Papers by Eugenio Poletti
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2016
Hyperthermic intraperitoneal chemotherapy (HIPEC) is delivered after cytoreductive surgery (CRS) ... more Hyperthermic intraperitoneal chemotherapy (HIPEC) is delivered after cytoreductive surgery (CRS) in selected patients with peritoneal carcinomatosis. The closed-abdomen technique, preferred by many centers, prevents heat loss and drug spillage, but does not warrant homogeneous distribution of the perfusion fluid (PF). The hypothesized formation of intra-abdominal adhesions during the closed-abdomen perfusion period has never been described. From March 2014 to April 2016, 10 consecutive patients with peritoneal carcinomatosis, selected for CRS, underwent the Laparoscopy-Enhanced HIPEC technique to explore the abdominal cavity during the perfusion. The aim of the study was to investigate the incidence and the extent of intra-abdominal adhesions that are formed after CRS during the perfusion period of closed-abdomen HIPEC. During the perfusion, adhesions developed in 70% of the patients. Adhesions developed mainly in the period between the closure of the abdomen and the subsequent filling of the abdomen with the PF. After their first division, during the following perfusion period, adhesions between the bowel and the abdominal wall reformed in 3 patients (30%). Intra-abdominal adhesions are frequently formed during closed-abdomen HIPEC and can hamper the adequate circulation of the PF. The Laparoscopy-Enhanced technique enables the early detection and the division of any intra-abdominal adhesions.
Minerva chirurgica, 1995
The diagnostic iter and treatment of peptic ulcer have evolved considerably over the past 20 year... more The diagnostic iter and treatment of peptic ulcer have evolved considerably over the past 20 years. The capillary spread of endoscopy has permitted secure and precise diagnoses to be made, in terms of both the site and size of the anatomic lesion, on the one hand, and on the other, the introduction of antisecretory drugs has led to the resolution of the majority of ulcers, so much so that the ulcer is no longer managed using strictly surgical methods but is now treated medically and only emergency cases, such as perforations, undergo surgery. Complications, such as digestive hemorrhage, penetration and stenosis, may lead to the need for surgery. In particular, perforation seems to be the only complication which has not been significantly influenced by the introduction of antisecretory therapy, the point that its status as a "complication" has been questioned leading to the suspicion of its nosological autonomy. The authors review the series of ulcer patients admitted to ho...
Minerva chirurgica, 2000
Three cases of acute diverticulitis of the right colon are described and a review of the internat... more Three cases of acute diverticulitis of the right colon are described and a review of the international literature about this rare disease is made. Diverticulitis of the ascending colon is an uncommon disease which mimics appendicitis or perforated neoplasm. The correct diagnosis is rarely made, but can be suggested by signs and symptoms and confirmed by the barium enema. It should be treated conservatively, like left-colon diverticulitis. Isolated diverticula can be managed by simple excision and primary closure. Local resection may be necessary if the involved area is too large. Right hemicolectomy is performed when carcinoma is strongly suspected.
Il Giornale di chirurgia
The authors experience in the surgical treatment of endocrine tumours of the digestive tract is r... more The authors experience in the surgical treatment of endocrine tumours of the digestive tract is reported. Particularly, they emphasize that in spite of the several syndromes associated with these neoplasms, diagnostic and therapeutic concepts herein analyzed are similar.
Il Giornale di chirurgia
The authors report their 10 year experience of 32 consecutive hepatic resections for metastases. ... more The authors report their 10 year experience of 32 consecutive hepatic resections for metastases. All patients were preoperatively evaluated with US and CT, however, in 9 cases the diagnosis was obtained at laparotomy. In the first years there were no codified criteria for indications to surgery, while recently these were restricted, because of more favourable prognostic evaluations, to the metastases from colorectal carcinoma, endocrine or carcinoid tumours, digestive system neoplasms invading adjacent liver (in this case usually with palliative goal). The low mortality and morbidity registered explain the safety and efficacy of this procedure, also taking into account the fact that currently surgery is the only effective procedure with curative purpose. Criteria for patients selection, particularly in case of colorectal cancer, are referred and discussed and consequently prognostic factors are proposed: hepatic involvement extent, stage of primary tumour, absence of extrahepatic me...
Annals of Surgery, Jan 29, 2014
We have read with great interest the well-written review by Shankaran and colleagues regarding th... more We have read with great interest the well-written review by Shankaran and colleagues regarding the different prosthetic used in abdominal wall surgery, and feel strongly that an important argument the use of such prostheses has yet be made. Abdominal wall surgical repair is classified as a minor branch of more surgical specialties. The function the abdominal wall is generally considered be less important than that of the nearby organs, and as such, compared other surgical fields, there is typically mainstream research conducted to refine improve surgical techniques addressing wall repair. Since the revolution-implementation of tension-free repairing such as the use of polypropilene other synthetic materials (SM s), abdominal wall surgery has changed dramatically. widespread use of such materials, with low cost and high effectiveness in replacment or otherwise supporting abdominal wall has ushered in an entirely new era of wall surgery. The main problems when using SM include material high adhesiogenic potential and the element of risk of prosthesis infection, especially polypropilene is used in potentially con-or infected fields. The subsequent of remodeling biomaterials (BM s) offers viable alternative to SM s and their inherent Prosthetic materials were initially into 2 major categories, absorbable nonabsorbable prostheses. Since the in-of BM s, the classification system been updated to create the remodeling category, which can, in turn, be into 2 subcategories: total remodeling partial remodeling materials. This addi-subclassification is due to the presence cross-linkages in the collagen chains of par-remodeling materials, which ultimately the collagenase-binding sites, thereby the prosthesis to be remodeled over course of a longer recovery period.
Minerva chirurgica
Carcinoid tumors are among the most frequently reported neuroendocrine neoplasms of the gastroent... more Carcinoid tumors are among the most frequently reported neuroendocrine neoplasms of the gastroenteropancreatic system. They occur more commonly as benign diseases but malignant ones can also be found. Gastric carcinoid is an uncommon pathology which accusin 2% of the carcinoid tumors of various districts and 0.5% of the gastric carcinomas. The authors report a case of gastric malignant multifocal carcinoid, diagnosed in a 63 year-old female patient. Diagnosis was confirmed at histologic analysis of the operating piece. The aim of this paper has been to review the frequency, prognosis and treatment of this neoplasm in the literature.
Digestive and Liver Disease
American Journal of Kidney Diseases, 1994
We report a case of renin-producing leiomyosarcoma associated with the hyponatremic hypertensive ... more We report a case of renin-producing leiomyosarcoma associated with the hyponatremic hypertensive syndrome and nephrotic-range proteinuria. Extremely high levels of active renin and, to a greater extent, of prorenin were found in plasma and tumor tissue. Immunohistochemical and in situ hybridization studies demonstrated that the neoplastic cells were the source of renin production. The hyponatremic hypertensive syndrome and proteinuria promptly responded to treatment with angiotensin-converting enzyme inhibitors, suggesting an angiotensin II dependency of these disorders. After removal of the leiomyosarcoma, plasma concentration of active renin, but not of prorenin, normalized and the hypertension, proteinuria, and electrolyte abnormalities disappeared. However, 5 months after operation, the patient presented once again with hypertension, hypokalemia, proteinuria, and markedly increased plasma levels of both active renin and prorenin that heralded the relapse of neoplastic disease.
International Journal of Surgical Oncology, 2014
Gastric cancer (GC) is the fourth most common cancer and the second leading cause of cancer death... more Gastric cancer (GC) is the fourth most common cancer and the second leading cause of cancer death in the world; 53-60% of patients show disease progression and die of peritoneal carcinomatosis (PC). PC of gastric origin has an extremely inauspicious prognosis with a median survival estimate at 1-3 months. Different studies presented contrasting data about survival rates; however, all agreed with the necessity of a complete cytoreduction to improve survival. Hyperthermic intraperitoneal chemotherapy (HIPEC) has an adjuvant role in preventing peritoneal recurrences. A multidisciplinary approach should be empowered: the association of neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), cytoreductive surgery (CRS), HIPEC, and early postoperative intraperitoneal chemotherapy (EPIC) could increase the rate of completeness of cytoreduction (CC) and consequently survival rates, especially in patients with Peritoneal Cancer Index (PCI) ≤6. Neoadjuvant chemotherapy may improve survival also in PC from GC and adjuvant chemotherapy could prevent recurrence. In the last decade an interesting new drug, called Catumaxomab, has been developed in Germany. Two studies showed that this drug seems to improve progression-free survival in patients with GC; however, final results for both studies have still to be published.
Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus ... more Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and the SC undertook the critical revision and prepared the presentation to the audience and the Panel on the day of the Conference. Then 3 recommendations were presented according to the 3 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on a email debate took place until December 2013 to reach a unanimous consent. We present results on the 3 following questions: which hemodynamically unstable patient needs an extraperitoneal pelvic packing? Which hemodynamically unstable patient needs an external fixation? Which hemodynamically unstable patient needs emergent angiography? No longer angiography is considered the first therapeutic maneuver in such a patient. Preperitoneal pelvic packing and external fixation, preceded by pelvic binder have a pivotal role in the management of these patients.
Emergency Medicine and Health Care, 2013
Background: Acute appendicitis is a very common disease with a life time risk of approximately 7-... more Background: Acute appendicitis is a very common disease with a life time risk of approximately 7-8%. Worldwide, the standard of care for appendicitis is appendectomy that is to date considered generally a "routine and safe operation". However, the mortality rate of appendectomy is 0.7% and 2.4% in patients without and with perforation, respectively. Aim: The paper aims to investigate the debate on surgical and non surgical treatment of acute uncomplicated appendicitis. Methods: Pubmed and embase were queried for "acute appendicitis, antibiotics, surgery, conservative treatment, diagnosis". All prospective randomized studies, meta-analysis, systematic reviews and significant retrospective studies were retrieved. A brief analysis of single RCT and meta-analysis was conducted. Finally, the topic was developed by focusing on several clinical aspects. Discussion and conclusions: The comparison of surgery and antibiotics, in terms of efficacy to treat acute appendicitis, is intrinsically complex due to the huge disparity of management and treatment options. After establishing an institutional validated clinical score, uncomplicated appendicitis in adult can be safely and successfully treated by antibiotic therapy an in-hospital setting if the patient is well informed. Nevertheless, outpatient antibiotic treatment cannot be proposed as a routine clinical practice. High risk patients should be treated with antibiotics whilst any treatment failure should be considered for mandatory surgery.
World Journal of Emergency Surgery, 2012
Introduction: Indications for repair of abdominal hernia are well established and widely diffused... more Introduction: Indications for repair of abdominal hernia are well established and widely diffused. Controversies still exist about the indication in using the different prosthetic materials and principally about the biological ones. Material and methods: In February 2012, the Italian Biological Prosthesis Work-Group (IBPWG), counting a background of 264 biologic implants, met in Bergamo (Italy) for 1-day meeting with the aim to elaborate a decisional model on biological prosthesis use in abdominal surgery. Results: A diagram to simplify the decisional process in using biologics has been elaborated.
Radiation Physics and Chemistry, 2001
The influence of scattering profiles on the resolution, scatter/primary ratio (S=P), and grid per... more The influence of scattering profiles on the resolution, scatter/primary ratio (S=P), and grid performance in mammography has been evaluated for human breast tissue (adipose and glandular) and two breast phantoms (water and Lucite). The scattering profiles were measured with a Molybdenum X-ray tube equipped with a graphite monochromator (17.44 keV) and a NaI detector. The loss of resolution on radiographic images due to scattering is obtained from the first zero of the Fourier transforms of the point spread functions. The S=P ratio was obtained using the Monte Carlo method and the grid performance was evaluated integrating the resulting S=P between zero and the grid acceptance angle, a simple and effective approach. The difference in the results for resolution loss due to the scattered fluency present discrepancies around 20%, but since the values of the resolution loss are very low, the scattering profile does not give rise to noticeable structure in a radiograph. Scatter/primary ratios are similar for water and glandular tissues but different for adipose (8%) and Lucite (15%). The ratios S=P obtained with a linear grid with grid ratio 5 : 1 are clearly different for each material showing that this grid could be more discriminating for glandular tissue than for adipose tissue or Lucite phantom. r
Radiation Physics and Chemistry, 2004
Nuclear Instruments and Methods in Physics Research Section B: Beam Interactions with Materials and Atoms, 2002
In this work we propose a method of obtaining elastic scattering differential cross-sections from... more In this work we propose a method of obtaining elastic scattering differential cross-sections from X-ray scattering experiments with amorphous samples taking into account all background sources and also multiple scattering processes. Background from the ambient and other scattering sources were measured directly. Multiple scattering was calculated through a Monte Carlo code that simulates the actual experiment and may use different theoretical approaches when considering the differential scattering cross-section. The same code, after slight modifications, provides also the attenuation coefficients and the mean scattering angle, which were compared with analytical results. The uncertainty for all experimental quantity was evaluated. As an illustration of the method, the procedure was applied to scattering data obtained for a glandular breast tissue measured inside a cylindrical container. Ó
Nuclear Instruments and Methods in Physics Research Section B: Beam Interactions with Materials and Atoms, 2010
Tissue-equivalent materials to be used as substitutes for human brain tissue in dosimetry for dia... more Tissue-equivalent materials to be used as substitutes for human brain tissue in dosimetry for diagnostic radiology have been investigated in terms of calculated total mass attenuation coefficient (l/q), calculated mass energy-absorption coefficient (l en /q) and absorbed dose. Measured linear attenuation coefficients (l) have been used for benchmarking the calculated total mass attenuation coefficient (l/q). The materials examined were bolus, nylon Ò , orange articulation wax, red articulation wax, PMMA (polymethylmethacrylate), bees wax, paraffin I, paraffin II, pitch and water. The results show that water is the best substitute for brain among the materials investigated. The average percentage differences between the calculated l/q and l en /q coefficients for water and those for brain were 1.0% and 2.5%, respectively.
Annals of Surgery, 2014
We have read with great interest the well-written review by Shankaran and colleagues regarding th... more We have read with great interest the well-written review by Shankaran and colleagues regarding the different prosthetic used in abdominal wall surgery, and feel strongly that an important argument the use of such prostheses has yet be made. Abdominal wall surgical repair is classified as a minor branch of more surgical specialties. The function the abdominal wall is generally considered be less important than that of the nearby organs, and as such, compared other surgical fields, there is typically mainstream research conducted to refine improve surgical techniques addressing wall repair. Since the revolution-implementation of tension-free repairing such as the use of polypropilene other synthetic materials (SM s), abdominal wall surgery has changed dramatically. widespread use of such materials, with low cost and high effectiveness in replacment or otherwise supporting abdominal wall has ushered in an entirely new era of wall surgery. The main problems when using SM include material high adhesiogenic potential and the element of risk of prosthesis infection, especially polypropilene is used in potentially con-or infected fields. The subsequent of remodeling biomaterials (BM s) offers viable alternative to SM s and their inherent Prosthetic materials were initially into 2 major categories, absorbable nonabsorbable prostheses. Since the in-of BM s, the classification system been updated to create the remodeling category, which can, in turn, be into 2 subcategories: total remodeling partial remodeling materials. This addi-subclassification is due to the presence cross-linkages in the collagen chains of par-remodeling materials, which ultimately the collagenase-binding sites, thereby the prosthesis to be remodeled over course of a longer recovery period.
Conference Presentations by Eugenio Poletti
Introduction Hyperthermic intraperitoneal chemotherapy (HIPEC) is based on the delivery of heat a... more Introduction Hyperthermic intraperitoneal chemotherapy (HIPEC) is based on the delivery of heat and cytotoxic drugs directly to the peritoneal surface. Heat and cytotoxic drugs act synergistically against cancer cells and are brought to the peritoneal cavity by means of the perfusion fluid (PF). As the whole peritoneal surface is exposed to cancer cells, the efficacy of HIPEC relies on both warranting adequate circulation of the PF and keeping the desirable temperature inside the entire abdominal cavity. Even if several techniques for delivering HIPEC have been proposed, they must all be considered variations between two main streams: the open (Coliseum) technique and the closed technique. The open technique focuses on stirring the abdominal contents to improve the circulation of the PF, but takes with it the considerable weakness of a great thermal dispersion and the potential risk for contamination of the operating field and personnel. The closed technique focuses on a better preservation of heat and a reduced risk for contamination, but may not allow the adequate exposure of the whole peritoneal surface to the PF. This inability, which is well known, is attributed to the onset of preferential flows and of intraoperative adhesions between the bowel and the abdominal wall. Both these factors could act together in creating standing pools of PF and closed peritoneal spaces that cannot be reached by the PF. The formation of intra-abdominal adhesions during closed-abdomen HIPEC (IAs) albeit strongly suspected has never been reported before and its incidence is still unknown. Recently, we described a novel technique, i.e. the Laparoscopy-Enhanced closed abdomen HIPEC (LE-HIPEC), in which the abdominal cavity is explored by means of laparoscopy during the perfusion period of closed-abdomen HIPEC. The aim of our study was to use LE-HIPEC to demonstrate the formation of IAs during the perfusion period and to describe its incidence and extent.
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Papers by Eugenio Poletti
Conference Presentations by Eugenio Poletti