Successful treatment of Takayasu arteritis with rituximab as a first-line immunosuppressant.

Takayasu arteritis is a rare large vessel vasculitis which has traditionally been treated with high-dose steroids. There have been a small number of publications where biological agents have been used to manage refractory cases. To the authors knowledge, there are no publications using biological agents in combination with steroids as a first-line treatment in Takayasu arteritis. In this publication, we document the case of Takayasu arteritis, in a 39-year-old woman, where rituximab was used in combination with steroids as a first-line agent in the setting of poorly controlled bipolar affective disorder.

Impact of Microcalcifications on Risk of Malignancy in Thyroid Nodules with Indeterminate or Benign Cytology.

OBJECTIVE: Adverse sonographic features such as microcalcification may predict increased likelihood of malignant cytology by fine-needle aspiration and, accordingly, increased risk of malignant histology. Our objective was to study the predictive value of microcalcifications and other sonographic features for malignancy among thyroid nodules with benign or indeterminate cytology. STUDY DESIGN: Case series with chart review. SETTING: Academic teaching hospital. SUBJECTS: Patients (N = 769) with 858 thyroid nodules undergoing 1142 ultrasound fine-needle aspirations; 411 cases had surgical correlation. METHODS: Sonographic features predictive of malignancy were correlated with malignancy as determined by histology. Incidental malignancies occurring outside the index nodule were discounted. RESULTS: Cytology was inadequate (87 cases), benign (518), indeterminate (210), and malignant (44). In 32 cases, initial benign cytology was upgraded to a higher-risk category after repeat ultrasound fine-needle aspiration. Microcalcification (P = .001) and irregular margins (P = .04) were significantly predictive of malignant cytology. Among surgical cases, microcalcification (P < .001) and irregular margins (P = .04) were significantly predictive of malignant histology; 170 patients with initial benign cytology and 161 with indeterminate cytology underwent surgery. Microcalcification was significantly associated with malignancy among cases with indeterminate cytology (P = .04) but not among cases with benign cytology (P = .23); however, only 13 of 33 cases with benign cytology and microcalcifications underwent surgery. CONCLUSION: Presence of microcalcification increases the risk of malignancy in thyroid nodules with indeterminate cytology and may thus aid in selection of cases for surgery.

Inflammatory bowel disease, such as Ulcerative colitis, is a risk factor for recurrent thromboembolic events: a case report.

Ulcerative colitis (UC), a member of the family of inflammatory bowel disease (IBD), occurs worldwide. It has an incidence which in recent years has been rising in areas such as Southern Europe and Asia, while remaining relatively constant in Northern Europe and North America. Complications associated with UC include toxic dilatation, perforation, carcinoma and massive haemorrhage. Extra-intestinal complications also occur and these include Thromboemboli (TE).Thromboembolic disease has a greater incidence and recurrence rate among patients with IBD than the general population.

Takayasu's Arteritis presenting as a dissecting aortic aneurysm history: a case report.

INTRODUCTION: Takayasu's Arteritis, formerly known as "pulseless disease", is a chronic idiopathic vasculitis which affects the large vessels in the body. First described in the 1800's, this rare condition is more commonly found in Asian women in their 40's. The aorta and its main branches are the primary vessels affected, with the most typical features reflected as ischemia or aneurysm formation. With Takayasu's Arteritis being a rare condition and its acute phase presentation often similar to other conditions, diagnosis is often difficult. CASE PRESENTATION: A 48 year old Irish Caucasian female, who presented as a typical history of an aortic dissection (chest pain radiating to her back in an interscapular region and a systolic blood pressure differential of 50 mmHg between her right and left upper limbs), was investigated with a number of imaging modalities and diagnosed with Takayasu's Arteritis, involving arteries affecting a number of organs. She was treated as per protocol for Takayasu's Arteritis. A diagnosis of cervical cancer quickly followed. CONCLUSION: This case report highlights that a differential diagnosis should never be dispelled based upon a "typical" history. The importance of modern day imaging techniques such as CT, MRI and angiography, can often be paramount to confirming a diagnosis and the extent of the pathology.A possible link between Takayasu's Arteritis and gynaecological malignancies may exist.