Factores asociados a violencia doméstica en mujeres mexicanas vistas en primer nivel atención / Intimate partner violence and family dysfunction among Mexican women seen a Primary Care Unit

Objetivos. Evaluar la prevalencia y factores de riesgo de violencia doméstica (VD) en mujeres que asistieron a una unidad de medicina de familia en Tijuana, México. Métodos. Se entrevistaron a 297 mujeres y se aplicaron 2 escalas validadas: violencia e índice de severidad y el APGAR familiar para evaluar VD y funcionalidad familiar. Resultados. La edad promedio (±DE) fue de 40,6 ± 13,8 años y 120 (40,4%) mujeres tuvieron VD: 47 (15,8%) violencia psicológica; 31 (10,4%) violencia sexual y 77 (25,9%) física y en 19 (6,4%) fueron acciones que pusieron en peligro la vida de las mujeres. La causas más comunes de violencia doméstica que refirieron las mujeres fue que su pareja se había puesto celoso o sospechaba de sus amistades (37,4%). Veintidós (7,4%) de las mujeres con violencia doméstica refirieron que sí habían buscado ayuda. Conclusiones. La prevalencia de VD fue alta y se asoció con la escolaridad de la pareja y la funcionalidad familiar (AU)

Objective. To assess the prevalence and risk factors for intimate-partner violence (IPV) in women who attended a Family Medicine Unit in Tijuana, Mexico. Methods. A total of 297 women were interviewed and evaluated using two validated scales: violence and severity index and family APGAR to assess family functioning and IPV respectively. Results. The mean age (± SD) was 40.6 ± 13.8 years, and 120 (40.4%) women had suffered IPV: 47 (15.8%) psychological violence; 31 (10.4%) sexual violence; 77 (25.9%) physical violence, and in 19 (6.4%) there were actions that threatened the lives of women. The most common causes of domestic violence were women who reported that their partner had been jealous, or suspicion from friends (37.4%). Twenty two (7.4%) of the women with domestic violence reported that they had sought help. Conclusions. The prevalence of IPV was high and associated with the education level of the couple and family functioning (AU)

[Intimate partner violence and family dysfunction among Mexican women seen a Primary Care Unit]. / Factores asociados a violencia doméstica en mujeres mexicanas vistas en primer nivel atención.

OBJECTIVE: To assess the prevalence and risk factors for intimate-partner violence (IPV) in women who attended a Family Medicine Unit in Tijuana, Mexico. METHODS: A total of 297 women were interviewed and evaluated using two validated scales: violence and severity index and family APGAR to assess family functioning and IPV respectively. RESULTS: The mean age (± SD) was 40.6±13.8 years, and 120 (40.4%) women had suffered IPV: 47 (15.8%) psychological violence; 31 (10.4%) sexual violence; 77 (25.9%) physical violence, and in 19 (6.4%) there were actions that threatened the lives of women. The most common causes of domestic violence were women who reported that their partner had been jealous, or suspicion from friends (37.4%). Twenty two (7.4%) of the women with domestic violence reported that they had sought help. CONCLUSIONS: The prevalence of IPV was high and associated with the education level of the couple and family functioning.

Riesgo de pie diabético en pacientes con diabetes mellitus tipo 2 en una unidad de medicina de familia / Diabetic foot risk in patients with type II diabetes mellitus in a family medicine unit

Objetivo: Conocer el riesgo para desarrollar pie diabético en pacientes con diabetes mellitus (DM) tipo 2 (DM2). Métodos: Se incluyeron pacientes con DM2 con una evolución ≥ 5 a˜nos que acudieron a la consulta externa en una Unidad de Medicina Familiar en Tijuana (México) durante septiembre a diciembre de 2011. Se aplicó el cuestionario síntomas de neuropatía diabética (SND) y se evaluó la sensibilidad con el monofilamento de Semmes-Weinstein. Se consideró paciente de alto riesgo para pie diabético si tuvo pérdida de la sensibilidad, deformidad en pies o ausencia de pulsos pedios. Resultados: Se estudiaron 205 pacientes, con una edad y evolución de la DM promedio (± DE) de 59 ± 10 y 10,7 ± 6,7 a˜nos, respectivamente. Noventa y un pacientes (44%) tuvieron alto riesgo para desarrollar pie diabético, y este se asoció con escolaridad menor de 6 a˜nos (OR: 2,3; IC 95%: 1,1-4,1), evolución de la DM mayor a 10 a˜nos (OR: 5,1; IC 95%: 2,8-9,4), sexo femenino (OR: 2,0; IC 95%: 1,1-3,6), ingreso mensual familiar < 236 euros (OR: 2,0; IC 95%: 1,1-3,8) y una hemoglobina glucosilada (HbA1c) ≥ 7,0% (OR: 2,8; IC 95%: 1,5-5,0). Conclusiones: Es necesario que a todo paciente con DM que acude a su clínica familiar se le realice anualmente exploración para la detección temprana de neuropatía diabética debido al alto riesgo de desarrollo de pie diabético (AU)

Objective: To determine the risk of diabetic foot in patients with type II diabetes mellitus (DM) seen in a Family Medicine Unit. Methods: The study included type II DM patients with a disease duration ≥ 5 years seen in a Family Medicine Unit, Tijuana, Mexico, during September-December 2011. Neuropathy was assessed with the Diabetic Neuropathy Symptom questionnaire, and pressure sensation using a 10-g Semmes-Weinstein monofilament. A patient had a high risk of diabetic foot if there was sensitivity loss, foot deformities, and non-palpable pedal pulses. Results: We studied 205 patients with an average (± SD) age and DM duration of 59 ± 10 years and 10.7 ± 6.7 years, respectively. Ninety one patients (44%) had a high risk of developing diabetic foot, and it was associated with; an education of less than 6 years (OR 2.3; 95% CI: 1-1-4.1), DM disease duration ≥ 10 years (OR 5.1; 95% CI: 2.8-9.4), female gender (OR 2.0; 95% CI: 1.1-3.6), monthly familiar income < 236 euros (OR 2.0; 95% CI: 1.1-3.8), and a glycosylated hemoglobin ≥ 7.0% (OR 2.8; 95% CI: 1.5-5.0). Conclusions: It is necessary that all DM patients seen in a family medicine clinic have a yearly screening for the early detection of diabetic neuropathy, since they have a high risk of diabetic foot (AU)

[Diabetic foot risk in patients with type II diabetes mellitus in a family medicine unit]. / Riesgo de pie diabético en pacientes con diabetes mellitus tipo2 en una unidad de medicina de familia.

OBJECTIVE: To determine the risk of diabetic foot in patients with type II diabetes mellitus (DM) seen in a Family Medicine Unit. METHODS: The study included type II DM patients with a disease duration ≥ 5 years seen in a Family Medicine Unit, Tijuana, Mexico, during September-December 2011. Neuropathy was assessed with the Diabetic Neuropathy Symptom questionnaire, and pressure sensation using a 10-g Semmes-Weinstein monofilament. A patient had a high risk of diabetic foot if there was sensitivity loss, foot deformities, and non-palpable pedal pulses. RESULTS: We studied 205 patients with an average (± SD) age and DM duration of 59 ± 10 years and 10.7 ± 6.7 years, respectively. Ninety one patients (44%) had a high risk of developing diabetic foot, and it was associated with; an education of less than 6 years (OR 2.3; 95%CI: 1-1-4.1), DM disease duration ≥ 10 years (OR 5.1; 95%CI: 2.8-9.4), female gender (OR 2.0; 95%CI: 1.1-3.6), monthly familiar income <236 euros (OR 2.0; 95%CI: 1.1-3.8), and a glycosylated hemoglobin ≥ 7.0% (OR 2.8; 95%CI: 1.5-5.0). CONCLUSIONS: It is necessary that all DM patients seen in a family medicine clinic have a yearly screening for the early detection of diabetic neuropathy, since they have a high risk of diabetic foot.

A study on parasites in Mexican rheumatic disease patients.

Blastocystis hominis is a common human parasite with infection rates up to 50% in developing countries, and giardiasis is the commonest intestinal one in Mexico. No doubt, various parasites as Giardia lamblia and Entamoeba histolytica can cause rheumatic diseases. This study coproparasitoscopic analysis evaluated the cysts by B. hominis, G. lamblia, E. hartmani, E. coli and E. histolytica in Mexican rheumatic disease patients. Also, ELISA was used to detect E. histolytica, Ascaris lumbricoides, Toxocara canis, and Trichinella spiralis in Mexican patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Thirty-six patients (24 with AS and 12 with RA) and 77 healthy control individuals were enrolled in this study. The frequencies of protozoan cysts were comparable in rheumatic disease patients (AS and RA) and healthy control donors (33 and 25 vs. 26%, respectively; p > 0.05). The frequency of antibodies to T. canis was significantly higher in AS patients than in healthy control donors (16 vs. 2.6%, respectively; p = 0.027), whereas no differences were observed for the prevalence of antibodies for the other parasites (E. histolytica, A. lumbricoides and T. spiralis) (p > 0.05). This information indicates the need to intensify educational efforts for the prevention of parasite infections associated with AS disease that cannot be controlled only by drugs.

Disease activity, damage and survival in Mexican patients with acute severe systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a clinical syndrome of varying severity. Although the survival and prognosis of SLE have steadily improved, there is a group of patients who present an acute fatal outcome despite aggressive therapy. We designed this study to evaluate the factors associated with mortality in patients with acute severe SLE. During 2004-06, 41 Mexican SLE patients that could not be managed in the out-patient clinic and with acute severe major organ system involvement [nephritis, severe thrombocytopenia (platelet count below 20 000 per microL) acute neuropsychiatric pulmonary, gastrointestinal or cardiac disease and generalized vasculitis] were studied. During the first admission, disease activity (SLE Disease Activity Index (SLEDAI), SLE Activity Measured), damage [SLE International Collaborating Clinics (SLICC)], and therapy were assessed. Survival using Kaplan-Meier curves, odd ratios with 95% confidence interval and logistic regression analysis were used to determine risk factors for mortality. Ninety percent were female with a mean age of 29 +/- 19 years and mean disease duration of 21 +/- 9 months. The principal causes of first admission were renal (27%), SNC (22%) and cardiopulmonary (15%). After a mean follow-up of 9.7 +/- 6 months, 16 (39%) patients died. Deceased patients had significantly higher SLEDAI (P = 0.004), and SLICC (P = 0.03) scores. The manifestations associated with mortality were renal disease activity (odds ratio, OR 4.6, confidence interval, CI 95% 1.0-20.6), infections (OR 3.2 CI 95% 2.0-5.3) and thrombocytopenia (OR 4.0, CI 95% 1.0-15.9). The survival at 9.7 months was 72, 62 and 50% in patients with an SLEDAI score of 3-10, 11-20 and > or =21, respectively. The SLEDAI score, the presence of damage and infection were associated with death in patients with acute severe SLE.

Infections in outpatients with systemic lupus erythematosus: a prospective study.

The objective of this study was to assess the incidence and risk factors of infections in 200 SLE outpatients. All outpatients with active or inactive SLE without infections in the previous month were included. They were assessed every 3 months. Major infections were those requiring hospitalization and parental antibiotic therapy; minor infections required oral or topical therapy. Sociodemographic, disease activity using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), therapy and laboratory variables were evaluated. After a follow-up of 22+/-7 months, 65 (32%) patients had infections; 35% of those were major. The most common sites for infection were urinary (26%), skin (23%), systemic (12%), and vaginal (9%). At infection onset, 50 of 65 patients (77%) had disease activity, with a mean SLEDAI score of 6.1. The variables significantly associated with infection in the univariate analyses were the presence of disease activity, SLEDAI score, renal activity, prednisone dose, and IV cyclophosphamide. The only variable associated with infection in the multivariate analyses was a SLEDAI score of 4 or higher. Most infections in SLE outpatients were single, minor, non-life threatening, and associated with disease activity independently of sociodemographic and therapeutic factors.

Two-dimensional echo Doppler findings in juvenile and adult onset ankylosing spondylitis with long-term disease.

The authors' objective was to determine by 2-dimensional echo Doppler (2DECHO) the cardiac abnormalities in juvenile onset ankylosing spondylitis (JOAS) and adult onset ankylosing spondylitis (AOAS) in male patients with long-term disease. Twenty patients with JOAS, 31 with AOAS, and 20 healthy controls of the same age and gender without cardiopulmonary symptoms were studied. Using 2DECHO, the heart dimensions were determined according to American Society of Echocardiography guidelines. The left ventricle ejection fraction (LVEF) was calculated by Teichholz's formula. Cardiomyopathy was established when 2DECHO had diminished LVEF. Statistics used were the Student t and Fisher test, chi2, and ANOVA. Ninety percent of JOAS and 51% of AOAS patients were B27+ (p=0.005). The disease duration was 19.3 +/- 8.8 years in JOAS and 14.8 +/- 12.8 years in AOAS (p=NS). Age at the time of the study was 30.7 +/- 9.9 years in JOAS vs 40.3 +/- 12.7 in AOAS (p=0.003), and vs 40.2 +/- 17 years in controls (p=NS). There was a higher frequency of cardiomyopathy in AOAS (32.2%) than in JOAS (25%) and the controls (0%) (p=0.01). Patients with JOAS had a higher mitral valve gradient (25%) than AOAS patients (19%, p=NS) and controls (0%, p=0.04). Abnormal aortic ring reflectance was shown in 19% of AOAS vs 0% abnormalities in JOAS and controls (p=0.01). The aortic root diameter was increased in 58% of AOAS, 30% of JOAS, and 0% of controls (p=0.001). The frequency of 2DECHO abnormalities was increased in cardiopulmonary asymptomatic spondylitis patients. Despite the high frequency of B27+, JOAS had a lower frequency of aortic abnormalities than AOAS. Mitral valve gradient was found in JOAS and in AOAS that could contribute to a decreased ejection fraction and to left ventricular dysfunction.

Damage in systemic lupus erythematosus and its association with corticosteroids.

OBJECTIVE: To evaluate the association between corticosteroid use and organ damage in patients with systemic lupus erythematosus (SLE). METHODS: The occurrence and date of organ damage, as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, were determined for 539 patients enrolled in the Hopkins Lupus Cohort Study. The risk of damage associated with the cumulative prednisone dose, high-dose prednisone (> or =60 mg/day for > or =2 months), and pulse methylprednisolone (1,000 mg intravenously for 1-3 days) was estimated using Cox proportional hazards regression analyses, controlling for age, race, and sex. Risk estimates for the cumulative prednisone dose were based on a reference dose of 36.5 gm (e.g., 10 mg of prednisone daily for 10 years [or equivalent]). RESULTS: The cumulative prednisone dose was significantly associated with the development of osteoporotic fractures (relative risk [RR] 2.5, 95% confidence interval [95% CI] 1.7, 3.7), symptomatic coronary artery disease (RR 1.7, 95% CI 1.1, 2.5), and cataracts (RR 1.9, 95% CI 1.4, 2.5). Each intravenous pulse was associated with a small increase in the risk of osteoporotic fractures (RR 1.3, 95% CI 1.0, 1.8); however, this result failed to reach statistical significance (P = 0.07). Each 2-month exposure to high-dose prednisone was associated with a 1.2-fold increase in the risk of both avascular necrosis (95% CI 1.1, 1.4) and stroke (95% CI 1.0, 1.5). CONCLUSION: SLE patients receiving long-term prednisone therapy were at significant risk of morbidity due to permanent organ damage. Additional research is required to determine the relative contributions of SLE disease activity and corticosteroids to the pathogenesis of specific types of organ damage. Furthermore, new steroid-sparing therapies are needed in order to treat disease activity and minimize cumulative and high-dose prednisone exposure.

Systemic lupus erythematosus in three ethnic groups. VI: Factors associated with fatigue within 5 years of criteria diagnosis. LUMINA Study Group. LUpus in MInority populations: NAture vs Nurture.

OBJECTIVE: To determine the frequency, degree and associated features of fatigue among Hispanic (H), African American (AA) and Caucasian (C) patients with recent onset (< or = 5 yr) systemic lupus erythematosus (SLE) at their baseline evaluation. METHODS: H (n = 69), AA (n = 83) and C (n = 71) patients from the LUMINA (LUpus in MInority populations: NAture vs Nurture) cohort were studied. Fatigue [Fatigue Severity Scale (FSS)] was defined as present if FSS score > or = 3.0. Variables from functional, clinical, sociodemographic, health behaviors, behavioral and psychological and immunogenetics domains were ascertained at study entry. Associations were examined using regression models. RESULTS: Eighty-six percent (85.7%) of patients reported having fatigue (82.6% H; 85.5% AA; 88.7% C); median FSS score, 5.3. Factors from the psychological and clinical domains were primarily associated with FSS; immunogenetic (HLA Class II phenotypes) features were not. Increased fatigue was strongly associated with decreasing function, both physical and mental. Variables associated with significantly greater degree of fatigue at baseline in the multivariable stepwise model in order of decreasing additional partial R2 explained included: abnormal illness-related behaviors, older age, higher self-reported pain, greater degree of helplessness, greater disease activity, Caucasian race, and lacking health insurance (model R2 = 37%). CONCLUSIONS: Fatigue is one of the most prevalent clinical manifestations of SLE across all ethnic groups. The perception of fatigue severity in SLE may be multifactorial in origin, including psychosocial factors and disease activity. If these prove causal, knowledge of their contribution may suggest therapeutic and/or behavioral interventions, which could ameliorate this pervasive and often incapacitating symptom of SLE.

Patterns of disease activity in systemic lupus erythematosus.

OBJECTIVE: To describe patterns of systemic lupus (SLE) disease activity over time. METHODS: Disease activity was measured in a prospective cohort of 204 consecutive SLE patients followed up quarterly for 2.0-7.5 years (911 person-years of followup). Physician's global assessment (PGA) and modified SLE Disease Activity Index (M-SLEDAI; omitting serology) scores were plotted against time for each patient. Definitions for disease activity patterns were developed by consensus using these plots, and the proportion of total follow-up time represented by each pattern was calculated. RESULTS: Three patterns of SLE activity were apparent: relapsing-remitting (RR), chronic active (CA), and long quiescent (LQ). The CA pattern was the most frequent for both the PGA and M-SLEDAI, representing 58% and 40% of total person-years, respectively. The least common pattern was LQ (PGA 16%, M-SLEDAI 25%), while the RR pattern was intermediate in frequency (PGA 26%, M-SLEDAI 35%). Average disease activity during RR periods tended to be mild, while that during CA periods was more likely to be moderately severe. The most common discrepancy between instruments was that the PGA depicted CA when the M-SLEDAI showed an RR pattern. The M-SLEDAI did not appear to capture mild degrees of activity. CONCLUSION: SLE activity was readily classified into 1 of 3 patterns: RR, CA, or LQ. The CA pattern was most common, suggesting that significant morbidity may arise from persistent disease activity. These findings may have important implications regarding the choice of outcome measures in SLE clinical trials, since comparison of flare rates may not account for chronic disease activity.

Measurement of damage in 210 Mexican patients with systemic lupus erythematosus: relationship with disease duration.

The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index is a validated instrument specifically designed to ascertain damage in SLE; this instrument has been applied mainly to Caucasians and African-American SLE patients. The objective of this study was to assess damage using the SLICC/ACR Damage Index in Mexican SLE patients. The SLICC/ACR Damage Index was applied to 210 consecutive SLE patients with disease of variable duration. The SLICC/ACR Damage Index was assessed by review of hospital clinical records, interview and physical examination. One hundred and seventeen (55.5%) patients had some damage. The proportion of patients with damage increased significantly with disease duration (33% at 1-60 months, 66% at 61-120 months and 70% at > or = 121 months, P < 0.001). The main organ systems involved were musculoskeletal (osteonecrosis), neuropsychiatric (neuropathy, seizures), gonadal (amenorrhea prior to age 40 years), ocular (cataracts), renal (glomerular filtration < 50%) and peripheral vascular (permanent damage by venous thrombosis). Damage was frequent, increased over time, particularly for ocular, renal, musculoskeletal and gonadal. Patients who experienced damage were older, had a longer disease duration, a greater number of ACR criteria at diagnosis, and were more likely to have renal involvement and antibodies to dsDNA. The damage occurred in many different domains and started to develop early after disease onset. Mexican patients had more peripheral vascular and gonadal involvement compared with published data from non-Hispanic SLE populations.

Anti-neutrophil cytoplasmic autoantibodies in leprosy.

The objective was to evaluate the frequency of cytoplasmic and peripheral antineutrophil cytoplasmic antibodies (ANCA) in patients with leprosy, and to correlate the presence of ANCA with type and disease activity. Consecutive patients with leprosy were assessed clinically, and IgG ANCA were measured by indirect immunofluorescence. The presence of three of the following was used to assess disease activity: reactional state, fever, new cutaneous lesions, erythrocyte sedimentation rate and C-reactive protein. Sixty-four patients were studied and divided according to the Ridley-Jopling classification: of 38 patients with lepromatous leprosy, eight (21%) had perinuclear (p) ANCA and two (6%) had cytoplasmic ANCA. ANCA titres ranged from 1:20 to 1:320. Of six borderline leprosy patients, one (16%) had p-ANCA. All 20 tuberculoid leprosy patients and 65 healthy control subjects had negative ANCA. There was no correlation between ANCA titres and disease activity in positive patients. ANCA, mainly those with a perinuclear pattern, may be present in leprosy, especially in the lepromatous pole. This disease should be added to the spectrum of diseases with ANCA positivity.

Epidermal growth factor and gastrin in scleroderma/CREST syndrome.

BACKGROUND: The objective of this study was to determine levels of epidermal growth factor (EGF) and gastrin (GA) in saliva, serum, and urine in scleroderma (Scl) and CREST syndrome. METHODS: EGF and GA levels were measured by radioimmunoassay in saliva, serum and urine in 10 patients (51 years, median; range, 35-66 years); 9 females and 1 male with Scl, 3 females with CREST syndrome, and 18 age- and sex-matched controls, 17 females and 1 male free of any systemic inflammatory disease. RESULTS: In serum, the EGF was lower in Scl/CREST than controls (p = 0.02), while GA serum concentrations were higher in Scl/CREST (p = 0.02). In urine, EGF in Scl/CREST was slightly lower than controls (p = NS) and GA concentrations were higher than controls (p = 0.03). In saliva, the EGF levels in Scl/CREST were also slightly lower than controls (p = NS), while GA concentrations in both Scl/CREST and controls were not different (p = NS). CONCLUSIONS: Low concentrations of EGF in serum probably play a role in the pathogenesis of Scl/CREST. GA concentration can be increased as a consequence of the low levels of EGF because of the structural homology of this peptide with urogastrone, a GA inhibitor factor.

Measurement of clinical activity of systemic lupus erythematosus and laboratory abnormalities: a 12-month prospective study.

OBJECTIVE: To assess flares in outpatients with systemic lupus erythematosus (SLE) using SLAM (systemic lupus activity measure) and to determine laboratory abnormalities as predictors of disease activity. METHODS: Fifty-three Mexican patients were assessed using SLAM scale. They were evaluated monthly for a total of at least 572 months. The SLAM scale was applied at each visit. Samples were drawn for complete blood cell count, erythrocyte sedimentation rate, urinalysis, 24-h protein and creatinine clearance, anti-DNA, C3 and C4. An SLE flare was defined as the occurrence of new clinical manifestations or worsening compared to the previous month that usually required restarting or increasing prednisone or immunosuppressive drugs. RESULTS: Thirty-three patients had flares, mainly in minor organs. The incidence of flares was 0.69/patient/year of followup. Active nephritis and extrarenal manifestations correlated with high levels of dsDNA and low complement levels. We found an odds ratio (OR) = 3 (CI = 1.7-5.7) for flare in asymptomatic patients with high dsDNA and OR = 2 (CI = 1.3-4.5) for low C3 levels. CONCLUSION: Flares are frequent in patients with SLE and they occur independent of disease duration and the time the disease has been under control. Flares are apparently predictable and are related to serologic abnormalities.

Intravenous cyclophosphamide pulses in the treatment of pyoderma gangrenosum associated with rheumatoid arthritis: report of 2 cases and review of the literature.

Pyoderma gangrenosum is a chronic ulceronecrotic inflammatory cutaneous disorder that can be associated with diseases such as rheumatoid arthritis (RA). No definitive treatment exists for this condition; steroids have been the mainstay of therapy, and the addition of immunosuppressives has been advocated. We describe 2 patients with pyoderma gangrenosum occurring in the setting of RA who, in addition to steroids, received pulse intravenous cyclophosphamide and had a remarkably good and lasting response. This is the first report of such a therapeutic approach. The pertinent literature is discussed. We conclude that pulse cyclophosphamide is another possible therapy for pyoderma gangrenosum.