[Clinical and diagnostic characteristics of bladder instability in urinary incontinence in the elderly]. / Características clínicas y diagnósticas de la inestabilidad vesical en la incontinencia urinaria del anciano.

Urinary incontinence is a common disease in elderly people, and the vesical instability is the most frequent cause. A prospective clinical study was done in elderly subjects with established urinary incontinence, produced by vesical instability, to find out if the analysis of several clinical parameters (general and urinary) together with the physical exam, are enough to establish a definitive diagnosis of vesical instability. The most characteristic urinary symptoms were urge incontinence (100%) and diurnal frequency (72%). Physical exam was normal in most patients. Our findings show that the clinical history and physical exam alone do not provide enough information to adequately characterize vesical instability, so, besides these parameters, an urodynamic study is needed to establish the originating mechanism of the urinary incontinence.

[Pink pityriasis in primary care. Review of 46 cases]. / Pitiriasis rosada en atención primaria. Revisión de 46 casos.

OBJECTIVE: We pretend to improve the knowledge and management of pityriasis rosea by family practitioners. DESIGN: A retrospective qualitative study by the review of the registry in a outpatient Dermatology clinic. SETTING: This work is made in the Dermatology clinic attending to San Sebastián de los Reyes population (Madrid) that's situated in the V Centenario Center. MEASUREMENTS AND MAIN RESULTS: 46 patients (28 females) were diagnosticated (mean age 25 +/- 13). Incidence was 85/100,000 hab; 12 patients were derivated urgently; 38 cases showed herald patch (82.6%). Lesions had characteristical distribution in 36 patients (78.3%); 43 cases had a clinic diagnosis (93.5%). Treatment wasn't necessary in 20 patients (43.5%). Most usual General Practitioner's presumption diagnosis was pityriasis rosea (21.7%); there was no diagnosis in 36.9%. CONCLUSIONS: We find inexperience in general practitioners about pityriasis rosea. It's necessary a correct knowledge and management of this pathology in Primary Care.

[Pigmented basocellular epithelioma. Presentation of 7 cases]. / Epitelioma basocelular pigmentado. Presentación de 7 casos.

OBJECTIVE: To review the clinical, histological, evolutive and therapeutical characteristics of basal cell carcinoma and the pigmented subtype. DESIGN: Descriptive transversal study. LOCATION: Primary Care; Clinic of Dermatology in a Primary Care of Madrid. PARTICIPANTS: Seven patients (4 males, 3 females) over 60 years old with pigmented lesions and skin little pigmented. MEASUREMENTS AND MAIN RESULTS: Medical records and the histological examination were reviewed in all the cases. The clinical evolution had been the same in all the patients starting with an asymptomatic papular lesion of dark pigmentation growing slowly. Finally the lesions were transformed to a plaque or a shining nodule. Prolonged exposure to sunlight was present in five cases. All the patients were referred to the Dermatology Clinic with the presumptive diagnosis of melanoma. The lesion histological examination was diagnostic. CONCLUSIONS: It is very important the knowledge of basal cell carcinoma in Primary Care due the elevated incidence mainly among the geriatric population and the immunosupressed subjects. We must think in this type of neoplasia, doing the differential diagnosis with the other pigmented lesions. It is necessary to perform the histological examination of the suspects lesions.

[Treatment with propantheline for urinary incontinence caused by bladder instability in the elderly]. / Tratamiento con propantelina de la incontinencia urinaria por inestabilidad vesical en pacientes ancianos.

We conducted a clinical study of a group of aged patients with established urinary incontinence due to vesical instability, in order to assess clinical response to propantheline. Mixed forms of vesical instability were excluded (associated to stress or lower urinary tract obstruction). All patients received propantheline orally at a dosage of 15 mg/6 hours. Modifications in the urinary symptomatology and the impact on functional capacity were analyzed at 3, 6 and 12 months of treatment. We observed a positive response in 63.4% of patients (36.6% curative and 26.8% improvement). Such response was observed during the first three months of treatment and persisted during the twelve months of clinical follow-up. Adverse effects were uncommon and well-tolerated by patients, being mouth dryness the most frequent symptom.