The effect of the mesocaval interposition shunt (n = 12) and the distal splenorenal shunt (n = 9) on the wedged hepatic venous pressure, the estimated hepatic blood flow, quantitative hepatic function, and the rate of portal systemic encephalopathy was evaluated in 21 patients who had bled from esophageal varices. After mesocaval shunt the wedged hepatic venous pressure was significantly reduced by 42% (from 26 +/- 3 mm Hg to 15 +/- 5 mm Hg, P less than 0.001) compared to 16% only (from 25 +/- 3 mm Hg to 21 +/- 2 mm Hg, P less than 0.005) after distal splenorenal shunt. The estimated hepatic blood flow also decreased significantly after mesocaval shunt by 61% (from 1.45 +/- 0.46 l/min to 0.56 +/- 0.25 l/min, P less than 0.001) compared to 29% (from 1.29 +/- 0.32 l/min to 0.91 +/- 0.39 l/min, P less than 0.05) after distal splenorenal shunt. Despite significantly different influences of both types of shunt operations on wedged hepatic venous pressure and estimated hepatic blood flow (P less than 0.001), postoperative changes of hepatic function were comparable in both groups of patients. The galactose elimination capacity, the initial plasma disappearance rate of Bromsulphalein, and the plasma ratio of valine, leucine, and isoleucine to phenylalanine and tyrosine were reduced by 13%, 26%, and 29%, respectively, after mesocaval shunt, compared to 12%, 25%, and 17% after distal splenorenal shunt. Only two patients of the mesocaval shunt group with the largest decrease in estimated hepatic blood flow developed portal systemic encephalopathy postoperatively, and the distal splenorenal shunt patients with their minor hemodynamic sequelae remained free of portal systemic encephalopathy.

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Focal nodular hyperplasia (FNH) is a benign tumor of the liver. It is most frequently found in women of reproductive age. An association with oral contraceptives and sexual hormones is therefore possible. FNH lesions are frequently discovered incidentally. Spontaneous complications are rare. When the diagnosis is known with reasonable accuracy, a nonoperative approach is in common use. We report here the rare case of spontaneous intraabdominal bleeding from FNH.

A particular kind of renal-artery stenosis was observed in three of 60 renal transplantations performed between 1969 and 1974. It was always 1.0-1.5 cm distal to the anastomosis and, as histological examination demonstrated, was definitely due to vessel injury after removal of the transplant. To avoid it the proximal arterial stump should be cut off before transplantation. The postanastomotic region must be dissected free during the operation and an extended graft venoplasty or sleeve resection performed.