Cipto Mangunkusumo Hospital Jakarta Research Articles

Gastroesophageal Reflux: Are There Differences of Characteristic in Infants and Children

Background: Gastroesophageal reflux (GER) is an involuntary passage of gastric contents into the esophagus. GER in infancy is usually a physiologic reflux whereas GER in children more than 12 months old is often considered as a pathologic reflux although without any clinical complications. This consideration may lead over-treatment of GER in children. The objective of this study was to find out the difference of GER characteristic in ‘healthy’ infants and children. Method: Cross sectional study in children age 0-36 months at Cipto Mangunkusumo Hospital Jakarta during 2005-2007 with inclusion criteria: clinically healthy, regurgitations/vomits ³ 4 times/day, well nourished and other etiologies of vomiting had been excluded. The characteristic of GER was evaluated by esophageal pH monitoring (pH-metri) included number of reflux episodes, reflux duration > 5 minutes, and reflux index. Results: Sixty children were enrolled in the study; consisting 30 infants (age 0-12 months) and 30 children (age 13-36 months). The median number of reflux in infants was 18 ( range1-19), whereas the median in children was 17 (range 3-27) ( p = 0.47). The median number of reflux > 5 minutes was 2 (range 0-2), whereas the median in children was 3 (0-30) (p = 0.85). The median reflux index in infants was 4.5% (range 0.6%-22.9%) whereas the median in children was 6.35% (0.1%-87.%) (p = 0.34). Conclusion: The characteristic of GER in ‘healthy’ infants and children were not significantly different; however reflux index > 5% (pathologic GER) was seen in children age 13-36 months. Clinical course monitoring are important in infants and children with GER. Keywords: gastroesophageal reflux, regurgitation, infant, children, pH monitoring

Association of HLA class II and history of atopy and frequent relapse of childhood steroid-sensitive nephrotic syndrome

Background The association between HLA class II and frequentrelapse of nephrotic syndrome (FRNS) has been reported.Objective To identify the association between HLA class II,history of atopy, and upper respiratory tract infection (URTI)with FRNS.Methods This was a case control study conducted at theDepartment of Child Health, Hasan Sadikin Hospital Bandungand Cipto Mangunkusumo Hospital Jakarta from November 2002to October 2003 on children aged 1-14 years with FRNS. Thesubjects consisted of 40 FRNS and 84 healthy children. HLAclass II was typed by polymerase chain reaction-sequence specificoligonucleotide (PCR-SSO) in Leiden, the Netherlands. Theassociation between HLA class II and FRNS was expressed byodds ratio (OR). The association between such factors and FRNSwas analyzed by logistic regression.Results Atopy was higher in patients than that in controls(P=0.013). URTI did not differ in both groups (P=0.173). HLA-DRB1*03 and DRB1*04 (OR=4.43, P=0.03), DQB1*02(OR=3.43, P=0.00), and DQB1*04 (OR=12.06, P=0.01) weresignificantly higher among patients than those in controls whereasHLA-DRB1*12 (OR=0.34, P=0.02) and DQB1*0301p(OR=0.35, P=0.02) were significantly lower among patients thanthose in controls. Using logistic regression analysis, only HLA-DRB1*12, DQB1*02 and atopy took part in FRNS.Conclusion HLA-DRB1*12, DQB1*02, and atopy all togetherhave association with FRNS.

Factors affecting school performance in children with rheumatic heart disease

The aim of this study was to determine the association between school performance and age, sex, duration of illness, educational achievement prior to illness, socioeconomic status of family, parent’s educational level, number of children in the family and severity of the disease of patients with rheumatic heart disease (RHD). Subjects were patients with RHD treated at the Division of Cardiology, Department of Child Health, Cipto Mangunkusumo Hospital Jakarta. The parameters of school performance were educational achievement, absent of school and dropout. All data were processed by using Epi-Info program to find out bivariate analysis and Statistic Program for Social Sciences (SPSS) for multivariate analysis. We obtained 80 patients with RHD; most of them were of mild severity (64 of 80%) and the remainder 16 (20%) with severe disease. There were 44 (55%) males and 36 (45%) females. Most parents (42 or 53%) had junior high school educational level, most of them, 23 (29%) had elementary school education, and 3 (4%) illiterate. Bivariate and multivariate analyses showed that severity of disease and parental educational level were associated withschool performance of patients with RHD, but age, sex, duration of disease, premorbid educational achievement, socio-economic level of the family and number of children in family were not.

Congenital uronephropathy pattern in children

To obtain the basic data of congenital uronephropathy pattern and the affecting factors in children, we conducted a cross-sectional study at the Department of Child Health Cipto Mangunkusumo (CM) Hospital Jakarta from 1995 to 1999 and 9 teaching hospitals throughout Indonesia. During the study period 134 patients were obtained, 116 patients from the CM Hospital and 18 patients from other teaching hospitals. Most patients (48.8%) were below 1 year of age; male were affected more than female (2.4:1). The disorder was classified into two groups, i.e., congenital nephropathy and uropathy. There were 10 children with nephropathy, i.e., 4 with unilateral renal hypoplasia, 3 with polycystic kidney, and 3 with renal agenesis. In the uropathy group, 43 were with hypospadia, 22 with primary reflux vesicoureter, 18 with neurogenic bladder, and 17 with ureteropelvic junction obstruction. The complications found were urinary tract infection (71.2%), chronic renal failure (15.7%), hypertension (3.7%), and acute renal failure (1.5%). Consanguinity, familial disorders, maternal diseases, x-ray exposure and abortion efforts were found in a small proportion of patients. History of drug or herbs use in the first trimester of pregnancy was found in a large proportion of patients, mostly took analgesics (especially acetaminophen). In conclusion, uropathy disorders were much more common than congenital nephropathy. The most common complication was urinary tract infection, followed by chronic renal failure, hypertension, and acute renal failure.

Urinary incontinence in children in Cipto Mangunkusumo Hospital, Jakarta: a serial case report

Urinary incontinence in children is a complex problem of varying causes. Most children brought to physician for evaluation of difficulties with urinary control will have single or diurnal enuresis, or will be experiencing urgency associated with functional or organic incontinence. To find out the magnitude of urinary incontinence problems in Child Health Department Cipto Mangunkusumo Hospital Jakarta, we retrospectively looked at medical report of such cases between the years of 1989-2001. During eleven years there were 20 cases, consisted of 10 males and 10 females, aged ranged between 3 months up to 16 years. Nineteen children showed significant bacteriuria defined as a urinary tract infection. Ten children were diagnosed as having neurogenic bladder, all had spinal lesions; 7 children had spinal dysraphyism while 3 others had osteolityc lesions in vertebrae due to malignancy. Non neurogenic bladder was defined in 6 children, while in other 4 children we defined that urinary incontinence was caused by anatomical abnormalities. Vesico-ureteral reflux in various degree were found in 9 children, while 11 out of 20 (55%) cases were experiencing chronic renal failure on their first visit. Although the annual incidence of urinary incontinence is low, these difficult cases causing many problems. Breakthrough infection was almost unpreventable and in most cases had progressed to renal failure. Many factors such as invasive procedures and prolonged treatment causing fear and frustration to the patients and their parents leading to poor compliance and lost to follow up. In summary we can conclude that urinary incontinence in children is a complex problem include medically, economically, and socially, not only for the patient and their parents, but also for medical profession.

Hospital based cancer registry in Cipto Mangunkusumo hospital Jakarta

Registrasi kanker berbasis rumah sakit di RSUPN Cipto Mangunkusumo, Fakultas Kedokteran Universitas Indonesia, telah dimu/ai tahun 1997, bertujuan untuk memberi data bagi program pengendalian kanker dan membanlu perencanaan rumah sakit. Maka/ah ini menyajikan registrasi kanker sepanjang tahun 1997-1998. Data dari semua pasien kanker yang baru terdiagnosis dicatat pada Formulir Registrasi Kanker. Yang didata ialah identitas pasien, demografi dan kultur, penilaian tumor dan usia, serta penatalaksanaan. Terdapat 2144 (0.48%) penderita kanker diantara 444.178 pasien baru yang berobat ke RSCM. Perbandingan perempuan dan laki-laki ada/ah 1.7 : 1. Usia terbanyak pada perempuan ada/ah 35-44 tahun, pada /aki-laki 45-54 tahun. Usia rata­ rata saat terdiagnosis umumnya lebih muda dibanding senter lainnya. Pada perempuan, kanker terbanyak ada/ah lqmker serviks, disusul o/eh payudara dan nasofaring sedang pada /aki-/aki terbanyak nasofaring, sumsum tu/ang dan hati. Pada anak, terbanyak ada/ah leukemia limfositik akut, leukemia non limfositik akut, retinob/astoma dan nefroblastoma . Pendidikan penderita perempuan lebih rendah dibanding laki-laki . Perempuan penderita kanker serviks. kulit, sumsum tu/ang, kelenjar getah bening dan laki-laki penderita kanker sumsum tulang, kelenjar getah bening dan mata mempunyai pendidikan yang lebih rendah. Sebanyak 85% diagnosis ditegakkan secara mikroskopik. Jum/ah kanker stadium awa/ lebih rendah dibanding stadium /anjut (47% vs 53%). Pada tahun 1998 terapi awal yang paling banyak diberikan ada/ah berturut-turut radioterapi, bedah dan kemoterapi. Hanya 45% pasien yang mempero/eh terapi da/am 3 bu/an pertama sete/ah diagnosis. Abstract The Hospital Based Cancer Registry in Registry in Cipto Mangunkusumo National Center General Hospital (RSCM), the teaching hospital of the Faculty of Medicine University of Indonesia, was set up in 1997. Its aims were toprovide information on the magnitude of cartcer problems , and data for focussing cancer control programs, to facilitate thefollow up and to help plan hospital facilities . This paper presents a summary of the cancer registry data collected during the period of 1997-1998. Data from al newly diagnosed cancer patients was recorded in Cancer Registration Forms by the oncology doctors. The collected items of information were patient 's identification, demographic and cultural items, the tumor and its investigations, and the treatment. There were 2144 (0.48%) cancer patients among 444,178 new patients treated in RSCM hospital. The female to male patients ratio was 1.7 : 1. The age peak ed in females within 35-44 years, and in males within 45-54 years. In general. the mean age at diagnosis of various cancer was younger compared to other centers. In females, the most common cancers were cervical, breast, and nasophayngeal, and in males, they were nasopharyngeal, bone marrow, and liver cancers. In children, the most common cancers were acute lymphocytic leukemia, acute non­ lymphocytic leukemia, acute non-/ymphocytic leukemia, retinoblastoma, and nephrob/astoma . Female patients had lower educational level than males. Females with cervical, skin, bone marrow, lymph nodes cancer and males with bone marrow, lymph nodes and eye malignancy had lower educational level. There were 85% patients diagnosed by microscopic examination. The number of early stage cancer was lower corned to late stage cases (47% vs 53%). In 1998, the most frequent initial treatment was radiotherapy, followed by surgery and chemotherapy, and only 45% patients received treatments within 3 months after diagnosis. Keywords: Cancer registry, site, age, education, staging, diagnosis, treatment

Commentary on menstruai regulation as a health service: challenges in Indonesia

In the 1800s Indonesia enacted laws forbidding the performance of abortions. These laws are still in force. Furthermore the Criminal Law of Netherlands Indies of 1918 makes induced abortion a criminal act. In 1973 the teaching hospital of the University of Indonesia began a menstrual regulation project. Qualified physicians can perform menstrual regulation. Despite changes in legal attitudes peoples attitudes do not change as fast. Many do not want to receive this new health service. Information from the 1970s on the frequency of abortions in hospitals and maternity clinics/hospitals in metropolitan Jakarta is cited. One of the larger studies is of 18 hospitals (85.7% of all hospitals in metropolitan Jakarta) and 22 maternity clinics or maternity hospitals in metropolitan Jakarta during 1972-75. Abortions rose while births remained constant. Estimations indicate that perhaps 25-60% of such abortions are induced. Research at the Dr. Cipto Mangunkusumo Hospital Jakarta using randomized response found premeditated abortion among 32.7% of the women admitted for all abortion types. A study of 1187 pregnant women who come to the Center for Maternal and Child Welfare in Surabaya found that the number of unwanted pregnancies rose with the number of living children. Several factors contribute to the high numbers of illegal abortion in Indonesia. These include the fact that abortion is not acceptable to many for religious or cultural reasons. Also many girls marry at too young an age or become sexually active before marriage. Health providers discourage women who seek help for unwanted pregnancies. Society regards abortion as taboo. Professional health services within easy financial reach should be provided. It should have clear legal standing. The procedure should be performed at an early gestational age. (Within 14 days after a missed period or at most within the 1st trimester.) Women must have information about this.

Standardization of Honey Application on Acute Partial Thickness Wound


 
 
 
 Backgrounds: : Inthe past few years, clinicians worldwide have been using honey for wound treatment. But until now, there was no such standard on method of honey application on wound. In our center, honey was applied on wound by once a day application and the result was observationally satisfactory. What if application of honey were done once every two days? Would the result become more satisfactory? This study aims to search honey application method, which gives the best result on wound treatment.
 Methods: This is single-blinded non-randomize clinical trial, which was conduscted in Cipto Mangunkusumo Hospital Jakarta from July until September 2012. 14 Patients with acute partial thickness wound resulted from STSG harvesting were involved in this study. Patients were devided into 2 groups: control (once every two days application of honey) and the rate of wound healing were evaluated. Rate of wound healing will be assessed as number of percentage of reduced non-epithelialized areas on the seventh day of application.
 Results: The mean percentage of non-epithelialized area reduction on treatment gruop was 86,76% and 97,97% on control group. There was significant difference on percentage of reduced area between control and treatment group (p<0,00).
 
 
 
 
 Conclusion: There was statistically signi!cant difference between once a day and once every two days application of honey. However, changing of honey dressing once a day is still a preferable method in wound treatment.
 
 
 
 
 
 
 

Frontoethmoidal Encephalomeningocele Revisited : The Convenience Of Teamwork Approach, A CaseSeries

Background: Frontoethmoidal encephalomeningocele (FEEM) is a congenital defect of the skull which poses many problems to the patient as it results in many craniofacial and neural morbidities. While recently surgical correction of this disease is done in a single-stage procedure, many in Indonesia still perform twostage surgery which bears more risks and is technically difficult to achieve good aesthetic results. This case series intend to assess the feasibility and convenience of teamwork approach between plastic surgeon and neurosurgeon in correcting FEEM in a single-stage operation. Methods:We reviewed 8 patients with FEEM treated in Plastic and Reconstructive Surgery Division, Cipto Mangunkusumo Hospital Jakarta from November 2005 until March 2010. Four of the cases were secondary cases from Neurosurgery Department, and the other 4 cases were treated in single-stage operation, in teamwork with Neurosurgery Department, using the Chula technique. Results of each surgery was assessed using objective parameters, which are Intercanthal Distance (ICD) and Interorbital Distance (IOD); and also subjective parameters which is aesthetic improvement.Result: All of the patients showed significant improvements in ICD and IOD measurements. No complication was found intra and post-operatively. All patients, especially the ones treated with singlestage surgery show good aesthetic results. Conclusion: To achieve goals of defect correction and aesthetically pleasant appearance, single-stage surgery in teamwork with the neurosurgery department seems to be most suitable and convenient.

PENGARUH VOLUME BULI-BULI TERHADAP PANJANG PROSTAT PADA PEMERIKSAAN ULTRASONOGRAFI TRANSABDOMINAL

Objective: To study the effects of different bladder volumes on the length of prostatic protrusion as measured by transabdominal ultrasonography. Materials & Method: We did an observational study on 48 patients with BPH and urinary retention in Urology outpatient clinic of Cipto Mangunkusumo Hospital Jakarta from 1 March 2006 to 28 February 2007. The bladder of each patient was filled with 50 ml normal saline and increased stepwise by 50 ml each time until either an urge to void or a volume of 500 ml was reached. Length of prostatic protrusion was measured by transabdominal ultrasonography at each volume of bladder filling in every patient. Results: The average length of prostatic protrusion in 50, 100, 150, and 200 ml bladder filling was 11,14; 11,42; 11,88; 10,20 mm respectively. There is no statistically significant difference in the length of prostatic protrusion with transabdominal ultrasonography in each bladder volume. Conclusion: Prostatic protrusion length can be measured with bladder volumes between 50 ml to 200 ml and shows no significant difference.