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PubMed2000

Pulse glucocorticoids.

High-dose intravenous (i.v.) methylprednisolone has been used therapeutically in a number of medical fields to avoid the complications and side effects of long-term glucocorticoid (GC) therapy and because of the perception that high-dose i.v. methylprednisolone may have "special" therapeutic effects. It is possible that aggressive early therapy with GCs allows for a more rapid taper of GCs and therefore prevents some of the dose-related side effects associated with long-term use. Some of the neurologic and rheumatologic literature related to multiple sclerosis and lupus nephritis suggest that i.v. methylprednisolone has therapeutic effects that are different from those of conventional doses of oral prednisone. There is still considerable debate about this in nondermatologic fields, and extrapolation of the role of pulse i.v. methylprednisolone to dermatologic disease, where trials are lacking, is difficult. Given this subset of possible candidates of this therapy as suggested by anecdotal reports, there is at least a rationale for considering the use of this modality in a subset of patients.

Clinical Trials as Topic↗

PubMed1999

Cutaneous manifestations of cancer.

The appearance of skin lesions in patients with occult or obvious malignancy may be of extreme value in the detection and management of cancer because the skin is readily accessible to examination and biopsy. Examination of the skin of our patients can provide important insights into underlying malignant processes or possible complications from cancer treatment. The range of cutaneous abnormalities is wide, and include cutaneous paraneoplastic syndromes such as xanthomas, acanthosis nigricans, carcinoid syndrome, unusual erythematous eruptions such as erythema gyratum repens, and a number of genetic syndromes associated with malignancies and inherited dermatoses.

Humans↗

PubMed1997

Men and women residents' experiences with women's health care in a family medicine center.

PURPOSE: To address the experience in women's health care available at the Queen's University Faculty of Medicine family residency program and to compare the amounts and types of experiences of men and women residents. METHOD: A retrospective analysis was made of 70,805 patient encounters with family medicine residents at the Queen's University Family Medicine Centre over a five-year period (June 1988-May 1993). Patient-encounter files contained patient, staff, and resident information, as well as service and diagnostic codes. Statistical analysis was done using a two-tailed Student's t-test to compare the mean numbers of encounters with the women patients for the men and women residents in ten service and diagnostic categories. RESULTS: Of the 70,805 patients, 65.1% were women. The mean numbers of patients seen by the 45 men residents (534) and the 90 women residents (519) did not differ significantly. The percentages of the women patients seen by the men and the women residents (58.6% and 68.4%, respectively), however, differed significantly. The mean ages of the women patients seen by the men and the women residents (44.5 years and 39.2 years, respectively) also differed significantly. The women had significantly more encounters with the women patients in five of the ten categories studied. CONCLUSION: The differences between the men and women residents' experiences was significant in several areas. A potentially confounding factor is that the women may have been preferentially placed in team areas with all women staff physicians and the men placed in team areas with all men staff physicians. As family medicine programs aim for levels of exposure that are sufficient and similar for men and women residents, it is important that they evaluate the clinical opportunities for residents in women's health and work to ensure that both men and women residents receive adequate exposure in this area. One step in this direction might be gender-balanced patient populations, which might be obtained by ensuring gender-balanced clinical teams.

Adult↗