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Hartnett KP, Powell KM, Rankin D, Gable P, Kim JJ, Spoto S, Breaker E, Hunter R, Dotson N, McAllister G, Stevens V, Halpin AL, Houston H, Epson E, Malarkey M, Mendoza M, McNeill L, Perkins KM. Investigation of Bacterial Infections Among Patients Treated With Umbilical Cord Blood-Derived Products Marketed as Stem Cell Therapies. JAMA Netw Open 2021; 4:e2128615. [PMID: 34618037 PMCID: PMC8498849 DOI: 10.1001/jamanetworkopen.2021.28615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE The number of clinics marketing stem cell products for joint diseases, chronic pain, and most recently, COVID-19, has increased despite warnings from the US Food and Drug Administration that stem cell products for these and other indications have not been proven safe or effective. OBJECTIVE To examine bacterial infections in 20 patients who received umbilical cord blood-derived products marketed as stem cell treatment. DESIGN, SETTING, AND PARTICIPANTS This case series is a national public health investigation including case-finding, medical record review and abstraction, and laboratory investigation, including sterility testing of products and whole-genome sequencing of patient and product isolates. Participants included patients who developed bacterial infections following administration of umbilical cord blood-derived products marketed as stem cell treatment during August 2017 to September 2018. Data analysis was performed from March 2019 to September 2021. EXPOSURES Umbilical cord blood-derived products marketed as stem cell treatment. MAIN OUTCOMES AND MEASURES Data were collected on patient infections and exposures. The Centers for Disease Control and Prevention performed sterility testing on undistributed and distributed vials of product marketed as stem cell treatment and performed whole-genome sequencing to compare patient and product bacterial isolates. RESULTS Culture-confirmed bacterial infections were identified in 20 patients (median [range] age, 63 [2-89] years; 13 male patients [65%]) from 8 US states who sought stem cell treatment for conditions including pain, osteoarthritis, rheumatoid arthritis, and injury; all but 1 required hospitalization. The most frequently isolated bacteria from patients with infections were common enteric species, including Escherichia coli (14 patients) and Enterobacter cloacae (7 patients). Of unopened, undistributed products sampled for testing, 65% (22 of 34 vials) were contaminated with at least 1 of 16 bacterial species, mostly enteric. A patient isolate from Arizona matched isolates obtained from products administered to patients in Florida, and patient isolates from Texas matched undistributed product sent from the company in California. CONCLUSIONS AND RELEVANCE Unapproved stem cell products can expose patients to serious risks without proven benefit. Sequencing results suggest a common source of extensive contamination, likely occurring during the processing of cord blood into product. Patients and health care practitioners who are considering the use of unapproved products marketed as stem cell treatment should be aware of their unproven benefits and potential risks, including serious infections.
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Affiliation(s)
- Kathleen P. Hartnett
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krista M. Powell
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Erin Breaker
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Gillian McAllister
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valerie Stevens
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hollis Houston
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin Epson
- California Department of Public Health, Sacramento
| | - Mary Malarkey
- US Food and Drug Administration, Silver Spring, Maryland
| | | | - Lorrie McNeill
- US Food and Drug Administration, Silver Spring, Maryland
| | - Kiran M. Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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2
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Spoto G, D'Alessandro L, Rubini C, Fioroni M, Rutjes AWS, Spoto S, Ferrante M, Della Malva M, Petrini M. Cyclic adenosine monophoshate phosphodiesterase: a possible marker of thyroid pathology? J BIOL REG HOMEOS AG 2019; 33:281-285. [PMID: 30697984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- G Spoto
- Laboratory of Medical Chemistry and Dental Materials, Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio, Chieti, Italy
| | - L D'Alessandro
- Laboratory of Medical Chemistry and Dental Materials, Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio, Chieti, Italy
| | - C Rubini
- Anatomy and Histopathology, Dental School, Polytechnic University of Marche, Italy
| | - M Fioroni
- Anatomy and Histopathology, Dental School, Polytechnic University of Marche, Italy
| | - A W S Rutjes
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - S Spoto
- Internal Medicine Department, University Hospital Campus Bio-Medico, Rome, Italy
| | - M Ferrante
- Laboratory of Medical Chemistry and Dental Materials, Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio, Chieti, Italy
| | - M Della Malva
- Laboratory of Medical Chemistry and Dental Materials, Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio, Chieti, Italy
| | - M Petrini
- Laboratory of Medical Chemistry and Dental Materials, Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio, Chieti, Italy
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3
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Perkins KM, Spoto S, Rankin DA, Dotson NQ, Malarkey M, Mendoza M, McNeill L, Gable P, Powell KM. Notes from the Field: Infections After Receipt of Bacterially Contaminated Umbilical Cord Blood-Derived Stem Cell Products for Other Than Hematopoietic or Immunologic Reconstitution - United States, 2018. MMWR Morb Mortal Wkly Rep 2018; 67:1397-1399. [PMID: 30571672 DOI: 10.15585/mmwr.mm6750a5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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4
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Ciccozzi M, Riva E, Vita S, Cella E, Fogolari M, Spoto S, Lopalco M, Ceccarelli G, Angeletti S. An acute febrile outbreak in a refugee community of an Italian asylum seeker center: lessons learned. Public Health 2018; 163:16-19. [PMID: 30031836 PMCID: PMC7111893 DOI: 10.1016/j.puhe.2018.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The management of infectious outbreaks in closed settings represents an important public health issue. An outbreak of acute febrile syndrome affecting 22 refugees resident at the Asylum Seekers Centre of Castelnuovo di Porto in Rome has been reported, and the preventive and control measures adopted have been described as an example of public health safety. METHODS Pharyngeal swab and whole-blood samples were collected from 22 cases observed and analyzed for standard bacterial cultures and respiratory and herpesviruses by qualitative CLART PneumoVir2 and Entherpex microarray. RESULTS A possible respiratory-transmitted etiology and a concomitant reactivation of multiple herpesviruses have been evidenced. The epidemiological investigation showed that the spread of the epidemic was promoted because patients were hosted in neighboring rooms or in the same room, facilitating the rapid spread of infectious disease. CONCLUSIONS The potential way of transmission was supposed, and preventive measures for infection control were adopted. The measures adopted are an example of best practice for outbreak management, and the microbiological surveillance is recommended for public health improvement.
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Affiliation(s)
- M Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | - E Riva
- Unit of Virology, University Campus Bio-Medico of Rome, Italy
| | - S Vita
- Migrant and Global Health Research Organisation, Centro di Ricerca Sulla Salute Globale e Delle Popolazioni Mobili (Mi-Hero), Italy
| | - E Cella
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | - M Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy
| | - S Spoto
- Internal Medicine Department, University Campus Bio-Medico of Rome, Italy
| | - M Lopalco
- Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Rome, Italy; Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - G Ceccarelli
- Migrant and Global Health Research Organisation, Centro di Ricerca Sulla Salute Globale e Delle Popolazioni Mobili (Mi-Hero), Italy; Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Rome, Italy; Auxilium Società Cooperativa Sociale, Senise (PZ), Italy; Department of Public Health and Infectious Diseases, University of Rome Sapienza, Italy
| | - S Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy.
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5
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Tewell M, Spoto S, Wiese M, Aleguas A, Peredy T. Mercury Poisoning at a Home Day Care Center - Hillsborough County, Florida, 2015. MMWR Morb Mortal Wkly Rep 2017; 66:433-435. [PMID: 28472024 PMCID: PMC5687081 DOI: 10.15585/mmwr.mm6617a1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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6
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Dalmasso F, Bourhaleb F, Russo G, Franza N, Spoto S, Attili A. Web-interfaced Monte Carlo simulation for quality assurance in radiation therapy. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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7
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Spoto S, Bourhaleb F, Petrone G. Augmented reality supporting innovation and accuracy in advanced radiation therapy facilities. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)30200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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8
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Fazio G, Grassedonio E, Cracolici E, Mongiovi M, Novo G, Sutera L, D'Angelo L, Visconti C, Spoto S, Pipitone S, Ferrara F, Midiri M, Novo S. Ventricular arrhythmias in children: the uselessness of MRI. Minerva Cardioangiol 2008; 56:575-576. [PMID: 18813191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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9
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Catanuto G, Spano A, Pennati A, Farinella G, Spoto S, Impoco G, Gallo G, Nava M. 232 ORAL Curvature mapping and outcome evaluation in breast plastic and reconstructive surgery. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Spoto S, Sgambato E, Costantino S. [Epilepsy]. Clin Ter 2004; 155:477-9. [PMID: 15702662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- S Spoto
- Area di Medicina Interna, Facoltà di Medicina e Chirurgia, Università Campus Biomedico, Roma, Italia.
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11
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Palma Modoni A, De Galasso L, Scriccia S, Milanetti F, Sgambato E, Spoto S, Costantino S. [A 52 year-old woman with fever, cough and dyspnoea]. Clin Ter 2004; 155:401-4. [PMID: 15700634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A 52 year-old woman with gastric cancer treated with surgery and chemotherapy, is admitted in our Internal Medicine Department because of the presence of fever (max 41.2 degrees C), dyspnoea, non-productive cough and mental confusion. The anamnesis and the physical examination address to the diagnosis of CAP (Community-Acquired Pneumonia); in particular the alteration of consciousness and the onset of symptoms after the insertion of a nose-gastric tube let us to consider the diagnosis of aspiration pneumonia. The clinical presentation and radiological imaging (Rx and CT of thorax) suggest the pattern of bronchiolitis obliterans with organizing pneumonia (BOOP). BOOP is not a disease, but a non specific pattern of answer to a lung injury. It can be either idiopathic or associated with a variety of causes, such as infections, drugs, radiations and connective tissue diseases. Besides the clinical course is complicated by the onset of an ARDS (Adult Respiratory Distress Syndrome). The gold standard for the diagnosis is represented by lung biopsy with hystopathologic confirmation but, if it cannot be done, it's necessary to start immediately steroid therapy because BOOP may be fatal. The patient received antibiotic and steroid therapy with success.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Anti-Bacterial Agents
- Carcinoma, Signet Ring Cell/complications
- Carcinoma, Signet Ring Cell/secondary
- Carcinoma, Signet Ring Cell/surgery
- Confusion/etiology
- Cough/etiology
- Cryptogenic Organizing Pneumonia/diagnosis
- Cryptogenic Organizing Pneumonia/diagnostic imaging
- Cryptogenic Organizing Pneumonia/etiology
- Diagnosis, Differential
- Drug Therapy, Combination/therapeutic use
- Dyspnea/etiology
- Female
- Fever/etiology
- Humans
- Intestinal Obstruction/etiology
- Intestinal Obstruction/therapy
- Intubation, Gastrointestinal/adverse effects
- Klebsiella Infections/complications
- Klebsiella Infections/drug therapy
- Klebsiella oxytoca
- Krukenberg Tumor/complications
- Krukenberg Tumor/secondary
- Krukenberg Tumor/surgery
- Middle Aged
- Ovarian Neoplasms/complications
- Ovarian Neoplasms/secondary
- Ovarian Neoplasms/surgery
- Peritoneal Neoplasms/complications
- Peritoneal Neoplasms/secondary
- Peritoneal Neoplasms/surgery
- Pneumonia, Aspiration/complications
- Pneumonia, Bacterial/complications
- Pneumonia, Bacterial/drug therapy
- Postoperative Complications/etiology
- Respiratory Distress Syndrome/diagnosis
- Respiratory Distress Syndrome/diagnostic imaging
- Respiratory Distress Syndrome/etiology
- Stomach Neoplasms/complications
- Stomach Neoplasms/surgery
- Tomography, X-Ray Computed
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12
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Costantino S, Sgambato E, Spoto S. [Aphasia]. Clin Ter 2004; 155:419-20. [PMID: 15700637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- S Costantino
- Area Medicina Interna, Campus Bio Medico, Roma, Italia
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13
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Spoto S. [Community-acquired pneumonia]. Clin Ter 2004; 155:279-80. [PMID: 15553253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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14
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De Galasso L, Modoni AP, Scriccia S, Milanetti E, Sgambato E, Campanale R, Spoto S. [54 old woman with recurrent urinary tract infection]. Clin Ter 2004; 155:317-9. [PMID: 15553259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- L De Galasso
- Area di Medicina Interna, Campus BioMedico, Roma, Italia
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15
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Spoto S. [Ascites]. Clin Ter 2004; 155:221-2. [PMID: 15344572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- S Spoto
- Area di Medicina, Campus Bio-Medico di Roma, Italia
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16
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Spoto S, Costantino S. [Does acyclovir prevent Bell's palsy in post surgical therapy for otosclerosis?]. Clin Ter 2004; 155:111-2. [PMID: 15354757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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17
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Spoto S, Costantino S. [Solitary thyroid nodule]. Clin Ter 2004; 155:101-3. [PMID: 15244115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- S Spoto
- Area di Medicina, Università Campus Bio-Medico, Roma, Italia
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18
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Picardi A, Navajas F, Zardi EM, Scarlata S, Spoto S, Vespasiani Gentilucci U, De Galasso L, Sgambato E, Costantino S. [Multiple cerebral tuberculomas resistant to conventional therapy in an immunocompromised subject]. Clin Ter 2003; 154:415-9. [PMID: 14994522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 33 years old immunocompromised woman was admitted for a fever of unknown origin during the last five months. She referred a body temperature up to 38.3 degrees C, headache, weakness. The physical examination revealed right homonymous hemianopia, hyperreflexia and Babinski on her right side. A TC scan and a following bioptic specimen showed multiple cerebral tuberculomas. A conventional therapy was started but no significative improvement was observed. She was finally treated with interferon gamma and GM-CSF in addition to the therapy with an important regression of the lesions and significative improvement of the fever and neurological findings.
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19
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Spoto S. [Chronic constipation]. Clin Ter 2003; 154:437-44. [PMID: 14994525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- S Spoto
- Area di Medicina, Università Campus Bio-Medico, Roma, Italia
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20
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Spoto S. [Chronic diarrhoea]. Clin Ter 2003; 154:369-73. [PMID: 14994928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- S Spoto
- Area di Medicina, Università Campus Bio-Medico, Roma, Italia
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21
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Spoto S, Sgambato E. [Hypertension in pregnancy]. Clin Ter 2003; 154:259-61. [PMID: 14618944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- S Spoto
- Università Campus Bio-Medico, Roma, Italia
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22
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Spoto S, De Galasso L, Costantino S. [Colorectal polyps]. Clin Ter 2003; 154:217-9. [PMID: 12910813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- S Spoto
- Università Campus Bio-Medico, Roma
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23
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De Galasso L, Spoto S, Costantino S. [Anemia]. Clin Ter 2003; 154:141-4. [PMID: 12856375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Spoto S, Navajas Martinez MF, Costantino S. [Dyslipidemias]. Clin Ter 2003; 154:65-9. [PMID: 12854288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- S Spoto
- Area di Medicina, Università Campus Bio-Medico, Roma, Italia
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25
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Spoto S, Navajas Martinez MF, Costantino S. [Sepsis]. Clin Ter 2002; 153:439-40. [PMID: 12645402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- S Spoto
- Università Campus Bio-Medico, Roma
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26
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Spoto S, Palma Modoni A, De Galasso L. [Diastolic cardiac insufficiency]. Clin Ter 2002; 153:355-7. [PMID: 12510423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- S Spoto
- Università Campus Bio-Medico, Roma
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27
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De Galasso L, Palma Modoni A, Spoto S. [Chronic heart failure]. Clin Ter 2002; 153:295-8. [PMID: 12400221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- L De Galasso
- Area di medicina, Università Campus Bio-Medico, Roma
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Vincenzi B, Santini D, Spoto S, Finolezzi E, D'Angelillo RM, La Cesa A, Tonini G. The antineoplastic treatment in the elderly. Clin Ter 2002; 153:207-15. [PMID: 12161983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
More than 550,000 American people died for cancer only in 1998 and more than third of them were over 65 years of age. According to recent data in next decade more than 70% of all the deaths for tumour will be verified in the population over 65 years. The cancers mostly frequently associated with the deaths in the elderly population are the tumour of the lung, colon, prostate and breast. Therefore the geriatrics oncology is progressively assuming a central and essential role within the medical oncology. One of the aspects of great interest in the treatment of the cancers of the elderly patient (> 65 years) is the study about some pharmacokinetic modifications of the antitumour medicines in such band of age, and the study about some pattern of toxicity characteristics in the elderly patients. In this ambit there are a few studies in literature devoted specifically to such aspect. This study represents an attempt of revision of the literature finalized to analyse the toxicological and pharmacokinetic characteristics of the principal chemotherapeutic agents used in the therapy of elderly patients affected with cancer. In the last part of the review we have tried to synthesize the state of the art of the achieved results about the medicines that have shown a better therapeutic index and a better impact on the clinical benefit in such population of patients.
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Affiliation(s)
- B Vincenzi
- Università Campus Bio-Medico, Rome, Via E. Longoni 69, Rome, Italy
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29
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Spoto S, De Galasso L, Costantino S. Community-acquired pneumonia. Clin Ter 2002; 153:225-7. [PMID: 12161986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- S Spoto
- University Campus Bio-Medico, Rome, Italy
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Spoto S, De Galasso L, Palma Modoni A. [Urinary tract infections]. Clin Ter 2002; 153:151-3. [PMID: 12078342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- S Spoto
- Università Campus Bio-Medico, Roma, Italia
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31
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Picardi A, Navajas F, Spoto S, Palma Modoni A, De Galasso L, Costantino S. [A 74-year-old woman with macrocytic anemia]. Clin Ter 2002; 153:65-7. [PMID: 11963638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
A seventy-four years old woman is assessed for asthenia, fatigue, non ulcerous dyspepsia with macrocytic anemia. The patient's medical history taking in Binswanger disease--diagnosed 5 aa before-, epilepsy-2 aa before- and a previous episode of TVP of the left leg, suggested the hypothesis that a B12 deficiency, by a chronic gastritis, would involve an increase of homocysteine cause of the clinical manifestations of megaloblastic anemia, Binswanger disease, tardive epilepsy and previous TVP. The fisic and blood and instrumental exams confirmed the clinical diagnosis. The patient is having vitamin B12.
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Affiliation(s)
- A Picardi
- Libera Università Campus Bio-Medico, Area di Medicina, Via E. Longoni, 85, 00155 Roma.
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Navajas MF, Spoto S. [Nephrolithiasis prophylaxis]. Clin Ter 2001; 152:337-8. [PMID: 11865526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Spoto S, Costantino S. [Asymptomatic bacteriuria]. Clin Ter 2001; 152:275-6. [PMID: 11794845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Costantino S, Navajas F, Spoto S. [Acute kidney failure]. Clin Ter 2001; 152:153-7. [PMID: 11692532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Costantino S, De Galasso L, Spoto S. [Is carbamazepine a new etiologic factor in algodystrophy?]. Clin Ter 2001; 152:79-80. [PMID: 11441527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Picardi A, Navajas F, De Iorio F, Amicarelli M, Spoto S, De Galasso L, Vespaciani Gentilucci U, Scarlata S, Zardi E, Di Cuonzo G. [A 35-year-old woman with fever, dyspnea, and pain in the left thigh]. Clin Ter 2001; 152:51-5. [PMID: 11382170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A thirty-five years old woman during her twelfth pregnancy presented fever and pain at the left thigh. After cesarean delivery dyspnea added to the first two symptoms and pulmonary embolism was suspected. A clinical history revaluation suggested a diagnosis of infectious endocarditis and femoural osteomielitis due to a septic embolus.
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Affiliation(s)
- A Picardi
- Università Campus Bio-Medico, Area di Medicina, Via E. Longoni, 85, 00155 Roma.
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Spoto S, Costantino S. [Treatment of hypertension in the prevention of cardiovascular damage]. Clin Ter 2000; 151:387-9. [PMID: 11211469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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D'Aprile M, Santini D, Di Cosimo S, Gravante G, Vincenzi B, Spoto S, Costantino S, Rabitti C, Tonini G. Atypical case of metastatic undifferentiated prostate carcinoma in a 36 years old man: clinical report and literature review. Clin Ter 2000; 151:371-4. [PMID: 11141722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Prostate carcinoma occurs infrequently in patient less than 50 years old with an incidence of 0.8% to 1.1%. In literature are described less than 20 cases occurred in younger men (< 40 years old). A 36 year-old man with a two-months history of lower back pain, anorexia and loss of weight, showed at clinical examination a mild enlargement of inguinal lymph nodes and right inferior leg and scrotus edema. CT scan demonstrated marked enlargement and fusion of pelvic, inguinal, sacral and periaortic nodes with a pelvic mass that caused local ureterohydronephrosis and obstruction of the urinary flow. X-rays showed osteoblastic metastases. At total body scintigram were observed fixation areas corresponding to lumbar metamers, pelvis, thigh bones, left humeral head, left acromioclavicular articulation and multiple ribs. Tumor markers resulted negative except prostate specific antigen (PSA: 500 mgr/ml) and prostatic acid phosphatase (PAP: 208 U/l); prostate biopsy showed an undifferentiated carcinoma. The patient was submitted to right percutaneous nephrostomy, chemotherapy (PEB, cisplatinum, etoposide and bleomycin for 6 cycles) and ormonotherapy (LHRH analogues) reporting a clinical partial response. After 6 months the disease progressed and was started a second line chemotherapy. After 18 months from diagnosis patient is still alive with progressing disease. Our patient represents, with respect to many features, an original clinical case of prostate carcinoma occurring in young age, for the atypical association of an undifferentiated carcinoma with high levels of PSA and PAP and with osteoblastic-pattern of bone metastases. Further studies would be useful to identify new risk factors for development of prostate cancer in young men in order to achieve early diagnosis.
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Affiliation(s)
- M D'Aprile
- Campus Bio-Medico University, Roma, Italia
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Spoto S, Galluzzo S, De Galasso L, Zobel B, Navajas MF. [Prevention of acute tubular necrosis caused by the administration of non-ionic radiologic contrast media]. Clin Ter 2000; 151:323-7. [PMID: 11141713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Radiographic contrast agents can cause acute renal failure that may be due to acute tubular necrosis (ATN). We prospectively studied 45 patients with risk factors for ATN who were undergoing computed tomography with three nonionic contrast agents (ioversolo, iobitridolo and iodixanolo). Patients were randomly assigned either to receive preventive management (0.45% saline intravenously, before and after administration of the contrast agent; mannitol 20% 250 mL i.v. 60 min before and 60 min after the contrast agent; furosemide 80 mg i.v. 30 min before the contrast agent; dopamine 3 g/Kg/min i.v. after administration of the contrast agent for 24 hours) or to receive placebo. Prophylactic management prevents the reduction in renal function induced by ioversolo, iobitridolo and iodixanolo, three noninonic contrast agents in patients with risk factors for ATN.
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Affiliation(s)
- S Spoto
- Dipartimento di Scienze Cardiovascolari, Università Campus Bio-Medico, Roma, Italia
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Picardi A, Manfrini S, Navajas F, Zardi E, Amicarelli E, De Iorio F, Galluzzo S, Valiani A, Spoto S, Scarlata S, Ves pasiani Gentilucci U, De Galasso L, Meloni MC, Costantino S. [67 year old man with abdominal pain, anorexia and low-grade fever]. Clin Ter 2000; 151:287-91. [PMID: 11107679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
A case of pericardial effusion presenting clinically with pretamponade is shown. TBC is not a rare cause of Pericardial effusion and at present Tuberculosis is a more and more frequent infection also in occidental countries. Guide lines for diagnosis and treatment are revised.
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Picardi A, Manfrini S, Navajas F, De Iorio F, Amicarelli E, Spoto S, Meloni MC, De Galasso L, Vespasiani Gentilucci U, Scarlata S, Costantino S. [A 61-year-old woman with abdominal pain and urination disorders]. Clin Ter 2000; 151:195-8. [PMID: 10958055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The case of a 61 yo diabetic woman presenting with dysuria and lower abdominal pain is described. The incomplete resolution of the clinical picture after short antibiotic treatment and a strong suspect of autonomic neuropathy oriented to an anamnestic reevaluation that evidenced the presence of pneumaturia. The last was the key-symptom that guided to diagnostic imaging showing emphysematous cystitis while a gastroscopy confirmed the presence of autonomic neuropathy manifested by gastroparesis. Emphisematous cystitis is a characteristic infectious complication of diabetic patients induced by a persistent incomplete bladder emptying and bacterial glucose fermentation. The complete eradication of the infectious agent requires a long term antibiotic course and a prompt identification of this pathology.
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Picardi A, Manfrini S, Navajas F, Amicarelli E, De Iorio F, Valiani A, Galluzzo S, Spoto S, Segna A, Scarlata S, Vespasiani Gentilucci U, De Galasso L, Meloni MC, Costantino S. [A 73-year-old woman with vomiting and metabolic alkalosis]. Clin Ter 2000; 151:119-23. [PMID: 10876980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
A severe, life-threatening metabolic alchalosis associated with a stenosing pancreatic carcinoma in a female type II diabetic patients is presented, and a review of the most frequent causes of hyperemesis, orthostatic hypotension and lethargy is shown.
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Santini D, Vincenzi B, Finolezzi E, Di Cosimo S, Gravante G, Spoto S, Tonini G. [The prevention of vomiting due to antineoplastic chemotherapy in the elderly cancer patient]. Minerva Med 1999; 90:205-9. [PMID: 10719419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- D Santini
- Oncologia Medica, Università Campus Bio-Medico, Roma.
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Caruso F, Motta S, Ciaccio G, Scaravilli F, Spoto S, Latteri S. [Current role of radical surgery in the treatment of breast tumors]. G Chir 1989; 10:124-7. [PMID: 2518538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Though currently conservative surgical procedures have an ever-growing importance in breast cancer treatment, there is still place for radical surgery. The Authors describe radical techniques and their indications. The surgeon must know how to choose the proper radical technique, when it is not possible to perform a conservative surgical procedure.
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