ABSTRACT
PURPOSE: Since 2005, the Ministry of Health & Welfare has provided financial support to promote palliative care for terminal cancer patients. We analyzed how palliative care facilities used the funding between 2006 and 2010. METHODS: Frequency analysis was conducted by the item of expenditure based on fiscal reports of the palliative care facilities. Linear regression analysis was performed to examine a trend over time. Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare expenditure items, the number of provision of financial support and type of palliative care units. RESULTS: About a half of the fund was spent to pay care givers salary, improve facilities and purchase equipment regardless of the year, the number of financial support provided or facility type. By year, the operation cost for palliative care program and the education cost for health care workers have significantly increased in linear regression analysis (P<0.01). However, the amount of financial support for the low income group has decreased over years (P=0.024). This trend was affected by evaluation criteria and weight. CONCLUSION: The government aid for palliative care units has been used to improve facilities and equipment. Moreover, desirable changes were noted such as a higher portion of expenses for program operation and care giver training to enhance the quality of care. However, the evaluation criteria need to be adjusted to prevent any further decrease in the support provided to the low income group.
Subject(s)
Humans , Caregivers , Delivery of Health Care , Financial Management , Financial Support , Financing, Government , Health Expenditures , Korea , Linear Models , Palliative Care , Practice Guidelines as Topic , Salaries and Fringe BenefitsABSTRACT
Although autoimmune liver diseases are common in Western countries, only sporadic cases have been reported in Korean children. Autoimmune hepatitis, primary biliary cirrhosis, autoimmune cholangiopathy and primary sclerosing cholangitis are major classes of liver diseases currently considered autoimmune. The overlap syndrome has features associated with both autoimmune hepatitis and other liver diseases. We treated a case of the overlap syndrome that included auoimmune hepatitis and cholangiopathy in a 12 year-old boy. Considering that these entities, autoimmune liver diseases or overlap syndromes, are potentially treatable diseases in children, a high index of suspicion is needed for the appropriate diagnosis.
Subject(s)
Child , Humans , Male , Cholangitis, Sclerosing , Diagnosis , Hepatitis , Hepatitis, Autoimmune , Liver Cirrhosis, Biliary , Liver DiseasesABSTRACT
PURPOSE: We performed this study to assess the clinical course of acute rejection and chronic rejection after liver transplantation in children. METHODS: Seventy-six liver transplantations were performed in 75 children between December 1994 and March 2002. Twenty-five boys and 50 girls were included in this study, and the mean age was 20 months old. We analyzed the incidence, clinical course and outcome of acute and chronic rejection after liver transplantation retrospectively. RESULTS: Forty out of 75 children (53%) experienced 45 episodes of acute rejection, and 32 episodes (71%) of them occurred within 1 month after transplantation. The degree of acute rejection was mild in 16 (36%), moderate in 14 (31%) and severe in 2 (4%) cases. Younger (<2 years old) recipient experienced higher incidence of acute rejection. But there was no association with recipient's sex, ABO matching, type of donor, and the kind of immunosuppressant. All 40 children with acute rejection improved with conventional treatment. There was no significant statistical relation between acute rejection and recipient's survival. Chronic rejection occurred in 7 (9%) children, and 3 of them died of chronic rejection itself but another 3 children improved during the follow-up periods. CONCLUSION: Acute rejection occurred in more than half of the pediatric liver transplantation recipients. Most rejection episodes were mild and occurred within 1 month after transplantation. Acute rejection did not affect the recipient's survival and graft function.
Subject(s)
Child , Female , Humans , Infant , Allografts , Follow-Up Studies , Incidence , Liver Transplantation , Liver , Retrospective Studies , Tissue Donors , TransplantsABSTRACT
Most patients with bile duct carcinoma are diagnosed at an advanced stage, commonly after the appearance of jaundice. The prognosis is generally poor when the diagnosis is made at this stage. Early diagnosis of cholangiocarcinoma at a nonicteric stage may more likely allow curative resection. Initial workup of suspected biliary tract obstruction begins with noninvasive radiologic examinations including US and CT, but these and with even ERCP have a limitation in the diagnosis of early bile duct carcinoma. A case of intrahepatic early bile duct carcinoma without jaundice in a 53-year-old man, is herein reported. The lesion could be early diagnosed, especially with the use of MR cholagiography and percutaneous transhepatic cholangioscopic examination, and eventually could be completely resected.
Subject(s)
Humans , Middle Aged , Bile Ducts , Bile , Biliary Tract , Cholangiocarcinoma , Cholangiography , Cholangiopancreatography, Endoscopic Retrograde , Diagnosis , Early Diagnosis , Jaundice , PrognosisABSTRACT
Asymptomatic intrahepatic early-stage bile duct carcinoma without jaundice is difficult to diagnose because it does not have any characteristic clinical signs and symptoms. The clinical implication of early-stage intrahepatic ductal cholangiocarcinoma is great, because it allows curative resection and excellent long-term survival. Recently we experienced early-stage intrahepatic cholangiocarcinoma which was incidentally detected by a clue of elevated serum alkaline phosphatase and gamma-GT without jaundice and any symptoms. Abdominal US showed focal intrahepatic bile duct dilatation. ERCP could not demonstrate the lesion, while MRCP revealed the obstructed duct (S6) with proximal dilatation. For evaluation of a focal intrahepatic stricture, PTCS examination and biopsy were done. With the help of MRCP and PTCS, the lesion was diagnosed as papillary adenocarcinoma preoperatively. The patient was underwent right liver lobectomy and confirmed early-stage intrahepatic ductal adenocarcinoma and she is well-being without cancer recurrence for a follow-up period of 1 year.
Subject(s)
Humans , Adenocarcinoma , Adenocarcinoma, Papillary , Alkaline Phosphatase , Bile Ducts , Bile Ducts, Intrahepatic , Biopsy , Cholangiocarcinoma , Cholangiopancreatography, Endoscopic Retrograde , Constriction, Pathologic , Dilatation , Follow-Up Studies , Jaundice , Liver , Recurrence , CholangiocarcinomaABSTRACT
Epstein-Barr virus (EBV)-associated disease is known to be one of the major complication after transplantation. Early identification and diagnosis is crucial. The objectives of this study are to evaluate the incidence and to analyze the risk factors of EBV-associated disease. Twenty-five children with liver transplantation from Oct. 1994 to Oct. 1997 had been surveyed. Laboratory data of EBV infection such as anti-viral capsid antigen (VCA) IgM and IgG, EBV PCR, EBV encoded small RNA (EBER) in situ hybridization had been obtained at pre op, and post op 1, 2, 3, 4, 12, 24 weeks, then annually or when EBV infection was suspected. We classified these cases as asymptomatic infection, EBV syndrome, posttransplant lymphoproliferative disease (PTLD). And we analyzed the incidence of EBV infection according to age, type of immunosuppression, and CMV disease. Incidence of EBV infection in this study was 48% (12 out of 25), among them, 5 children were symptomatic and PTLD developed in 2 children. The significant risk factors were age at transplantation and CMV infection. One of PTLD cases resulting from EBV infection showed fatal outcome, the other was improved. We suggested that physicians especially in the care of the children after the liver transplantation should recognize the risk factors of the development of the EBV infection to avoid the progression into the potentially fatal PTLD.
Subject(s)
Child , Humans , Asymptomatic Infections , Capsid , Diagnosis , Epstein-Barr Virus Infections , Fatal Outcome , Herpesvirus 4, Human , Immunoglobulin G , Immunoglobulin M , Immunosuppression Therapy , In Situ Hybridization , Incidence , Liver Transplantation , Liver , Polymerase Chain Reaction , Risk Factors , RNAABSTRACT
BACKGROUND/AIMS: Transarterial chemoembolization (TACE) has been reported to be one of the useful palliative treatments in patients with unresectable hepatocelluar carcinoma. However, Bile duct injuries following TACE have been reported occasionally. In this study, we intended to clarify the incidence, pathogenic mechanisms and clinical implications of bile duct injuries following TACE. METHODS: A total of 950 consecutive patients with hepatocellular carcinoma (HCC) were subjected. 807 patients were treated with TACE. The remaining 143 were treated with transarterial chemoinfusion (TACI) of cisplatin. RESULTS: None of 143 HCC patients treated with TACI revealed to have any ischemic biliary injury radiologically. In contrast, out of 807 with TACE, 17 (2%) appeared to have biliary complications. Twelve out of 17 (71%) had bilomas at subcapsular area, three out of 17 (18%) had focal strictures at common hepatic duct or common bile duct with marked dilatation of intrahepatic bile ducts and two out of 17 (11%) had diffuse mild dilatation of intrahepatic bile ducts. Interestingly, two (17%) out of 12 bilomas were found at the lobe which was not embolized with Gelfoam. The median sessions of TACE to the occurrences of focal strictures tended to be longer compared with those of bilomas (median: 6 vs. 2.5; p=0.08). All three patients with focal strictures and four (33%) out of 12 patients with bilomas were associated with serious bacterial infections at presentation. CONCLUSIONS: Biloma seems to be caused by lipiodol rather than Gelfoam; focal strictures of large bile ducts by Gelfoam. It is suggested that adjustments of the amounts of lipiodol or Gelfoam and the sites or embolization may be required to reduce the ischemic biliary injuries following TACE.
Subject(s)
Humans , Bacterial Infections , Bile Ducts , Bile Ducts, Intrahepatic , Bile , Carcinoma, Hepatocellular , Cisplatin , Common Bile Duct , Constriction, Pathologic , Dilatation , Ethiodized Oil , Gelatin Sponge, Absorbable , Hepatic Duct, Common , Incidence , Palliative CareABSTRACT
PURPOSE: Living related donor liver transplantation (LRLT) was introduced into our pediatric liver transplantation program as a response to the shortage of donors. This study was performed to evaluate the indication, complication and outcome of LRLT in children. METHODS: From December, 1994 to May, 1997, a total of 20 LRLTs had been performed at Asan Medical Center for end-stage liver disease. The patients ranged in age from 6 months to 14 years (median : 1 year 4 months) and in body weight from 5.8 to 50.5kg (median : 9.8kg). The indications for transplantation were biliary atresia (11), Wilson disease (3), nonsyndromic intrahepatic bile duct paucity (2), Byler syndrome (1), cirrhosis (1), fulminant hepatitis (1) and posthepatectomy bile duct stricture (1). Among them 3 ABO blood group incompatibilities were included. The lateral segment or the left lobe of the liver was used for the graft. As for immunosuppression, cyclosporin A based immunosuppression was used for the initial 11 cases which later changed into FK506 based for the last 9 cases. RESULTS: The actuarial survival rate of recipients was 90% for our cases. Two deaths occurred, one of whom died of acute respiratory distress syndrome due to respiratory syncytial virus infection on 51st postoperative day and the other died of gastrointestinal bleeding from Epstein- Barr virus infection and posttransplant lymphoproliferative disease on 11th postoperative month. No patient died of surgical complications. Acute rejection episodes were observed in 6 (5 among 11 cyclosporin A based immunosuppression and 1 among FK506 group) which were managed successfully. All donors (6 fathers and 14 mothers) are alive and well with normal activity. CONCLUSION: We concluded that LRLT is a promising option for alleviating the shortage of livers for pediatric transplantation.
Subject(s)
Child , Humans , Bile Ducts , Bile Ducts, Intrahepatic , Biliary Atresia , Blood Group Incompatibility , Body Weight , Constriction, Pathologic , Cyclosporine , Fathers , Fibrosis , Hemorrhage , Hepatitis , Hepatolenticular Degeneration , Immunosuppression Therapy , Liver Diseases , Liver Transplantation , Liver , Living Donors , Respiratory Distress Syndrome , Respiratory Syncytial Viruses , Survival Rate , Tacrolimus , Tissue Donors , TransplantsABSTRACT
Posttransplant lymphoproliferative disease(PTLD) represents a diverse lymphoproliferative disorder ranging from non-specific reactive hyperplasia to malignant immunoblastic sarcoma developed in a setting of immunosuppression following organ or cellular transplantation. It is often associated with Epstein-Barr virus infection and high dose immunosuppression. EBV detection and immunotyping including immunoglobulin clonality is crucial for prediction of prognosis and treatment modality. We report one case of PTLD developed 5 months after renal transplantation in 33 year-old man. Clinical manifestion was submandibular mass, and EBV was detected by in situ hybridization. Histology and immunotyping revealed immunoblastic lymphoma andl lambda chain monoclonality. He has been treated with reduction of immunosuppression, acyclovir and radiotherapy, and is in stable condition with normal renal function at postoperative 11months without evidence of disease reccurrence.
Subject(s)
Adult , Humans , Acyclovir , Herpesvirus 4, Human , Hyperplasia , Immunoglobulins , Immunosuppression Therapy , In Situ Hybridization , Kidney Transplantation , Lymphoma , Lymphoma, Large-Cell, Immunoblastic , Lymphoproliferative Disorders , Prognosis , RadiotherapyABSTRACT
Diffuse alveolar hemorrhage is a very rare manifestation in Henoch-Schoenlein purpura. Recently we experience a case of diffuse alveolar hemorrhage associated with Henoch-Schoenlein purpura which was diagnosed by typical clinical manifestation and renal biopsy. A 25 year old male was admitted due to hemoptysis and dyspnea. Chest X-ray, HRCT and BAL revealed diffuse alveolar hemorrhage. He also had a history of skin rash, polyarthralgia, and hematochezia with abdominal pain. Renal biopsy which was taken for the evaluation of microscopic hematuria showed IgA nephropathy. Under the diagnosis of Henoch-Schoenlein purpura, we treated him with solumedrol pulse therapy, plasma-pheresis and prednisolone with cytoxan. After then he showed marked improvement in clinical manifestation and was discharged with prednisolone and cytoxan.
Subject(s)
Humans , Male , Abdominal Pain , Arthralgia , Biopsy , Cyclophosphamide , Diagnosis , Dyspnea , Exanthema , Gastrointestinal Hemorrhage , Glomerulonephritis, IGA , Hematuria , Hemoptysis , Hemorrhage , Methylprednisolone Hemisuccinate , Prednisolone , IgA Vasculitis , ThoraxABSTRACT
No abstract available.