Research Spotlight

Hoang, J. T., R. Yang, Z. A. Shah, J. J. Spigel and J. E. Pippen (2019). “Clinico-radiologic features and management of hematological tumors in the breast: a case series.” Breast Cancer 26(2): 244-248.

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Hematological tumors arising in the breast are uncommon and require different treatment modalities dependent upon tumor type. Current treatment options include surgical excision, chemotherapy, and radiotherapy. Management of these breast malignancies are poorly outlined in the literature. The purpose of this case series is to report five cases consisting of extranodal marginal zone lymphoma, lymphoplasmacytic lymphoma, and extramedullary plasmacytoma occurring in the breast. The cases illustrate heterogeneous radiologic findings and varying management approaches to these tumors. The case series underscores the importance of having a wide differential at diagnosis and recognizes management of disease should be taken on an individual basis with consideration of prognosis and first-line treatment options.E

Grayburn, P. A. (2019). “Multimodality Imaging of Suspected Mechanical Prosthetic Valve Obstruction: Importance of the Patient and the Clinical Context.” JACC Cardiovasc Imaging Feb 11. [Epub ahead of print].

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[Editorial; no abstract available.]

Grayburn, P. A. (2019). “The Challenge of Assessing Residual Mitral Regurgitation During MitraClip Procedures: Is 3D Vena Contracta Area the Answer?” JACC Cardiovasc Interv Feb 22. [Epub ahead of print].

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[Editorial; no abstract available.]

Goraya, N. and D. E. Wesson (2019). “Clinical evidence that treatment of metabolic acidosis slows the progression of chronic kidney disease.” Curr Opin Nephrol Hypertens Mar 1. [Epub ahead of print].

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PURPOSE OF REVIEW: We review the growing clinical evidence that metabolic acidosis mediates chronic kidney disease (CKD) progression and that treatment to increase the associated low serum bicarbonate (HCO3) in CKD is disease-modifying. RECENT FINDINGS: Seven prospective studies of patients with wide ranges of estimated glomerular filtration rates (eGFRs) and serum HCO3 examined the effect on CKD of increasing serum HCO3 using dietary acid reduction with either oral alkali (sodium bicarbonate or sodium citrate), a vegetarian diet very low in acid-producing protein (0.3 g/kg/day) supplemented with ketoanalogues or added base-producing fruits and vegetables. Clinical outcomes included slower kidney function decline (using eGFR measurements) and fewer patients progressing to end-stage kidney disease. Post hoc analyses demonstrated that: treatment of metabolic acidosis for 2 years decreased the number of patients with at least a 40% eGFR decline, a validated surrogate for progression to end-stage kidney disease and across four studies, treatment to increase serum HCO3 by 4-6.8 mEq/l in acidotic patients with CKD was associated with a approximately 4 ml/min/1.73 m reduction in the rate of eGFR decline over 6-24 months compared with controls. SUMMARY: Metabolic acidosis appears to enhance CKD progression and its treatment should be studied further as a potential disease-modifying intervention.

Galiano, A., L. Wolford, J. Goncalves and D. Goncalves (2019). “Adolescent internal condylar resorption (AICR) of the temporomandibular joint can be successfully treated by disc repositioning and orthognathic surgery, part 2: Treatment outcomes.” Cranio 37(2): 111-120.

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OBJECTIVE: To evaluate treatment outcomes for patients with TMJ adolescent internal condylar resorption (AICR) treated by a specific surgical protocol, including: (1) Removal of bilaminar tissue surrounding the condyle, (2) Articular disc repositioning with Mitek anchor technique, and (3) Concomitant orthognathic surgery. METHODS: This study evaluated 24 AICR patients treated by the specific surgical protocol with clinical subjective and objective examinations and lateral cephalogram assessments for surgical changes and long-term outcomes. RESULTS: Mean age at diagnosis was 16.5 years, and mean follow-up was 30.3 months. All 24 patients had significant reduction in TMJ pain, facial pain, and headaches, with improvement in jaw function, diet, and disability. Cephalometric analysis showed significant surgical changes but good long-term occlusal and skeletal stability. CONCLUSION: Patients with AICR treated with the specific surgical protocol demonstrated good skeletal and occlusal stability as well as improvement in TMJ pain, headaches, jaw function, diet, and disability.