Abnormal Doppler ultrasound signals were detected in 44 of 47 patients with primary malignant tumors of the liver, kidney, adrenal gland, or pancreas (94%). Two different signal types were noted: a high-velocity signal (n = 38) with Doppler shifts exceeding 3 kHz (at an insonating frequency of 3 MHz) and a very low-impedance signal (n = 9) demonstrating little systolic-diastolic variation. In three patients, both types were present. In 19 patients, histologic (n = 12) and/or angiographic (n = 16) correlation was available. Among 13 patients with angiographic studies and signals over 3 kHz, arteriovenous shunting was demonstrated in six. The ratio of the systolic to diastolic Doppler shift is a function of vascular impedance. This systolic/diastolic index was less than 3 in eight patients with histologic correlation. All eight had prominent vascular spaces, and the flow in such thin-walled, endothelium-lined spaces would account for the low-impedance signals. Of nine patients with systolic/diastolic indexes of 3 or less and angiographic correlation, three had marked and four had moderate tumor staining.

The present study was designed to investigate the effect of propranolol on portal pressure of patients with alcoholic cirrhosis and portal hypertension and to correlate these effects with clinical and laboratory parameters. The mean baseline hepatic venous pressure gradient in the 50 patients studied was of 18.2 +/- 4.1 mm Hg. It decreased significantly 2 hr after the oral administration of 40 mg of propranolol to 15.7 +/- 4.2 mm Hg (a mean reduction of 13.4 +/- 17%). This reduction in hepatic venous pressure gradient resulted mainly from a decrease in mean wedged hepatic venous pressure. There was no correlation between the decrease in hepatic venous pressure gradient and the decrease in heart rate. When results were analyzed individually, only 15 (30%) showed a large decrease in hepatic venous pressure gradient (greater than 20%), 15 (30%) showed a moderate decrease (10 to 19%), and in 20 patients (40%) there was no reduction or an increase in hepatic venous pressure gradient. Comparison of "responders" (those that reduced hepatic venous pressure gradient greater than 10%) and "nonresponders" (hepatic venous pressure gradient reduction less than 10%) showed no significant differences in baseline laboratory and hemodynamic parameters, in the severity of the liver disease, in the heart rate and blood pressure response to propranolol, nor in the propranolol plasma levels achieved 2 hr after propranolol administration. Propranolol plasma levels correlated with the reduction in heart rate but not with the reduction in hepatic venous pressure gradient. Of 14 nonresponders to 40 mg of propranolol who received additional doses, six showed a reduction in hepatic venous pressure gradient.(ABSTRACT TRUNCATED AT 250 WORDS)

Eight patients (seven post partum, one post abortion) with massive pelvic hemorrhage related to pregnancy and one patient with uncontrollable bleeding following a cervical biopsy underwent angiography to facilitate the identification and treatment of bleeding sites. In all nine patients pelvic hemorrhage was successfully controlled with embolization under angiographic guidance. Angiographic embolization allowed preservation of the uterus in six patients referred prior to hysterectomy, and one patient subsequently became pregnant. When conservative measures and minor surgical repairs have failed, embolization should be the next step in the treatment of postpartum hemorrhage to avoid major surgery in an unstable patient and to maintain reproductive function.

Renal allografts are subject to many vascular complications. Over a 2-year period, 334 duplex Doppler ultrasonographic (US) examinations were performed in 88 renal allograft recipients. Vascular occlusion on the basis of severe vascular rejection was documented in ten patients (11.4%) for a sensitivity and specificity of 100%. Seven patients, for whom there was clinical and Doppler US evidence for renal artery stenosis, underwent angiography. A significant stenosis was confirmed and treated by angioplasty in four patients; one had an insignificant stenosis in an accessory artery, one had kinking of the renal vessels, and another had normal findings. The most reliable criteria for stenosis were a high-velocity jet exceeding 7.5 kHz and distal turbulence. One arteriovenous fistula was diagnosed by the presence of an intrarenal high-velocity jet. Duplex Doppler US is a useful, noninvasive, and portable initial procedure with which to screen patients for vascular complications of renal transplantation.

Absence of the portal vein with systemic visceral venous return was demonstrated in an 8-year old girl with oculoauriculovertebral dysplasia (Goldenhar syndrome) during preoperative evaluation of a liver mass. Congenital absence of the portal vein is a rare malformation of potential clinical significance.