c to id re a c tio n s , p e r io rb ita l e d e m a , c o n ju n c t iv a l a n d s c le ra l in je c tio n , p h o to s e n ­s itiz a tio n , a r th ra lg ia a n d a lle rg ic m yo c a rd it is ; G a s ­tro in te s tin a l re a c t io n s : N a u se a , em es is , a b d o m in a l p a in s , h e p a tit is , d ia r rh e a , a n o re x ia , p a n c re a tit is an d s to m a titis ; C .N .S . re a c tio n s : H e a d a c h e , p e r ip h e ra l n e u rit is , m e n ta l d e p re s s io n , co n v u ls io n s , a tax ia , h a l­lu c in a tio n s , tin n itu s , v e rt ig o a n d inso m n ia ; M is c e l­la n e o u s re a c tio n s : D ru g feve r, c h il ls a n d to x ic n e ­p h ro s is w ith o lig u r ia a n d a n u ria . P e r ia rte r it is n o d o sa a n d L.E. p h e n o m e n o n h a ve o c c u r re d . D u e to c e rta in c h e m ic a l s im ila r it ie s w ith s o m e g o itro g e n s , d iu re tic s (a c e ta z o la m id e , th ia z id e s ) a n d o ra l h y p o g ly c e m ic a g e n ts , s u lfo n a m id e s h a ve c a u s e d ra re in s ta n c e s of g o ite r p ro d u c t io n , d iu re s is a n d h y p o g ly c e m ia as w e ll as th y ro id m a lig n a n c ie s in ra ts fo llo w in g lo n g -te rm a d m in is tra tio n . C ro s s -s e n s itiv ity w ith th e s e a g e n ts m a y ex is t.D o s a g e : C o n tra in d ic a te d in in fa n ts u n d e r 2 m o n th s e x c e p t in th e tre a tm e n t o f c o n g e n ita l to x o ­p la s m o s is a s a d ju n c t iv e th e ra p y w ith p y rim e th a m in e . U s u a l a d u lt d o s a g e — 2 to 4 G m in itia lly , th e n 4 to 8 G m /2 4 hrs, in 4 to 6 d o se s . U s u a l d o s a g e fo r in fan ts o v e r 2 m o n th s a n d c h ild re n — V2 2 4 -h r d o s e in itia lly, th e n 150 m g /k g /2 4 h rs in 4 to 6 d o se s ; no t o v e r 6 G m /2 4 hrs.H o w S u p p lie d : T ab le ts c o n ta in in g 0 .5 G m su lf is o x ­azo le , w h ite , s c o re d - b o tt le s o f 100, 5 0 0 a n d 1000; d ru m s o f 50 00 ; Te l-E -D ose® p a c k a g e s o f 100; P re s c r ip ­t io n P a k s o f 100, a v a ila b le s in g ly a n d in tra ys o f 10. P e d ia tr ic S u s p e n s io n , c o n ta in in g , in e a ch te a s p o o n ­ful (5 m l), th e e q u iv a le n t o f a p p ro x im a te ly 0 .5 G m s u lf is o x a z o le in th e fo rm o f a c e ty l su lfiso xa zo le ; ra s p ­b e rry f la v o re d — b o tt le s o f 4 o z a n d 16 oz (1 p in t).S y ru p , c o n ta in in g , in e a c h te a s p o o n fu l (5 m l), the e q u iv a le n t o f a p p ro x im a te ly 0 .5 G m s u lf iso x a zo le in th e fo rm o f a c e ty l s u lf iso x a zo le ; c h o c o la te f la v o re d — b o tt le s o f 16 o z (1 p in t).

B O O K REVIEWS

C o n tin u ed fro m page 123

endocrinologist. It specifically avoids discussion of disease states and the overall clinical approach to diagnosis and management. The authors specifically state that it is not a textbook or laboratory man­ual of endocrinology—and it is not. It must be used in conjunction with a textbook and sound clinical judgment.

Given its self-described limita­tions, this book does a very com­mendable job of drawing together a large amount of practical and useful information regarding the collec­tion and interpretation of endocrino- logic tests. The first chapter on endocrinologic technique is worth­while reading, and even periodic re­reading. The book is logically con­structed and well indexed. Each chapter is uniform in outline and concise. An appendix of appropriate costs provides needed and worth­while information.

This book should be in every Family Practice Center where it would be readily accessible for fre­quent clinical use. Students and residents will find it helpful but should follow the pathology labora­tory methodology if it is available. Any practitioner who conducts or orders endocrinologic tests should have this handbook readily avail­able.

John L. Buckingham, MD University of Alabama

Birmingham

Patient Education for the Family: Practical Patient Aids for Health Care Professionals. David Brunworth, Scott Rigden. Published by the authors, 1979, 109 pp., $36.00.

Patient education is so much a matter of individual style that it is

difficult to review objectively a book such as this. The format is a loose-leaf binder containing over 100 pages of patient instructions on a wide variety of subjects, from “how to tan without burning,” to “how to control your time and life.” The foreword suggests that these sheets may be copied for patient use; with this purpose in mind, one wonders why tan paper stock, which does not reproduce cleanly, was used.

It is also suggested that the physician might want to use the material as a starting point for de­veloping his/her own set of patient instructions. To this reviewer, it appears that this would be neces­sary for almost all of the instruc­tions, for they are written in a style and with a vocabulary so sophisti­cated that many practitioners will find it of little value. Patients lack­ing a college education may find much of the information confusing and some of it unintelligible.

As to content, it is apparent that methods of therapy differ among physicians, and no criticism should be made on that basis. But the book does not live up to its authors’ ad­monition that the contents should be accurate. Triaminic is described as a decongestant. Germicidal soaps are lumped together with Ivory as “mild” soaps, and some of the illus­trations are anatomically inaccurate, There are numerous typographical errors, and names such as Valsalva are not capitalized. Finally, there are references to “PMA cards," “Mandino’s Book,” and “the 80-20 Rule,” which are intelligible o n ly to the initiated.

With more care in editing to ensure that the contents would be understandable and usable by a

Continued on page 128

R o c h e L a b o ra to r ie sD iv is io n o f H o f fm a n n - L a R o c h e Inc .N u t le y , N e w J e rs e y 07110

THE JOURNAL OF FAMILY PRACTICE, VOL. 10, NO, 1, 1980

B O O K REVIEW S

C o n tin u e d fro m p ag e 126

larger group of patients and their physicians, this might have been a valuable book. As it is, few family physicians will find it worth the price.

Collin Baker, Ml) University o f South Carolina

Columbia

Office Techniques for Diagnosing Skin Disease. William H. Eaglstein, David M. Pariser. Year Book Med­ical Publishers, Chicago, 1978, 185 pp., $23.95.

An interesting variant of the usual dermatology book, this work deals entirely with diagnostic techniques to be used by the physician, nurse, student, or other medical personnel when a patient presents himself with a skin dis­ease. It is highly organized, dealing with purpose, diagnostic value, and clinical indications. It also de­scribes the materials needed, where to find them, actual tech­niques, and discussion of the find­ings.

There are over 100 pages of both high quality illustrations of tech­niques and actual pictures of le­sions. The book should be ex­tremely helpful to the examining physician as well as the person re­sponsible for dealing with the specimens.

Office Techniques is well organ­ized and has excellent readability. It contains material relevant to family practice and should help one improve his/her diagnostic tech­niques. If properly used, this book should take much of the guess work out of diagnosing common skin dis­eases and should eliminate the need for therapeutic trials in many cases. All of the procedures can be easily done in the physician’s office and

the book is written in enough detail to allow the physician to reach an endpoint in diagnostic efforts.

The book should serve well in a residency training program, in the practicing physician s office, and as a textbook for medical students and allied health professionals.

Neil Chisholm, MD University of Colorado

Denver

Health, Stress and Coping. Aaron Antonovsky. Jossey-Bass, San Francisco, 1979, 255 pp., $13.95.

As one of the most experienced workers in the field of stress, An­tonovsky should have something important to contribute in a new book, and he does: the latest find­ings from international interdisci­plinary studies and a balanced view of the state of the art.

Unfortunately, “ stress” has be­come a catchword, a cliche, a salespitch for vitamins, paper­backs, and whatnot. If the mind- body link were not, in fact, so pow­erful, stress could be dismissed as a passing fad; but increasingly, scien­tists are finding bio-amine pathways between emotions, nervous net­works, endocrine glands, and target organs. Meanwhile, waiting rooms and emergency rooms are filled with casualties of stress related illnesses, ranging from disabling headaches to life threatening disease.

To what extent is a unifying con­cept of stress useful to a family physician? How skilled must he/she be in understanding stress: its variants; its pathophysiology; its demographic, cultural, and en­vironmental features? Should he know what is fact and what is theory? The animal work and the human studies? The difference be-Continued on page 130

SYNEMOL’(FLUOCINOLONE ACETONIDE) C R E A M 0 .0 2 5 %

D escription S Y N E M O L ( f lu o c in o lo n e a c e t o n id e ) h a s th e c h e m ic a l n a m e 6 a , 9 a -d i f lu o ro -1 6 a - h y d r o x y p r e d n is o lo n e - 1 6 , 1 7 -a c e to n id e .The c r e a m c o n ta in s f lu o c in o lo n e a c e ­to n id e 0 .2 5 m g . / g . in a w a te r -w a s h a b le a q u e o u s e m o l l ie n t b a s e o f s te a ry l a lc o h o l, c e ty l a lc o h o l , m in e r a l o i l , p r o p y le n e g lyco l, s o rb ita n m o n o s te a r a te , p o ly s o r b a te 60, p u r i f ie d w a te r a n d c i t r i c a c id .Ind ica tio n s I n f la m m a to r y m a n ife s ta t io n s o f c o r t ic o s te r o id - r e s p o n s iv e d e rm a to s e s . C o n tra in d ic a tio n s T o p ic a l s te ro id s a re c o n t r a in d ic a te d in th o s e p a t ie n ts w ith a h is to ry o f h y p e rs e n s it iv i ty to a n y o f th e c o m p o n e n ts o f th e p r e p a r a t io n . Precautions If i r r i t a t io n d e v e lo p s , d is c o n t in u e th e p r o d u c t a n d in s titu te a p p r o p r ia t e th e ra p y .In th e p r e s e n c e o f a n in fe c t io n in s titu te th e use o f a n a p p r o p r ia t e a n t i f u n g a l o r a n t ib a c te r ia l a g e n t . If a f a v o r a b le response d o e s n o t o c c u r p r o m p t ly , d is c o n t in u e the c o r t ic o s te r o id u n til th e in fe c t io n h a s b e e n a d e q u a te ly c o n t ro l le d .If e x te n s iv e a r e a s a r e t r e a te d o r if occlusive te c h n iq u e is u s e d , th e r e w ill b e in c re a s e d s y s te m ic a b s o r p t io n o f t h e c o r t ic o s te ro id a n d s u ita b le p r e c a u t io n s s h o u ld b e taken, p a r t ic u la r ly in c h i ld r e n a n d in fa n ts .T he s a fe ty o f t o p ic a l s te ro id s in p re g n a n t w o m e n h a s n o t a b s o lu te ly b e e n established. In la b o r a to r y a n im a ls , in c re a s e s in incidences o f fe ta l a b n o r m a l i t ie s h a v e b e e n associated w ith e x p o s u re o f g e s t a t in g fe m a le s to t o p ic a l c o r t ic o s te r o id s , in s o m e c a s e s a t ra th e r lo w d o s a g e le v e ls . T h e re fo re , d rugs of th is c la s s s h o u ld n o t b e u s e d e x te n s iv e ly on p r e g n a n t p a t ie n ts , in la r g e a m o u n ts o r for p r o lo n g e d p e r io d s o f t im e .SYNEM OL® ( f lu o c in o lo n e a c e t o n id e ) c r e a m is n o t fo r o p h t h a lm ic use.A dverse R e a ctio n s L o c a l a d v e r s e reactions r e p o r te d w ith t o p ic a l c o r t ic o s te r o id s : burn­in g , i tc h in g , i r r ita t io n , d ry n e s s , fo llicu lit is , h y p e r tr ic h o s is , a c n e f o r m e ru p t io n s , h y p o p ig m e n ta t io n , p e r io r a l d e rm a t it is , a l le r g ic c o n t a c t d e r m a t it is , m a c e ra t io n of th e sk in , s e c o n d a r y in fe c t io n , sk in a trophy, s tr ia e , m il ia r ia .H ow S u p p lie dSYNEMOL® ( f lu o c in o lo n e a c e t o n id e ) C re a m 0 .0 2 5 % — 15, 3 0 a n d 6 0 g . tu b e s .

e ^ K IT C V Syntex Laboratories, Inc IM I t Z / \ pa |0 A lto . C alifornia 94304

1 2 8

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C o n tin u e d fro m p a g e 128

tween objective and subjective stress, the use and abuse of life event scores, the concept of person-environment fit? How to differentiate predisposing, pre­cipitating, and perpetuating fac­tors? These are, in my opinion, basic working tools as useful to the physician as to the social scientist.

In this book, Antonovsky sharpens our perceptions by de­lineating “ social networks,” “gen­eralized resistance resources,” “breakdown points,” “ state of tension,” and “ tension manage­ments.” He expands Parson’s categories of doctor-patient rela­tionship to include the “ sacred” model. His linkage of societal ex­pectations of health and the organ­ization of health services has inter­national relevance.

Most importantly, Antonovsky focuses on a key question puzzling all serious students of stress: “Why do some persons cave in and give up under stress, while others emerge stronger and more confi­dent than ever?” The answer is something he calls “a strong sense of coherence,” a concept triggered by an indepth study of 77 Central European survivors of concentra­tion camps, now settled in Jerusa­lem. Despite experiencing the Holo­caust and displaced person camps, struggle and uncertainty, and three wars, some of these women were functioning at levels higher than anyone would expect (from 14 psy­chosocial measures of adaptation). Why? Because, the author con­cluded, such individuals possess “a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments

are predictable, and that there is a high probability that things will work out as well as can reasonably be ex­pected.”

To detect such a vital sense of coherence in patients is to begin to understand the dynamics of health in one’s practice. (Health, as de­fined by Dubos: “ a modus vivendi enabling imperfect men to achieve a rewarding and not too painful experience while they cope with an imperfect world.” )

In an imperfect world of ambula­tory care, Antonovsky’s insights can help one recognize and differ­entiate the range of response to stress, from disabling disease to re­silient and vigorous health.

Stanley H . Schuman, MD Medical University o f South Carolina

Charleston

a p L O l • No 94 ;NDC 00140066-02

L o m o til 11«**~'*5 "» / *» <W«»»

CAl.1TtenLomotil

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Available at your pharmacy in bulk bottles for filling any prescription quantity, in convenient 30-Pack tablet dispensers, and as liquid in 2-oz. bottles with calibrated droppers.

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Address m edica l inquiries to:G. D. Searle & Co.M ed ica l C om m unica tions Department. Box 5110 C h icago. I llin o is 60680