ABSTRACT
Biliary papillomatosis is rare, and its pathogenic mechanisms are not yet clear. Because of its high risk for malignancy transformation, surgical resection is regarded as a standard treatment. Photodynamic therapy (PDT) has been used by the intravenous administration of hematoporphyrin derivative followed by laser exposure. A photochemical process causes disturbance of the microvascular structure and degradation of membrane. Cholangitis is a major complication after PDT. A healthy 56-year-old man was diagnosed with biliary papillomatosis involving the common hepatic duct, both proximal intrahepatic bile ducts (IHD), and the right posterior IHD. After biliary decompression by endoscopic nasobiliary drainage, PDT was performed to avoid extensive liver resection and recurrence using endoscopic retrograde cholangiographic guidance. After portal vein embolization, the patient underwent extended right hemihepatectomy. Following administration of chemoradiation therapy with tegafur-uracil and 45 Gy due to local recurrence at postoperative 13 months, there was no local recurrence or distant metastases. This is the first case report on PDT for biliary papillomatosis in Korea. Preoperative PDT is beneficial for reducing the lesion in diffuse or multifocal biliary papillomatosis and may lead to curative and volume reserving surgery. Thus, PDT could improve the quality of life and prolong life expectation for biliary papillomatosis patients.
Subject(s)
Humans , Male , Middle Aged , Antineoplastic Agents/therapeutic use , Bile Duct Neoplasms/diagnosis , Bile Ducts, Intrahepatic/pathology , Embolization, Therapeutic , Gamma Rays , Hepatectomy , Hepatic Duct, Common/pathology , Neoplasm Recurrence, Local , Papilloma/diagnosis , Photochemotherapy , Tegafur/therapeutic use , Uracil/therapeutic useABSTRACT
BACKGROUND: The mortality rate from tuberculosis in Korea is the highest among OECD countries. However, general public's knowledge of tuberculosis is limited. Currently, exposure to tuberculosis in high school students is a big problem. METHODS: A written questionnaire was distributed to 78 high school students in Busan. RESULTS: Almost all the students had heard of tuberculosis (95%). However, their knowledge of tuberculosis was very superficial and limited. The attitude about tuberculosis was 'nothing to worry about' and there was no systemic education in the school or home. CONCLUSION: Although tuberculosis is quite serious in Korea, most people know little about it and have the wrong attitude. In particular, high school students are easily exposed to tuberculosis because they spend most of their time as a group. Therefore, education of high school students on tuberculosis is strongly recommended in schools and the home. In addition, medical practitioners should play a role in education and prevention programs.