Table 1 Laboratory data on admission. Fig. 1 US shows a hyperechoic large tumor. Fig. 2 CT shows a large hepatic tumor. Central necrosis and dilatatio

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2 Table 1 Laboratory data on admission. Fig. 1 US shows a hyperechoic large tumor. Fig. 2 CT shows a large hepatic tumor. Central necrosis and dilatation of the intrahepatic bile duct can be found.

3 Fig. 3 Angiography shows a hypervascular hepatic tumor. Fig. 4 Super selective angiography of the right hepatic artery shows a hypervascular hepatic tumor. The portal vein is visualized hepatofugally on the venous phase.

Table 2 Data of hepatic catheterization. (PVP: portal vein pressure, FHVP: free hepatic vein pressure, WHVP: wedgea hepatic vein pressure, IVCP: inferior vena cava pressure) Fig.

4 Table 2 Data of hepatic catheterization. (PVP: portal vein pressure, FHVP: free hepatic vein pressure, WHVP: wedgea hepatic vein pressure, IVCP: inferior vena cava pressure) Fig. 5 Portalgraphy through the shunt shows reversed portal flow. The MCH shut and the inferior vena cava which is compressed by a hepatic tumor are visualized. Fig. 6 B mode scanning of the splenic vein (left) and Doppler signal (up right). (SPV: splenic vein, SMA: superior mesenteric artery, BFV: blood flow vol. ume)

5 Fig. 7 A schema of the hemodynamics of the portal system in this patient.

6 4) Drapanas T: Interposition mesocaval shunt for treatment of portal hypertension. Ann Surg 176: , ) Reiner DS, Kaminski DL: Comparative evaluation of selective and nonselective peripheral postosystemic shunts for treatment of variceal hemorrhage. Am J Surg 44: , ) Vogt PP, Santoscoy T, Cooperman AM, et al: Surgical management of portal hypertension and esophageal varices, 10 year experience. Am J Surg 146: , ) Reuter SR, Berk RN, Orloff MJ: An angiographic study of the pre- and postoperative hemodynamics in patients with side-to-side portocaval shunts. Radiology 116: 33-39, ) Sarfeh IJ, Rypins EB, Conroy RM, et al: Portacaval H Graft: Relationships of shunt diameter, portal flow patterns and encephalopathy. Ann Surg 197: , ) Holmin T, Alwmark A, Forsberg L: The Ultrasonic Demonstration of Portacaval and Interposition mesocaval Shunt. Br J Surg 69: , 1982

7 A case with large hepatoma which showed some interesting findings of the hemodynamics of the portal system after interposition mesocaval shunt Osamu NISHIDA, Fuminori MORIYASU, Takefumi NAKAMURA, Nobuyuki BAN, Kensuke MIURA, Masahiko SAKAI, Haruto UCHINO*, Takeo MIYAKE**, Kaoru KUMADA, Keiichiro MORI, Yorinori HIKASA***, Ataka SHIBATA and Yasuhide TAKEDA**** A 63-years old woman was admitted to our hospital because of severe jaundice. Five years ago, an interposition mesocaval shunt operation was performed because of bleeding from esophageal varices. US and CT detected a large hepatic tumor. Hepatic catheterization was performed. The blood flow volume was measured by an ultrasonic duplex system, and blood pressure was measured simultaneously in the portal venous system. Pressure gradient of the shunt was 6 mmhg and its blood flow was about 3,000 ml/min. It was proved that the vascular resistance was very low. It was found that the portal blood flow had been reversed. But we suspected sufficient blood flow through the hepatic sinusoid. The high sinusoidal pressure was maintained by both the high portal vein and high inferior vena cava pressures, which were caused by an obstruction of the inferior vena cava from the growth of the hepatic tumor. * The 1st Department of Medicine, Kyoto University, School of Medicine, Kyoto, Japan (Kyoto) ** Department of Geriatrics, Kyoto University, School of Medicine, Kyoto, Japan (Kyoto) *** The 2nd Department of Surgery, Kyoto University, School of Medicine, Kyoto, Japan (Kyoto) **** Department of Medicine, Ijinkai Takeda Hospital, Kyoto, Japan (Kyoto)

8 The Bulletin of Meiji University of Integrative Medicine API II 61 ASO X 11 7 X-4 6 X m 5 X-2 4 X 3 9 X 11 7 API 0.84 ASO X 1 1 MR-angio

8 The Bulletin of Meiji University of Integrative Medicine API II 61 ASO X 11 7 X-4 6 X m 5 X-2 4 X 3 9 X 11 7 API 0.84 ASO X 1 1 MR-angio 7-14 2010 1 1 1 2 1 1 1 2 Fontaine II ASO61 3 API ASO ASO ASO API API KKKKKKKKKK ASO Fontaine II API Received April 14, 2009; Accepted July 16, 2009 I arteriosclerosis obliterans: ASO ASO 50 70 1,2 Fontaine