Levels of l-arginine and l-citrulline in patients with erectile dysfunction of different etiology.

Nitric oxide is a physiologic signal essential to penile erection. l-citrulline (l-Cit) is converted into l-arginine (l-Arg), the precursor from which nitric oxide is generated. The level of l-Arg and l-Cit in the field of male sexual function remains relatively underexplored. The aim of the study was to evaluate the level of serum l-Arg and of l-Cit in a group of patients with erectile dysfunction. Diagnosis and severity of erectile dysfunction was based on the IIEF-5 and its etiology was classified as arteriogenic (A-ED), borderline (BL-ED), and non-arteriogenic (NA-ED) with penile echo-color-Doppler in basal condition and after intracaversous injection of prostaglandin E1. Serum l-Arg and l-Cit concentrations were measured by a cation-exchange chromatography system. l-Arg and l-Cit levels of men with A-ED were compared with those of male with BL-ED and NA-ED. Median level of l-Arg and l-Cit in 122 erectile dysfunction patients (41 A-ED, 23 ED-BL, 58 NA-ED) was 82.7 and 35.4 µmol/L, respectively. l-Arg and l-Cit levels in control patients were not significantly different (p = 0.233 and p = 0.561, respectively) than in total erectile dysfunction patients. l-Arg and l-Cit levels in control patients were significantly higher (p < 0.001 and p < 0.018, respectively) than in A-ED patients, but no difference (p > 0.50) was observed in controls and in both BL-ED and NA-ED patients. Patients with severe/complete-erectile dysfunction (IIEF-5 < 10) had l-Arg or l-Cit level significantly lower (-17%, p < 0.03; -13%, p < 0.04) and were more frequent (p < 0.01 and p < 0.04) under the respective median level (82.7 and 35.4 µmol/L) than those with mild-erectile dysfunction (IIEF-5 = 16-20). l-Arg and l-Cit levels in A-ED were significantly lower (p < 0.007 and p < 0.001, respectively) than in NA-ED patients. Penile echo-color-Doppler revealed that A-ED (peak systolic velocity ≤ 25 cm/sec) was more frequent in men with l-Arg under 82.7 µmol/L or l-Cit under 35.4 µmol/L and in the same population, the median peak systolic velocity values were lower in l-Arg deficient (29 vs. 35; p < 0.04) and also in l-Cit deficient (31 vs. 33, p > 0.3) but without reaching the statistical significance. Our study shows that a significant proportion of erectile dysfunction patients have low l-Arg or l-Cit level and that this condition is more frequent in patients with arteriogenic etiology. Low levels of these nitric oxide synthase substrates might increase the erectile dysfunction risk by reducing the concentration of nitric oxide.

[Statistical notes and long-term results in 178 patients operated for benign breast diseases]. / Considerazioni statistiche e risultati a distanza in 178 pazienti operati per affezioni benigne della mammella

178 patients of both sexes operated on for benign conditions of the mamilla between 1957 and 1967 were reviewed and the results are reported. The most frequent condition was sclerocystic mastosis, followed by benign cancer and forms with chronic inflammatory aetiology. The most affected sex, obviously, was the female. At follow-up, on average 9 yrs after operation, 19 female patients reported the reappearance of benign neoformations of the mamilla while carcinoma had occurred in a further 7 patients.

[Statistical notes on the age and survival of 178 patients operated for malignant breast tumors]. / Considerazioni statistiche sull'etå e sopravvivenza di 178 pazienti sottoposte ad intervento chirurgico per tumore maligno della mammella

Age and survival data in a series of 178 patients operated for malignant breast tumour during the period 1957-67 are statistically assessed. The mean survival period was 9 yr. Young subjects had a greater chance of survival, while their mortality rate was the lowest after the fifth year.