VISCERAL ORTHOSTATIC HYPOTENSION IN PATIENTS WITH SEVERE AUTONOMIC DYSFUNCTION

Although changes in the blood flow of the cerebral vessels and the per ipheral vessels in the extremities after changing body postures have b een well examined in patients with orthostatic hypotension (OH), such changes in visceral vessels have not been well investigated. To elucid ate the effect of autonomic dysfunctions on changes in the abdominal b lood flow, the blood flow velocity of the portal vein was measured by Doppler ultrasonography in 11 patients with familial amyloidotic polyn europathy (FAP) (Met30), 3 with pandysautonomia, 1 with Shy-Drager syn drome, and 10 healthy controls, in the supine and at the upright posit ion. Among the 15 patients with the above-mentioned autonomic disorder s, 5 of the patients showed a marked decrease in blood flow after stan ding, and one of these 5 patients exhibited transient hepatic and inte stinal ischemia during intensive rehabilitation because of a severe de crease in visceral blood flow. Another 7 patients exhibited moderate d ecreases in the blood flow after standing. In contrast, no such change was observed in the 10 healthy controls. The FAP patients with L-thre o-3,4-dihydroxyphenylserine (L-threo-DOPS) administration showed no si gnificant correlation between the degree of OH and the decrease in the blood flow of the portal vein, and the patients without the drug exhi bited a weak correlation. On the contrary, the pandysautonomia and Shy -Drager syndrome patients exhibited a linear positive correlation. The se results suggest that FAP is a disease for which this kind of ultras onographic examination should be applied, and that Doppler ultrasonogr aphy may be a helpful tool to evaluate visceral OH. (C) 1998 Elsevier Science B.V.