Relapse of Takayasu’s arteritis with tuberculosis relapse: a rare presentation.

Takayasu’s Arteritis (TA) is a disease of unknown etiology with incidence between 1.2 to 2.3 cases per million per year. It is a chronic granulomatous arteritis affecting large elastic arteries, predominantly the aorta, its main branches, pulmonary and coronary arteries characterized histologically by an inflammatory cell infiltrate that affects all the layers of the arterial wall. The etiology of TA is not clear but a causal relationship between TA and tuberculosis (TB) have been suggested. The first case of Takayasu’s arteritis was described in 1908 by Japanese ophthalmologist Mikito Takayasu. Despite the association with tuberculosis and the similarity between granulomatous lesions in both the diseases, the exact role of Mycobacterium tuberculosis in the pathogenesis of TA is still unknown.

Improving care in ovarian cancer: the role of a clinico-pathological meeting.

BACKGROUND: We assessed the impact of clinico-pathological meetings on the diagnosis and management of patients with ovarian cancer. METHODS: Between January 2005 and December 2006, about 400 patients of suspected or confirmed ovarian cancer were evaluated in the 'Gynaecology Tumour Clinic'. Of these, 108 cases were referred for discussion in the weekly clinico-pathology meeting for various indications. These cases were retrospectively analysed regarding their initial clinical and pathological diagnosis, the indication for referring the case for discussion in the meeting and the impact this had on the overall management. Alterations in diagnosis, which impacted management, were classified as 'major changes' and those, which did not, were called 'minor changes'. RESULTS: Ninety-one of the 108 cases discussed were available for analysis; 75.8% of cases were initially diagnosed as epithelial ovarian cancers. In 48 of 91 cases (52%), there was an alteration in the diagnosis as a direct result of discussion in the meeting, mainly after clarifications regarding histological grading in 34 cases. Of the remaining 14 cases, 3 had a change in histopathological diagnosis; 2 cases, which were initially labelled as undifferentiated tumours, had their diagnosis clarified; and in the remaining 9 cases, in which the primary site was not known, a possible primary site could be assigned (with the help of clinical, radiological and pathological inputs). Among the 14 cases with alterations other than grading, the change was contributed by slide review alone in 7 cases and in the rest by a combination of slide review and clinical inputs. As a direct outcome of the meeting, 20 of 91 cases (22%) had their management plan modified (major change). CONCLUSION: The practice of conducting weekly clinicopathological meetings has a major impact on the management of cases of ovarian cancer.