Here we report a case of a man affected by metastatic GIST since march 2007. His oncologic history began in 2006 when he was submitted to ileal resection and diagnosis of abdominal GIST was made. He was free of disease at radiologic controls until march 2007, when peritoneal nodules were shown. He started imatinib as first line therapy at standard dose of 400 mg/day and he reached a partial response at 6 months according to Response Evaluation Criteria In Solid Tumors (RECIST). After 24 months he performed CT scan that showed progression disease. For this reason he increased imatinib dose to 800 mg/day. Imatinib was safely administered and radiologic analysis performed at 3 and 6 months demonstrated stable disease according to RECIST. The patient is continuing oral therapy with imatinib at 800 mg/day and the disease is still stable.

A Moroccan 66-year-old female patient arrives in the hospital, where the physicians make the diagnosis of hepatic encephalopathy, HBV-related cirrhosis and decompensated diabetes. This article points out the problems and the aims that a good nursing management must face in the case of a multipathological patient who doesn’t speak italian. In this case the difficulty consists also in the understanding and the acceptance of a new life-style by the patient and her family, due to the chronicity of the diseases. The team work, helped by the assistance of the italian-speaking caregiver, taking into account the clinical condition and the culture and religion related needs, let the patient understand the therapeutic schedule to follow at home and obtained a good compliance by the patient and by her family.

We report the case of a 51-year-old woman with limited Small Cell Lung Cancer (SCLC). Cytological diagnosis has been made by fibroscopy. Chemotherapy schedule was cisplatin 30 mg/mq and VP-16 100 mg/mq days 1,2,3 q21 as first line treatment. The serum levels of cromogranine A and NSE (Neuron-Specific Enolase) were higher than normal; for this reason we prescribed, together with chemotherapy, octreotide LAR 30 mg every 28 days. Associated toxicity was easily manageable. Subsequent thoracic and panencefalic prophylactic radiotherapy improved tumour response and quality of life. We continued octreotide LAR 30 mg every 28 days even after the end of chemotherapy, as a maintenance therapy, checking periodically serum levels of NSE and cromogranine A. No side effects were observed.

Here we describe a case of a young patient with chronic myeloid leukemia at low risk, according to the Sokal index. After cytoreduction with hydroxyurea, the patient started imatinib at standard dose (400 mg/day) obtaining a minor cytogenetic response (Ph+ 42.5%) after six months of treatment.Considering the low imatinib concentration evaluated with the blood level testing, we increased the dose of imatinib at 600 mg/day. After about 3 months treatment the patient presented a partial cytogenetic response (Ph+ 30%). Therefore he was considered suboptimal responder according to European LeukemiaNet (ELN) recommendations 2006. For this reason he switched to second generation tyrosine kinase inhibitor nilotinib, at dose 800 mg/die. After switching to nilotinib the patient reached complete cytogenic response and major molecular response, maintained until last molecular evaluation.This kind of patient shows a different response for imatinib and nilotinib, whereas nilotinib therapy has shown to be safe and efficacy.

We describe the case of a 60-year-old woman who was admitted to our hospital in 1999. A blood test performed for pain in the upper left side of the abdomen had showed leukocytosis. At the admission the patient was apyretic, with no systemic signs. An important splenomegaly was found at physical examination. The results of the bone marrow aspiration (hypercellularity) and the cytogenetic analysis (chromosoma Ph in all metaphasis) allowed us to diagnose CML. The patient’s Sokal score was high (1.252). The patient was treated with hydroxyurea until 2002, when imatinib became available. Then she started imatinib at the dosage of 400 mg/die. Tests performed during the follow up showed a fast haematological response but no cytogenetic response in two years. The patient received imatinib until February 2004, when a psoriasiform-lichenoid dermatosis appeared. Therefore we decided to interrupt the therapy and the skin lesions disappeared. After starting again imatinib, also dermatosis reappeared, so we decided to interrupt imatinib definitively. On July 2007 the patient started dasatinib, a 2nd generation TKI. No adverse events occurred and cytogenetic analysis performed periodically was always positive (no response). She continued on dasatinib until May 2010, when she switched to nilotinib. In seven months a complete cytogenetic response (CCyR) was documented with level reduction of Bcr Abl transcript from 13.0 to 2.0. Currently the patient is still receiving nilotinib, with persistent CCyR.

Toxic megacolon is a severe complication of Clostridium difficile infection (CDI) with a high percentage of mortality. The mainstay of treatment is currently represented by medical management, while surgical intervention is indicated in patients not improving after 2-3 days of antibiotic therapy. Generally metronidazole and vancomycin are administered as first-line treatment, but recently several cases of refractory C. difficile have made the treatment of this infection more difficult. Fidaxomicin is a narrow-spectrum oral macrocyclic antibiotic with excellent in vitro activity against C. difficile strains. We report the case of a woman admitted with a diagnosis of toxic megacolon complicating a C. difficile colitis not responding to standard antibiotic therapy.

come il cibo e i rapporti sessuali, rende l'uomo schiavo di abitudini e voglie.

The recent improvements in multiple sclerosis therapy have lead to consequent improvements in its prognosis: however, it still remains a chronic and unpredictable disease. The moment of the diagnosis is the starting point of a durable relationship between the physician and the patient, but, most of all, it is often referred to as the most traumatic experience in patients’ life. Patients’ compliance to prescribed therapies, so important in the course of every chronic condition, particularly hangs on the psychological approach used by the doctor in communicating and explaining the diagnosis for the first time, in addition to the patient’s personality. A brief overview on the main types of physicians’ and patients’ behaviours and communications styles is provided in this article.

Tourette syndrome is a neurodevelopmental disorder characterised by the chronic presence of multiple motor tics (e.g. eye blinking, shoulder shrugging, etc.) and at least one vocal/phonic tic (e.g. grunting or sniffing). The clinical picture of patients with Tourette syndrome is often complicated by tic-related behavioural problems and associated psychopathology. The pathophysiology of Tourette syndrome is poorly understood, however converging evidence from neuroimaging studies suggests abnormalities within the fronto-striatal pathways. The pharmacological management of the tic symptoms focuses on the dopaminergic and noradrenergic pathways and aims to improve the health-related quality of life of patients.