Das Lactat/Pyruvat-System als Indicator des Ruhestoffwechsels bei arterieller Verschlußkrankheit der Gliedmaßen

Effects of intra‐arterial prostaglandin E1 in patients with peripheral arterial occlusive disease

“…We believe that there is also a metabolic effect on muscle cells, as indicated by the decrease of high lactate/pyruvate ratios, which serve as an indicator for tissue hypoxia [35]. These results are in accordance with a study on healthy volunteers and patients with peripheral arterial occlusive disease which indicated an impaired increase of lactate during ergometric strain and PGEl infusion [36].…”

Influence of Deproteinized Hemodialysate on Rest Pain and Walking Distance in the Presence of Peripheral Chronic Arterial Occlusive Disease

“…Lactacidosis, ionized calcium, and hyperosmolarity exert a certain concentration-dependent effect, as well as a drastic deterioration of blood flow conditions ; this leads to a vicious circle and finally brings microcirculation to a standstill until cytolysis occurs. [1][2][3]5,6,9,37 In the occurrence of rest pain it is the aim of every conservative therapy to finally improve the metabolic situation with elimination of tissue acidosis and recovery toward at least a short pain-free walking distance.45 The clinical effect in patients suffering from rest pain has been proved only for prostaglandin E, in recently conducted extensive studies . 46,47 The selected reference substance bencyclan, like prostaglandin E, , has strong vasodilating properties acting mainly on the arteriolar musculature35; it leads to an improvement of blood flow conditions, especially under lactacidotic and hyperosmolaric stress conditions, as they locally occur in patients with rest pain.…”

“…Energy supply mainly takes place compensatorily under anaerobic conditions via glycolysis: glucose utilization is reduced, the lactate/pyruvate ratio is shifted toward lactate, oxygen utilization is decreased, and the content of high-energy phosphates in the cells is lower.2-5 These metabolic changes are combined with a decrease in perfusion pressure and perfusion disturbance in the microcirculatory range.4 '6 In the presence of rest pain as a result of hemodynamic decompensation, peripheral perfusion is reduced to such an extent that there are local ischemic changes in metabolism with a strong increase in lactate and ionized calcium. 2,5,7,8 The clinical symptoms can be facultatively influenced by dropping the respective extremity and thus creating an increase in the arterial/venous pressure gradient; walking without claudication is not possible, the pain-limited walking distance is confined to a few meters.9 9 The deproteinized hemodialysate is a metabolically active substance with insulin-like efficacy. It increases glucose take-up into the cells by direct stimulation of the membrane-based glucose carriers,'°-'4 as well as of oxygen utilization.…”

Zur Stoffwechselsituation des Herzens in der Abgangsphase der extrakorporalen Zirkulation*

“…Dieser Anstieg ist nur von einem vergleichsweise halb so hohen Anstieg der arteriellen Brenztraubensäure gefolgt, so daß der arterielle Laktat-Pyruvatquotient, welcher in Ruhe bei wachen Patienten 10 bis 12 beträgt auf über 20 ansteigt (HILD U. Mitarb. [9]). Die dürfte einerseits in der während der extrakorporalen Zirkulation sich entwickelten Azidose (KIRKLIN u. Mitarb.…”