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The work was aimed at determining the concentration of lactate as a marker of ischaemia in patients with lower-limb atherosclerosis obliterans (hereinafter referred to as LLASO) on the background of dosed physical load (terrain cure and general physical exercises). We examined a total of 157 patients subdivided into 4 groups, i.e., 2 study groups and 2 control groups. All the patients were found to have grade 2a-2b ischaemia. The first study group consisted of the patients who had previously been receiving standard conservative therapy for several years. They were recommended to continue this type of therapy to be only supplemented with dosed physical loading. The 1st control group enrolled a total of 20 patients commissioned to receive conventional therapy alone. Patients from the 2nd study group had received no previous therapy. They were offered monotherapy in the form of dosed physical loads. Patients of the 2nd control group, also previously untreated, were given standard conservative therapy combined with physical loads. All the patients examined were initially found to have had high values of the blood lactate level. We then determined the possibility of walking and the dynamics of the blood lactate level on the background of the therapy offered, thus allowing us to confirm high efficacy of terrain cure eventually leading to increased distance of pain-free walk, both as a constituent part of the combined modality therapy and in the form of monotherapy in patients presenting with LLASO. We also revealed a correlation between the blood lactate level and the increase in the distance walked. The obtained findings suggest that the blood lactate level may be a marker of the presence of ischaemia in LLASO patients and the degree of its severity.

On the basis of rich clinical material and the findings of pathophysiological studies the authors suggest a new concept of the ischemic syndrome in acute disorders of arterial circulation in the limbs with identification and description of pathophysiological features of its separate stages--occlusion, recirculation, and early and late postrecirculation. The competence of the reported theoretical assumptions, is confirmed clinically by comparison of the results of treatment of various patient groups. The necessity for active surgical tactics in acute occlusion of the great limb arteries is substantiated.

The contribution of some regulatory humoral systems (sympathoadrenal, pituitary-adrenal, kallikrein-kinin and renin-angiotensin ones) to the development of postischemic hemodynamic disorders associated with acute arterial occlusion are demonstrated. Pathogenetic rationale is offered for methods of postischemic cardiovascular functional disorders control (the use of antienzyme drugs, cortisol, tocopherol on days 1-3 of the postischemic period).

Examined were 47 patients with acute ischemia of the extremities: 29--with favourable outcome, and 18-with the development of gangrene. Scintigraphy of the extremity with 99mTc-Sn-pyrophosphate was performed; urinary excretion of epinephrine and norepinephrine, DOPA and dopamine, and vanillylmandelic acid as well was studied; the content of ACTH, cortisol and cyclic adenosine monophosphate in the blood was defined. The use of radionuclide and biochemical methods of investigation permits to assess the degree of severity of the ischemic injury to the tissues of the extremities.

The results of examination of the hypophyseal-adrenal and sympatheticoadrenal systems in 69 patients with embolism of the main limb arteries are discussed. Marked activation of these systems in this category of patients during ischemia was revealed. A discrepancy was found between the blood adrenalin and cortisol levels in patients in a definite stage of the postischemic period and their hormonal effect on the body. The need to keep a record of disorders of the mechanisms of neurohumoral regulation in correcting the cardiovascular function in patients with acute arterial obstruction is emphasized.