After moving to Boston for 1 year to complete my work with Dr. Zimmerman, I returned to Washington to work with Dr. Cohn on hepatic hemodynamics. At the time, it was clear to me that the circulation of a particular organ could not be isolated from the study of the systemic circulation.

Therefore, from June of 1968 to September of 1971, I became a “cardio-hepatologist” under Dr. Cohn’s tutelage.4 I worked in the arterial hypertension outpatient clinic and consulted on patients for the clinical hemodynamic section of the Department of Medicine. The patients were for the most part in cardiogenic or septic shock, but there were also many patients with cirrhosis who had advanced hemodynamic derangements, including refractory ascites and the hepatorenal syndrome. The prognosis for patients Wnt signaling with end-stage liver disease was extremely poor in the era preceding liver transplantation, but my clinical role afforded

me an important opportunity to learn to perform hemodynamic studies in patients with cirrhosis. These were very productive years because together with Dr. Cohn and collaborators, we described new techniques to measure both hepatic blood flow5 and portal systemic shunting in patients with cirrhosis,6, 7 and documented Y27632 the existence of a hyperdynamic splanchnic circulation in this group of patients.8 My collaboration with Dr. Cohn produced a series of publications, but more importantly, this experience focused my research interest on the circulatory abnormalities of patients with liver disease and portal hypertension. By 1970, I found myself at a crossroads. I had developed

a unique area of specialization and scientific interest in a field that was only practiced at a few academic medical centers. My clinical expertise did not conform to the recognized and typical clinical subspecialities, and the next steps were unclear to me. Meanwhile, my family had grown with the births of my two children. Since marrying, I had asked my wife to move four find more times in order to pursue my academic calling, but now the political situation in Argentina had improved somewhat because the military government promised to hold free democratic elections. My former medical chief and mentor, Dr. M. Royer offered me a solid academic position as a scientific investigator in the Argentine National Research Council. Aida and I acquiesced to the expressed wishes of our families and our own desire to be closer to family and old friends and we moved back to Buenos Aires in 1971. Back in Argentina, I rejoined the group that I had worked with previously at the National Institute of Gastroenterology, now renamed Policlinico A Posadas, an indication that there would be a new emphasis on clinical medicine. I was very warmly welcomed and I enjoyed the personal support of my colleagues.