Impact of exclusive e-cigarettes and heated tobacco products use on muco-ciliary clearance.

BACKGROUND: Tobacco smoking impairs mucociliary clearance (MCC) efficiency as shown by prolonged saccharin test transit time (STTT). Avoiding exposure to tobacco smoke from combustible cigarettes may restore MCC function and former smokers have been shown to exhibit similar STTT as never smokers. The impact on STTT of switching from smoking to combustion-free tobacco products such as e-cigarettes (ECs) and heated tobacco products (HTPs) is not known. METHODS: We report STTT of exclusive EC and HTP users. Test results were compared with those obtained in current, former, and never smokers. RESULTS: STTT were obtained from 39 current, 40 former, 40 never smokers, and from 20 EC and 20 HTP users. Comparison of STTT values showed significant difference among the five study groups (p < 0.00001) with current smokers having a median [interquartile range (IQR)] STTT of 13.15 min, which was significantly longer compared with that of all other study groups. In particular, compared with former (7.26 min) and never smokers (7.24 min), exclusive EC users and exclusive HTP users had similar STTT at 7.00 and 8.00 min, respectively. CONCLUSION: Former smokers who have switched to exclusive regular use of combustion-free nicotine delivery systems (i.e., ECs and HTPs) exhibit similar saccharin transit time as never and former smokers. This suggests that combustion-free nicotine delivery technologies are unlikely to have detrimental effects on MCC function.

Comfort rules for face masks among healthcare workers during COVID-19 spread.

BACKGROUND: The outbreak of Coronavirus disease 2019 (COVID-19) made imperative the use of protective devices as a source control tool. As there is no definite antiviral treatment and effective vaccine, the only efficient means of protecting and mitigating infectious contagion has been the use of personal protective equipment, especially by healthcare workers. However, masks affect the humidification process of inhaled air, possibly leading to a basal inflammatory state of the upper airways. STUDY DESIGN: This is a single-center observational study conducted at the University Hospital of Catania from April 1, 2020, to June 31, 2020. METHODS: We analyzed the role of protective masks on the elimination of upper airways complaints in healthcare workers of the University Hospital of Catania. We evaluated 277 subjects through a self-administered 17 item questionnaire based on respiratory, work performance and health-related quality of life domains. RESULTS: A higher prevalence of nasal and ocular symptoms, perceived reduced work performance, difficulty in concentrating, and sleep disorders were found. After two weeks adhering to a list of good practices that we recommended, significant reversibility of the symptoms investigated and work performance enhancement were observed. CONCLUSIONS: Despite clinical complaints related to personal protective equipment, effective amelioration through usage rules is easily obtained. Given the essential use of protective masks, healthcare workers have to adhere to appropriate work and safety prevention rules.

Hearing and Vision Screening Program for newborns in Italy.

Materials and Methods: Data were collected through a nationwide survey conducted in 2018. All maternity wards active in Italy in 2017 were included. Background: The aims of this paper were to present data on the implementation and coverage of simultane-ous Universal Neonatal Hearing and Vision Screening programmes and to evaluate the organization and management of these healthcare procedures in Italy. Conclusions: Our results show that implementation of simultaneous hearing and vision screening increased the coverage of both screening tests and is a new multi-disciplinary approach to sensorineural disability. The use of both ABR and TEOAE tests in the hearing screening decreases the number of newborns sent for audiological evaluation, with a notable reduction of costs. The consideration that ocular problems are two to three times more common in deaf and hearing impaired children than their in hearing peers, confirms the importance of establishing guidelines for simultaneous hearing and vision screening, that favors the formation of a multi-disciplinary team (pediatrician, audio-logist, ophthalmologist). Results: HEARING SCREENING. Overall 427,365 newborns out of 448,386 (95.3%) received the hearing screening test (first level) in 391 out of the 409 maternity hospitals (95.5%), with a national mean referral rate of 3.63% (SD ± 4.58). A statistically significant increase (p<0.034) of newborns sent to audiological examination was found in maternity hospitals with Neonatal Intensive Care Unit (NICU) with "TEOAE only" protocol (9.32% SD ± 7.57), compared to those with "TEOAE/AABR" (3.0% SD ± 3.29). VISION SCREENING. Overall 335,262 newborns out of 448,386 (74.7%) received vision screening (Red Reflex test) for vision impairment in 302 out of 409 maternity hospitals (73.8%), before nursery discharge. The mean referral rate, recorded in only 22 maternity hospitals out of 302 (7.2%), was 0.48% with a rate of lost to follow up of 0.75 %.

Oral lesion as unusual first manifestation of multiple myeloma: case reports and review of the literature.

Extramedullary plasmacytoma (EMP) and solitary bone plasmacytoma (SBP) represent a disease continuum through a multistage process of cell differentiation, survival, proliferation, and dissemination, strictly related to multiple myeloma (MM), the second most common hematological malignancy. Herein, we report two cases of recurrent oral plasmacytoma progressed to MM, in which the first clinical sign of a more widespread disease was limited to the mouth. Based on our experience, we recommend a strict workup for the differential diagnosis between EMP, SBP, and MM for patients with oral plasmacytoma, including radiological exam of the skeleton, magnetic resonance imaging (MRI) of the bone, and positive emission tomography (FDG-PET). MRI and possibly PET can all be used to more sensitively detect EM plasmacytoma sites.

Bisphosponates and dental implants: a case report and a brief review of literature.

This paper reports a brief review of literature about dental implant in patients taking bisphosphonates (BPs) and a case of a patient taking zoledronate, submitted to postextractive implant surgery. A 54-years-old woman was referred to our observation, at the First Section of Dentistry of Department of Medical-Surgical Specialties, University of Catania. The patient, affected by multiple myeloma, reported being subjected to implant surgery, during the administration of zoledronate. Clinical and radiographic evaluations showed an area of BPs-related osteonecrosis in the only postextraction site where no implant was positioned. From this brief review of literature, we can conclude that the risk of bisphosphonates-related osteonecrosis and of implant failure in patients taking oral bisphosphonates may be low. This is a unique case of implant surgery in patient taking intravenous bisphosphonates. For that, we cannot conclude that implant surgery is safe in patients taking intravenous bisphosphonates or that the immediate implant placement following extraction may prevent the osteonecrosis. According to guidelines of AAOMS, to date any kind of surgical procedure involving alveolar bone in patients treated with itravenous BPs is contraindicated. More studies would be needed to optimize the clinical guidelines for the treatment of patients taking BPs.

Dental extractions in patient treated with intravenous bisphosphonates and risk of osteonecrosis of jaws: presentation of a preventive protocol and case series.

AIM: The exact pathogenesis of bisphosphonates-related osteonecrosis of jaws (BRONJ) is still not clear. Two broad theories have been articulated to explain the pathogenesis of BRONJ. One centres on the bisphosphonate induced osteoclast inhibition and the other explains the process in terms of antiangiogenic mechanisms. Both try to address the predilection for this occurrence in the jaws. In most cases the development of osteonecrosis in those taking bisphosphonates (BPs) has been associated with trauma, predominantly dental extraction. This study reports a case series of patients, treated with Zoledronate, submitted to a preventive protocol of dental extraction, in order to minimize the risk of occurrence of bisphosphonates-related osteonecrosis. METHODS: A total of 34 patients treated with Zoledronate and requiring single or multiple dental extractions were treated, at our Center for research, prevention and care of BRONJ, I Section of Dentistry, Department of Medical Surgical Specialties, University of Catania. The protocol provides an antibiotic prophylaxis and the surgical extraction of interested teeth, accompanied by the removal of the adjacent alveolar bone. RESULTS: A total of 71 extractions in 34 patients were performed with this approach. The follow-up was 12 months. No signs of inflamed tissue or necrotic exposed bone in any patients. CONCLUSION: With limits of present study, the results of our case series are very promising because BRONJ did not develop in any of the patients. In all patients taking Zoledronate and showing untreatable inflammatory dental conditions, the present protocol might be advisable.

The use of mineral trioxide aggregate in endodontics.

UNLABELLED: Mineral trioxide aggregate (MTA), composed mainly of tricalcic silicate, tricalcic alluminate, bismuth oxide, is a particular endodontic cement. It is made of hydrophilic fine particles that harden in the presence of dampness or blood. It is biocompatible, radiopaque and it is harder to infiltrate, compared to classic materials for root filling such as amalgam, cements, Super-EBA, and IRM. and SEM studies of sections and copies in resin of root neoapices filled with amalgam, IRM, Super-EBA and MTA, as well as tests of microinfiltration have shown that MTA has excellent sealing capacities. It requires a working time of about 5 min and a hardening time that varies from 2 h and 45 min to 4 h according to the density of the air entrapped during mixing and the dampness of the receiving site. The long hardening time reduces internal tensions and the incidence of marginal infiltration, but it forces to definitively fill the tooth in the following sitting, with an interval of at least 3 days from the MTA application. Clinical experience shows how MTA is a material of choice in cases not only of endodontic surgery, apicectomy and retrograde filling but also in the sealing filling of perforations of the pulp chamber and of the root, stripping, internal reabsorptions, readaptations, lacerations, and apical transports. It has been used with success also in direct cappings and in apexifications instead of calcium hydroxide, leading to quicker therapies and more predictable RESULTS: The authors outline the operative phases of the different treatments proposed, make a survey of the most important studies published so far and hope that a new sealing cement with more reduced hardening times will soon be available.

Physiological, metabolic, neuroendocrine and pharmacological regulation of nitric oxide in humans.

Genetically controlled nitric oxide production is currently assessed mainly by the colorimetric determination of the plasma levels of nitrite/nitrates, specific end-products of NO, or by the magnitude of the vasorelaxation obtained with forearm occlusion venous plethysmography after infusion of stimulating (acetylcholine) or inhibiting (N-monomethyl-arginine) substances. NO levels decrease in the elderly compared to young people and more in men than in women. Many shear stresses (physical exercise, cold pressor test, mental test) increase NO production; in these circumstances NO inhibits platelet aggregation and endothelial adhesivity: among endogenous metabolic factors mainly LDL impairs endothelium dependent vasodilation through an altered synthesis of NO, whereas triglycerides seem to have no influence; oxidized LDL may stimulate NO-production to counteract its damaging effects on endothelial cells. The hypothesis whereby an early production of NO is followed by a drop due to a prolonged cell injury is still controversial. Lipid lowering agents (drugs, apheresis) improve endothelial function. Some endogenous vasoactive substances, (acetylcholine, adenosine, bradykinin, and arginine) stimulate NO production, whereas others, such as angiotensin II, histamine, aspirin, indomethacin have inhibitory effects. As regards drugs glyceriltrinitrate and isosorbide dinitrate, acting as NO donors, improve endothelial function; other drugs are current being studied in this sense.

Plasma levels of E-selectin in normolipemic and hyperlipemic arteriopathic patients after vasoactive and lipid-lowering treatment.

BACKGROUND: The authors studied the plasma levels of E-selectin in a group of arteriopathic patients, before and after vasoactive and lipid-lowering treatment. METHODS: The series consisted of 73 subjects (53 males, 20 females, aged 54 +/- 9 suffering from occlusive peripheral arteriopathy; 21 subjects with total cholesterol (TC) below 200 mg/dl were considered as normolipemics (group A); 24 subjects with TC between 200 and 240 mg/dl, mild hypercholesterolemics (group B); 18 with TC above 240 mg/dl, severe hypercholesterolemic (group C); 10 subjects who had high triglyceride values (above 200 mg/dl), (group D); 12 normal controls were also considered. All patients underwent a vasoactive treatment for 15 days; group B also underwent a standard hypolipidic diet (phase I NCEP, lipid 30% die) groups C and D underwent the same diet associated respectively with simvastatin (200 mg/die) and bezafibrate (400 mg/die). For each sample of plasma before and after treatment the determination of levels of E-selectin was carried out by an immunoenzymatic method (kit ELISA Amersham). RESULTS: In groups A-B-C-D a reduction of the plasma levels of E-selectin was found, which was significant (p < 0.05), for group C and D, compared to controls. In groups A-B-D significant changes of E-selectin were not found after treatment; in group C the difference between the values after treatment and at baseline was significant (p < 0.05). CONCLUSIONS: The reduction of the E-selectin plasma levels was proportional to the values of total cholesterol and triglycerides; the chronicity and the dyslipidemia may be responsible for the basal diminished biosynthetic endothelial function; in the severe hypercholesterolemics the lipid-lowering treatment caused a significant decrease of E-selectin, due to a probable reduced endothelial irritation dependent on the hyperlipemic stress.

Nitrite, endothelin and E-selectin plasma levels after arginine infusion in normal, obese and type 2 diabetic subjects.

BACKGROUND: The authors studied the behaviour of nitrites (specific end-products of nitric oxide), endothelin and E-selectin after arginine infusion (biosynthetic precursor of nitric oxide). METHODS: The series consisted of 28 female subjects (mean age 59 +/- 8) of whom: 12 normal controls; 12 suffering from essential obesity (BMI 31.4 +/- 0.7); 14 suffering from uncomplicated type 2 diabetes mellitus. Each subject received intravenous arginine (20 g in two hours); before the infusion and after 1 hour and 2 hours venous blood withdrawal was performed. For each plasma sample the levels of nitrites (colorimetric reaction), endothelin (ELISA method) and E-selectin (ELISA method) were determined. RESULTS: In the controls plasma nitrites decreased significantly (p < 0.05), more evidently at the second hour. In the obese subjects a sharp significant (p < 0.05) fall of nitrites was observed, more evidently at the second hour. In the diabetics nitrite values were reduced (p < 0.05) compared to the baseline. Endothelin levels after arginine were almost unchanged in normal and obese subjects, while in diabetics a significant (p < 0.05) reduction was observed. In the three groups of subjects E-selectin values were not modified by arginine. CONCLUSIONS: This study demonstrates that arginine infusion increase NO biosynthesis in normal, obese and diabetic subjects, inducing a significant reduction of nitrites for an early process of organic reconversion; endothelin showed a reductive trend, mainly in diabetics, probably due to an antagonistic balanced response towards an overproduction of nitric oxide. E-selectin did not change, without correlation with the nitrite and endothelin values, because of an independence from the production of the two "hemodynamic markers".

Cardiovascular diseases and nitric oxide in humans.

The production of nitric oxide is impaired in patients with clinical and instrumental signs of arteriosclerosis (chronic coronary heart disease, stable and unstable angina, myocardial infarction); the NO deficiency is assessed through the vascular response to the infusion of stimulating (acetycholine) or inhibiting (N-mono-methylarginine) substances upon NO synthesis. Also in hypertensive subjects a weak endothelium-dependent vascular relaxation was documented, but this phenomenon is not constant and is still to be confirmed. In hypercholesterolemic patients a hyporesponsive endothelium-dependent vasodilation has been well documented, lipid lowering agents (drugs, apheresis) improve endothelium function. In heart failure low NO levels are found proportionally to the severity of disease: the expression of No is depressed, but cytokine mediated i NOS expression is enhanced, causing exaggerated amounts of NO and producing myocyte damage or death. Interesting findings indicated NO inhalation as a useful tool for reducing pulmonary hypertension and congestive heart failure.

Nitrite plasma levels after an oral fat meal in normolipemic subjects.

BACKGROUND: The authors, investigating the effects of an oral triglyceride-rich fatty load upon the endothelial function as regards the production of nitric oxide, performed the determination of plasma nitrites, which are stable, specific and irreversible end-products of nitric oxide. METHODS: The series consists of 13 metabolically normal female subjects (mean age 55 +/- 7 years); after an overnight fasting each subject undertook an oral fat load (butter 1 g/kg); a venous blood withdrawal was carried out before oral fat meal and after two and four hours. For each plasma sample total cholesterol, HDL-cholesterol and triglyceride plasma levels were determined by enzymatic methods; LDL-cholesterol was calculated by Friedwald's formula; the nitrite plasma levels were obtained by the Gutman and Hollywood colorimetric method. RESULTS: Total cholesterol, HDL-cholesterol, LDL-cholesterol did not show significant changes after the oral fat load; triglycerides rose significantly (p < 0.05) after 4 hours as compared to the basal value (226 +/- 12 vs 175 +/- 12 mg/dl, +30%). The nitrite plasma levels were almost unchanged before oral fat load and after 2 and 4 hours. CONCLUSIONS: The results suggest that the acute biochemical stress consisting of increased triglyceride-rich very low density lipoproteins was not able to stimulate the endothelial production of nitric oxide.

Nitrite plasma levels in normolipemic and hypercholesterolemic arteriopathics after vasoactive and lipid-lowering treatment.

BACKGROUND: The authors studied the plasmatic levels of nitrites, stable end-products of nitric oxide in arteriopathic patients before and after vasoactive and lipid-lowering treatment. METHODS: The series consisted of 63 subjects (mean age 64 +/- 9) suffering from peripheral arterial occlusive disease; 21 subjects with total cholesterol (TC) lower than 200 mg/dl were considered as normolipemic (group A); 24 subjects with TC ranging between 200 and 240 mg/dl were considered as mild hypercholesterolemic (group B); 18 subjects with TC higher than 240 mg/dl were consider as severe hypercholesterolemic (group C). All the patients were examined before and after 15 and 30 days of a vasoactive treatment (calciparine, aspirin, buflomedil and pentoxiphylline); group B after vasoactive and diet (NCEP phase 1) treatment and group C after vasoactive, diet and drug (simvastatin) treatment. Nitrite plasma levels were determined by the Gutman and Hollywood colorimetric method. RESULTS: In group A the basal value of nitrites was sharply (p < 0.05) lower than controls; after vasoactive treatment a significant increase (p < 0.05), was observed after 15 and 30 days; in group B the basal value was higher than controls; after 15 days a significant increase (p < 0.5) was noted, but a regression was found after 30 days. Also in group C the basal value of nitrites was higher (p < 0.05) than controls; after treatment significant changes were not found. CONCLUSIONS: The increase of nitrites in group A may be due to an improved endothelial function; this phenomenon, less appreciable in group B and no longer evident in group C may depend on the lipid-lowering treatment.

Indications and results of fronto-lateral laryngectomy using a combined endolaryngeal and external approach.

Patients with laryngeal anterior commissure, cord-commissure, bilateral anterior cord-commissure carcinomas (T1 and T2 N0 M0) were subjected to a new method of frontolateral laryngectomy using a combined endolaryngeal and external approach. The proposed surgical procedure allowed the removal of the anterior commissure and part of one or both vocal cords in a single unit, together with the cartilaginous framework, respecting the integrity of the superior portion of the thyroid cartilage. The internal procedure permitted an accurate delimitation of the posterior part of the laryngeal neoplasm. In particular, this was performed during suspension microlaryngoscopy using the CO(2) laser or traditional cutting tools for section of the laryngeal visceral structures to the internal surface of the thyroid cartilage. Following this, the external approach included incision of the external perichondrium along the superior edge of the thyroid cartilage and along the median line, from the incisura to the inferior edge of the thyroid cartilage. The superior opening of the larynx is made side-to-side and the epiglottis separated at the level of the superior edge of the thyroid cartilage. The ends of the section are joined together with the superior parts of the section created during the laryngeal approach. Then progressive craniocaudal detachment of the internal perichondrium is performed backwards until the endolaryngeal sections are reached and downwards to the insertion of the cord ligaments. The inferior opening of the larynx is made by a horizontal section of the cricothyroid membrane at the level of the superior edge of the cricoid cartilage. Section of the thyroid cartilage is therefore performed in a trapezoidal shape. This section involves the inferior part of the protruding corner of the thyroid cartilage. After joining the ends of the cricothyroid section with the inferior extremities of the endolaryngeal sections, the surgical specimen is removed as a single unit. The method must be used only after accurate clinical evaluation. It is mostly recommended in subjects with cord-commissure carcinomas previously treated with radiotherapy. The results obtained were extremely satisfactory both as regards survival and functional results. In all, 27/28 patients (96.4%) were free from disease. The quality of voice was satisfactory but hoarse in 30% and breathy in 70% of the patients.

Plasma levels of E-selectin in normolipemic and hyperlipemic arteriopathic patients.

BACKGROUND: The authors studied the plasmatic levels of E-selectin in a group of normolipemic and hyperlipemic arteriopathic patients. METHODS: The series consisted of 73 subjects (53 male, 20 female, age 54 +/- 9) suffering from occlusive peripheral arteriopathy; 21 subjects with total cholesterol (TC) below 200 mg/dl were considered as normolipemics (group A), 24 subjects with TC between 200 and 240 mg/dl, mild hypercholesterolemics (group B), 18 with TC above 240 mg/dl, severe hypercholesterolemics (group C); 10 subjects had high triglyceride values (above 200 mg/dl), (group D); 12 normal controls were also considered. For each subject the determination of the E-selectin E-plasma levels was performed with an immunoenzymatic method (kit ELISA Amersham). RESULTS: In group A a value of E-s (4.03 +/- 0.37 ng/ml) statistically lower (p < 0.05) compared to normal controls (5.71 +/- 0.61 ng/ml) was found; in group B the E-s value (3.81 +/- 0.31 ng/ml) was slightly lower than that of group A; in group C the value of E-s was 3.53 +/- 0.23 ng/ml, statistically lower compared normal controls (p < 0.01) and to group A (p < 0.05); in group D the E-s value (3.24 +/- 0.23 ng/ml) was sharply reduced compared to controls (p < 0.01) and to groups A-B-C (p < 0.05). CONCLUSIONS: The reduction or E-selectin, was proportional to the magnitude of total cholesterol and triglycerides; the chronicity of the vasculopathy and the dyslipidemia may be responsible for an impaired biosynthetic endothelial function.

Nitrite plasma levels in chronic lung disease patients.

BACKGROUND: The authors carried out a study in a group of lung disease patients, about the behaviour of the plasmatic levels of nitrites (stable, specific and irreversible end-products of nitric oxide). METHODS: The series consisted of 13 male patients (mean age 65 +/- 7 years) with chronic obstructive pulmonary disease with type 1 respiratory failure; 33 male subjects (mean age 58 +/- 5 years) without internistic disease were considered as controls. For each subject the determination of nitrite plasma levels by the Gutman and Hollywood method based on the Griess colorimetric reaction was performed. RESULTS: The mean value of the plasmatic nitrites was significantly reduced (p < 0.05) as compared to the controls (11 +/- 0.48 mumol/l vs 21 +/- 0.92 mumol/l). CONCLUSIONS: The authors hypothesized that in chronic lung disease patients there would be a condition of initial pulmonary hypertension; in this condition long-term endothelium-dependent nitric oxide production, aimed at the vasodilating effects with secondary excessive exhaled amount of NO, might cause a reduction in nitrite plasma levels. These levels may represent an early marker of pulmonary hypertension and suggest interesting therapeutic treatments through inhalation of exogenous NO.

Nitrite plasma levels in type 1 and 2 diabetics with and without complications.

BACKGROUND: The authors thought it interesting to examine the interrelationship between nitric oxide and diabetes mellitus by the determination of the nitrite plasma levels, stable end-products of nitric oxide, in various clinical patterns of diabetes mellitus. METHODS: Our series consisted of 161 female subjects (mean age 54 +/- 7 years, disease duration 5 +/- 3 months) subdivided into: a) 13 patients suffering from insulin-dependent diabetes (IDDM) without clinical and instrumental signs of micro- and macroangiopathy; b) 148 suffering from non insulin-dependent diabetes mellitus (NIDDM) of whom: 1) 52 without vascular complications (28 normal weight, BMI < 25, and 24 obese, BMI > 30); 2) 40 with clinical and instrumental signs of non hypertensive coronary heart disease (CHD); 3) 25 with CHD and hypertension (arterial blood pressure over 160/95 mmHg); 4) 31 with hypercholesterolemia (values over 250 mg/dl). All patients were examined in good glycometabolic conditions reached by oral hypoglycemiant (12 cases) or insulin (149 cases) treatment. As normal control 37 female subjects (mean age 48 +/- 7) without internistic diseases were considered. For each sample we determined the plasma levels of nitrites by the Gutman and Hollywood method. RESULTS: Almost similar nitrite plasma levels in IDDM (17 +/- 0.5 mumol/L) and normal controls (17 +/- 0.2 mumol/L) were found; in non complicated non obese NIDDM a not significantly elevated value (21 +/- 0.8 mumol/L) as compared with the IDDM and control group was found; the obese NIDDM patients showed a value (18 +/- 0.4 mumol/L) not significantly different in comparison with the non obese NIDDM group. In the NIDDM group with non hypertensive CHD) the nitrite value was almost similar (20 +/- 0.5 mumol/L) to the corresponding group without vascular complications. In the patients with CHD and hypertension the nitrite level was superimposable (20 +/- 0.7 mumol/L) on the one recorded in NIDDM patients without vascular complications and in those with CHD without hypertension. In NIDDM patients with hypercholesterolemia the mean nitrite value was sharply elevated (24 +/- 0.8 mumol/L); the difference between this group and those of non hypercholesterolemic, non obese, obese and CHD (with or without hypertension) patients was significant (p < 0.05). CONCLUSIONS: It is conceivable that diabetes mellitus per se causes a tendential not significant increase of NO production in comparison with normal controls; some factors such as blood pressure, overweight, disease duration, therapeutic treatment and coronary complications appear not to influence NO production. In hypercholesterolemic diabetic patients the nitrite enhanced level in plasma might mean a compensatory response to a continuous inactivation of NO involved in a protective competition towards damaging factors and chiefly against oxidised LDL.

Nitrite plasma levels in normolipemic and hypercholesterolemic patients with peripheral occlusive arteriopathy.

BACKGROUND: The authors studied the nitrite plasma levels in a group of patients with peripheral obstructive arteriopathy. METHODS: The series consisted of 63 subjects (43 males, 20 females, mean age 64 +/- 9 years) suffering from peripheral arterial occlusive disease of the lower limbs, at II (55 cases) and III (8 cases) Fontaine stage; 21 subjects with total cholesterol (TC) lower than 200 mg/dl were considered as normolipemics, 24 subjects with TC values between 200 and 240 as mild hypercholesterolemics, 18 subjects with TC above 240 mg/dl as severe hypercholesterolemics. For each subject the determination of nitrite plasma levels was carried out, by the Gutman and Hollywood colorimetric method. RESULTS: In the normolipemic arteriopathics the basal value of nitrites was sharply reduced (p < 0.05) compared to the controls; in the mild hypercholesterolemics the mean basal value of nitrites was markedly higher compared to the controls; in the severe hypercholesterolemics the mean basal value of nitrites was statistically (p < 0.05) higher than that of the controls. In the arteriopathic patients, globally considered, the mean basal value of nitrites was superimposable on that of the normal control subjects. CONCLUSIONS: This study, carried out on the nitrite plasma levels in a group of arteriopathic patients allowed us to show the enhanced levels of nitric oxide due to the increase of LDL; this effect, previously observed in hypercholesterolemic diabetic and coronaropathic patients, leads us to the hypothesis of a stimulating effect of LDL upon NO endothelial synthesis; this would be a compensatory response to the damaging and vasoconstricting action of LDL.