PIKKVIKSKY SYNDROME - a combination of the chronic progressing respiratory insufficiency (in the absence of primary pathology in lungs) with obesity, drowsiness and gradual development of a pulmonary heart. The name of a syndrome was cast by the artistic image created by Ch. Dickens in the novel «Notes of Pikkviksky Club».
The item of page for the first time under such name was described by Eeruell (Page S. Bur-well) with soavt, in 1956, and in domestic literature — B. B. Kogan in 1962.
Etiology, apparently, it is various. It was noted possible etiol, a role of a contusion of a brain, a mental injury, inf. diseases, pathology of childbirth. However it is not always possible to establish accurate connection between P. by the village and the postponed diseases.
Pathogeny. The central place in P.'s development by page is allocated to dysfunction of a hypothalamus, a cut is shown by increase in appetite, obesity and frustration of a dream. Obesity (see) develops on hypothalamic type with a preferential adiposity on a trunk, in a stomach. Intra belly pressure increases, high standing of a diaphragm with decrease in its excursion is noted. Thereof the area of the ventilated alveoluses decreases, especially at horizontal position of a body.
Respiratory insufficiency (see) it is caused by also central disturbances of regulation of breath gaining the leading value from certain patients. Most often the minute volume of breath decreases and disturbances of its rhythm are observed. The respiratory arrhythmia is caused by decrease in sensitivity of a respiratory center to changes of concentration of carbon dioxide gas in blood. Hypoventilation of lungs brings to hypoxias (see) and hypercapnias (see), to disturbances of acid-base equilibrium, and also to hypertensia of a small circle of blood circulation (see) which is aggravated with restrictive changes in lungs (especially at a frequent complication of P. of page hron, pneumonia) and leads to development pulmonary heart (see).
Clinical picture. Patients complain of the asthma amplifying at an exercise stress, drowsiness; the increased appetite, sometimes thirst, excess weight, an adynamia, decrease in a libido are noted. The people suffering from P. page draw with the drowsiness attention of people around; they fall asleep at once as soon as they appear in a quiet situation. The dream can come during meal, survey of the patient with the doctor. Also disturbance of a night dream which does not bring satisfaction with the patient is observed, and they often complain of a bad dream, a headache in the mornings. The respiratory rhythm is in most cases broken, is more often as Cheyn's breath — Stokes (see. Cheyna — Stokes breath ) with the periods of an apnoea, to-rye are especially expressed during sleep.
At survey obesity with uneven distribution of fatty deposits (preferential on a face, a thorax, but especially on a stomach, it is frequent in the form of an apron), the hyperhidrosis, cyanosis of mucous membranes and integuments, an asthma come to light; at a decompensation of a pulmonary heart hypostases are possible. Short wind and cyanosis amplify at an exercise stress and in position of patients on spin.
Perkutorno also radiological is defined an elation of the lower bounds of lungs (2 — 3 edges higher than norm), decrease in an excursion of the lower pulmonary fields. At auscultation of lungs bitter rattles, homogeneous on caliber, in a projection of the lower shares are quite often listened; in case of accession hron, pneumonia (see) or bronchitis (see) the auskultativny picture respectively changes. By means of an electrocardiography and radiological signs of a hypertrophy of the right departments of heart are defined, and their dilatation at a decompensation of a pulmonary heart is found also at percussion. Increase in the ABP is possible.
Diagnosis establish on typical a wedge, to signs and results of a research of respiratory functions. Reduction of vital and total capacity of lungs, decrease in minute volume of breath comes to light.
In blood increase in number of erythrocytes, concentration of hemoglobin and delay of ROE — signs is observed polycythemias (see) as compensatory reaction of an organism to a long anoxemia which is found at a research of blood gases. The difference in the oxygen content between an arterial and venous blood is lowered and tension of carbon dioxide gas in plasma is increased.
Treatment it is carried out taking into account an estimated etiology, but the leading place is taken by the symptomatic therapy directed first of all to weight reduction of a body. The diet at the rate of 600 — 800 kcal in the first 7 — 10 days, then on 1200 kcal a day is appointed. Apply diuretics. Inhalations of oxygen carry out only in combination with use of respiratory analeptics and with obligatory control of dynamics of carbon dioxide gas in plasma since at reduced sensitivity of a respiratory center to carbon dioxide gas braking of its reflex stimulation by the anoxemia eliminated by oxygenation of a blood plasma is possible. Apply LFK for the purpose of development of diaphragmal respiration. Purpose of the hypnagogues oppressing a respiratory center, contraindicated.
Forecast for life rather favorable. Working capacity and the general condition of patients is defined by hl. obr. degree of respiratory insufficiency and a current of the pages which are often accompanying P. hron, bronchitis and pneumonia.
Bibliography: Vane A. M., Latash L. P. and Yakhno H. N. Pikkviksky syndrome, Klin, medical, t. 50, No. 1, €. 55, 1972; Kogan B. B. Clinic of a pulmonary heart at patients with obesity (Pikvik's syndrome), in the same place, t. 40, No. 4, €. 27, 1962; Burwell of Page S. Extreme obesity associated with alveolar hypoventilation, Pickwickian syndrome, Amer. J. Med., v. 21, p. 811, 1956; Pulmonary medicine, ed. by G. A. Guenter, Philadelphia, 1977.
A. G. Chuchalin.