The usefulness in cirrhotic patients of hemodynamic measurements by Doppler ultrasonography (US) is still not defined. We investigated the relationships between Doppler measurements and the severity of ascites. Portal blood flow velocity and volume, and hepatic and renal arterial resistance indexes (RI) were measured in 57 cirrhotic patients (19 without ascites, 28 with responsive ascites, and 10 with refractory ascites) and 15 healthy controls. The renal arterial RI were obtained for the main renal artery, interlobar vessels, and cortical vessels. Cirrhotic patients had decreased portal blood flow and an increased congestion index (CI). Only the CI was correlated to the severity of ascites, showing that it is also a reliable measure of the severity of portal hypertension in patients with ascites. The hepatic and renal artery RI were increased in cirrhotic patients, and the two values were correlated (r ؍ .68; P ؍ .00001). The RI of renal interlobar and cortical vessels were higher in patients with refractory ascites than in patients without ascites (P F .02 and P F .009), and correlated with sodium excretion rate (r ؍ Ϫ.45; P F .003), the reninaldosterone system, and creatinine clearance (r ؍ Ϫ.62; P F .0002). The RI decreased from the hilum of the kidney to the outer parenchyma in healthy subjects and patients with responsive ascites, but this difference disappeared in patients with refractory ascites. This indicates that the degree of renal vasoconstriction varies in different areas according to the severity of the ascites. Cortical vessels are involved mainly in patients with refractory ascites, suggesting that the intrarenal blood flow distribution in cirrhosis tends to preserve the cortical area and that severe cortical ischemia is a feature of refractory ascites. (HEPATOLOGY 1998; 28:1235-1240.) Doppler ultrasonography (US) is a noninvasive tool for the assessment of vascular patency. It has been used to measure the hepatic arterial and venous flows of patients with portal hypertension [1][2][3][4] and to document the increases in renal resistances that occur in some cirrhotic patients. [5][6][7][8] That some of these measures have prognostic value has been demonstrated. 4,7-9 Although a diagnostic gray-scale US is widely employed in the evaluation of cirrhotic patients, Doppler is rarely used. One pending problem is to establish which Doppler measurements correlate best with the different complications of portal hypertension. This could also help to determine whether or not the Doppler is useful in monitoring the effects of pharmacological therapies.The aim of the present study was to correlate the Doppler measurements of portal blood flow and of hepatic and renal arterial resistances with the presence and severity of ascites and renal failure in cirrhotic patients. PATIENTS AND METHODSFifty-seven cirrhotic patients, 35 men and 22 women, admitted consecutively to our hospital were enrolled in the present study. Their mean age was 57 Ϯ 9 years (range, 37-73 years), and their mean body weight was 6...
Background:The risk of thyroid carcinoma in patients with Graves disease has been particularly emphasized when nodules coexist with thyroid hyperplasia; a surgical approach has been suggested.
US is useful in the selection of candidates for extracorporeal electromagnetic shock wave lithotripsy and in monitoring the progress of treatment.
To investigate possible correlations between thyroid vascularization and activity of Graves' disease, we measured blood flow (TBF) at the inferior thyroid artery and intraparenchymal vascularization (number of vessels per square centimeter) by color Doppler ultrasonography (CDU) on Graves' patients at different phases of the disease. We studied 88 patients cross sectionally: 22 untreated; 17 euthyroid after 6 months of methimazole; 49 euthyroid at drug withdrawal after 12 to 24 months of treatment. The patients of the latter group were followed up for 29.1 +/- 6.3 months after discontinuation of treatment. On the day of CDU examination, free triiodothyronine (FT3), free thyroxine (FT4), thyrotropin (TSH), antiperoxidase and anti-TSH receptor (TRAb) antibodies were measured. Vascularization indices were significantly higher in the Graves' patients than in controls. In the patients euthyroid under treatment, vascularization was not significantly lower than in the untreated group, but TBF and vessel number both appeared clearly reduced in the patients tested at drug withdrawal. The vascularization indices at drug withdrawal were significantly higher in the patients who relapsed than in those in stable remission: TBF (mL/min) 50.6 +/- 36.8 vs. 23.8 +/- 17.5, p = 0.001; vessel number/cm2 1.8 +/- 0.8 vs. 0.8 +/- 0.5, p = 0.002. A multivariate analysis, evaluating the predictive value of vascularization, hormonal and immunological parameters for relapse, demonstrated a significant predictive value for TRAb (RR 8.2; p = 0.001) and a weak predictive value for TBF (RR 1.1; p = 0.02). In conclusion, CDU examination confirms that thyroid hypervascularization in Graves' disease is not related to thyroid hormone circulating levels. The association of increased TBF and high levels of TRAb in the relapsing forms of disease suggests that thyroid hypervascularization is probably related to the activity of the underlying autoimmune processes.
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