Guía terapéutica en atención primaria basada en la evidencia, 2. ª edición: una obra honesta y práctica / Therapeutic guide to Primary Care based on the evidence, 2nd edition: an honest and practical work

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Subungual hemorrhages. A primary manifestation of diabetes mellitus.

Subungual hemorrhages may be observed in a variety of systemic diseases and in some otherwise healthy persons. We describe three male patients who were referred because of toenail hemorrhages. Analytical investigations showed hyperglycemia in all the patients. Toenail bilateral hemorrhages were the first manifestation of previously undiagnosed type II diabetes mellitus in all cases. Ophthalmologic examination showed signs of background diabetic retinopathy in all three patients. The existence of retinopathy suggests that subungual hemorrhages might be due to microvascular involvement and could herald the presence of diabetes mellitus.

Electronic maps for terminal area navigation: effects of frame of reference and dimensionality.

Two experiments are reported that contrast rotating versus fixed electronic map displays, which pilots used for a simulated approach to a landing. In Experiment 1, a rotating versus fixed-map display was experimentally crossed with a two-dimensional (2D) versus three-dimensional (3D) view (perspective map) as pilots' ability to maintain the flight path and demonstrate awareness of the location of surrounding terrain features were assessed. Rotating displays supported better flight path guidance and did not substantially harm performance on terrain awareness tasks. 3D displays led to a substantial cost for vertical control but did not differ from 2D displays in lateral control. In Experiment 2, pilots flew with the rotating 2D display and with an improved version of the rotating 3D display, designed to reduce the ambiguity of representing altitude information. Vertical control improved as a result of the 3D display design improvement, but lateral control did not. The results are discussed in terms of the costs and benefits of presenting information in 3D, ego-referenced format for both flight path control and terrain awareness.

[Molluscum contagiosum: one year examination at a health center]. / Molluscum contagiosum: revisión de un año en un centro de salud.

OBJECTIVE: To study the prevalence of Molluscum contagiosum in our environment, in order to understand and control it better. DESIGN: A retrospective descriptive study was undertaken. SETTING: The Dermatology Clinic of the "V Centenario" Health Centre at San Sebastián de los Reyes (Madrid). PATIENTS: All cases diagnosed during 1991 were selected. MEASUREMENTS AND MAIN RESULTS: The following variables were analysed: age, sex, date of the consultation, duration of the lesions, family members affected, number and site of the lesions, referral diagnosis and HIV serology. The method of comparing proportions was used for the analysis. Twenty-nine patients (9 female), with an average age of 12 +/- 11 years, were diagnosed: this supposed 0.37% of the patients seen at the clinic over a year. Six patients identified a possible source of contagion. 55.2% had less than 5 lesions. The most common site was the trunk (44.8%) and extremities (48.2%). Only 24% had a correct diagnosis in the interclinic notes. 20.7% were not diagnosed. Two patients were HIV (+); both with numerous lesions in the genital area. All the cases were treated by mechanical means. CONCLUSIONS: Knowledge of the disease must be improved, to make diagnosis more rapid and thus avoid transmission; given that diagnosis and treatment is simple and completely attainable at the Primary Care level.

[The usefulness of the annual electrocardiogram in arterial hypertension follow-up]. / Utilidad del electrocardiograma anual en el control de la hipertensión arterial.

We evaluated the usefulness of ECG in the follow up of 223 hypertensive patients included in a program for the control of hypertension. Yearly ECG was requested in 84.3% of the evaluated patients. Its interpretation resulted in therapeutic changes in 6 patients. The agreement of the interpretation of 122 ECG tracings between the primary care team and a cardiologist was moderate. General practitioners overrated normality (87 versus 69 cases), and underdiagnosed left ventricular hypertrophy (6 versus 10 cases) and ischemic heart disease (6 versus 17 cases). Half of the diagnoses of ischemic heart disease made by the general practitioner were not accepted by the cardiologist. The compliance with a protocol does not guarantee a higher quality of care.

[The most often quoted journals in primary care]. / Las revistas más citadas en atención primaria.

The bibliographical references of original articles published during 1988 in four primary care magazines from diverse cultural backgrounds were analysed: Canadian Family Physician (Canada), Journal of Family Practice (United States), Atención Primaria (Spain), and Journal of the Royal College of General Practitioners (United Kingdom). There are 4,225 bibliographical references used in the 328 original reviewed articles. These references had been published in 725 different magazines, of which the ten most oft-quoted account for 38% of the total references. In addition to the four magazines included in our review, the list includes the following: British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Lancet, Canadian Medical Association Journal, Annals of Internal Medicine, and American Journal of Obstetrics and Gynecology.

[Amyloidosis maculosa: diagnosis in primary care]. / Amiloidosis maculosa: diagnóstico en atención primaria.

Amyloidosis maculosa is a clinical entity with low incidence factor in our medium, which basically affects middle-aged women. The lesion is characterised by the presence of poorly defined, hyperpigmented, brownish or greyish maculae that converge and focus basically on the upper back and shoulders, usually accompanied by pruritus. Three patients were erroneously catalogued for years as having pityriasis versicolor. Two of these patients presented a typical clinical amyloidosis maculosa, and the third presented a less common manifestation of the disease: a single, well-defined lesion in the subscapular region. We believe that the approach to the diagnosis of pityriasis versicolor with hyperpigmented lesions that do not respond to specific treatment should be revised. Although amyloidosis maculosa has a low incidence in our medium, it is an entity which should not be discarded in these cases.