Cytomegalovirus-Induced Polyarteritis Nodosa in a Liver Transplant Recipient.

Polyarteritis nodosa (PAN) is a necrotizing vasculitis that has been associated with viral infections, especially hepatitis B virus. We hereby report a case of tissue-invasive cytomegalovirus (CMV)-induced PAN in a liver transplant recipient presenting with acute kidney injury and active urinary sediment. Treatment directed against both PAN and CMV resulted in improvement in kidney function, normalization of urinary indices and resolution of the CMV infection. There was no recurrence of either PAN or CMV after a 3-year follow-up period.

[Job demands, meaningful work, and turnover intention among nurses]. / Richieste lavorative, significatività percepita del lavoro e intenzione di turnover degli infermieri.

BACKGROUND: The shortage of nurses is a worldwide issue. Since turnover intention (TI) is considered one of the major determinants of turnover behaviour, it is essential to look deeper into the way it operates. OBJECTIVES: This study uses the job demands-resources model to investigate the TI of nurses, on the one hand looking at the relationship that some demands (workload, emotional dissonance and abusive supervision) have on TI and on the other, investigating the role of a specific resource (meaningful work - MW) in terms of its effect on TI and as a potential moderator of the relationship between each demand and TI. METHODS: The research project was carried out in a large hospital in Northern Italy by administering a self-report questionnaire to all nurses; 630 questionnaires were distributed, 423 (67.14%) of which were completed. The statistical analyses were performed with PASW 18. RESULTS: The results highlight a positive relationship between demands and TI and a negative relationship between meaningful work and TI. Moreover, a significant moderating effect of meaningful work on the relationship between emotional dissonance and TI also emerged. No significant moderating effects were found for the relationship between the other two demands and TI. CONCLUSIONS: This research allowed us to verify the importance of constructs such as abusive supervision and meaningful work that have not yet been extensively studied, within the context of nursing staff in Italy; it also offered a range of suggestions for organizational developments and for further investigations in this field.

[Identification of risk factors for work-related stress in a hospital: a qualitative and quantitative approach]. / L'identificazione dei fattori di rischio stress lavoro-correlato in un'Azienda Sanitaria Ospedaliera: un approccio quali-quantitativo.

BACKGROUND: Italian legislation establishes the obligation for the employer to assess any risks to the safety and health of workers, including those relating to work-related stress (WRS). Several studies have proved the existence of a link between WRS and both individual diseases and organizational results. OBJECTIVE: The research aimed at detecting WRS risk factors in a hospital consisting of 53 departments employing 2334 workers. METHODS: A qualitative and quantitative approach was adopted divided into six steps: 1) analysis of the hospital indicators; 2) semistructured interviews of the 53 department heads; 3) preparation of a checklist including 42 WRS risk indicators; 4) observation by shadowing of the 53 departments; 5) setting up of 53 focus groups with staff from each department; 6) distribution of the check-list to a representative sample of 747 employees. RESULTS: Data analysis showed a "low" level of WRS risk regarding the hospital as a whole, a "medium" level regarding six transversal indicators and eight departments. Three indicators considered particularly significant were examined in detail: "workplace and ergonomic conditions", "shift work", "interruptions in work flow". CONCLUSIONS: The results helped to identifj a series of best practices aimed at reducing WRS risk that are applicable to other health care settings. The qualitative and quantitative approach produced a keen involvement of the employees of the hospital which will positively encourage the real efficacy of the measures taken.

Global cardiovascular risk management in different Italian regions: an analysis of the Evaluation of Final Feasible Effect of Control Training and Ultra Sensitisation (EFFECTUS) educational program.

BACKGROUND AND AIM: The Final Evaluation Feasible Effect of Ultra Control Training and Sensitization (EFFECTUS) is an educational program, aimed at improving global CV risk stratification and management in Italy. The present study evaluates differences on clinical approach to global CV risk among physicians involved in the EFFECTUS program and stratified in three geographical macro-areas (North, Center, South) of our Country. METHODS AND RESULTS: Physicians were asked to submit data already available in their medical records, covering the first 10 adult outpatients, consecutively seen in the month of May 2006. Overall, 1.078 physicians (27% females, aged 50 ± 7 years) collected data of 9.904 outpatients (46.5% females, aged 67 ± 9 years), among which 3.219 (32.5%) were residents in Northern, 3.652 (36.9%) in Central and 3.033 (30.6%) in Southern Italy. A significantly higher prevalence of major CV risk factors, including obesity, physical inactivity, hypertension and diabetes, was recorded in Southern than in other areas. Accordingly, Southern physicians more frequently prescribed antihypertensive, glucose and lipid lowering agents than other physicians, who paid significantly more attention to life-style changes in their clinical practice. CONCLUSIONS: This analysis of the EFFECTUS study demonstrates a high prevalence of CV risk factors in Italy, particularly in Southern areas, and indicates some important discrepancies in the clinical management of global CV risk among physcians working in different Italian regions.

Impact of physicians' age on the clinical management of global cardiovascular risk: analysis of the results of the Evaluation of Final Feasible Effect of Control Training and Ultra Sensitisation Educational Programme.

AIM: To evaluate the potential impact of physicians' age on global cardiovascular (CV) risk management in the population of the Evaluation of Final Feasible Effect of Ultra Control Training and Sensitisation (EFFECTUS) study. METHODS: Involved physicians were stratified into three age groups (≤ 45, 46-55 and > 55 years), and asked to provide clinical data covering the first 10 adult outpatients, consecutively seen in May 2006. RESULTS: Overall 1078 physicians, among whom 219 (20%) were aged ≤ 45, 658 (61%) between 46 and 55, and 201 (19%) > 55 years, collected data of 9904 outpatients (46.5% female patients, aged 67 ± 9 years), who were distributed into three corresponding groups: 2010 (20%), 6111 (62%) and 1783 (18%), respectively. A higher prevalence of myocardial infarction and stroke was recorded by younger physicians rather than those aged > 46 years. Older physicians frequently recommended life-style changes, whereas a higher number of antihypertensive, antiplatelet, glucose and lipid-lowering prescriptions was prescribed by physicians aged ≤ 45 years. CONCLUSIONS: This analysis of the EFFECTUS study indicates a higher prevalence of vascular diseases among outpatients who were followed by younger physicians, who prescribed a higher number of CV drugs than older physicians. These older physicians have more attitude for prescribing favourable life-style changes than younger physicians.

Effects of a phytosterol-enriched dairy product on lipids, sterols and 8-isoprostane in hypercholesterolemic patients: a multicenter Italian study.

BACKGROUND AND AIMS: Plant sterols, added to several food sources, lower serum cholesterol concentrations. Plant sterol-induced cholesterol lowering is paralleled by a mild decrease in plasma levels of the antioxidant beta-carotene, the amount of this decrease being considered clinically non-significant. Whether the effect on lipid profile of daily consumption of plant sterol-enriched low-fat fermented milk (FM) is paralleled by a concomitant variation in a reliable marker of the oxidative burden like plasma isoprostane levels is unresolved. METHODS AND RESULTS: The effect of plant sterol consumption on plasma lipid and isoprostane levels of hypercholesterolemic patients was evaluated in a multicenter, randomized double blind study. Hypercholesterolemic patients consumed a FM daily for 6 weeks. Subjects were randomized to receive either 1.6g of plant sterol-enriched FM (n=60) or control FM product (n=56). After 6 weeks of plant sterol-enriched FM consumption, LDL cholesterol was reduced from 166.2+/-2.0 to 147.4+/-2.8 mg/dL (p=0.01). A significant reduction was observed for total cholesterol (from 263.5+/-2.6 to 231.0+/-3.2mg/dL, p=0.01). There was greater LDL cholesterol lowering among hypercholesterolemic patients with higher LDL cholesterol at baseline. We found a reduction of plasma 8-isoprostane in patients taking plant sterol-enriched FM (from 43.07+/-1.78 to 38.04+/-1.14 pg/ml, p=0.018) but not in patients taking the control product (from 42.56+/-2.12 to 43.19+/-2.0 pg/ml, p=NS). Campesterol and beta-sitosterol levels were not influenced by phytosterol consumption. CONCLUSIONS: Daily consumption of low-fat plant sterol dairy product favourably changes lipid profile by reducing LDL-cholesterol, and may also have an anti-oxidative effect through a reduction of plasma isoprostanes.

[Association between demographic characteristics and psychosocial factors of job stress in a sample of health care workers employed in two Italian hospitals]. / Correlazioni tra variabili demografiche e fattori psicosociali di stress occupazionale in un campione di operatori sanitari di due aziende ospedaliere.

BACKGROUND: Job stress has negative effects on both health care work ers' (HCW) health and on work organization. OBJECTIVES: To assess whether the presence of stressful conditions, individually considered, or combined in the iso-strain model, is significantly associated with specific socio-demographic characteristics, also with the aim of providing organizational tools for management to reduce stress in the working environment according to Italian law 81/2008. METHODS: The extended version of the Job Content Questionnaire was administered to 265 healthy HCW in seven paired wards of two hospitals. The five psychosocial scales Job Demand (JD), Job Control (JC), Social Support (SS), Skill Underutilization (SuS), and Job Insecurity (JI) were calculated. The factors JD, JC, and SS were combined together to separate a group of 33 HCW in iso-strain conditions from another group of 232 HCW not in iso-strain conditions. Several socio-demographic variables were collected. RESULTS: Statistically significant associations were found between socio-demographic characteristics and psychosocial factors, whereas the iso-strain conditions were not related to any socio-demographic parameter. CONCLUSIONS: Data suggest the need for alternative policies to reduce job stress: for example, actions addressed to operative units or HCW with specific socio-demographic characteristics could be effective in improving individual psychosocial factors; however, integrated actions aimed at reorganizing the working environment as a whole should be implemented to correct iso-strain conditions.

Kidney allocation to liver transplant candidates with renal failure of undetermined etiology: role of percutaneous renal biopsy.

The feasibility, value and risk of percutaneous renal biopsy (PRB) in liver transplant candidates with renal failure are unknown. PRB was performed on 44 liver transplant candidates with renal failure of undetermined etiology and glomerular filtration rate (GFR) <40 mL/min/1.73 m(2) (n = 37) or on renal replacement therapy (RRT) (n = 7). Patients with >or=30% interstitial fibrosis (IF), >or=40% global glomerulosclerosis (gGS) and/or diffuse glomerulonephritis were approved for simultaneous-liver-kidney (SLK) transplantation. Prebiopsy GFR, urinary sodium indices, dependency on RRT and kidney size were comparable between 27 liver-transplant-alone (LTA) and 17 SLK candidates and did not relate to the biopsy diagnosis. The interobserver agreement for the degree of IF or gGS was moderate-to-excellent. After a mean of 78 +/- 67 days, 16 and 8 patients received LTA and SLK transplants. All five LTA recipients on RRT recovered kidney function after transplantation and serum creatinine was comparable between LTA and SLK recipients at last follow-up. Biopsy complications developed in 13, of these, five required intervention. PRB is feasible in liver transplant candidates with renal failure and provides reproducible histological information that does not relate to the pretransplant clinical data. Randomized studies are needed to determine if PRB can direct kidney allocation in this challenging group of liver transplant candidates.

Stromelysin gene promoter polymorphism and common carotid geometry in diabetic subjects.

AIM: Stromelysin (MMP3), through its action on collagen and other matrix metalloproteinases, influences arterial wall remodeling. In healthy subjects, the 5A/6A polymorphism located in the promoter of the MMP3 gene is associated with common carotid remodeling, 6A/6A subjects having increased arterial diameter, wall thickness (intima-media thickness, IMT) and decreased wall shear stress (WSS). In the present study, we have investigated the influence of the 5A/6A polymorphism on common carotid remodeling in subjects with diabetes mellitus. METHODS: Diabetic subjects (N.=136) and age-matched healthy male controls (N.=101) have been studied. Common carotid diameter, IMT and flow velocity have been measured by echo-Doppler. Blood viscosity has been measured by a cone/plate viscometer. WSS has been calculated. RESULTS: Diabetic patients had increased common carotid diameter, IMT, and decreased flow velocity and WSS (all P<0.05), compared with controls. In controls, subjects homozygous for the 6A allele had increased diameter, IMT and decreased WSS. In diabetics, no difference was observed in vascular parameters among the three genotypes. CONCLUSION: The 5A/6A polymorphism of the MMP3 gene influences arterial remodeling of the common carotid artery in healthy subjects, but not in patients with diabetes mellitus. Therefore, the significance of the 5A/6A polymorphism as a marker of risk in this high cardiovascular risk population seems to be somehow blunted.

[Determining factors of job-satisfaction: presence of work-family conflict in a sample of Italian nurses]. / Le determinanti della soddisfazione lavorativa del personale infermieristico: il ruolo del conflitto lavoro-famiglia.

BACKGROUND: Organization research has shown increasing interest in the dynamics of work-family conflict (w.f.c.). The NEXT study highlights that w.f.c. significantly influences satisfaction for one's job and the decision to quit the nursing profession. OBJECTIVES: This study analyzes w.f.c. in a sample of Italian nurses, with the aim of examining the main differences in relation to personal variables, and understanding the degree to which w.f.c. explains job satisfaction. METHODS: A self-reporting questionnaire was administered to 325 nurses in different hospitals of Northern Italy. Descriptive, reliability and Anova data analysis was performed. The relationships between variables were analyzed through correlations (Pearson's r); the role of w.f.c. in explaining job satisfaction was estimated via multiple regression. RESULTS: W.f.c. appeared to be more critical in subjects who had care responsibilities and in those who had more demanding work assignments. W.f.c. contributed to explaining job satisfaction, even if it was not its principal determining factor. CONCLUSIONS: This area of research appears to be important in that it leads to a better comprehension of the dynamics involved in work satisfaction and can suggest possible initiatives for support and development.

Splanchnic metabolism of plasma apolipoprotein B: studies of artery-hepatic vein differences of mass and radiolabel in fasted human subjects.

The metabolism of apoprotein B-containing plasma lipoproteins by human splanchnic tissues has been studied in 29 men undergoing coronary angiography. Before catheterization autologous radio-iodinated lipoproteins were infused into a peripheral vein: 10 subjects received (125)I-labeled Sf 12-60 lipoproteins; 12 received (125)I-labeled Sf 12-60 plus (131)I-labeled Sf 100-400 lipoproteins; and 7 received (125)I-labeled Sf 12-60 plus (131)I-labeled Sf 0-12 lipoproteins. Paired arterial and hepatic vein blood samples were subsequently collected for replicate measurements of apoprotein B (apo B) mass, radioactivity and specific activity in each lipoprotein class. Splanchnic plasma flow was measured with indocyanine green. All studies were conducted after a 14-h overnight fast. Newly synthesized apo B was shown to be secreted by splanchnic tissues as a component of Sf 100-400 lipoproteins, with no detectable uptake of apo B from this class. Sf 12-60 apo B was extracted by the splanchnic bed, with no detectable secretion. After continuous intravenous infusion of (125)I-labeled Sf 12-60 for five or more hours, 41-67% (mean 55%) of extracted Sf 12-60 apo B radioactivity reappeared in hepatic vein Sf 0-12 apo B. There was no detectable splanchnic catabolism of Sf 0-12 apo B. The rates of Sf 100-400 apo B secretion, calculated as the product of artery-hepatic vein concentration difference and splanchnic plasma flow, were greater than the previously reported rates of very low density lipoprotein apo B turnover in fed subjects obtained by kinetic analysis of plasma specific radioactivity decay curves, suggesting that there may be a diurnal variation in hepatic apo B synthesis. They also exceeded the splanchnic extraction rates of Sf 12-60 apo B, suggesting there was some extrasplanchnic catabolism of the apo B of Sf > 60 lipoproteins.

[Job satisfaction among nursing personnel: application of the Italian version of the Stamps Index of Work Satisfaction (1997)]. / La soddisfazione lavorativa del personale infermieristico. Adattamento italiano della scala Index of Work Satisfaction di stamps.

BACKGROUND: A high level of job satisfaction among nurses is related to a feeling of wellbeing, productivity and patient satisfaction. Furthermore job satisfaction is considered capable of reducing turnover and absenteeism. OBJECTIVES: This contribution describes the first application of the Italian version of Stamps' Index of Work Satisfaction (1997), consisting of a 44 item questionnaire used to evaluate job satisfaction among professional nurses operating in healthcare organizations. METHODS: Working in four different hospitals of the Piemdont and Lombardy regions. RESULTS: Analysis of the principal components revealed the presence of seven factors (Autonomy, Professional status, Pay, Job requirements, Work Organization policies, Interaction with physicians, Interaction with nurses) with an elevated internal coherence that explains 52% of the total variance. The first five factors coincided with those defined by Stamps (1997), while the last two were the result of the separation of the original "Interactions" factor. Validity, measured by correlation with a single item of job satisfaction, was good. The reliability of the entire questionnaire and the single sub-scales, measured by Cronbach's alpha coefficient and item-total correlations, was satisfactory and the scores' distribution curves were symmetrical. The sample's job satisfaction levels appeared higher for Professional status, Interaction with nurses and Autonomy factors, but regarding Work Organization policies, Task requirements and Pay factors perceptions of dissatisfaction emerged. The variability of perceived job satisfaction appeared related to age, service seniority and hospital. CONCLUSIONS: Subject to further confirmation of validity and reliability, the questionnaire may be used as a tool to survey the job satisfaction levels perceived by professional nurses operating in healthcare organizations, with the additional purpose of identifying management strategies and target groups in which to carry out specific activities aimed at promoting job satisfaction.

Flow-mediated vasodilatation of the brachial artery and intima-media thickness of carotid artery in never-treated subjects.

AIM: Data on the association between brachial artery flow-mediated dilatation (FMD) and common carotid intima-media thickness (IMT) are contrasting. The present study investigated the relationship between FMD and IMT and carotid atherosclerosis in never treated subjects. METHODS: Seventy-seven subjects were investigated: 46 had no coronary heart disease (CHD) risk factors, 21 had only one, and 10 had more than one risk factor. IMT of the common carotid was measured by ultrasonography and FMD was evaluated according to standardized methods. RESULTS: IMT increased with increasing number of risk factors (0.66+/-0.12, 0.69+/-0.12 and 0.8+/-0.17 mm, respectively, ANOVA P<0.05). FMD decreased with increasing number of risk factors (10.44+/-5.2, 6.52+/-7.11 and 7.35+/-4.42%, respectively, P<0.05). Endothelium-independent vasodilatation was similar in the 3 groups. IMT and FMD did not correlate neither in subjects without risk factors (r=-0.151, P=0.3), nor in those with 1 (r=-0.196, P=0.4) or with 2 or more risk factors (r=-0.387, P=0.2), while in the group as a whole the correlation was borderline significant (r=-0.217, P=0.058). Eleven subjects had carotid atherosclerosis and higher values of IMT, but not reduced FMD. In multiple regression analysis, diabetes and IMT, but not FMD, were associated with carotid atherosclerosis. CONCLUSIONS: The present findings indicate that, in never treated subjects, FMD is not strictly associated with IMT or atherosclerosis of the carotid arteries.

Clinical expression of familial hypercholesterolemia in clusters of mutations of the LDL receptor gene that cause a receptor-defective or receptor-negative phenotype.

Seventy-one mutations of the low density lipoprotein (LDL) receptor gene were identified in 282 unrelated Italian familial hypercholesterolemia (FH) heterozygotes. By extending genotype analysis to families of the index cases, we identified 12 mutation clusters and localized them in specific areas of Italy. To evaluate the impact of these mutations on the clinical expression of FH, the clusters were separated into 2 groups: receptor-defective and receptor-negative, according to the LDL receptor defect caused by each mutation. These 2 groups were comparable in terms of the patients' age, sex distribution, body mass index, arterial hypertension, and smoking status. In receptor-negative subjects, LDL cholesterol was higher (+18%) and high density lipoprotein cholesterol lower (-5%) than the values found in receptor-defective subjects. The prevalence of tendon xanthomas and coronary artery disease (CAD) was 2-fold higher in receptor-negative subjects. In patients >30 years of age in both groups, the presence of CAD was related to age, arterial hypertension, previous smoking, and LDL cholesterol level. Independent contributors to CAD in the receptor-defective subjects were male sex, arterial hypertension, and LDL cholesterol level; in the receptor-negative subjects, the first 2 variables were strong predictors of CAD, whereas the LDL cholesterol level had a lower impact than in receptor-defective subjects. Overall, in receptor-negative subjects, the risk of CAD was 2.6-fold that of receptor-defective subjects. Wide interindividual variability in LDL cholesterol levels was found in each cluster. Apolipoprotein E genotype analysis showed a lowering effect of the epsilon2 allele and a raising effect of the epsilon4 allele on the LDL cholesterol level in both groups; however, the apolipoprotein E genotype accounted for only 4% of the variation in LDL cholesterol. Haplotype analysis showed that all families of the major clusters shared the same intragenic haplotype cosegregating with the mutation, thus suggesting the presence of common ancestors.

Modulation of transforming growth factor-beta production in normal human osteoblast-like cells by 17 beta-estradiol and parathyroid hormone.

Although our laboratory has reported that normal human osteoblast-like (hOB) cells contain estrogen receptors, we have failed to find major effects of 17 beta-estradiol (E2) on modulation of proliferation of bone matrix protein production by hOB cells. Because the major effect of E2 in vivo is to decrease bone resorption and because transforming growth factor-beta (TGF-beta) has been reported to decrease osteoclast-mediated bone resorption, we have tested the hypothesis that the effect of E2 on osteoclast activity is, at least in part, indirectly mediated by enhancing production of TGF-beta by osteoblasts. We therefore have extended our studies to examine possible TGF-beta gene expression including the modulation of the release of TGF-beta by E2 in near homogenous populations of hOB cells. TGF-beta protein production was measured using growth inhibition of CCL-64 cells and verified by blocking effects with anti-TGF-beta antibodies. TGF-beta 1 messenger RNA (mRNA) steady state levels were assessed by northern blot analysis and quantitated by densitometric measurement using 18S ribosomal RNA as a reference. There was an E2 dose-dependent increase in TGF-beta protein production within 24 h of challenge with E2. Northern blots from these cells demonstrated a dose-dependent increase in steady state mRNA levels of TGF-beta 1 within 6 h of treatment. PTH was also a potent stimulator of TGF-beta protein and message levels in a dose-dependent manner. Interestingly, coincubation of equimolar concentrations of E2 and PTH (10(-8) M) abrogated the stimulation of TGF-beta 1 mRNA and protein. Decreasing the relative concentration of PTH in this coincubation with E2 increased TGF-beta 1 mRNA and protein levels. These data support the fact that E2 modulates TGF-beta production in osteoblasts. In this manner TGF-beta may mediate E2 inhibition of osteoclast activity.

Evaluation of common carotid hemodynamic forces. Relations with wall thickening.

The localization of atherosclerotic lesions is influenced by hemodynamic factors, namely, shear stress and tensive forces. The present study investigated the relationships between shear stress and circumferential wall tension and between these hemodynamic factors and the intima-media thickness (IMT) of the common carotid artery in healthy men. Fifty-eight subjects were studied. Shear stress was calculated as blood viscosityxblood velocity/internal diameter. Circumferential wall tension was calculated as blood pressurexinternal radius. Blood velocity, internal diameter, and IMT were measured by high-resolution echo-Doppler. Mean shear stress was 12.6+/-3.3 dynes/cm(2) (mean+/-SD; range, 4.8 to 20.4) and was inversely related with age, blood pressure, and body mass index (BMI). Mean circumferential wall tension was 3.4+/-0.6x10(4) dynes/cm (range 2.4 to 5.6) and was directly associated with age and BMI. IMT was inversely associated with shear stress (r=0.55, P<0. 0001) and directly associated with circumferential wall tension (r=0. 43, P<0.0001). Shear stress and circumferential wall tension were inversely correlated (r=0.66, P<0.0001). In multiple regression analysis, shear stress and (marginally) cholesterol were independently associated with IMT, whereas circumferential wall tension, age, and BMI were not. These findings confirm that common carotid shear stress varies among healthy individuals and decreases as age, blood pressure, and BMI increase. Our findings also demonstrate that circumferential wall tension is directly associated with wall thickness, age, and BMI and that shear stress is associated with common carotid IMT independent of other hemodynamic, clinical, or biochemical factors.

The effects of probucol on plasma lipoproteins in polygenic and familial hypercholesterolaemia.

During treatment with probucol at the dose of 1 g per day, the mean reduction in low density lipoprotein (LDL) cholesterol concentration was 11.2% in polygenic hypercholesterolaemia (n = 9) and 9.4% in heterozygous familial hypercholesterolaemia (n = 6). However, there was marked heterogeneity of response: in seven of the patients with polygenic hypercholesterolaemia who had in common moderate elevation of LDL cholesterol (5.3-6.4 mmol/1), the reduction ranged from 13 to 40% (mean, 23%). In two of this group the change in LDL concentration was associated with a decrease in LDL apolipoprotein B synthetic rate. Of the patients with familial hypercholesterolaemia one showed a 33% reduction in LDL cholesterol, and one a 13% reduction. Total high density lipoprotein (HDL) cholesterol concentration tended to decrease during treatment. This reflected a reduction of the cholesterol concentration in the HDL3 subclass; HDL2 cholesterol remaining unchanged. Plasma triglyceride and very low density lipoprotein cholesterol were unaffected by probucol. The drug was well tolerated with only one patient complaining of severe diarrhoea, and two of mild and transient diarrhoea. No clinically significant changes occurred in serial resting electrocardiograms. Thus, probucol appears to be a useful drug for the treatment of most patients with polygenic hypercholesterolaemia, and of some patients with heterozygous familial hypercholesterolaemia.

Early extracoronary atherosclerosis and coronary heart disease risk factors in a sample of civil servants in southern Italy.

One hundred and thirty-eight male subjects working as civil servants in the Catanzaro city hall, aged over 45, underwent Echo-Doppler examination of carotid and femoral arteries. Forty-one subjects (30%) presented evidence of early atherosclerotic lesions in at least 1 of the 10 examined arteries. Age, systolic blood pressure, serum triglycerides and serum glucose were higher in this group when compared with subjects without evidence of extracoronary atherosclerosis (EA), while HDL cholesterol and apolipoprotein A-I were lower. After adjustment for age, only serum triglycerides and apolipoprotein A-I levels remained significantly different. Only 21 subjects had no major coronary heart disease (CHD) risk factors, 46 had one, 47 two and 24 more than two risk factors. The prevalence of lesions was significantly higher in individuals with total cholesterol/HDL cholesterol ratio greater than 5. The presence of smoking and hypertension was almost equally represented in individuals with or without lesions. Serum triglycerides, total cholesterol/HDL cholesterol > 5 and apolipoprotein A-I seem to play a fundamental role in the development of EA, as detected by Duplex examination of carotid and femoral arteries. Age is also closely related to the presence of lesions, probably reflecting the exposure duration to CHD risk factors.

Plasma lipids and geriatric assessment in a very aged population of south Italy.

A very old population of a rural area of Southern Italy with a mean age of 87 years was investigated in order to evaluate serum lipid levels and their possible association with health conditions, such as mental status, social behaviour and physical autonomy. Among 101 subjects with ages above 82 years, 73 were investigated (participation rate 72%, 31 men and 42 women). Mean +/- SD serum cholesterol level was 199 +/- 36 and 210 +/- 40 mg/dl and mean serum triglyceride level was 107 +/- 43 and 148 +/- 74 mg/dl (P less than 0.05) in men and women, respectively. Mean high density lipoprotein (HDL)-cholesterol level was 49 mg/dl in both sexes. All subjects were investigated by means of geriatric and neuropsychometric scales such as Sandoz Clinical Assessment Geriatric Scale (SCAGS), Hachinski Dementia Scale (HDS), Plutchik Geriatric Rating Scale (PGRS) and Indexes of Activity of Daily Living (ADL). When subjects were divided into 3 groups according to levels of serum lipids, HDL-cholesterol appeared to be better related to clinical conditions than total serum cholesterol: the group with the higher HDL-cholesterol level presented better scores at all the administered assessment scales when compared to the groups with lower and modal levels (P range between less than 0.05 and less than 0.001). Subjects in the higher serum cholesterol group presented better scores at PGRS only (P less than 0.01). No relation was observed between serum total triglyceride levels and geriatric assessment scores.

Extracoronary atherosclerosis in familial hypercholesterolemia.

Sixty-two patients (31 males, 31 females) with familial hypercholesterolemia (FH) underwent a vascular examination by Doppler ultrasound. The ankle/arm systolic pressure index was determined, and serum lipoproteins were analyzed. Eight of 124 legs examined (6.5%) showed an ankle/arm pressure index less than 0.95, suggesting flow reducing stenosis. Common carotid, internal carotid, and iliac arteries were evaluated by echo Doppler examination with spectral analysis. Forty-five of the 372 arteries examined (12.1%) had detectable abnormalities at echo Doppler examination. Iliac and internal carotid artery lesions were significantly (P less than 0.01) more frequent among FH patients than in a control group (30 men, 20 women) comparable for sex and age. The mean age of the patients with heterozygous FH and detectable arterial lesions was 45.3 years and that of those without lesions 30.7 years (P less than 0.05). When 14 patients with heterozygous FH and arterial lesions were compared to another 14 without lesions and matched for age and gender, it was found that patients with lesions had on average lower concentrations of HDL-cholesterol, and that 10 of 14 cases were actual smokers.