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...

Genetic factors are clearly involved in the pathogenesis of essential hypertension in man. In at least three rat models of genetic hypertension it is possible to transplant the hypertension with the kidney. To see whether or not the same is true for humans, we carried out a 2-year retrospective study of 50 selected recipients of a cadaver kidney. We correlated the following factors by multivariate statistical analyses: presence or absence of hypertension in the family of donor and recipients; donor’s and recipient’s age; mean blood pressure (MBP) and antihypertensive therapy (AHT) score during dialysis; months of dialysis and body surface before transplantation; body weight, plasma creatinine, prednisone dosage and cumulative rejections with MBP and AHT score at various time intervals after transplantation. The results obtained showed that, considering the recipients coming from normotensive families, the AHT score after transplantation was significantly greater (p < 0.05 1st and p < 0.0l 2nd year) in the patients receiving a kidney removed from donors with hypertensive families than in the patients receiving a kidney removed from donors with normotensive families. This difference was not present when the recipients coming from hypertensive parents were considered. AHT score after transplantation is also correlated with AHT score on dialysis (p < 0.01 1st and 2nd year), body weight (p < 0.02 1st and p < 0.01 2nd year), cumulative rejections (p < 0.025 1st and 2nd year) and inverse MBP after dialysis (p < 0.025 2nd year).

Objective. To evaluate the use of color-flow Doppler ultrasonography, a direct, noninvasive technique, for measurement of kidney blood flow in patients with systemic sclerosis (SSc).Methods. Twenty-five normal volunteers and 25 SSc patients (median disease duration 8 years, range 2-21 years) were studied. All were free of clinical symptoms of renal damage. The resistance index (RI) was determined on main, interlobar, and cortical vessels.Results. In SSc patients, the RI was significantly increased at every sampling site examined ( P C 0.001). RI values were strongly correlated with disease duration (main artery r = 0.56, P C 0.04; interlobar artery r = 0.63, P < 0.02; cortical artery r = 0.75, P C 0.002). Regression analysis showed no relationship between RI and creatinine clearance values.Conclusion. Color-flow Doppler ultrasonography is a sensitive and noninvasive technique for evaluating vascular damage of the kidney in patients with SSc.

In a previous report we published the immediate results of a 3-month placebo-controlled trial (n = 34) showing that cyclosporin (n = 37) has a beneficial therapeutic effect in active chronic Crohn's disease. Here we report on the final outcome of the patients. During the 3-month tapering-off period eight initially improved patients (36%) in the cyclosporin group worsened, as did six (55%) in the placebo group. The therapeutic gain of cyclosporin treatment was consistently significant during this period. It ranged from 22% to 25% (95% confidence limits, 2-46%). An outcome ranking showed that 7 patients of the cyclosporin group (19%) were substantially improved, 7 (19%) moderately improved, and 23 (62%) not improved after the tapering off. In contrast, no significant differences were seen during the 6-month follow-up period. Four patients of the cyclosporin group (11%) were substantially improved, 3 (8%) moderately improved, and 30 (81%) not improved at final follow-up. Significant interactions between cyclosporin and prednisolone treatment were demonstrated both at the end of the initial treatment period and at the end of the tapering-off period. We conclude that a short course of cyclosporin treatment does not result in long-term improvement in active chronic Crohn's disease.