To elucidate the functioning of a prosthetic valve after aortic valve replacement, echocardio-graphy must be used to evaluate any changes in the actual aortic valve area and transvalvular pressure gradient, and also check for aortic regurgitation. This examination is generally performed when the patient is at rest, and not normally during exercise. In the present study, we evaluated the functioning of mechanical prosthetic valves and stentless bioprosthetic valves, before and after peak exercise using treadmill stress echocardio graphy.
The subjects were 16 patients who had received a mechanical prosthetic valve replacement (bileaflet valve group) and 14 who had stentless bloprosthetic valves (freestyle valve group). The actual area of the aortic valve was larger in the freestyle valve group than that in the mechanical valve group, though they were rated as the same valve size. After stress was incurred on a treadmill, both peak and mean transvalvular pressure gradients were markedly lower in the freestyle valve group, and those patients showed no low transvalvular pressure gradient complications. Our findings demonstrated that the freestyle stentless aortic bioprosthesis had an excellent hemodynamic function, as compared to the mechanical valve. We considered that the reason [or such a difference is because the freestyle valve has no supporting structure like that seen in mechanical and stented valves, which allows it to open and close in a more natural and physiological manner during maximum exercise.
Valve replacement with the freestyle valve Is expected to decrease cardiac hyperwphy, however, in patients who receive an aortic stenosis where left ventricular hypertrophy already existed, the left ventricular mass index must be evaluated for various prosthetic valves. Further, an evaluation of durability must wait for long-term clinical and follow-up results, though for those elderly patients for whom warfarin therapy seems to be contraindicated, the freestyle valve is a promising solution.

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Objective : The relationship between the drainage blood flow of hepatocellular carcinoma (HCC) and the tumor diameter was examined.
Material and Methods : The subjects are 151 histopathologically and/or clinically diagnosed HCC lesions from 147 patients the drainage blood flow of which was detected with Doppler ultrasound. The outflow signals were analized for which part of the lesion they were detect-ed and for which vein they were communicated with.
Results and Discussion : 1. Drainage flow continuous to the hepatic vein was detected in 14 lesions. Eleven cases (79%) of them were less than 3.0 cm in diameter and were shown to be fed by the portal blood flow. 2. An outflow signal with constant waveform was shown to run reversely along a pulsatile inflow signal in 85 lesions with a variety of diameter. In such caces. it was considered that a normal portal branch remaining within the tumor worked as the drainge vessel. The larger the diameter of the tumor, the more peripherally the out-flow signal was detected. 3. A drainage flow signal nut continuous to the hepatic vein nor being accompanied by a pulsatile arterial signal was observed in 62 lesions. Such a drainage vessel was considered to have been newly produced by the neoplasm. and it was shown to communicate with the portal vein at the periphery of the tumor. Fifty-four (87%) of the lesions were larger than 3.0 cm in diameter.
Conclusion : Drainage blood flow from HCC is speculated to change multistepwise as the lesion grows; it goes via the hepatic vein at the beginning, then via the remnant portal vein within the tumor, and finally via the newborn vessels in typical matured cases.

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Background : Enlargement of the lymph node around common hepatic artery (No8LN) is fre-quently finding during ultrasonography (US) in patients with chronic hepatitis C. We have reported that No8LN found in 73.7% of patients with chronic hepatitis C. In this report we assess the relation between hepatitis C virus (HCV) viremia and size of No8LN.
Materials and method : The subjects were 56 taken medical checkup by US in the Health Care Center, and 25 outpatients who underwent abdominal US examination for hepatitis C. They ere 67 males and 14 females with mean age of 53.9 yeas old. 56 without Ever diseases in medical checkup subjects are normal control and they are negative for antigen (Ag) of HBs and anti-body (Ab) of HCV. The long (a) and short (b) diameters of lymph node were measured. LN index was calculated by the equation of a x b. Size of lymph nodes was compared with labora-tory diagnostic tests and serum HCV core Ag (HCV-Ag) levels. According to the level of HCV-Ag, we introduced grade I as negative, grade II as minimal, grade Ill as medium and gradelV as extensive HCV-Ag levels.
Results : LN index was 131.12±76.74mm² in the patients with hepatitis C and 70.63±46.96mm² in the control (p<0.001). LN index showed significant correlation with HCV-Ag (r=0.436, p<0.05). No significant differences were found but LN index increased in patients with grade IV (160.0±50.86mm) compared to grade I (57.0±98.73mm², grade h (95.3±65.32mm²) and grade B (149.7±41.09mm²).
Conclusions :The possibility is suggested that No8LN reflects level of HCV-Ag. The mecha-nism of perihepatic lymphadenopathy with hepatitis C is unknown, but, it is suggested that the subjects are suffered from the viral replication in the lymph node, and No8LN can be targeted for hepatitis by HCV treatments

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