The Canadian Journal of CME
2001 Back Issues


• Jul • AugSeptOctNovDec

April 2001

Waking Up To Obstructive Sleep Apnea
By Nigel Duguid, MD
Sleep apnea is a very common clinical disorder, which goes undiagnosed in most patients. Family physicians can identify most patients with this disorder through appropriate questioning of the patient and the patient’s partner

The Keys To Figuring Out Fibromyalgia
By Paul Woolfrey, MD, FRCPC
Fibromyalgia is a common syndrome characterized by diffuse widespread pain and tender points, with associated sleep disturbance and fatigue. Understanding the complexity of chronic pain and treating any underlying treatable conditions or associated factors may be helpful.

The Bare Bones on Osteoporosis
By Sean Hamilton, MD, FRCPC
Osteoporosis has become an influential disease entity of the 21st century. Its pathophysiology is intricate, and its diagnosis relies heavily on measurement of bone mineral density.

Irritable Bowel Syndrome
By Ford Bursey, MD, FRCPC, FACP
Symptoms compatible with the diagnosis of IBS are common in western societies. Investigations should be reserved for those with a family history of IBD, colorectal neoplasia or those with worrisome symptoms or signs.

The Automatic External Defibrillator in Cardiac Arrest
By Mike Hatcher, MD, FRCPC
The recent release of new advanced cardiac life support guidelines have led to some changes in how physicians approach and manage superventricular and ventricular dysrhythmias. This article will examine the automatic external defibrillator and its use in the resuscitation of cardiac arrest victims.

Solving Slowing Progressive Renal Disease
By Brendan Barrett, MB, MSc, FRCPI, FRCPC
Risk factors and treatment strategies for patients with kidney and cardiovascular disease overlap. Thus, evaluating renal function in patients with diabetes, hypertension and cardiovascular disease is essential.

New Developments in Upper and Lower Genital Tract Cancer
By Catherine Popadiuk, MD
Unique to the gynecologic cancers are the direct elements of sexuality, fertility and femininity. The family physician is integral to helping patients navigate their journey through this difficult time of not only life and death, but identity.

Nutrition in Pregnancy
By Cheryl Pugh, MD, MBA
Healthy eating is essential for general good health throughout a person’s lifespan, but particularly during pregnancy. Patients should be encouraged to follow a complete diet, and some may require vitamin supplementation.

Lower-Back Pain
By Brendan D. Lewis, MD, FRCSC, B.Sc., B. Med. Sc., Dip. Sport. Med., ABOS, FAAOS

10 Steps to Your Successful CME Event
By Mark J. Berber, MB, MRCGP, MRCPsych, FRCPC
It takes time and hard work to deliver a CME event of high quality. Attention to many small details can greatly enhance your performance and the improved outcome is well worth the time and effort. Visual aids, lighting, location and sound are just some of the many components to be considered when planning the perfect CME program.

May 2001

Office Management of Benign Prostatic Enlargement
By Assaad El-Hakim, MD, and Mostafa Elhilali, MD, FRCSC
Symptomatic benign prostate enlargement is a common medical problem encountered in our aging society. Watchful waiting, medical treatment and surgery are some of the options you should explore with your patient.

Anxiety Disorders: From Diagnosis to Treatment
By Pierre Bleau B.Sc., MD, CSPQ, FRCPC
Physicians are often called upon to diagnose anxiety disorders. It is important to be familiar with these common psychiatric disorders and their treatment modalities.

Mastering Migraine and Women’s Related Issues
By Michel Aubé, MD
Migraine in women poses a series of specific and challenging questions, which need to be addressed to optimize the treatment.

Diagnosis and Treatment of Latent TB Infection
By Dao Nguyen, MD, and Dick Menzies, MD
Identifying and treating LTBI in high-risk people reduces the risk of developing active TB, and benefits general public health by reducing future transmission. Primary-care physicians can play a pivotal role in this effort by identifying patients at high risk to develop active TB.

Keeping Current With Common Infections in the Office
By Michael Libman, MD
This look at common infections will give family physicians a quick overview of urinary tract infections, productive coughs, methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus.

Four Common Rheumatological Consultations Based On Misunderstandings
By Morton A. Kapusta, MD, CM, FRCP(C), FACP
There are a number of misunderstandings that occur during rheumatological consultations, most of which can be handled quite readily by primary-care physicians.

Pitfalls in Pediatric Orthopedic Trauma: The Limping Child
By Thierry E. Benaroch, MD, FRCS(C)
Disorders that cause limping vary in children of different ages. This article will examine disorders leading to gait disturbances in three different age groups—one to three years, four to 10 years, and adolescents aged 11 to 15 years.

Bereavement Counseling: The Role of the Family Physician
By Michael A. Dworkind, MDCM, CCFP, FCFP
At some point in every patient’s lifetime, he or she will experience a great sense of loss due to the death of a loved one. The primary-care physician can play a vital role in guiding these patients during their time of need.

Interdisciplinary Health-care Teams: What Should Doctors Be Aware Of?
By Mark J. Yaffe, MD, CM, M.Cl.Sc., CCFP, FCFP, Iryna M. Dulka, MSW, and Jordan I. Kosberg, Ph.D.
There are barriers to refining interaction among health-care professionals; however, an interdisciplinary approach has a far-reaching potential to improve health care for patients and doctors alike.

Cardiovascular Diseases and Cardiac Risk Factors
By Raja Al-Dashti, MD, FRCPC, and George Honos, MD, FRCPC, FACC
Effective primary prevention of cardiovascular disease requires both clinical and public health approaches. The family physician’s role consists of risk factor identification, intervention planning and regular follow-up.

Management of Acute Transient Ischemic Attacks and Stroke
By Jeffrey Minuk MSc, MD, FRCPC
Stroke is the third leading cause of death and the number one cause of long-term disability in Canada. Proven and effective therapies for acute stroke will hopefully diminish the burden of this disease.

Prevention of Ischemic Stroke
By Robert Côté, MD
Several approaches can be applied to reduce the risk of ischemic stroke. These are not only based on the characteristics of the ischemic event itself, but also on the presence of co-existing vascular risk factors.

June 2001

Practical Approach To Patients With Electrolyte Disorders
By André Gougoux, MD, FRCPC
When dealing with hospitalized patients, electrolyte disorders, such as hypernatremia, hyponatremia, hyperkalemia and hypokalemia, can cause complications and should be guarded against.

The Management and Treatment of Type 2 Diabetes
By Jean-Pierre Hallé, MD, CSPQ, FRCPC
A thorough understanding of the physiopathology of diabetes and the mechanism of action of the drugs used to treat it is essential for the coherent use of today’s therapeutic arsenal, which is growing in complexity.

Relieving Chronic Non-cancer-Related Pain
By François Lehmann, MD
Treating patients with chronic pain requires patience, as the modalities used are unlikely to eradicate pain. Most patients can achieve pain relief through a variety of therapeutic approaches, but they must be made to understand that a certain level of pain is likely to persist.

RV Myocardial Infarction and Post-Infarction Mechanical Complications
By Arsène-J. Basmadjian, MD, MSc
Right ventricular (RV) infarction requires particular attention in order to recognize and treat it accordingly. The mechanical complications of myocardial infarction generally have a rapid clinical course with high mortality and require early diagnosis in order to properly manage the patient and refer to a center with cardiac surgery.

Signs, Symptoms and Prevention of Viral Hepatitis
By Grégoire E. Noël, MD., MSc., FACTM, and Chantal Violette, M.D.
The complex clinical and biological manifestations of hepatitis B warrant particular attention. This article discusses the parameters that enable physicians to recognize and assess the disease, as well as counsel, guide and follow-up with patients who are at risk of becoming chronic carriers of viral hepatitis.

Genital Herpes: Psychosexual Impacts and Counselling
By Catherine Vezina, BA, MA, and Marc Steben, MD, CCFP, FCFP
Genital herpes is a sexually transmitted disease that has enormous psychologic and sexual consequences for the patient. Primary-care physicians must be aware of them so that they can offer infected persons the best possible counselling.

Psychosexual Impacts of Human Papillomavirus
By Catherine Vezina, BA, MA, and Marc Steben, MD, CCFP, FCFP
As a first-line resource, physicians have a crucial responsibility to provide HPV patients with counselling suited to their needs. This requires physicians to go beyond their traditional roles and adopt fuller, more personalized counselling.

Recognition and Management of Common Forms of Tendinitis and Bursitis
By Michael Starr, MD, FRCP(C), and Harbhajan Kang, MD
Tendinitis and bursitis are common complaints, and are primarily due to overuse or repetitive microtrauma. This article focuses on supraspinatus tendinitis and subacromial bursitis, pes anserine, iliopsoas and trochanteric bursitis and lateral epicondylitis.

Gastrointestinal Symptoms in Terminal Illness
By Denise I. Marshall, MD, CCFP

July 2001

Behavioral Problems in the Elderly
By Esther Samson, MD, FRCP(C)
Up to 90% of Alzheimer’s patients present with behavioral problems during the course of their illness. It is essential that effective treatment strategies be devised to enhance patients’ quality of life, and provide support for their families.

Breaking Down Beta-Blockers and Heart Failure
By Michel Samson, MD
Beta-blockers, which used to be contraindicated in heart failure, now form part of the standard therapeutic armamentarium and even represent the best approach in terms of absolute value.

The Pros and Cons of Treating Parkinson’s Disease
By Paul J. Bédard, MD, PhD, FRCP(C)
Although not life threatening, Parkinson’s disease affects patients’ quality of life. Effective management may involve a combination of surgery and medication, with careful monitoring of potential side effects.

Subclinical Thyroid Disease: A Laboratory Finding of Clinical Relevance?
By André Nadeau, MD, FRCPC
The diagnosis of subclinical thyroid disease has emerged, following the development of a more sensitive TSH assay. Until more clinical trials are conducted, physicians must use their own judgment to decide if a patient with this disease should be treated.

Telemedicine: An Implementation Model
By Alain Cloutier, MD, FRCPC, and Jean-Paul Fortin, MD, CSPQ
Thanks to new information technologies, it is now possible to offer access to specialized care for patients living in remote areas, without the need for them to travel.

Medical Research on the Internet
By Isabelle Thivierge, MD, Hélène Masson, MD, FRCPC and Michel Dugas, MD, FRCP(C)
It is difficult to find reliable Web sites among the many sources of medical information available on the Internet. This article offers a review of Internet sites on cerebrovascular and degenerative neurological diseases.

August 2001

Uterine Artery Embolization: Treatment For Symptomatic Uterine Fibroids
By François Belzile, MD, Andrew J. Benko, MD, and Bao Bui, MD
The most common gynecologic neoplasms in women of reproductive age are uterine fibroids, also known as leiomyomas or myomas. Uterine artery embolization is an increasingly popular alternative to surgery for the treatment of symptomatic fibroids.

Natural Products and Gynecology
By Paul Bessette, MD
It is our role as physicians to keep an open mind about the field of alternative medicine. Clinical research regarding herbal medicine should increase in the future, so that decisions about prescribing these products can be guided using evidence-based data.

A Weighty Problem: Assessment of Diabetes
By Chantal Godin, MD, FRCPC, CSPQ
Diabetes is a chronic disease, which can be treated and, above all, controlled in order to reduce the consequences of chronic complications. The prevalence of this condition makes it essential for physicians to keep up to date.

Polypharmacy and the Elderly
By Serge Brazeau MD, CSPQ, FRCPC
Reducing adverse drug events in the elderly can be achieved by making precise diagnoses and by using treatment based on specific literature. When extrapolating from studies of younger patients, physicians should consider the physiology of aging, as well as ethical issues relevant to the elderly.

Pneumonia In The Critical Care Setting
By Christian Sinave, MD, CSPQ, FRCPC
As family physicians may be the first health-care providers to see a patient with a potential case of
pneumonia, it is essential they be able to identify the infection and give the patient a quick referral.

Essential Guidelines For Preoperative Assessment
By Luc Lanthier, MD, FRCPC, and Pierre Cossette, MD, MSc, FRCPC
An event-free surgical procedure and post-operative period depends to a large extent on the preoperative assessment. The assessment determines the type of surgery to be performed, the type of anesthesia to be administered, and the degree of risk to the patient.

Abdominal Aortic Aneurysms: A New Endovascular Approach
By Véronique Lapie, MD, FRCS(C)
An aneurysm of the abdominal aorta can be treated either surgically or via a prosthetic endovascular implant. This article explains what endovascular treatment consists of and outlines its primary advantages and disadvantages.

September 2001

Scleroderma: A Chronic Disease with Many Facets
By Melanie D. Beaton, MD; and David A. Bell, MD, FRCPC
The diagnosis of scleroderma should be considered in patients who present with skin changes typical of the disorder along with a history of Raynaud’s phenomenon.

The Renal Effects of Cox-2 Inhibitors
By Louise Moist, MSc, MD, FRCPC
When using prostaglandin inhibitors, such as the Cox inhibitors or NSAIDs, physicians must identify high-risk patients and adopt a proactive approach to anticipate renal problems.

Seborrheic Dermatitis Associated With Psychosis:Two Case Reports
By Ashifa Jiwa, BSc (Hons); and Jatinder Takhar, MD, FRCPC
Seborrheic dermatitis can occur when patients experience exacerbations of a psychotic disorder. It is thought that the imbalance between monoamine neurotransmitters and acetycholine in the brain may contribute to immunologic dysfunction underlying the development of such skin disorders.

Thrombotic Thrombocytopenic Purpura - Hemolytic Uremic Syndrome
By Faisal Rehman MD; Amit X. Garg, MD, MA,, FRCPC; and William F. Clark, MD, FRCPC, FACP
Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome is an uncommon illness that can result in significant morbidity and mortality. Physicians need to be aware of the clinical presentation of this syndrome and the potentially life-saving treatment of plasma exchange.

The Psychiatric Aspects of Living With HIV
By Margaret Pelz, MD, FRCPC, and Mark Halman, MD, FRCPC
Cognitive problems and depression can result from HIV infection and HIV treatment. As HIV-infected patients now live longer, the psychological issues associated with living with the disease are becoming more significant.

Non-Hodgkin’s Lymphoma: Clinical Manifestation, and How to Reach a Diagnosis
By Kamilia S. Rizkalla, MD, FRCPC; and Kang Howson-Jan, MD, FRCPC

Sorting Out Syncope: Patients, Tests and Diagnoses
By Andrew D. Krahn, MD, FRCPC, FACC
Despite a large armamentarium of investigative tools, syncope remains a challenging problem. Many of the conventional investigative tools used in treating this disorder are low yield, but loop recorder technology has become a strong alternative.

Pick’s Disease
By Andrew Kertesz, MD, FRCPC
In the past, the term Pick’s Disease has been used to describe various entities linked to frontotemporal dementia. Recent advances in neuroimaging, histochemistry and genetics have narrowed the scope of the disease terminology.

Diagnosis and Management of Epilepsy
By Warren T. Blume, MD, FRCPC
By providing family physicians with overall management goals and the range of the treatment plan for a patient, physicians can effectively participate in ongoing management of relatively complex epilepsy problems.

What’s New In Childhood Epilepsy
By Simon Levin, MD
For the majority of children with epilepsy, seizure control is easily obtained and maintained. In fact, assessment and treatment are usually straightforward, but families will require considerable reassurance and support.

Sudden Neurological Death
By David A. Ramsay, MB, ChB, DPhil, FRCPC, FRCPath
Sudden neurological death is rare, as most fatal neurological illnesses evolve over hours or days, giving health-care practitioners time to recognize them before a patient dies. There are, however, certain circumstances where neurological disease should be considered as a cause of sudden death.

Repetitive-Strain Injuries: Description, Not Diagnosis
By Thomas A. Miller, MD, FRCPC
Chronic work-related hand and upper-extremity disorders are a multifaceted problem that requires insight into both the workplace and patient factors.

October 2001

Workshop: New Treatments For Influenza
Richard Ward, MD, CCFP, FCFP
Aggressive immunization of high-risk individuals and health-care workers for influenza A and B remains the most important public health measure in the war against the "flu bug."

Fatigue and Sleep
Charles H. Samuels, MD, CCFP
Fatigue is a common problem seen in primary care and the family physician’s responsibility is to identify the medical condition causing the fatigue. An important part of the evaluation is screening and referral for primary sleep disorders that require a comprehensive sleep evaluation.

Understanding FAS
Margaret E. Clarke, MD, FRCPC
Primary-prevention strategies, systematic screening of all pregnant women and timely provision of interventions can help prevent FAS.

Pediatric Nephrology Problems
Julian Midgley, BM Bch, MRCP(UK), FRCPCH,

There are often non-specific results from laboratory investigations that may be due to serious disease. Distinguishing the unimportant from the significant is essential for appropriate referral.

Carpal Tunnel Syndrome

Ron Gorsché MD, MMedSc (Occupational Health), CCFP
To establish a work-related association, there should be a history of excessive or unusual hand use of a nature known to be associated with carpal tunnel syndrome prior to the onset of symptoms.

Breast Cancer in Family Practice
Carl Brown, MD, and Daphne Mew, MD
Initiating the appropriate investigations and referral can ensure women with breast cancer receive the best oncologic treatment possible.

Building-Related Illness
David Cross, MD, FRCPC
Building-related complaints are exceedingly common, and the vast majority of cases are not linked to serious health problems. An organized approach can result in a proper categorization of the problem and effective therapy.

Clinical Evaluation of Women with Ischemic Heart Disease
Debra L. Isaac, BN, MD, FRCPC, FACC
Physicians must recognize gender differences and biases when faced with a woman with possible cardiovascular disease.

Management of Cardiac Arrhythmias

Anne M. Gillis, MD, FRCPC
With many types of cardiac arrhythmias presenting in the clinical setting, family physicians must be able to distinguish each in order to refer dangerous cases to a specialist.

When Is My Patient Ready To Return To Work?
Brendan D. Adams, MD
Return to gainful employment is viewed as one of the essential outcomes in disease or injury treatment. It is important for physicians to work with their patients to ensure a satisfactory outcome.

Delirium: A Condition of All Ages
Darren Burback, MD, FRCPC
While delirium can strike at any age, physicians need to be particularly watchful for it in elderly patients, so that a search for the underlying etiology can be promptly
initiated and appropriate treatment given.

Managing Depression in Primary Care
Robin T. Reesal MD, FRCPC, DABPN; and Helen Ewing RN, BN, MN
Once diagnosed, depression usually can be treated successfully with patients regaining their previous level of functioning.

Epilepsy: Medical and Surgical Approaches
Neelan Pillay, MB, ChB, FCP(SA), MRCD(UK), FRCPC
There are several relatively new options for physicians to explore in the areas of epilepsy diagnosis and treatment. As the first-line of defence, family physicians must keep up-to-date in this area of diagnosis and treatment.

CME on the Internet

Barrie McCombs, MD, CCFP, CCFP(EM), FCFP
Do you want to learn what’s new in medicine, plan a tropical holiday or do both at the same time? Or would you rather spend a quiet evening studying at home? The Web sites described in this article can help you.

ADHD: A Diagnostic Dilemma
Geraldine A. Farrelly, LRCP, LRCSI, DCH(IREL), D. Obst., FRCPC
This article is intended to provide a practical approach to the diagnosis of ADHD. This can be a challenge as other conditions have similar symptoms.

November 2001

Workshop: Keeping Patients Healthy Abroad
Major Tim Cook, FRCPC, DTM&H, CD and Jay Keystone, FRCPC, MSc (CTM)
It is possible for the general practitioner to provide effective travel advice if close attention is paid to travellers’ medical history, travel plans and lifestyle.

Nutritional Supplements and Herbal Medicine in Diabetes
Michael Heffer, BSc., Phm. MHSc
To better counsel and inform patients regarding the risks and benefits of nutritional supplements and herbal products, physicians must be aware of the evidence, or lack thereof, concerning their use.

Sleep-Related Breathing Disorders in Children
Family physicians need to be aware of the clinical features of various sleep-related breathing disorders, as they will be called on to evaluate symptoms that may either comprise a normal variation in human physiology or indicate serious disease.

Evaluating Pediatric Head Injuries
Donna A. Goldenberg, MDCM, FRCPC
Children with intracranial hemorrhages may initially present with subtle findings, and must be carefully checked.

Early Recognition and Management of Meningitis
Dan Cass, BSc, MD, FRCPC
A high index of suspicion is necessary when differentiating bacterial meningitis from viral meningitis, particularly in light of nonclassical and atypical presentations.

Dietary Carbohydrates In The Insulin Resistance Syndrome
Thomas MS Wolever, MD, PhD
The areas of carbohydrates, glycemic index of foods and physical activity all play important roles in managing insulin-resistant patients, and should be understood before consulting with this patient population.

The Tired Child: Differentiating Sleepiness and Fatigue
Harvey Moldofsky, MD, FRCPC
The importance of understanding how the sleep-wake habits and activities during sleep contribute to the behavior of the tired child is stressed in this article.

Research Ethics: Key Issues Facing Clinicians
Aideen M. Moore MD, FRCPC, MHSc
As more research is being conducted, it is important that clinicians understand the ethical issues surrounding medical research, and, in particular, the role of the Research Ethics Board.

Early Detected Lung Cancer: Finding an Appropriate Treatment

Robert J. Ginsberg, MD, FRCSC
Using modern technology, subcentimeter tumors are now being identified. As with other malignant lesions, it is possible that less destructive treatments will successfully manage these very early diagnosed lung cancers.

Options for Management of Esophageal Cancer
Gail Darling, MD, FRCSC
In the absence of distant metastatic disease, treatment of esophageal cancer should aim for a cure, while, in the presence of distant metastatic disease, the goal should be the most expeditious and durable palliation of dysphagia.

Genetics Of Pancreatic Cancer: What Are The Risks?
Geeta Lal, MD, MSc, FRCSC; and Steven Gallinger, MD, MSc, FRCSC
Although the risk of pancreatic cancer and ultimate prognosis in asymptomatic mutation carriers is yet to be defined, genetic screening may be justified in the future.

Treating Erectile Dysfunction
Sender Herschorn, BSc, MDCM, FRCSC
It was previously thought that erectile dysfunction (ED) was essentially a psychologic disorder. Increasingly, however, sophisticated medical examinations are now able to determine physical causes for ED.

Treating the Overactive Bladder
Sender Herschorn, BSc, MDCM, FRCSC
As the population ages, urinary incontinence is becoming more common. Pharmacologic treatment for the overactive bladder can be successful if correctly applied.

Diseases: New and Emerging
Murray McQuigge, MD, Hon. BSc, CCFP, MPH
Canadian health-care workers face the challenge of finding ways to prevent, or minimize, the spread of new diseases, particularly those resistant to antibiotics, as well as those originating in other countries.

Office Tips
Presented by Vernon Curran, PhD; and Memorial University of Newfoundland
o Get a Jump Start on Tax Planning
o Symptomatic Abdominal Aortic Aneurysm
o Inaudible BP: How to Turn up the Volume!

You Asked About...
Presented by Wayne Olsheski, MD and the University of Toronto
o Oppositional Defiant Disorder

December 2001

Workshop: Autism and Related Disorders: Early Diagnosis is Critical
Helena H. Ho, MD, FRCPC; and Linda C. Eaves, PhD
Even though there is no cure for autism, early intensive intervention may modify difficult behavior and permit children to develop to their full potential. Early diagnosis is critical to help affected children and their families access appropriate help and support.

Eosinophilic Lung Disease: A Clinical Overview
The eosinophilic lung diseases are a diverse group of pulmonary disorders ranging from the trivial to the potentially fatal. Accurate diagnosis is essential, since effective treatment is available in most cases.

Long-Term Management of Hepatitis C Virus Infection
Alnoor S. Ramji, MD, and
Eric M. Yoshida, MD, MHSc, FRCPC

Hepatitis C virus is now the main cause of chronic liver disease in North America and, as such, family physicians must be prepared to identify it upon first glance.

Clinical Assessment of the Shoulder
Robert H. Hawkins MD, FRCSC
When assessing shoulder pain, a structured physical examination, as directed by the patient’s history, allows the clinician to look for important diagnostic clues. A look-feel-move approach helps the examiner gather the necessary information.

My Patient’s Sleepy, And It’s Not Sleep Apnea
Jonathan A.E. Fleming, MD
Excessive daytime sleepiness is not a benign complaint and always requires careful investigation.

Approach to Female Urinary Incontinence
Howard N. Fenster, MD, FRCSC
Although the majority of incontinence patients can be diagnosed and treated effectively by family doctors, there are a number of patients who present with more complex problems and require referral.

Women’s Sexual Response and Dysfunction: A Reappraisal
Rosemary Basson, MB, BS, MRCP
By moving away from the concept that conscious sexual desire (neediness or hunger) needs to be present to allow rewarding sexual experiences, an alternative model of women’s sexual response allows clarification of the common complaint of low desire.

Polycystic Ovarian Syndrome in Clinical Practice
Sheila M. Pride MD, FRCSC; and Anthony P. Cheung MBBS MPH, FRACOG, FRCSC
Although polycystic ovarian syndrome was first
recognized and described more than 60 years ago, the primary cause remains unknown. An endocrine work-up should exclude other endocrine problems that may be confused with it.

Preventive Cardiology For Women
Mann Chandavimol, MD, FRCPC, and Kenneth Gin, MD, FRCPC
The recognition and management of coronary heart disease in women represents a challenge for physicians. This article reviews clinical data evaluating risk factors for coronary heart disease in women, as well as how to assess and manage them.