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The study investigated the hemodynamic and neurohumoral effects of albumin infusion after total paracentesis in 18 patients with cirrhosis and tense ascites. Measurements of systemic and splanchnic hemodynamics, and vasoactive neurohumoral systems were performed before and immediately after total paracentesis. The patients were then randomized to receive albumin or not, and hemodynamic and humoral measurements were repeated at 24 hours. Hemodynamic and humoral changes just after paracentesis were similar in patients later randomized to receive albumin infusion or not. Twenty-four hours after total paracentesis, patients not receiving albumin had significant reductions in cardiac index (-13%; P = .005), femoral blood flow (-17% P = .004), and pulmonary capillary pressure (-16%; P = .02), which were accompanied by significant increases in plasma renin activity (PRA) and plasma aldosterone (PA) and by significant decreases in atrial natriuretic factor (ANJ?) and plasma sodium. By contrast, there were no significant changes in patients receiving albumin, except for an increase in ANF and a further decrease in PA. In both groups, hepatic venous pressure gradient (HVPG) and azygos blood flow decreased just after paracentesis returning to baseline at 24 hours. This study shows that albumin infusion prevents the impairment in systemic hemodynamics, vasoactive neurohumoral systems, and plasma sodium after a large-volume paracentesis, without detrimental effects on portal pressure and portocollateral blood flow. (HEPATOLOGY 1995;22: 753-758.)

Total paracentesis is widely used in the treatment of patients with cirrhosis and tense ascites. However, very little information is available regarding its consequences on splanchnic circulation, and its effects on portocollateral blood flow have not been investigated. Ten cirrhotic patients admitted because of tense ascites had measurements of hepatic and systemic hemodynamics, renal function and endogenous vasoactive neurohumoral systems at baseline, just after total paracentesis and 1 hr later. Total paracentesis caused a significant increase in cardiac output ( + 11%; 95% confidence interval, +4% to + 19%) and a rapid fall in portal pressure, as shown by significant decreases in both the wedged hepatic venous pressure ( -27% & 8%; p < 0.005) and the hepatic venous pressure gradient ( -10%; 95% confidence interval, -3% to -18%). This was accompanied by a marked decrease in azygos blood flow ( -28%; 95% confidence interval, -13% to -43%).These favorable hemodynamic effects were associated with a fall of the elevated levels of plasma renin activity ( -47% -+ 9%; p < 0.05), plasma aldosterone ( -31% 2 21%; p < 0.05) and plasma norepinephrine and by a decrease in levels of serum creatinine (-24% f 15%; p < 0.05) and blood urea nitrogen ( -4% 2 3%; p < 0.05). These changes were maintained 1 hr later. This study indicates that in patients with cirrhosis and tense ascites total paracentesis favorably influences the systemic hemodynamics, portocollateral blood flow and portal pressure. (HEPATOLOGY 1994;20: 30-33.)Total paracentesis has regained popularity in the treatment of patients with tense ascites (1-4). Although many studies have examined the effects of total paracentesis on the systemic hemodynamics (5-81, little infor- PATIENTS AND METHODS Patients.Ten patients were included, of which five were men and five were women. The mean age was 63 t 8 yr (mean 2 S.D.). The cause of cirrhosis was alcohol in five patients, hepatitis C in three and hepatitis B in one; in one patient it was cryptogenic. The mean Child-Pugh score was 10.5 t 1.7 points. Two patients were classified as Pugh grade B, and eight were classified as grade C. In addition to tense ascites, nine patients had peripheral edema, all patients had varices and two had bled from varices. Their mean urinary sodium excretion was 11 t 4 mEq/day. The criteria for inclusion were cirrhosis with tense ascites, serum bilirubin level lower than 10 mg/dl, prothrombin time greater than 40%, platelet count higher than 40,000/mm3, serum creatinine level lower than 3 mg/dl, and absence of hepatoma, of portal thrombosis, of hepatic encephalopathy, of infection and of recent hemorrhage from gastroesophageal varices (within 2 wk) (1). Patients gave informed consent to participate in the study.Study Design. After admission patients began a low-sodium diet (40 mEq/day) and did not receive diuretics or vasoactive drugs. On the fourth day, blood samples were taken to measure levels of serum creatinine and blood urea nitrogen (BUN). At 9 AM of the fifth day, after patients had...

We studied 23 patients with cirrhosis who had undergone retroperitoneal distal splenorenal shunt without portal-azygos disconnection more than 2 yr earlier. We investigated the suitability of the Doppler technique (ultrasound + Doppler) to assess the patency and blood flow direction through the portal vein and the distal splenorenal shunt and its correlation with the continuous thermal dilution technique. The study also assessed the influence of the distal splenorenal shunt and time after surgery on portal perfusion and liver function. Ultrasound + Doppler distal splenorenal shunt thrombosis in two patients; however, none was confirmed by continuous thermal dilution. Ultrasound + Doppler flowmetry was possible in 19 patients (83%) (mean, 1.58 +/- 0.53 L/min). Distal splenorenal shunt continuous thermal dilution measurements were performed in all patients (100%), (mean, 1.65 +/- 0.5 L/min). Good correlation was seen between them (r = 0.66). Ultrasound + Doppler of the portal vein showed a hepatopetal flow in 16 patients (69.9%). Hepatic blood flow was significantly higher in patients with hepatopetal flow (p = 0.003). Hepatic clearance and intrinsic hepatic clearance of indocyanine green were significantly lower in patients with hepatofugal flow. Patients with hepatofugal flow had a higher incidence of chronic encephalopathy. None of the patients with a follow-up of less than 4 yr exhibited hepatofugal flow, whereas 7 of the 16 patients with a longer follow-up had hepatofugal flow (43.7%). The difference was statistically significant (p = 0.04). This study suggests that ultrasound + Doppler sonography may provide useful data in the evaluation of the patency and blood flow direction through the portal vein and the distal splenorenal shunt.(ABSTRACT TRUNCATED AT 250 WORDS)