It has been stated that it is inappropriate to conduct an extensive search for occult malignancy in patients with thromboembolism, unless there is some more specific indication. The present study defines those specific indices. By analyzing the clinical features of 11 consecutive patients with occult cancer presenting with thromboembolism (TE), criteria which differentiate TE in occult cancer from TE complicating other disorders were defined. These are the absence of an apparent cause for the TE at the time of the patient's admission, age more than 50 years, multiple sites of venous TE, associated venous and arterial TE, TE resistant to therapy with oral anticoagulants, and the presence of associated paraneoplastic syndromes. The incidence of these parameters in case reports from the literature was also analyzed. The six criteria that were prevalent in our series of patients with paraneoplastic TE, were observed to occur with similar incidence in different groups of historical cases. These criteria may be useful for stratification of patients with TE with regard to the probability of the presence of an occult cancer and the indications for further investigations.

Adult↗

PubMedDate not supplied

Incidence and diagnostic significance of paraneoplastic thromboembolism disorders. A survey from a community hospital.

The incidence of paraneoplastic thromboembolic disorders (PTD) at first presentation of cancer and its diagnostic significance as a cancer marker are unknown. Fourteen thousand two hundred and eighty-seven patients were admitted to the department of medicine during the period 1978-1987. Nine amongst those patients had thromboembolic disorders (TE) as the initial clinical disturbance. In another 2 patients TE was the first sign of recurrence in apparently cured cancer. PTD patients were elderly (median age 70 years), the clinical variants of PTD included solitary venous thrombosis in 3, migratory thrombophlebitis in 4, pulmonary TE in 1, arterial occlusion in 2, and associated arterial and venous occlusion in 1 case. PTD antedated the diagnosis of neoplasia by 3-180 days (median 21 days). Analysis of the impact of TE on the initiation of search for occult malignancy (PTD-cancer relevance) and on patient survival (PTD-cancer prognosis) demonstrated high PTD-cancer relevance scores in 9 among 11 cases, but favorable PTD-cancer prognosis scores in only 3 cases. This is consistent with the significance of TE for the earlier diagnosis of a, usually, disseminated cancer. The present study demonstrated a higher than usually stated association of TE with occult cancer (4.6%). It differs from recent studies by including not only venous thrombosis, but a variety of venous and arterial TE disorders as well. By studying the population from a community hospital, we believe that these data would reflect the situation in the general population at large. In this way our study differs from those of tertiary care hospitals in that our patients were not preselected.

Adult↗

PubMedDate not supplied

Acute cholecystitis as a complication of unrelated operations: an update review.

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Acute Disease↗

PubMedDate not supplied

Rational and cost-effective management of the patient with a solid breast lump.

The rational management of the palpable breast lump requires a tissue diagnosis. The more conventional approach is biopsy under general anesthesia, examination of frozen sections and "follow-on" mastectomy when indicated. In the present study, we aimed at arriving at an unequivocal tissue diagnosis by studying permanent sections at a separate ambulatory procedure either with formal biopsy under local anesthetic or, in suspicious lumps, with the Trucut biopsy needle (Travenol Laboratories, Inc. USA). Only 7 (14%) of the 56 women with 64 breast lumps were hospitalized for biopsy under general anesthesia. In 13 out of 22 breast cancers, the definitive diagnosis was made by examining Trucut needle biopsy specimens. This alternative approach provides a significant reduction of costs, more efficient utilization of operating time and a fully evaluated, psychologically prepared patient, when mastectomy is indicated.

Adolescent↗

PubMedDate not supplied

Secondary hyperparathyroidism and nonmedullary thyroid cancer.

Nonmedullary thyroid carcinoma is known to occur in association with primary hyperparathyroidism. A combination of secondary, uremic, hyperparathyroidism and non-medullary thyroid carcinoma is rare and was hitherto reported in only 12 cases. We report another three patients with this parathyroid/thyroid disease combination, suggesting that it may represent not merely a coincidence. A number of factors active in secondary hyperparathyroidism may play a role in the induction and/or promotion of the thyroid cancer. These include parathyroid endocrinopathy, goiterogenic effect of prolonged hypercalcemia, and uremia. During surgery on the parathyroid glands, associated thyroid lesions demand special considerations.

Adenocarcinoma↗

PubMedDate not supplied

Excision of intrathyroid metastases from extrathyroidal sources.

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Aged↗