Is the Patellar Pubic Percussion Test useful to diagnose only femur fractures or something else? Two case reports.

In the literature, the utility of the Patellar Pubic Percussion Test (PPPT) to diagnose occult fractures of the femur is well described. However, up to now there are no studies demonstrating the efficacy of this test in recognizing fractures of the pelvis. In this two case report a positive PPPT allowed the therapist to recognize clinical conditions requiring caution, protecting patients from a potentially unsuitable treatment. Both patients had a negative pelvis and femur x-ray after a fall, but the clinical findings and a positive PPPT lead the physiotherapist to suggest further examinations. In these two cases the PPPT seemed to be a useful diagnostic tool to identify periacetabular, ileo-pubic and ischio-pubic ramus fractures. These findings suggest that PPPT could be positive even for a bone lesion in any of the transit points of the vibration, from the patella to the pubic symphysis.

The frequency of smoking and problem drinking among general hospital inpatients in Brazil - using the AUDIT and Fagerström questionnaires.

CONTEXT: Although the CAGE questionnaire is one of the most widely used alcohol screening instruments, it has been criticized for not identifying people who are drinking heavily or who have alcohol related problems but do not as yet show symptoms of alcohol dependence. The AUDIT (Alcohol Use Disorder Identification Test) questionnaire was developed by WHO as a screening instrument specifically designed to identify problem drinkers, as well as those who were already dependent on alcohol. OBJECTIVE: The aim of this study was to use the AUDIT and Fagerström questionnaires in a general hospital inpatient population to measure the frequency of problem drinking and nicotine dependence, and to see if levels varied between medical speciality. DESIGN: Retrospective cross-sectional study. SETTING: Federally funded public teaching hospital. SAMPLE: 275 inpatients from both genders. MAIN MEASUREMENTS: Socio-demographic data, AUDIT (Alcohol Use Disorders Identification Test) and Fagerström Test for Nicotine Dependence. RESULTS: We interviewed 275 inpatients, 49% of whom were men and 51% women. Thirty-four patients were identified as "cases" by the Audit questionnaire; 22% of the male patients and 3% of the females. Just over 21% of inpatients were current smokers. The gastroenterology (26%) and general medicine (16%) inpatient units had the largest number of individual cases. CONCLUSIONS: Only by knowing the prevalence of alcohol abuse/dependence and nicotine dependence in a general hospital can we evaluate the need for a specialized liaison service to identify and treat these patients.

Environmental tobacco smoke exposure among non-smoking waiters: measurement of expired carbon monoxide levels.

CONTEXT: Exposure to environmental tobacco smoke is a health risk that is of concern to patrons and of particular concern to employees of restaurants and bars. OBJECTIVE: To assess environmental tobacco smoke exposure (using expired carbon monoxide levels) in non-smoking waiters before and after a normal day's shift and to compare pre-exposure levels with non-smoking medical students. DESIGN: An observational study. SETTING: Restaurants with more than 50 tables or 100 places in São Paulo. SUBJECTS: 100 non-smoking restaurant waiters and 100 non-smoking medical students in São Paulo, Brazil. MAIN MEASUREMENTS: Levels of expired carbon monoxide, measured with a Smokerlyser (Bedfont EC 50 Scientific), before and after a normal day's work. RESULTS: Waiters' pre-exposure expired carbon monoxide levels were similar to those of medical students, but after a mean of 9 hours exposure in the workplace, median levels more than doubled (2.0 ppm vs. 5.0 ppm, P <0.001). Post-exposure carbon monoxide levels were correlated with the number of tables available for smokers (Kendall's tau = 0.2, P <0.0001). CONCLUSIONS: Exposure to environmental tobacco smoke is the most likely explanation for the increase in carbon monoxide levels among these non-smoking waiters. These findings can be used to inform the ongoing public health debate on passive smoking.

Nurses' attitudes towards alcoholism: factor analysis of three commonly used scales.

OBJECTIVE: To investigate the psychometric properties of three scales commonly used to measure attitudes and beliefs about alcoholism. DESIGN: Cross-sectional study using a systematic sample. SETTING: Hospital São Paulo (a public general tertiary hospital) and the adjoining Federal University of São Paulo, Brazil. PARTICIPANTS: 310 nurses and nursing teachers. INSTRUMENTS: The Marcus Alcoholism Questionnaire, The Seaman Mannello Nurses' Attitudes Towards Alcohol and Alcoholism Scale and The Tolor-Tamarin Attitudes Towards Alcoholism Scale, which were combined into one self-administered questionnaire. ANALYSIS: The scales were re-grouped into their original formats and each underwent a principal components analysis with orthogonal rotation of factors. RESULTS: Each scale was found to consist of three main factors. There was some degree of overlap in the nature of the factors that the scales measured but each scale also measured something unique. CONCLUSION: The results of this comparative analysis could be used as a basis for developing a new scale covering all the important attitudinal groups identified by this study.

Distribution and Activity of the Plasma Membrane H+-ATPase in Mimosa pudica L. in Relation to Ionic Fluxes and Leaf Movements.

Plasma membrane H+-ATPase was immunolocalized in several cell types of the sensitive plant Mimosa pudica L., and transmembrane potentials were measured on cortical cells. In comparison with the nonspecialized cortical cells of the petiole or stem, the proton pump was highly expressed in motor cells. These immunological data are in close agreement with electrophysiological data, because the active component of the transmembrane potential was low in the nonspecialized cortical cells and high in motor cells. Therefore, motor cells contain the plasma membrane H+-ATPase required to mediate the ionic fluxes that are involved in circadian leaf movements and that are necessary to recover the turgor potential that is considerably affected by the large K+ and Cl- efflux associated with seismonastic movement. With the exception of sieve tubes, the phloem also had a high density of H+-ATPase. This suggests that the recovery of the transmembrane ionic gradients (K+ and Cl-), which is affected by various stimuli, is more energized by the companion and parenchyma cells than by the sieve elements. In addition, at the phloem/cortex interface collocytes displayed the required properties for lateral transduction of the action potential toward the pulvinal motor cells.

[The extra- and intracranial correlations of cerebral hemodynamics]. / Correlazioni extra-intracraniche dell'emodinamica cerebrale.

The transcranial Doppler method, at the present, allow us to study, in non-invasive way, the cerebral haemodynamics and its changes in case of extra- and intracranial vascular disease. The correlations between the intracranial data, obtained by means the transcranial doppler, and the informations, received by the duplex Doppler ultrasound and the color doppler ultrasonography, permit us to effect a complete and correct assessment of the cerebral circulation and to indicate an efficient medical or surgical therapy. The valuation of the compensatory intracranial circulation and the cerebral vasodilatator capacity is very important to establish the degree of cerebrovascular damage. Finally the transcranial Doppler allow us an indirect valuation of the intracranial lesion of the circle of Willis.

Selective trafficking of KNOTTED1 homeodomain protein and its mRNA through plasmodesmata.

Plasmodesmata are intercellular organelles in plants that establish cytoplasmic continuity between neighboring cells. Microinjection studies showed that plasmodesmata facilitate the cell-to-cell transport of a plant-encoded transcription factor, KNOTTED1 (KN1). KN1 can also mediate the selective plasmodesmal trafficking of kn1 sense RNA. The emerging picture of plant development suggests that cell fate is determined at least in part by supracellular controls responding to cellular position as well as lineage. One of the mechanisms that enables the necessary intercellular communication appears to involve transfer of informational molecules (proteins and RNA) through plasmodesmata.

Immunolocalization of the Plasma Membrane H+ -ATPase in Minor Veins of Vicia faba in Relation to Phloem Loading.

The immunolocalization of the plasma membrane H+ -ATPase, which generates a proton motive force energizing the uptake of inorganic and organic solutes, was studied by electron microscopy. The cells studied were in minor veins of Vicia faba L. exporting leaves, where photosynthates are supposed to be absorbed from the apoplast by phloem transfer cells. Immunologically detectable H+ -ATPase varied among the different cell types and was considerably denser in the transfer cells than in the other cell types, particularly in the sieve tube. Moreover, the distribution of the H+ -ATPase was not homogeneous in transfer cells, that pump being more concentrated in the region adjacent to the bundle sheath, phloem parenchyma, and xylem vessels than along the smooth part of the wall bordering the sieve tube. These results show that the plasma membrane infoldings of transfer cells possess the proton-pumping machinery required to energize an efficient uptake of photosynthates from the phloem apoplast and an efficient retrieval of nitrogenous compounds from the vascular sap.

Light-reflection rheography and acute deep vein thrombosis.

The authors examined 47 subjects affected by acute phlebothrombosis of the lower limbs by means of light-reflection-rheography (LRR). The diagnosis was based on the results of clinical, Doppler, and duplex scanner evaluations. The results were compared with those obtained in 30 healthy subjects (control group). The LRR examinations were performed by two methods: the one consisting of a passive execution of postural movements of the limb, the other using the technique of plethysmographic venous occlusion. The pathological LRR curves were characteristic for each type of disease and for the site of thrombosis and were different from the normal ones. The results obtained show the usefulness of the method and it potential in studying the collateral circulation and the effects of different therapies.

Light reflection rheography and thoracic outlet syndrome.

The authors have studied with a light reflection rheograph (LRR) 112 cases: 54 patients with suspected "thoracic outlet syndrome" (TOS) in the functional phase, 28 patients with phlebothrombosis localized in upper limbs, and a control group of 30 healthy subjects to evaluate the upper limbs' venous outlet. They recorded a good correlation among results obtained with LRR, clinical examination, Doppler, and phlebographic examination. The data obtained lead them to propose this methodology as an important examination in the evaluation of upper thoracic pathology.