Efficacy of total androgen blockade in metastatic prostatic carcinoma with transient hypogonadotropic hypogonadism: a case report.

A patient affected by metastatic prostatic carcinoma and hypogonadotropic hypogonadism (HH) was treated with flutamide 750 mg/day plus an LH-RH analog. After confirmation of basal castration during treatment, he continued with antiandrogens alone. Following the normalization of gonadic function and subjective mild bone flare-up, the patient resumed the initial treatment and obtained a partial response. When flutamide was interrupted because of liver toxicity, the patient showed progressive disease in the bone, which was unresponsive to both flutamide resumption and salvage hormone therapy (bicalutamide). The patient is currently receiving chemotherapy with VP16 and estramustine phosphate and is showing both serologic (PSA) and symptomatic response. The interest of this case lies in the incidental detection of HH during therapy and in the responsiveness to treatment.

[The presentation of a picture archiving and communication system (PACS) and the initial experiences with its use]. / Presentazione di un sistema di archiviazione e di trasmissione delle immagini ("Picture Archiving and Communication System"--PACS) e prime esperienze applicative.

INTRODUCTION: The use of computers has yielded new diagnostic techniques (US, CT, MRI and computed radiography) that can successfully replace conventional film in data acquisition, image display and image interpretation. Thanks to the Picture Archiving and Communication System (PACS), we can now manage the whole of diagnostic data because the images are acquired, coupled to the patient data stored in the Radiology Information System (RIS), sent to display workstations and finally sent to the archives. PURPOSE: To present the configuration and functions of a new PACS used in radiology and nuclear medicine departments and to evaluate its efficacy one year after implementation. Particular attention is paid to the objective difficulties radiologists found in approaching the system. RESULTS: Secretarial work reduction and a more rational archiving organization are two of the advantages of automation. PACS permits rapid image display, retrieval nd archiving for both scientific and statistical purposes; however, its correct use is hindered by a series of problems, namely: a) reluctance to use PACS by many members of the medical staff, due to the complexity of its procedures; b) lack of panoramicity on the display monitor in multi-image examinations and c) underuse of viewing workstations in several wards of our institution due to lack of know-how. CONCLUSIONS: Although the use of PACS has improved the workload management in our departments, the system still needs to be customized to the radiologist to optimize its use. Workstations must be user-friendly, with simultaneous display of more images. On the other hand, radiologists need to expand their knowledge of new techniques, thus modifying obsolete working procedures.

[Diagnostic impact of ultrasonography in abdominal diseases]. / Impatto diagnostico dell'ecografia nelle malattie addominali.

The diagnostic accuracy of conventional radiography and ultrasound (US) in patients with acute or chronic abdominal pain was investigated by the authors in two prospective studies to assess the capabilities of the two imaging techniques. 262 patients (135 men and 127 women, age range: 25-83 years) were entered into the study within 8 months. The patients were divided into different groups according to clinical presentation (80 patients with acute and 182 with chronic pain) and to the referring physician (a hospital clinician for 127 patients and a general practitioner for 135 patients). For each technique the presence (positive result) or the absence (negative result) of abnormal imaging features related to clinical symptoms was recorded and the agreement of conventional radiography and US findings was assessed. Statistical analysis showed similar sensitivity of conventional radiography and US in the examination of acute hospitalized patients (54.3% positive results), chronic hospitalized patients (28.1% negative results) and chronic nonhospitalized patients (47.2% negative results). The results of our prospective studies showed poor diagnostic accuracy of the two techniques and clearly evidenced the improper use of diagnostic imaging methods by referring physicians, with a technical-oriented attitude in imaging examination requests. In the authors' opinion, a clinical-based approach by referring physicians with accurate patient selection might improve diagnostic accuracy, the cost/benefit ratio and the clinical effectiveness of imaging techniques.