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`Peter Lit#,,
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`tti; iiKclici
`
`May 13, 1996
`
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`Dr. G. Sher
`Toronto General Hospital
`EN-3-306
`
`Dear Graham :
`
`RE: MR. CAF
`
`It was a pleasure to see this 24-year-old young man with previous he
`fallu
`back in 1987 with impaired left ventricular function from iron overload. . Since hW'stait on;
`Unfortunately he. did"'rioetolerate
`L1, he has had a dramatic reversal of his situation .
`interferon therapy in 1994, and he is now resuming on L1 .=
`
`From a study point of view, he has graduated from courses of human biology this-
`summer. He is contemplating a graduate program in invitro fertilization in the anatomy
`department . He is able to keep up with the demands of the academic study without any'
`problems .
`
`Currently he is still receiving transfusions at 700 'cc's every three -weeks
`maintaining a hemoglobin over 100. If he uses a lower dose, he would feel quite fatigued :.
`In terms of chelatioil, he is continuing on Ll on the doses of 3-4-4 pills per day . . He does
`have the side effect of bilateral knee effusion that requires occasional taps . He can walk
`adequately, but cannot rwi comfortably . This annears'to be a necessary side effect for him
`to benef from the L1 .
`
`Cardiac function inquiry is essentially negative . He can walk two kilometers on
`the level, and more than 7 flights of stairs .
`
`His current medications included Insulin 15 units q .a.m. and 18 units q.p.m.,
`Penicillin 300 mg . b.i.d., and a medication cased-Rochotrol at 375 mg. b.i.d
`
`1 of 2
`
`Taro Pharmaceuticals, Ltd.
`Exhibit 1066
`
`
`
`
`
`Physical examination revealed a well-looking young man with a resting blood
`pressure of 100/60 mmHg . The NP was at the sternal angle with no inspiratory rise . On
`auscultation the heart sounds were normal with occasional S3 and a Grade IVVI systolic
`ejection murmur in the outflow tract . The liver edge was palpable, but not tender. There
`was a splenectomy scar. The chest was clear and there was no peripheral edema .
`
`C_ has done very well over the past few years, ever since the LI was started .
`His resting ejection fraction in September of 1995 has now increased to 68%, and up to
`71% with exercise . The left ventricle was normal sized with normal contractilty . The
`diastolic function parameters were only very minimally abnormal.
`
`Therefore, CMS has done an amazing turn around with completely :normal
`ventricular function . This can be credited to the chelation effectiveness from the-Ll. _ .
`have asked him to continue with his medication, and allow us to monitor his iron kvets
`well with MR . He should nevertheless keep active. We will be delighted to see him again
`in one year's time .
`
`PL'eb
`
`Peter Liu, M .D.FRCP(C)
`
`2 of 2
`
`Taro Pharmaceuticals, Ltd.
`Exhibit 1066
`
`
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