Splenorenal shunt has some advantages over other procedures for portal hypertension. Removal of the spleen in this procedure may correct the condition of hypersplenisrn secondary to the portal bed block. Surgical risk in this procedure is ususlly less than that of portacaval anastomosis, in the sense that there is less frequent liver failure and ammonia intoxication after anastomosis. The sprenorenal shunt, however, is inferior to portacaval shunt as to effectiveness on portal decompression and it thromboses more easily. Considering these facts, we have recently devised a new operative procedure, splenocaval shunt, for the treatment of portal hypertension, and 16 patients were treated with this procedu This report is concerned with experimental and clinical studies on the efficacy of the splenocaval shunt. 1) The effect of this procedure on portal pressure decompsession was theoretically investigated with an aid of a model resembling the vascular system. 2) The postoperative change in hemodynamics in portal system was studied by determining free portal pressure (FPP) and occluded hepatic protal pressure (OHPP) as well as by using the dye dilution technique. 3) Beneficial effects of this procedure on laboratory examination data including liver function test, esophageal varices as well as the postoperative course were analyzed in clinical patients. The results obtained may be summarized as follows: 1) The model experiment indicated that the splenocaval shunt is more effective in reducing the portal pressure than the splenorenal shunt. 2) OHPP was lower than FPP in 6 dogs and 6 patients with splenocaval shunts. This fact was interpreted as indicating that blood was flowing into the liver in spite of the presence of a direct connection between the portal system and the caval system through splenocaval shunt. In 2 patients, however, the relationship between OHPP and FPP was reversed, indicating a reversed blood flow in the proximal segment of the portal vein. A similar result was obtained in the dye dilution study. 3) Since October 1961 sixteen patients have been treated with this procedure and nine of these are still doing well 5 to 24 months after surgery. Reduction in portal pressure by this procedure ranged between 50 and 330 mmH2O, with a mean of 144 mmH2O from preoperative value. Esophageal varices have completely disappeared or markedly diminished in 11 out of 14 patients. However, recurrence of esophageal bleeding after this procedure was noted in 3 out of 9. From the experimental and clinical data mentioned above, it was concluded that the splenocaval shunt was efficient procedure for portal hypertension, and was also superior to the splenorenal shunt in the effect on decompressing portal pressure.
As a part of the pathophysiological research project undertaken in the Matsukura department centering around the liver function in disorders of the digestive organs, the author undertook investigations on the serum enzymes elaborated by the liver, with special reference to serum Glucose-6-Phosphatase. The author chose for his studies a total of 133 cases treated in the department for diseases of the digestive organs dur-ing a period of three years and eight months from December, 1958 to March, 1962, in which the diagnosis had been confirmed clinically and histologically. The values of serum G-6-Pase were measured in all these cases at the time of their admission to the hospital as well as before and after operations. The comparison studies were made on these values with those of serum transaminase closely related to serum G-6-Pase and also the results simultaneously obtained from various liver function tests, such as serum protein density, Takata's reaction, Gross' reaction, C. C. F. test, B. S. P. test Meulengracht icteric index, etc.
From the pathophysiological standpoint attention has been focused on the unspecific increases and decreases of serum mucoprotein in various disorders. These complexes of protein and polysaccharid are so variable that unanimous agreement regarding the names, classification, physiological significances and site of production has not yet been reached. As a part of the research project on the pathophysiology of liver disorders undertaken in the Matsukura surgical department, the author has carried out studies on the glycoproteins in serum, under the direction of Prof. Dr. Matsukura. The main emphasis centered around changes of serum mucoprotein together with simultaneous determinations of closely related serum protein-bound- polysaccharid (hereinafter called PBP), serum mucoprotein-bound-polysaccharid (hereinafter called PMP), serum proteinogram and glycogram. To gain greater insight of the physiological significance and site of production of these proteinpolysaccharid complexes, detailed obervations were carried out in cases with disorders of the digestive tract prior to and after operative treatment.