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Abstract: Objective: Within the context of the Open Three Consortium project, a new version of the Picture Archiving and Communication System (PACS) was developed in order to take advantage of new technologies and comply as best as possible to some requirements for a state-of-the-art health information system. Such requirements are the result of ten years of research run by the Bioengineering and ICT group from the University of Trieste. Materials and methods: The requirements include the use of open source technologies, but developing a PACS system using such approach and model generates some issues, since a PACS represents always a critical system. The main issue is the opposition that Open Source has to face in literature and market due to doubts concerning its reliability. The requirements also include the use of open standards, portability and scalability. This paper describes the state-of-the-art in literature as seen under the light of the mentioned requirements and how the author faced the challenges to make O3-DPACS achieve the best degree of satisfaction to those requirements, taking care of each of them as early as from the software design phase and using original solutions. Results: Original solutions were developed for great scalability and portability, granting the execution of the software on different Application Servers. Real world success stories are reported and compared. Moreover, the architecture of the software is analyzed, proposing it as a model for the development of open source critical systems. Conclusion: The solutions implemented in O3-DPACS seem to make it the system which best fits the requirements to date, and we think the software architecture proposed, coupled with organizational arrangements, is able to take reliability and quality into healthcare open source applications.

Midline primary hernias represent one of the most frequent abdominal wall defects in the adult population and in almost half of the cases they are associated with a rectus abdominis diastasis (RAD). Despite the high incidence of these defects there is currently no consensus in the literature on what is the preferred surgical technique for treatment. In this paper we present the first case series treated with an innovative technique that aims to repair the defects of the midline and RAD, while combining the advantages of the sublay Rives-Stoppa technique with those of the minimally-invasive surgery.

Abstract: Objective: Within the context of the Open Three Consortium project, a new version of the Picture Archiving and Communication System (PACS) was developed in order to take advantage of new technologies and comply as best as possible to some requirements for a state-of-the-art health information system. Such requirements are the result of ten years of research run by the Bioengineering and ICT group from the University of Trieste. Materials and methods: The requirements include the use of open source technologies, but developing a PACS system using such approach and model generates some issues, since a PACS represents always a critical system. The main issue is the opposition that Open Source has to face in literature and market due to doubts concerning its reliability. The requirements also include the use of open standards, portability and scalability. This paper describes the state-of-the-art in literature as seen under the light of the mentioned requirements and how the author faced the challenges to make O3-DPACS achieve the best degree of satisfaction to those requirements, taking care of each of them as early as from the software design phase and using original solutions. Results: Original solutions were developed for great scalability and portability, granting the execution of the software on different Application Servers. Real world success stories are reported and compared. Moreover, the architecture of the software is analyzed, proposing it as a model for the development of open source critical systems. Conclusion: The solutions implemented in O3-DPACS seem to make it the system which best fits the requirements to date, and we think the software architecture proposed, coupled with organizational arrangements, is able to take reliability and quality into healthcare open source applications.

Axillary lymph node metastasis from an occult breast carcinoma is a rare occurrence. We report this condition in a 59-year-old woman who presented with a swelling in the right axilla. No breast mass was clinically evident. Mammography, ultrasonography and multiple random fine-needle breast biopsies yielded no pathological findings. No extramammary primary lesions were present. Axillary sampling was performed and histological examination revealed the presence of metastatic adenocarcinoma in three of the 12 dissected lymph nodes. Estrogen receptors were positive and immunohistochemistry pointed to a breast origin. All these data were suggestive of occult breast cancer. The patient refused any further treatment but accepted clinical and radiological follow-up. Eight years later mammography revealed in the same breast a 10-mm nodule containing microcalcifications, which was not evident at physical examination. The patient underwent a lumpectomy. Intraoperative histology was positive for breast carcinoma and complete axillary clearance was performed. Histological examination revealed a lobular invasive breast carcinoma and the presence of micrometastasis in one of the 23 removed lymph nodes. The patient was given radiotherapy to the breast and axilla and tamoxifen. At present, one year after the appearance of the primary tumor, she is free of disease. Based on this case report we suggest an eclectic approach in the management of patients with axillary metastasis from occult breast cancer, depending on the clinical, pathological and biological findings.