Natalizumab treatment in multiple sclerosis patients: a multicenter experience in clinical practice in Italy.

We evaluated efficacy of natalizumab in relapsing-remitting multiple sclerosis patients in a clinical practice setting. We report data on the first consecutive 343 patients receiving natalizumab in 12 multiple sclerosis (MS) Italian centers enrolled between April 2007 and November 2010. The main efficacy endpoints were the proportion of patients free from relapses, disease progression, combined clinical activity, defined as presence of relapse or disease progression, from MRI activity, and from any disease activity defined as the absence of any single or combined activity. At the end of follow-up, the cumulative proportion of patients free from relapses was 68%; the proportion of patients free from Expanded Disability Status Scale (EDSS) progression was 93%; the proportion of patients free from combined clinical activity was 65%; the proportion of patients free from MRI activity was 77%; and the proportion of patients free from any disease activity was 53%. Natalizumab was effective in reducing clinical and neuroradiological disease activity. Its effectiveness in clinical practice is higher than that reported in pivotal trials and was maintained over time.

Postoperative enteral immunonutrition in head and neck cancer patients.

AIMS: to determine if postoperative feeding of head and neck cancer patients, using an enteral diet supplemented with arginine, improves immunological and nutritional status, and clinical outcome, i.e., reduces postoperative infectious/wound complications and length of stay, when compared with an isocaloric, isonitrogenous control diet. METHODS: at operation 44 patients were randomized into two groups to receive: a) an enriched diet (n=23);b) an isocaloric, isonitrogenous control diet (n=21). Thirteen patients with a history of significant weight loss (> or = 10% over the last 6 months) were considered malnourished. Preoperatively and on postoperative days 1, 4 and 8 the following parameters were evaluated: albumin, prealbumin, transferrin, total number of lymphocytes, lymphocyte subsets (CD3, CD4, CD8 and CD4/CD8 ratio) and immunoglobulins. Postoperative complications and length of stay were recorded. RESULTS: 'visceral' serum proteins and immunological parameters decreased on postoperative day 1 in both groups. However, only the enriched group demonstrated a significant increase (P<0.05) in the total number of lymphocytes, CD4, CD4/CD8 on postoperative day 4, and total number of lymphocytes, CD3, CD4, CD4/CD8 on postoperative day 8. In the malnourished subgroup the administration of the enriched formula significantly reduced both postoperative infectious/wound complications and length of stay compared with the control group (P<0.05). CONCLUSIONS: enteral immunonutrition of head and neck cancer patients improves postoperative immunological response. Significant clinical advantages were observed in malnourished patients.

Nutrition in the head-injured patient.

Head injury initiates a systemic response characterized by hypermetabolism, hypercatabolism, the acute-phase response, decreased immunologic function, hyperglycemia, increased counterregulatory hormone levels, increased ventricular fluid and serum cytokine levels and altered gastrointestinal function. Early and adequate nutrition, whether enteral or parenteral, is believed to be an essential component of patient care and has been shown to improve outcome. Recent studies indicate that enteral nutrition is more effective than parenteral nutrition in maintaining the integrity of gastrointestinal mucosa, reducing the incidence of septic morbidity and decreasing the risk of bacterial translocation. Thus, enteral administration of nutrients is the preferred route of nutrition. Because of the high incidence of gastroparesis, enteral nutrition support may be difficult. However, many benefits of early enteral nutrition can be achieved even if the patient receives only 1/3 of needs. Supplemental parenteral nutrition may be used until enteral nutrition becomes adequate. Modulation of injury response by provision of specific nutrients such as arginine appears to improve the immune response in critically ill patients, but has not been specifically evaluated in patients following head injury. Future researches should be aimed at defining optimal nutritional support utilizing specific nutrients and nutritional regimens to improve the outcome of patients with head injury.

Endodermal sinus tumor of the ovary in pregnancy.

The ultrasonographic evidence of an irregular mixed mass, cystic and solid, in retrouterine area and the high levels of alpha(1)-FP values in a young pregnant woman, indicated the possibility of an ovarian germ cell neoplasia. Respecting the patient's will, pregnancy was protracted until the 36th week. A cesarian section allowed the releasing of a vital fetus and the removal of a neoplastic mass which proved to be an endodermal sinus tumor (EST) at stage Ia. Then the patient, the 12th case of EST in pregnancy reported in the literature, underwent 5 PVB chemotherapy cycles and, 3 years after the intervention, appears disease-free.

Inadequacy of combined 5-Fluorouracil, very-high-dose leucovorin, mitomycin-C and Cisplatin as 2nd-line therapy for advanced colon-cancer.

Fourteen patients with metastatic colon cancer which had progressed under fluoro-folates chemotherapy were treated with MM-C (10 mg/m(2) on day 1), 5-FU (370 mg/m(2) for 5 consecutive days), l-LV (500 mg/m(2) for 5 consecutive days) and CDDP (70 mg/m(2) on day 4), every 29th day till further disease progression. Neither CR nor PR were observed; 3 patients only had stable disease, while the extant 11 patients progressed. Resulting toxicity was severe. Since no antitumor effects were evidenced in the first 14 patients, the study was discontinued according to commonly accepted criteria.