Background: In previous studies we demonstrated that spironolactone 50 mg OD, added in hypertensive patients who do not normalize pressure with enalapril 10 mg in the morning, after 3 months reduces pressure and reduces arterial stiffness.

The educational system in radiology programs worldwide are different. In the American system, they offer a certificate program (Cert) then an associate degree (AAS) -in some colleges then a diploma (Dip) - after that a bachelor’s degree (B.S.). A radiographer a.k.a radiologic technologist can continue to get a post-baccalaureate certificate or a master’s degree (M.S.) and -rarely in America due to the shortage of Ph.D. programs- a doctorate of philosophy in radiology.

Some of the numbers in radiology used as a criteria to make or role out a diagnosis for some conditions. These numbers should not be taken for granted since personalized medicine state that every patient is different and should be treated based on his/her condition. Those numbers can’t be used as a golden slandered in all case. This commentary will focus on some examples where numbers as a criteria failed or made the diagnosis impossible.

Mammary hamartoma is uncommon typically non-malignant benign breast lesion, comprising varying amounts of fatty, fibrous connective tissue and glandular elements. The co-existence of hamartomas and malignancy is very rare and it has no special propensity to undergo malignant transformation. We present a case report of a 66-year-old patient diagnosed with Inflammatory Breast Carcinoma within a previously diagnosed mammary hamartoma in the right breast. The comprehensive work-up with mammography, ultrasound, Positron Emission Tomography – Computed Tomography (PET-CT) and ultrasound-guided biopsy confirmed invasive ductal carcinoma within the hamartoma. Although malignancy arising within hamartoma is an extremely rare entity, the radiologist should be aware and prudent of the atypical as well as suspicious features within hamartoma during interpretation of imaging modalities and should thoroughly investigate any architectural distortion or microcalcifications within an otherwise typical hamartoma. No case has been reported for inflammatory breast carcinoma in mammary hamartoma as per our best of knowledge.

Background: In IgAN with cellular crescents (CIgAN) urinary excretion of a2-macroglobulin (a2m/C, MW 720 kDa) may be a marker of podocytes damage induced by crescents. The purpose of the study was the evaluation of the clinical significance of a2m/C excretion in 177 patients with glomerulonephritis (GN), nephrotic syndrome (NS) and functional outcome. Methods: In all 177 patients a2m/C excretion was measured; the patients were divided in 2 groups: a2mC=0 (n. 72) and a2m/C >0 (n. 105); for each group were assessed the outcomes considered in combination: Remission & persistent nephrotic syndrome (PNS) with long lasting NRF designed “Remission & NRF”; ESRD & eGFR < 50% & PNS with CRF designed “Progression and progression risk”. Results: In 72 patients with a2m/C=0 “Remission & NRF” was 78% and “Progression & progression risk” was 22%; in 105 patients with a2m/C>0 “remission & NRF” was 52% and “Progression & progression risk” was 48%. “Remission & NRF” in each GN type with a2m/C=0 was: 100% in MCD and LN; 82%, 79%, 67% in FSGS, IMN, MPGN; in a2m/C>0 “Progression and progression risk” was 0%, 38%, 46%, 54%, 56%, 85% in MCD, LN, IMN, MPGN, FSGS, CIgAN with cellular crescents, respectively. Conclusion: Urinary excretion of a2m is a very simple marker available in all clinical practice laboratories, marker of damage of podocytes at least in CIgAN and LN with crescents and marker of GFB damage in different GN types and useful to predict outcome and treatment responsiveness.