A nocturnal increase in portal pressure and blood flow was demonstrated in patients with cirrhosis, suggestingPatients. Fourteen patients with cirrhosis (10 men and 4 women, that these hemodynamic changes may contribute to the mean age 53 { 6 years [mean { SEM]; range, 35-63 years) were triggering of the hemorrhagic episodes observed during included in this study. Diagnosis of the disease was made by liver the night in these patients. It is known that propranolol biopsy in nine patients and was based on clinical and biochemical reduces portal flow, thus reducing the risk of variceal data in five. The origin of cirrhosis was alcoholic in nine patients, posthepatitic in three, and cryptogenic in two. All of these patients bleeding. In a double-blind, placebo-controlled study, we fested by a significant reduction in heart rate (Ï21% { sured with a Toshiba Sonolayer SSA 270 (Tokyo, Japan), a duplex scanner consisting of a real-time, two-dimensional ultrasonic device 4%, P Ú .01) and cardiac output (Ï12% Ô 2%, P Ú .05). A and an attached 3.5-MHz pulse Doppler flowmeter. After a sampling significant decrease in portal blood flow (Ï20% Ô 4%, P marker had been set in the middle of the lumen of the portal vein Ú .01) was also observed in these patients. Propranolol along the beam axis, a second marker was positioned parallel to the administration blunted the time-related changes in cardirection of blood flow. Care was taken to maintain the angle formed diac output and portal blood flow. In contrast, patients by the ultrasonic beam and blood flow direction below 60Њ because the receiving placebo had a nocturnal peak of both parame-accuracy of the hemodynamic measurements decreases at increasing ters similar to that observed under basal conditions. Our angles. Measurements were carried out during expiration because study shows that chronic propranolol administration they can be easily standardized, allowing for a better visualization abolishes the nocturnal peak of portal blood flow in pa-of the portal vein for Doppler purposes, as the angle formed by the ultrasonic beam and blood flow direction is reduced to a minimum. duce the risk of variceal bleeding. [5][6][7][8] The purpose of the presTwenty-Four Hour Study. The patients were admitted to hospital ent randomized study was to evaluate the effect of propranotwo days before the study. During this time, they underwent an lol on the daily fluctuation of systemic and splanchnic acclimation period in a quiet room at 20Њ to 24ЊC. On the day of the hemodynamic parameters in patients with cirrhosis. baseline study, systemic and portal hemodynamic parameters were measured at 0800, 1600, 2400, and 0800 hours. During this period, the patients pursued ordinary activities within the room. HemodyFrom the 1 Seccion Ecografia and the 3 Unidad de Higado, Hospital Dr Bonorino Udaondo, namic studies were performed at least two hours after meals and
tients with cirrhosis and indicates a preventive effect of
