Cachexia

КАХЕКСИЯ, cachexia (from Greek *kakos*—bad and *exis*—condition), a symptom complex observed in a number of diseases leading to exhaustion, expressed as a general decline in nutrition, severe emaciation, and physical weakness. Cachexia is most frequently observed in malignant neoplasms, chiefly in cancer (cancer cachexia), especially in cases where cancer affects the digestive tract. Cachexia is also encountered in certain systemic diseases of the lymphatic glands, primarily in malignant lymphogranulomatosis (Hodgkin's disease). Severe heart diseases with prolonged decompensation can also lead to signs of cachexia (cardiac cachexia of French authors). Cachexia is sometimes accompanied by severe cases of chronic infections (tuberculosis, syphilis, malaria, etc.). ^a Also certain chronic intoxications and poisonings (mercury, lead poisoning). A special form of cachexia is caused by the complete removal of the thyroid gland (cachexia thyreopriva Kocher's; see Thyroid Gland). Disease of the brain appendage sometimes gives the picture of hypophyseal cachexia described by Simmonds. - The general appearance of cachectic subjects is suffering, emaciated, with sunken eyeballs and a blue tint under the eyes. Usually dryness and decreased turgor of the skin are observed, a pale, waxy, yellowish-greenish, sometimes dirty brown color of the skin, often signs of furunculosis, acne, and various pigmentation (acne, purpura, chloasma cachecticorum). Hair loss, brittleness of nails, and other trophic disorders are also observed. Almost complete disappearance of the subcutaneous fat layer accounts for the picture of severe emaciation with significant weight loss. Muscle atrophy, flaccidity, and hypotonia are noted. On the blood side, signs of hypochromic anemia are observed. Edemas (hydro ps cachecticorum) are often observed, which cannot be explained by cardiac phenomena or changes in the kidneys, as was previously thought. The occurrence of edemas apparently stands in connection with observed quantitative (hydraemia) and qualitative changes in blood proteins, which facilitate changes in the conditions of distribution of fluid between the blood and tissues. The pathogenetic essence of cachexia is not established. Cachexia in malignant neoplasms is of particular interest, as it is one of the most important symptoms. As is known, cachexia is especially frequently observed in cancer, which directly hinders the passage of food through the digestive tract (cancer of the esophagus, pylorus, intestines). In these cases, the appearance of cachexia can be explained to a certain extent by the stenosing factor, which causes quantitative disturbance of the nutrition of the organism (inanitio). This is corresponded to by the circumstance that analogous cachexia phenomena are observed in the so-called edema disease (Oedemkrankheit), which appears as a result of ordinary starvation. It is also noted that cachexia in cases of pyloric cancer noticeably decreases after gastrostomy operation, despite the progressive growth of metastases. However, such an explanation of the development of cancer cachexia from the point of view of the mechanical factor cannot be considered satisfactory, as cachexia is observed quite often in cases of cancer of the stomach in the absence of obstacles to the passage of food. The frequent appearance of cachexia in cancer of the digestive organs was attempted to be explained by disturbance of their function (cancer of the liver, stomach, pancreas). It must be noted, however, the obvious discrepancy between the spread of the tumor in any organ and the degree of cachexia. It is known that a cancer tumor of small size can cause cachexia just as well as a widespread cancer, having had time to give metastases. Furthermore, other malignant (and especially benign) neoplasms of the same organs give cachexia significantly less often, despite approximately the same area of involvement of the organism. One must therefore think of some specific cause, which causes secondary disturbance of nutrition and cachexia. There is a hypothesis (by many others) that cancer cells, as a result of their vital activity, produce a special poison (Krebsgift), which causes cachexia. It was not possible to isolate this poison. Some authors emphasize the significance of the enzymatic activity of cancer cells. Thus, Borst considers that in stomach cancer the glands of the mucous membrane secrete special digestive enzymes, which act destructively on the whole organism. Blumenthal and Neuberg attribute to cancer cells the ability to produce a heterolytic enzyme, which destroys tissue protein (more details—see Cancer). In this way, the question of the pathogenesis of cachexia is quite complex. First of all, one has to abandon the specific cause causing cachexia. Cachexia is a secondary phenomenon and can apparently be conditioned by various factors or the predominance of some of them (obstruction of the gastrointestinal tract, to which putrefactive processes often join, absorption of products of disintegration of tumor cells, etc.).

O. Mavarevich. YaTs Yakov Yuryevich (born in 1869), a prominent public physician and a large figure in sanitary organization. He graduated from the physics-mathematics and medical faculties of Moscow University in 1890–93. For about 25 years he worked in the zemstvo sanitary organization, first as a district physician in the districts of Tula province (from 1894), and then as a sanitary physician of Dmitrovsky district of Moscow province. £*.. . +'тщ. (from 1908). He took active part in the Pirogov Society; in 1917 he was elected a member of its board. In 1917 he transferred to the Moscow sanitary bureau, where he conducted a number of sanitary investigations and sanitary-statistical studies. In 1919 he took the place of initially deputy head, and in 1920 head of the sanitary-epidemic subdepartment of Moszdravotdel. Here YaTs became one of the ideologists and practical conductors of the so-called Moscow system of dispensarization. YaTs participated in professional organization (chairman of the All-Russian Union of Professional Associations of Physicians of 1917; member of the bureau of the medical section of the World Medical Sanitary Labor of the first years). His teaching activity was carried out as a professor of child hygiene at the medical-pedological courses of NKZdr (1918), and from 1920 at the pedological institute and ped faculty of 2nd MSU. From 1925 YaTs is elected a member of the Moscow Council of R. and K. D. of several convocations. YaTs is the author of numerous journal articles on various sanitary questions published before the revolution in "Obshchestv, vrach", in periodic publications of Moscow Zemstvo, etc. The chief works of YaTs in recent times: "System and methods of dispensarization" (M., 1925); "Dispensary system of service in the light of two-year experience of the city of Moscow and Moscow province" (M., 1926); "Sanitary organization of Moscow province" (M., 1928). From 1925 YaTs edits the collections "Labor and health of workers" (M., until the end of 1929, 17 issues were published).

~-щ (from 1908).