[Paraneoplastic thromboembolic syndrome as the first sign of a malignant disease]. / Paraneoplastický tromboembolický syndróm ako prvý príznak zhubného ochorenia.

We describe the paraneoplastic thromboembolic syndrome in venous and arterial (coronary, cerebral, peripheral) systems and in the heart (paraneoplastic endocarditis). We emphasise that the syndrome may signal presence of an occult malignant disease that, at that time, might be treatable.

Myocardial infarction paraneoplastically facilitated?

The prothrombotic effect of malignant diseases on organism is commonly known. We review the documentation of the Medical Department in Liptovsky Mikulas filed in years 1996-2002 (15,512 patients). 120 patients suffered from significantly coinciding acute myocardial infarction and malignant diseases (p = 0.05). In 17 of them the correlation was possible; in 38 it was probable. Most common were the tumours of digestive organs, uropoetic system and oncohematological diseases. The acute myocardial infarction usually preceded the diagnosis of malignant diseases. Under certain conditions, e.g. under that of paraneoplastic syndrome, some acute myocardial infarctions can serve as a hint that it is necessary to assume and solve also possible presence of occult malignancies (Fig. 1, Re of 46).

[Myocardial infarction and malignant diseases]. / Infarkt myokardu a zhubné ochorenia.

Not much known relations between acute myocardial infarction and malignant diseases have been pointed out recently. Melanomas, often hidden by various paraneoplastic effects (in changed coagulation status, especially thrombotic) can facilitate ischemic processes in myocardium.

[Visceral panniculitis in occult pancreatic carcinoma. Case report from clinico-pathologic archives]. / Viscerálna panikulitída pri okultnom karcinóme pankreasu. (Kazuistika z klinicko-patologického archívu).

The authors describe a 75-year-old man with acute abdominal disease leading to lethal prerenal failure. Necropsy revealed massive visceral panniculitis with a small adenocarcinoma of the head of the pancreas. The authors assume that a very rare, early paraneoplastic syndrome was involved.

[The little known Fay syndrome (benign carotidynia)]. / Málo známy Fayov syndróm (benígna karotidynia).

The authors describe the little known Fay syndrome (benign carotidynia, extracranial vascular cephalea). They emphasize the importance of a careful case-history (in particular sore throat--usually unilateral), with careful physical examination (palpation sensitivity of the carotid artery beneath the bifurcation). The authors assume that the syndrome is not as rare but that it is rarely correctly diagnosed. The drug of choice are non-steroid antirheumatic drugs. The authors describe in an epicritical manner eight of their own observations made during the last three years.

[A rheumatologic syndrome (paraneoplastic?) in benign tumors]. / Reumatoidný syndróm ("paraneoplastický"?) pri benígnych nádoroch.

The authors discuss the possible development of rheumatoid paraneoplastic syndrome in patients with benign tumours. They present three observations they made (cardiac myxoma, subpleural lipoma and pulmonary fibrosclerotic pseudotumour). Paraneoplasias in these cases are interesting from the pathogenetic aspect as regards their development, possibly malignant transformation of benign intrathoracic tumours.

[A rare symptom of peptic ulcer perforation: subcutaneous emphysema]. / Zriedkavý príznak perforácie peptického vredu: podkozný emfyzém.

The authors describe a 50-year-old man who was hospitalized on account of one-week increasing epigastric pain with marked regression several hours after admission. The revealed small subcutaneous emphysema near the umbilicus directed the diagnostic procedure and led to detection of a covered perforation of a peptic prepyloric ulcer.

[Little known paraneoplastic syndromes]. / Málo známe paraneoplastické syndrómy.

The author describes briefly some little known paraneoplastic syndromes: hypertension, circulatory failure, arterial ischaemia, Stauffer's syndrome, visceral neuropathy, thyroiditis and others. He comments on them, based on his own experience.

[The validity of laboratory tests in the diagnosis of alcoholism and alcoholic liver injury]. / Validita laboratórnych vysetrení pre diagnostiku alkoholizmu a alkoholických poskodení pecene.

The authors assessed the value of commonly available laboratory examinations for the diagnosis of suspected excessive alcohol intake and suspected liver damage by alcohol. They tested the validity of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gammaglutamyl transferase (GMT), the blood sugar level, serum cholesterol, bilirubinaemia, ferrinaemia and mean corpuscular volume (MCV). The highest validity as regards sensitivity of the examination was recorded in the MCV with a sensitivity of 0.78 and examination of GMT with a sensitivity of 0.72. By combination of MCV and GMT in an alternative manner, the sensitivity rose to 0.87. Evaluation of the groups by the method of discrimination analysis, using all ten parameters, revealed the possibility of 100% correct classification of non-alcoholic subjects and a 86.2% correct qualification of alcoholic subjects.

[Paraneoplastic syndromes in internal medicine]. / Paraneoplastické syndrómy vo vnútornom lekárstve.

Paraneoplastic syndromes supplement the complex clinical picture of malignomas. Their knowledge improves early diagnosis. The development, course and regression of paraneoplastic syndromes indicates that they have a multifactorial origin and their manifestation depends on the biochemical, metabolic and immunological situation of the organism. The pathogenesis involves many obscure points and the clinical picture is often a surprise, an unexpected variant with regard to theoretical expectations. Sometimes paraneoplastic syndromes prove fatal in patients with a tretable tumour. There does not exist any paraneoplastic syndrome specific for a certain malignoma. In the authors' group of 1538 patients with malignant tumours belonging into the competence of internal medicine a paraneoplastic syndrome was found in 282 (18.3% patients). In 144 (9.4%) it was the first symptom of disease, incl. 74 (4.8%) where it was also an early sign of the disease. In the group thrombohaemorrhagic and rheumatological paraneoplastic syndrome was most frequently encountered. The relatively highest incidence of early paraneoplasias was observed in those malignomas which affect the immunocompetent apparatus (immunocytomas, haemoblastoses, and lymphomas). The authors recommend that suspect paraneoplastic syndromes should be dispensarized as precanceroses.

Early paraneoplastic syndrome in medical oncology: clinicopathological analysis of 1694 patients treated over 20 years.

During the period of 1963-1982 we treated at our hospital 1694 patients with diagnosed internal malignancies. Of them, paraneoplastic syndrome as the first manifestation of the disease was found in 127 (7.4%). In 79 patients (4.6%) this first symptoms has also been an early manifestation of the malignoma (good general condition, without typical clinical symptoms of cancer). The paraneoplastic syndrome as the first symptom of the disease was manifested mainly as rheumatologic (58 patients; 3.4%) and thrombophlebitis (33 patients; 1.9%) symptoms. While thrombophlebitis as the first symptom of the disease was at the same time only in 48% also an early symptom, rheumatologic syndromes were also early symptoms in as many as 74% of cases. Hemoblastoses, lymphomas, and plasmacytomas are diseases which were accompanied by a paraneoplastic syndrome not only as the first but also as an early manifestation of the disease.

The thrombo-embolic disease as a paraneoplastic syndrome.

Out of 4139 patients autopsied, 629 had the thrombo-embolic disease (15.2%). 548 patients suffered from various malignancies, and among them 102 (19.9%) had the thrombo-embolic disease as well. Only 5 patients with the thrombo-embolic disease had an occult malignoma. The increased incidence of the thrombo-embolic disease in patients suffering from various types of malignancies is statistically significant (0.05 less than p greater than 0.02). The interceptibility of the paraneoplastic thrombo-embolic disease at the hospital departments is very low when compared to necropsy (about 3%) but, on the other hand, in more than one half of all cases studied it represents the first clinical symptoms of a malignoma, though rarely evaluated correctly. The clinico-pathologic aspects of the paraneoplastic thrombo-embolic disease are discussed.