No adequate randomized trials have been reported for a comparison between hepatic resection (HR) versus radiofrequency ablation (RFA) for the treatment of patients with very early stage hepatocellular carcinoma (HCC), defined as an asymptomatic solitary HCC <2 cm. For compensated cirrhotic patients with very early stage HCC, a Markov model was created to simulate a randomized trial between HR (group I) versus primary percutaneous RFA followed by HR for cases of initial local failure (group II) versus percutaneous RFA monotherapy (group III); each arm was allocated with a hypothetical cohort of 10,000 patients. The primary endpoint was overall survival. The estimates of the variables were extracted from published articles after a systematic review. In the parameter estimations, we assumed the best scenario for HR and the worst scenario for RFA. The mean expected survival was 7.577 years, 7.564 years, and 7.356 years for group I, group II, and group III, respectively. One-way sensitivity analysis demonstrated that group II was the preferred strategy if the perioperative mortality rate was greater than 1.0%, if the probability of local recurrence following an initial complete ablation was <1.9% or if the positive microscopic resection margin rate was >0.3%. The 95% confidence intervals for the difference in overall survival were ؊0.18-0. Although several observational studies and suboptimal randomized controlled trials have demonstrated that radiofrequency ablation (RFA) was comparable to HR with regard to the overall survival of patients with early stage HCC, 3-9 few comparative studies have been reported for very early stage HCC between HR and RFA. To obtain a definitive conclusion, it would be mandatory to perform a well-designed randomized trial concerning overall survival. However, an adequate randomized controlled trial would require enrollment of an enormous sample size of several thousands of patients.In this study, instead of performing a real randomized controlled trial, a simulated randomized trial was performed to compare the overall survival of compensated cirrhotic patients with very early stage HCC treated with HR, RFA, or the combined approach of primary RFA followed by HR for cases of initial local failure. Patients and MethodsStudy Purpose. We tried to compare HR and percutaneous RFA for the treatment of compensated cirrhotic patients with very early stage HCC by using a Markov model wherein the primary endpoint was overall survival.

BACKGROUND.Many liver staging systems have been proposed for patients with hepatocellular carcinoma after locoregional therapy; however, controversies persist regarding which system is the best. In this study, the authors compared the performance of 7 staging systems in a cohort of patients with hepatocellular carcinoma who underwent transarterial chemoembolization.METHODS.In total, 131 patients with hepatocellular carcinoma who underwent transarterial chemoembolization between August 1998 and February 2005 were included in the study. Demographic, laboratory, and tumor characteristics were determined at diagnosis and before therapy. At the time of censorship, 109 patients had died (83.2%). Predictors of survival were identified by using the Cox proportional hazards model. The likelihood‐ratio chi‐square statistic and the Akaike Information Criterion were calculated for 7 prognostic systems to evaluate their discriminatory ability. Comparisons of the survival rate between each stage were performed to evaluate the monotonicity of the gradients using Kaplan‐Meier estimation and the log‐rank test.RESULTS.The 5‐year survival rate for the entire cohort was 13.6%. The independent predictors of survival were serum albumin level (≤3.4 g/dL), the presence of ascites, serum α‐fetoprotein level (>60 ng/mL), and portal or hepatic vein tumor thrombosis (P = .001, P = .001, P = .004, and P = .000, respectively). The Cancer of the Liver Italian Program classification system was superior to the other 6 prognostic systems regarding discriminatory ability and the monotonicity of the gradients.CONCLUSIONS.In this comparison of many staging systems, the Cancer of Liver Italian Program system provided the best prognostic stratification for a cohort the patients with hepatocellular carcinoma who underwent transarterial chemoembolization. Cancer 2008. © 2007 American Cancer Society.

The absence of the inferior vena cava is an uncommon congenital anomaly that has recently been identified as an important risk factor contributing to the development of deep venous thrombosis. Congenital agenesis of the right hepatic lobe is a rare anomaly which is found incidentally in radiologic examinations. We present a case of a congenital absence of the infrarenal inferior vena cava, combined with agenesis of the right hepatic lobe in a 62-year-old man presented with symptoms of deep venous thrombosis.

ObjectiveWhile the prognostic factors of survival for patients with hepatocellular carcinoma (HCC) who underwent transarterial chemoembolization (TACE) are well known, the clinical significance of performing selective TACE for HCC patients has not been clearly documented. We tried to analyze the potential factors of disease-free survival for these patients, including the performance of selective TACE.Materials and MethodsA total of 151 patients with HCC who underwent TACE were retrospectively analyzed for their disease-free survival (a median follow-up of 23 months, range: 1-88 months). Univariate and multivariate analyses were performed for 20 potential factors by using the Cox proportional hazard model, including 19 baseline factors and one procedure-related factor (conventional versus selective TACE). The parameters that proved to be significant on the univariate analysis were subsequently tested with the multivariate model.ResultsConventional or selective TACE was performed for 40 and 111 patients, respectively. Univariate and multivariate analyses revealed that tumor multiplicity, venous tumor thrombosis and selective TACE were the only three independent significant prognostic factors of disease-free survival (p = 0.002, 0.015 and 0.019, respectively).ConclusionIn our study, selective TACE was a favorable prognostic factor for the disease-free survival of patients with HCC who underwent TACE.

Malaria is a serious, mosquito-borne, infectious disease that is caused by Plasmodium species. Plasmodium species are transmitted by infected female mosquitoes of genera that bite humans. These parasites grow within erythrocytes and are released by cyclic hemolysis. Malaria is distributed worldwide in endemic areas such as South America, Africa, and South Asia. South Korea was known to be an area endemic for P. vivax , and the reemergence of this disease has been reported along the western edge of the Demilitarized Zone since 1993. 1The main symptom of malaria is episodic fever. Abdominal symptoms of P. vivax malaria are usually mild and nonspecific and include abdominal pain or hepatosplenomegaly. 2, 3However, abdominal computed tomography (CT) findings of patients with P. vivax malaria are not well known. To the best of our knowledge, only a few sporadic case reports are found in the English literature.2-5 Malaria is still a worldwide lifethreatening infection and should be included in the differential diagnosis of a fever wherever malaria is present. Therefore, the purpose of this study was to investigate the abdominal CT findings of P. vivax malaria.This retrospective study was reviewed and approved by our institutional review board and patient consent was waived. During January 2004-February 2009, the medical records of 405 patients in our hospital who were confirmed as having P. vivax malaria by peripheral blood smear were obtained. Among them, 47 patients underwent an abdominal CT examination and 51 patients underwent abdominal ultrasonography because of gastrointestinal symptoms.Exclusion criteria were more than a three-day interval between the peripheral blood smear and CT scan (n = 8), nondigitalized images (n = 2), unavailable peripheral blood smear slides (n = 2), and monophasic CT (n = 1). Thus, our final study population was composed of 34 patients (24 men and 10 women, mean age = 48.1 years). All patients were completely cured by treatment with chloroquine and most patients were lost to further follow-up. Two patients underwent follow-up CTs for other reasons. One patient underwent a splenectomy for a spontaneous rupture. Two patients with a subcapsular hematoma were hemodynamically stable and were successfully managed with supportive care.We retrospectively searched and evaluated the medical records of 80 consecutive patients (40 men and 40 women, mean age = 48.7 years) among those who visited the emergency department with high fever (> 38.3°C), had negative results for a peripheral blood smear, and underwent bi-phasic abdominal CT. The causes of their fever were acute hepatitis (n = 17), acute pyelonephritis (n = 11), acute gastroenteritis (n = 9), cholecystitis (n = 9), liver abscesses (n = 8), and cholangitis (n = 5), and so on. All diagnoses were confirmed by available date in the form of image characteristics, pathologic results, and clinical courses. For the normal group, we also tested 120 consecutive persons (86 men and 34 women, mean age = 45.9 years) who visited a health promotion cente...

No definite evidence indicates that the treatment of HGDNs by RFA provides additional long-term overall survival benefit as compared with regular follow-up and timely treatment. The findings of the present study concur with the present American Association for the Study of Liver Diseases guidelines.

ObjectiveTo determine the prognostic factors for local recurrence of nodular hepatocellular carcinoma after segmental transarterial chemoembolization.Materials and MethodsSeventy-four nodular hepatocellular carcinoma tumors ≤ 5 cm were retrospectively analyzed for local recurrence after segmental transarterial chemoembolization using follow-up CT images (median follow-up of 17 months, 4-77 months in range). The tumors were divided into four groups (IA, IB, IIA, and IIB) according to whether the one-month follow-up CT imaging, after segmental transarterial chemoembolization, showed homogeneous (Group I) or inhomogeneous (Group II) iodized oil accumulation, or whether the tumors were located within the liver segment (Group A) or in a segmental border zone (Group B). Comparison of tumor characteristics between Group IA and the other three groups was performed using the chi-square test. Local recurrence rates were compared among the groups using the Kaplan-Meier estimation and log rank test.ResultsLocal tumor recurrence occurred in 19 hepatocellular carcinoma tumors (25.7%). There were: 28, 18, 17, and 11 tumors in Group IA, IB, IIA, and IIB, respectively. One of 28 (3.6%) tumors in Group IA, and 18 of 46 (39.1%) tumors in the other three groups showed local recurrence. Comparisons between Group IA and the other three groups showed that the tumor characteristics were similar. One-, two-, and three-year estimated local recurrence rates in Group IA were 0%, 11.1%, and 11.1%, respectively. The difference between Group IA and the other three groups was statistically significant (p = 0.000).ConclusionAn acceptably low rate of local recurrence was observed for small or intermediate nodular tumors located within the liver segment with homogeneous iodized oil accumulation.

TACE can be a safe and effective treatment for patients who have HCCs with central bile duct invasion. In particular, long-term survival can be expected if patients have strongly enhancing tumors without poor prognostic factors such as extrahepatic metastasis, PT-INR prolongation, and vascular invasion.