While animal studies show that ischemic preconditioning (IPC) is beneficial in liver transplantation (LT),

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Hepatofugal flow (ie, flow directed away from the liver) is abnormal in any segment of the portal venous system and is more common than previously believed. Hepatofugal flow can be demonstrated at angiography, Doppler ultrasonography (US), magnetic resonance imaging, and computed tomography (CT). The current understanding of hepatofugal flow recognizes the role of the hepatic artery and the complementary phenomena of arterioportal and portosystemic venovenous shunting. Detection of hepatofugal flow is clinically important for diagnosis of portal hypertension, for determination of portosystemic shunt patency and overall prognosis in patients with cirrhosis, as a potential pitfall at invasive arteriography performed to evaluate the patency of the portal vein, and as a contraindication to specialized imaging procedures (ie, transarterial hepatic chemoembolization and CT during arterial portography). Hepatofugal flow is generally diagnosed at Doppler US without much difficulty, but radiologists should beware of pitfalls that can impede correct determination of flow direction in the portal venous system.

We evaluated normal uterine involution prospectively with real-time ultrasonography in 100 women after uncomplicated term vaginal delivery. Transducers easily distorted the spongy uterus during early postpartum scanning, an effect minimized with sector transducers that are superior to linear or convex probes for accurate early postpartum uterine measurement. Long-axis measurements correcting for uterine angulation were the most reproducible and accurate, irrespective of bladder distention. Uterine T o our knowledge, only three studies have addressed ultrasonographic measurement of normal postpartum uterine dimensions. 1-J Since only static scanners were utilized in these studies, the reported dimensions bear uncertain relevance to real~time ultrasonography owing to two factors: (1) The long axis of the postpartum uterus often is oriented obliquely rather than parallel to the sagittal plane of the body." Imaging in standard orthogonal planes may therefore underestimate the true sagittal uterine dimension. (2) Our initial real-time ultrasono--graphic observations indicated that the early postpar- contractions caused instability of particularly the transverse dimension. Increasing maternal parity was associated with slightly but significantly larger uterine dimensions up to 4 weeks post partum. The uterus reassumed nongravid dimensions by 6 to 8 postpartum weeks. Uterine involution was unrelated to infant birth weight or breast feeding. KEY WORDS: Uterus, ultrasonography; Uterus, size; Puerperium; Uterine involution; Obstetrics, ultrasonography; Pregnancy, ultrasonography. tum uterus is highly susceptible to distortion from trivial pressure applied via hand-held transducers as opposed to articulated-arm probes that glide across the abdominal skin surface without producing distortion.In each of the cited studies the sagittal dimension apparently was measured without correction for an~ gulation of the uterus as it arches over the sacral promontory in the early postpartum period. l -3 Moreover, uterine dimensions were markedly discrepant between studies, particularly the mean sagittal dimension, which varied from 17.3 to 21.2 cm in the early postpartum period.t. 2 In two studies the sagittal dimension was measured from the fundus to the internal cervical OS,2.3 apparently excluding the cervix, which was incorporated into the sagittal measurement in the other study. 1 Citing unspecified effects of bladder distention on uterine measurements, previous investigators scanned subjects at varying degrees of bladder fullness ranging from emptyJ to moderately distended' to full.

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