Optimized synthesis of phosphatidylserine.

The synthesis of phosphatidyl serine containing saturated fatty acids was thoroughly studied and optimized in order to establish a protocol amenable to large-scale synthesis. The key step was a one-pot multicomponent reaction involving an O-benzyl phosphorodiamidite, protected serine and diacylglycerol, followed by in situ oxidation of the resulting phosphite. In order to replace expensive and poorly stable tetrazole, a screening of substitutes was carried out and imidazolium chloride was selected as the best suited one.

[Carbamazepine-induced agranulocytosis. Apropos of 2 cases]. / Agranulocitosi indotta da carbamazepina. A proposito di due casi.

Carbamazepine-induced agranulocytosis (CIA) is a rare event. We report on two cases, highlighting the wide variability of the bone marrow, which may show pseudohypercellularity with disappearance of neutrophils and excess of immature cells (myeloblasts and promyelocytes), thus mimicking the features of acute myeloid leukemia. Although its pathogenesis is still unclear, CIA must be considered as an idiosyncratic hemopathy and moreover it appears to be an unpredictable complication among patients taking the drug. It should be clearly distinguished from the benign neutropenia frequently associated with carbamazepine therapy and often self-limiting. Anyhow a careful clinical and hematological monitoring is the only mean to recognize promptly this life-threatening disease and to treat it with the withdrawal of the drug and the administration of an adequate anti-infectious therapy.

[2 cases of acute cholestasis caused by ticlopidine]. / Due casi di colestasi acuta da ticlopidina.

We report the case of two patients suffered from cholestatic jaundice occurred 3-4 weeks after starting ticlopidine therapy. In both cases the diagnosis was made by ruling out any other known cause of acute hepatitis or cholestasis. One patient underwent liver biopsy, which showed a typical intralobular cholestatic pattern and a slight lymphocytic infiltration of the portal tracts. The other patient, a 29 year-old woman, was taking ticlopidine as the sole drug, further to an ischemic stroke occurred while she was taking oral contraceptives; she presented a diffuse itchy dermatitis, fever and slight eosinophilia besides cholestasis. In both patients ticlopidine was discontinued and liver tests returned to normal values within 4-8 weeks; no rechallenge was attempted and ticlopidine was replaced with another antiplatelet drug. To the best of our knowledge 19 cases of ticlopidine-related cholestatic disease have been described so far in the literature. Its pathogenesis is still unknown, although some clinical findings and experimental results from patients with acute enteropathy or agranulocytosis induced by ticlopidine suggest that the drug may act through a toxic mechanism, perhaps mediated by prostaglandins.

Effects of nicergoline on age-related decrements in radial maze performance and acetylcholine levels.

The effects of chronic oral administration of nicergoline (5.0 mg/kg; bid) on locomotor activity, eight-arm radial maze performance plus striatal, cortical, and hippocampal acetylcholine (ACh) levels were examined in young and aged Wistar rats. Chronic nicergoline administration did not modify either the locomotor activity or radial maze learning in young rats. Young rats learned the radial maze procedure rapidly and improved their performance throughout the successive training sessions. Radial maze performance in young rats was characterised by very few arm reentries. Aged rats were hypoactive and did not explore or enter the radial maze arms, and consequently performed poorly in the radial maze throughout the training sessions. Nicergoline treatment did not significantly modify locomotor activity in aged rats. Aged rats treated with nicergoline also performed poorly initially but improved with repeated training in the radial maze. This improvement was associated with an increasing number of arms being entered and very few arm reentries. Reduced acetylcholine (ACh) levels were also associated with age. Aged rats had significantly reduced levels of ACh in the straitum and cortex, but not the hippocampus as compared to young rats. Nicergoline treatment did not change ACh levels in young rats, but substantially restored the reduced ACh levels in aged rats. These results indicate that nicergoline is an effective cognitive enhancer in a learning model of age-related deficits and that these results may be related to changes in the cholinergic system.

[Sarcomatous degeneration in Paget disease of bone. Apropos of a clinical case]. / Degenerazione sarcomatosa nella malattia ossea di Paget. A proposito di un caso clinico.

Sarcomatous degeneration is the most dreaded complication of Paget's disease of bone: this case report offers an opportunity for underlining the difficulties of differential diagnosis in a case of pulmonary metastatization in the presence of osteitis deformans. Immunohistochemical assay applied to the cytology of pulmonary needle-aspiration and surgical biopsy targeted to the suspected neoplastic lesion allowed correct diagnosis. This case confirms the very poor prognosis of this kind of neoplasm: the rapidity of the fatal outcome was not significantly influenced even by the most aggressive polychemotherapy. This poor prognosis appears to be related to a more aggressive growth of the neoplasm and to the reduced immunologic resistance of the elderly.

[The Mallampati's scale: a study of reliability in clinical practice]. / Scala di mallampati: studio di validità nella pratica clinica.

The need to predict the rank of difficulty of tracheal intubation is of paramount importance in anaesthesia as has been well documented in numerous studies. We assessed the use of the Mallampati scale as possible predictive indicator of difficult tracheal intubation in a study conducted on 700 patients. The rank of difficulty determined during the pre-anaesthesiological examination by the Mallampati scale, was compared to the Cormack scale as assessed by the laryngeal direct examination at the beginning of anaesthesia. The correlation between the two first ranks of both scales was highly significant. The evaluation by the scale of Mallampati showed a good sensibility and a low specificity with incorrect overestimation only for the difficult intubation. In our study orotracheal intubation was rated difficult in 10.4% of the patients by the Mallampati scale and in 11% of the patients score by the Cormack scale. The chin to jugulum distance, also studied as a possible predictive parameter, did not correlate with the Cormack scale.

[Osteomas of the jaws. A clinical and rehabilitative problem]. / Osteomi dei mascellari. Un problema clinico e riabilitativo.

The authors study, based on three cases of maxillary osteoma brought to their attention, evaluates the most suitable type of operation to perform, and the method with which to attention which to approach the problem of postoperative functional rehabilitation. This pathological condition is characterized by slow developments and the late appearance of symptoms deriving from the invasion of surrounding tissues. The chosen technique is surgery, involving the removal of the neoplasm. The benign nature of the neoplasm makes conservative surgery possible, including the partial removal of the neoplasm, in order to preserve the bone tissue indispensable for prosthetic rehabilitation. In cases in which the neoplasm spreads to surrounding tissues, in which more destructive surgery is required with an attendant loss of considerable portions of bone, we have used osteo-muscular pedicle flaps in combination with implantation techniques to obtain adequate functional and prosthetic rehabilitation.

Cold agglutinin hemolytic anemia in a patient with adult-onset Still's disease.

We report on a patient with adult Still's disease who developed, at the onset of her illness, an autoimmune hemolytic anemia (AHA) due to cold agglutinin (CA). Hemolysis spontaneously subsided and CA disappeared before starting therapy with aspirin and prednisone. The occurrence of AHA in patients affected with collagen diseases is currently explained by a loss of tolerance, leading to the emergence of multiple autoreactive clones. In our case the self-limiting course of AHA leads us to propose another interpretation, i.e. that the cold reactive autoantibody might have been related to a transient infection able to play a pathogenetic role in the systemic disease, as suggested by several authors.

[Acute hybrid leukemia. Review of the literature and presentation of a case]. / La leucemia acuta ibrida. Rassegna della letteratura e illustrazione di un caso.

In the last years, the development of immunophenotypic and molecular analyses allowed to recognize several cases of hybrid acute leukemia (AL), whose blast cell display both lymphoid and myeloid features. Hybrid, or mixed-lineage, AL seems to have distinct clinical manifestations and hematological findings, and is mainly characterized by resistance to chemotherapy and poor prognosis. We report on a patient with AL, which showed a very rapid switch from the lymphoblastic phenotype exhibited at presentation to a myelomonoblastic one, appeared at first relapse, and lastly progressed to an undifferentiated leukemia in the terminal phase. Together with this morphologic and cytochemical evolution, leukemic cells expressed, besides the primary early-B antigens, new immunological markers related to T-lymphocytic and myeloid lineages. Based on this observation and current understanding of the ontogenesis of hematologic malignancies, we discuss biological mechanisms which are likely to underlie hybrid leukemia.

[Polycythemia vera and hemoregulator hormones. Considerations on an unusual clinical case]. / Policitemia vera e ormoni emoregolatori. Considerazioni su di un caso clinico insolito.

The case is reported of a patient with polycythemia vera, who developed an anterior panhypopituitarism, due to an adenoma, some years later. The endocrine deficiency caused the return of the hemoglobin count and global red cell volume to the normal range. The finding suggests that in polycythemia vera the neoplastic growth is still partially responsive to normal hemoregulator factors.

[Juvenile myocardial infarct. A description of 2 cases occurring before 20 years of age and a review of the literature]. / L'infarto miocardico giovanile. Descrizione di due casi manifestatisi prima dei 20 anni e revisione della letteratura.

Authors report two cases of myocardial infarction occurred before the age of twenty: the former in a man without risk factors, who had 12 years later a cerebral embolic stroke, caused by a left-ventricular thrombus; the latter in a young woman who was taking oral contraceptives. The review of the literature shows that the prevalence of myocardial infarction in juvenile age is not negligible. Especially in those cases occurred before the age of 35, risk factors, clinical features, coronary angiographic findings and possible pathogenetic mechanisms are quite different from those generally observed in elderly patients. Cigarette smoking and estro-progestinic drugs represent the main risk factors; myocardial infarction is often the first event of ischaemic heart disease and usually effort angina is lacking; several patients have patent coronary arteries or minor (single vessel) lesions and collaterals are generally absent; coronary spasm and/or intravascular thrombosis probably play a predominant pathogenetic role.

Exploratory behavior and the dual activity of some psychoactive drugs. Part 5. Alcohol.

Alcohol is reported to impair acquisition and learning processes and it is considered a depressant of the brain activities impairing rapidity and consistency of some behaviors. The experiments reported here are concerned with the exploratory performances of the already described subpopulations of Albino mice under the effect of alcohols of different types.

Exploratory behavior and the dual activity of some psychoactive drugs. Part IV. Neuroleptics.

Exploration is an essential, life-preserving component of animal higher nervous functions. The experiments presented here show that exploratory behavior may differ in relation to the subject's emotional baseline, and that accordingly, it is affected differently by various neuroleptics.

Difference in learning and retention by Albino-Swiss mice. Part 5. Effect of some antidepressants.

According to the methods described earlier (1), the effect of some antidepressants on memory retention in "good" and "poor" learning mice was studied. The present study indicates that several antidepressants have different activity on memory retrieval of the two subtypes of animals, which is directly responsible for the results here reported. In general terms, the data obtained show that, in addition to the classical antidepressant activity, some derivatives may exert a behavioral disinhibition.

Exploratory behavior and the dual activity of some psychoactive drugs. Part III. Antidepressants.

Exploration is an essential, life-preserving component of animal higher nervous functions. The experiments presented here show that exploratory behavior may differ in relation to the subject's emotional baseline, and that accordingly it is affected differently by various antidepressants.

Exploratory behavior and the dual activity of some psychoactive drugs: Part II.

Exploration is an essential, life-preserving component of animal higher nervous functions. The experiments presented here show that exploratory behavior may differ according to the experimental subject's emotional baseline, and that exploratory performance is accordingly affected differently by some nutrients and central stimulants.