Symptomatology of oncological diseases consists not only of local symptoms caused by the primary malignancy or its metastases, but also by general systemic signs that are not directly connected with the tumor. These symptoms are mostly associated with auto-immunity or endocrine influences. In many cases, the source of paraneoplastic syndromes (PNS) is unknown. Nearly 15 % of on-cological patients demonstrate these syndromes but it is diagnosed much more rarely. The survey of the numerous PNS is offered. The significance of the PNS differs for oncologists and other physicians who encounter it m their practice. The reason of those differences, as well as the connection between PNS and cancer toxicity is discussed. The experience of antitoxic therapy (hemosorption, lymphosorption, enterosorption) used in our clinic in the previous years is overviewed.

Patients with juvenile idiopathic arthritis older than 18 years and with more than 3 years of disease duration living in different parts of Ukraine were included into the study. Data regarding sociodemographic features, fulfillment of adult classification criteria, Health Assessment Questionnaire, articular and extra-articular Juvenile Arthritis Damage Index and disease activity were analyzed. We observed 122 adult patients with the history of juvenile idiopathic arthritis irrespective of the presence of active inflammation at the moment of the examination. This group included patients from different regions of Ukraine diagnosed with juvenile idiopathic arthritis during 1984 - 2013. An adult rheumatologist examined all patients and the diagnosis was revised according to the adult classification of rheumatic diseases. Typical diagnostic criteria for rheumatoid arthritis were estimated in 32,8 % of patients, ankylosing spondylitis - in 31,1 % of patients, undifferentiated arthritis - in 13,9 % of patients, Stillіs disease - in 4,9 % of patients, psoriatic arthritis - in 0,8 % of patients, steady clinical laboratory remission - in 16,5 % of patients. Most patients (81,8 %) with rheumatoid factor positive polyarticular juvenile idiopathic arthritis fell under rheumatoid arthritis criteria in adulthood, and in 85 % of patients with enthesitis-related arthritis as well as 53,8 % of patients with extended oligoarthritis ankylosing spondylitis developed in adulthoixi. 68,8 % of patients with systemic juvenile idiopathic arthritis, 68 % of patients with rheumatoid factor negative polyarthritic subtype and 55 % of patients with enthesitis-related arthritis had disability and incapacitation. Minimal disorders of the patientsі general condition according to the Health Assessment Questionnaire in adult age were found in most subtypes of juvenile idiopathic arthritis classified according to the International League of Associations for Rheumatology (extended and persistent oligoarthritis, rheumatoid factor positive polyarthritis, systemic subtype); moderate disorders of the general condition were found in enthesitis-related arthritis and rheumatoid factor negative polyarthritis. Side effects of juvenile idiopathic arthritis according to the articular Juvenile Arthritis Damage Index included severe articular damage being most frequently found in systemic and rheumatoid factor positive polyarthritis subtypes of juvenile idiopathic arthritis, while side effects of juvenile idiopathic arthritis according to the extra-articular Juvenile Arthritis Damage Index included extra-articular damage being found in systemic and rheumatoid factor negative polyarthritis subtypes of juvenile idiopathic arthritis, that was confirmed by the assessment of physical health according to the Short Form Health Survey-36, which was the worst in patients with systemic (40,3 +- 12,6) and rheumatoid factor negative polyarthritis (38,9 +- 9,4) subtypes of juvenile idiopathic arthritis. Conclusions: further research of remote consequences of juvenile idiopathic arthritis in adult age and long-term observation of such patients require a detailed study to improve diagnostics and provide adequate treatment of rheumatic diseases with juvenile onset in adult age.

Ювенільний ідіопатичний артрит (ЮІА) - це термін, що використовується для позначення групи гетерогенних педіатричних ревматичних захворювань. Багато з цих станів персистують і в більш зрілому віці. Наявність хронічного запального захворювання разом із лікуванням глюкокортикоїдами є фактором ризику остеопорозу в молодих чоловіків. Мета роботи - вивчення мінеральної щільності кісткової тканини (МЩКТ), показників T і Z у молодих чоловіків з ЮІА. Дослідження включало 50 пацієнтів віком 19 - 25 років, розподілених на 2 групи: I - 25 практично здорових молодих чоловіків; II - 25 молодих чоловіків із різних регіонів Україіни, у яких у дитинстві був діагностований ЮІА, незалежно від наявності або відсутності активного запалення під час спостереження. Двохенергетичну рентгенівську денситометрію (Prodigy, GE Lunar, Madison, США) було проведено в Інституті геронтології ім. Д. Ф. Чеботарьова, Українському науково-медичному центрі проблем остеопорозу разом з аналізом МЩКТ, показників T і Z у різних частинах скелета. Молоді пацієнти з ЮІА та здорові чоловіки не відрізнялися за віком, ростом, вагою й індексом маси тіла. У 4 пацієнтів з ЮІА (16 %) були переломи, тоді як у контрольній групі їх не відзначалося. Негативний вплив ЮІА на МЩКТ було виявлено в II групі на відміну від першої. МЩКТ поперекового відділу хребта в II групі була нижчою (p << 0,01), ніж у здорових суб'єктів, як і показник Z (p << 0,001) на рівні L1 - L4 поперекового відділу хребта. МЩКТ, індекси T і Z в ділянці шийки стегнової кістки були нижчими в II групі, ніж у першій (p << 0,001; p << 0,001; p << 0,01 відповідно). Значні відмінності між двома групами було виявлено щодо загальної МЩКТ (p << 0,001), показників T (p << 0,01) і Z (p << 0,05). У пацієнтів з ЮІА нижчими були МЩКТ (p << 0,01) й індекс T (p << 0,05) в ультрадистальній ділянці променевої кістки. Зниження МЩКТ до рівня остеопенії (показник Z << -2 SD) було виявлено у 20 % пацієнтів на рівні L1 - L4 поперекового відділу хребта, у 8 % - в ділянці шийки стегнової кістки, у 12 % - всього організму і у 8 % пацієнтів - в ультрадистальній ділянці променевої кістки. Висновки: у молодих чоловіків з ЮІА віком 19 - 25 років відзначається зниження загальної МЩКТ, показників T і Z, що вказує на негативний вплив захворювання на кісткову тканину у порівнянні зі здоровими чоловіками відповідного віку.

Prolonged pain, stress, pathological conditions and related emotions can alter the perceived sensation of pain. The aim of our study was to study the QL and the level of alexithymia in adult patients with different types of juvenile idiopathic arthritis (JIA). 173 young people aged 18 - 40 years old were examined: 118 adult patients with different ILAR variants of JIA, 30 patients with ankylosing spondylitis (AS) and 25 healthy young people. The QL was assessed using the Short-Form-36 questionnaire (SF36) with further assessing the level of alexithymia by Toronto alexithymia scale (TAS-20). The analysis of QL shows that PCS (44,8 +- 9,9) was significantly lower (p = 0,001) in patients with JIA than in healthy subjects (55,7 +- 6,9) of the corresponding age and sex, but did not differ from patients with AS (42,3 +- 7,5). Patients with JIA had lower physical (p = 0,001), role functioning (p = 0,001) and bodily pain (p = 0,001) compared with healthy, with no difference from patients with AS. In the distribution of patients with JIA in groups by the level of alexithymia, differences in QL were riot revealed by MCS or PCS and scales related with them. The relationship analysis between the alexithymia and QL in patients with JIA shows, that elevated and high levels of alexithymia were related with low levels of MCS (p << 0,05), role functioning (p << 0,05), mental health (p << 0,05). PCS and physical functioning did not affect the level of alexithymia in adult patients with JIA. PCS, role functioning, bodily pain, tnd general health were the lowest in patients with poly-articular JIA. However patients with oligo-, poly-articular, enthesyte-related to PCS. Patients with poly-JIA with elevated and high levels of alexithymia revealed significantly lower social (p << 0,05) and role (p << 0,05) functioning, mental health (p << 0,05) compared to patients without alexithymia The presence of low bodily pain in alexithymic patients was found. Signs of alexithymia were found in 90 % and 85 % of adult patients with the oligo-arthritis and enthesyte- related JIA, respectively. The comparison of the QL in patients with oligo-arthritis and enthesitis-related JIA with different levels of the alexithymia shows no significant differences. Conclusions: 85,2 % of adult patients with different variants of JIA have elevated and high levels of alexithymia Adult patients with JIA have lower physical functioning than healthy individuals of the same age and sex, although they do not differ from the control group and AS group on psychological functioning and related vitality, social and role functioning, and mental health. The presence of alexithymia is related with a low level of psychological functioning, role functioning, mental health. However, physical functioning did not affect the level of alexithymia in adult patients with JIA. Patients with poly-JIA have the lowest physical role function, bodily pain and general health, but recording to the psychological functioning there were no differences between different variants of JLA in adulthood. Patients with poly-JIA with elevated and high levels of alexithymia have significantly lower social (p << 005), role (p << 0,05) functioning and mental health (p << 0,05) compared to patients without signs of alexithymia.