[Occupational asthma]. / Asma profesional.

OBJECTIVE: Description of three cases of work-related asthma. DESIGN: Retrospective clinical observations. SETTING: Primary care clinics in the centre of the metropolitan health area of Madrid. PATIENTS: A 19-year old male who worked in the manufacture of Psyllium and reported one month's evolution of an irritative cough on getting up in the morning. A 33-year-old male who worked as a car mechanic and reported episodes of respiratory difficulty while at work. A 17-year-old male employed by a bread manufacturer who attended because of a catarrhal condition accompanied by respiratory difficulty. MEASUREMENTS AND MAIN RESULTS: The maximum expiratory flow monitor (MEFM) was used to measure maximum expiratory flow (MEF) in two patients. The third was temporarily separated from his work environment. The monitoring of the MEF showed a slow fall of 25% in the patient who worked with Psyllium and a rapid fall of 36% in the mechanic, which coincided with the symptoms. The patient with asthma probably caused by flour evolved favourably while off work and deteriorated again on returning to work. The allergological study showed sensitivity to Psyllium, Isocyanate and flour, respectively. The three patients stayed asymptomatic on being separated from the catalysing substances. CONCLUSIONS: The early diagnosis of work-related asthma requires a high level of diagnostic awareness. It is extremely important to separate the patient from the catalysing agent. The MEFM is a very useful instrument of diagnosis for the primary care doctor.

[Bowen's disease. A report of 9 cases]. / Enfermedad de Bowen. Presentación de nueve casos.

OBJECTIVE: To revise clinical histological, therapeutic and evolutive specifications of Bowen's disease. To emphasise the importance of an early diagnosis and to promote treatment with topical 5-fluorouracil by the family doctor. DESIGN: Descriptive and transversal study. SETTING: Outpatient and dermatology departments in a hospital in the metropolitan area of Madrid. PATIENTS AND OTHER PARTICIPANTS: Nine patients (5 male and 4 female), aged over 50, with slightly pigmented skin and diagnosed to have Bowen's disease. TREATMENT: In five patients. Topical 5-fluorouracil (Efudix) was applied once a day for 20-30 days. Surgery was performed on three patients and one underwent radiotherapy. MEASUREMENTS AND MAIN RESULTS: The clinical histories of the patients were used. In each case a histological study of the papule that had confirmed diagnosis was carried out. Treatment was effective in all patients and no recidivation was observed during the one year follow up. CONCLUSIONS: An early diagnosis and treatment of Bowen's disease is important for preventing its progression to invasive epidermoid carcinoma and later dissemination. The use of topical 5-fluorouracil is an efficient measure that can be prescribed by the family doctor.