Dr Cipto Mangunkusumo Research Articles

Correlation between Blood Types and Intraabdominal Infection A Preliminary Study

Introduction . Intra-abdominal infection (IAI) remain a clinical problem with high mortality rate. Among factors contributed to this mortality, the important one is blood type that never be considered. It was thought to have correlation with a certain type. Thus, a retrospective study as a preliminary study run to find out the evidence. Method. A descriptive analytic with cross sectional design was run. Data of those diagnosed with intraabdominal infection due to abdominal trauma and gastrointestinal infections managed at dr Cipto Mangunkusumo General Hospital was taken from medical record. ABO blood types and microbial culture results in two groups were the focus of a study and were analyzed statistically. Results. In the study, out of 230 subjects, there were 22 subjects (9.6%) with postoperative intra-abdominal infection were observed during January 2014-March 2016. There was a significant correlation between blood transfusion (p <0.001, OR = 0.02) with intraabdominal infection. However, there was no significant correlations found in blood type to the occurrence of intra-abdominal infection. Conclusion. The study unable to show that blood type has a correlation to intra-abdominal infection in those diagnosed with abdominal trauma and gastrointestinal infections. Keywords : intra-abdominal infection, blood type

Relative Expression of cMyc mRNA in Human Glioma Cells and its Relationship with the Degree of Malignancy

Relative Expression of cMyc85Vol. 5, No. 2, Agustus 2017RESEARCH ARTICLERelative Expression of cMyc mRNA in Human Glioma Cells and its Relationship with the Degree of Malignancy Fidinny I. Hamid,1 Novi S. Hardiany,2* Febrial Hikmah,3 Syaiful Ichwan41Undergraduate Program FM Universitas Indonesia2Department of Biochemistry and Molecular Biology, FM Universitas Indonesia3Biomedical Sciences Program FM Universitas Indonesia4Department of Neurosurgery FM Universitas Indonesia -Dr Cipto Mangunkusumo General Hospital*Corresponding author: novi.silvia@ui.ac.idReceived 10 April 2016; Accepted 23 Agustus 2017DOI: 10.23886/ejki.5.7467AbstractPluripotency of cMyc genes may be one factor for the high glial cell differentiation in glioma thus it can become an alternative therapeutic target. The objective of the study is toanalyze the cMyc mRNA expression and its relationship with the degrees of glioma malignancy. This is a cross-sectional study from 20 glioma samples with different degree of malignancy from Dr. Cipto Mangunkusumo General Hospital, Jakarta during the period of October 2014 until February 2015. The mRNA obtained from glioma samples are converted to cDNA and then amplified. Relative quantification of cMyc mRNA expression is measured by calculating the cycle threshold values of Real Time RT PCR and normalized towards 18s rRNA to predict the relationship between the expression of cMyc and the degree of malignancy. The cMyc expression is increased in accordance with the tumor grade. The cMyc expressions in high grade glioma are 17424.23 folds higher when calibrated to the normal cell, whereas the genes in lower grade tumors are expressed with the rate of 6167.35. Although the values obtained are not statistically significant, this research has strengthened molecular diagnosis, specifically pluripotency as the factor that gives a greater prognostic relevance than the histopathologic diagnosis. As a conclusion, there is a clinical tendency where the relative mRNA expression was higher in in glioma cMyc high degrees compared with low-grade glioma, however it is not statistically significant.

Variasi Genetik Gen CD40 Daerah 5’-UTR dan Karakteristik Pasien: Hubungannya dengan Risiko Kambuh Penyakit Graves

More than 50% patients graves' disease (GD) can relapse after remission period. This can be influenced by treatment, gender, age of diagnosis and genetic. One of the genes that regulate immune response is CD40 gene, which is found on the surface of Lymphocyte B. The aim of this research was to determine genetic variation at 5'-UTR of CD40 gene and the role of age and gender that influence the risk for relapse. This study was conducted in Dr Cipto Mangunkusumo Hospital from August to December 2014. This study was a case-control study comparing 30 relapse patients and 30 non-relapse patients after treatment with anti-thyroid drug was terminated. Genetic variation was analyzed with PCR-RFLP and clinical characteristic by medical record. In this research, we found that both genotype and alleles 5'-UTR of CD40 gene variation have no association with risk for relapse (p>0.05), but age of diagnosis was considered significant with risk for relapse (p=0.001). In conclusion, genetic variation in 5'-UTR CD40 gene is not risk for relapse but age of diagnosis may be a risk for relapse in GD patients.

Comparison of Japanese Classification with the TNM System in the Assessment of Staging of Sigmoid and Rectal Cancer Patients at dr Cipto Mangunkusumo and Fatmawati Hospital (Preliminary Study)

Introduction. Lymph node metastasis of colorectal cancer is an independent prognostic factor and used as a guidlines for adjuvant therapy. Paralleled to this, TNM staging system has been used widely and nowadays referred to a gold standard of colorectal cancer staging. So far, such a system classifies the staging based on the numbers of positive lymph node involvement. Japanese classification was another kind of system do that categorize based on the distribution of lymph nodes involved (i.e. paracolic/rectal, intermediate, root of mesenteric artery). Method. This was a preliminary study analyzed of 15 subjects with sigmoid and rectal cancer underwent surgery at dr Cipto Mangunkusumo and Fatmawati Hospital between September and October 2015. We studied the specimen for histopathological evaluation focused on the numbers of positive lymph nodes and the distribution of lymph node metastasis. Staging was carried out using both of TNM system and Japanese classification, and these variables were subjected to agreement analysis. Results. We found more than twelve lymph nodes from each sample. Based on TNM staging system, there are seven subjects on stage II, three subjects with stage IIIb and five subjects with stage IIIc, meanwhile based on Japanese Classification, there were seven subjects with stage II, one subjects with stage IIIa and seven subjects with stage IIIb. Analysis of agreement between both of classifications resulted in coefficient Kappa of 49.3% (moderate category) with p-value of 0.04. Conclusion. Our preliminary study showed that agreement between both of classifications to specify sigmoid and rectal staging is in moderate category. Japanese classification is feasible to be used. Agreement accuracy may be obtained with a bigger samples (New Ropanasuri J Surg.2016;1(1):e34)

Hemorrhoid: Pathophysiology and Surgical Management Literature review

Hemorrhoids remains the major problem in adult, though the incidence is difficult to be found accurately as mostly those with this kind of a disease were not expressed properly. The other reason is there are so many non–medical services in Indonesia involved in the treatment, particularly the alternative medicine. In gastro–intestinal clinic of dr Cipto Mangunkusumo hospital there were 150 patients treated annually during period of 2005–2010. The majority of chief complain found was the bloody defecation, particularly in second and third degree internal hemorrhoids. Male and female were found equal in the second to fifth decade of life.

Implementation of revised Baux Score to Predict Mortality Burn Injured Patients in Burn Unit of dr Cipto Mangunkusumo Hospital, Jakarta

Introduction. Implementation of stratification in burn injured patients referred to a very helpful approach for surgeon distinguishing severity of problems as well as predicting the outcome and lead a surgeon to make an accurate decision and a guidance to deliver patient’s condition to his/her family. A stratification tools for prediction should be simple and applicable in clinical setting. It also feasible to be applied for clinical use, research purpose, and system audit. Amongst scoring systems in burn surgery, revised Baux score is the one. The study is aimed to run validation in our burn characteristics. Method. A study run to find out validation for revised Baux score, prior to its use for application in our setting. We run cohort study enrolled burn injured patient treated during period of January 2010 to December 2012, retrospectively. Total body surface area involved, age and inhalation injury referred to variables subjected to statistical analysis. Results. Out of 442 burn injured patient, there were 234 subjects included in the study. Statistical analysis using Hosmer and Lemeshow test addressed to evaluate calibration of scoring performance showed p value of p = 1 (> 0.05), and for its precision we found the performance of discrimination of r–Baux score showed the area under curve (AUC) of 0.87 (CI 95%; 0.825–0.915), showing a p value of <0.001, and sensitivity 77.9% and specificity 76.9%. Conclusion. We revised Baux score provide a good performance and likely would provide a merit of its clinical application (New Ropanasuri J Surg.2016;1(1):e40).

Antiplatelet Glycoprotein Antibodies Profile in Adult Patients with Primary Immune Thrombocytopenia and the Comparison with Regards to the Treatment Response to Corticosteroids

Background: Platelet destruction in immune thrombocytopenia (ITP) is mediated by autoantibodies against platelet antigens. Anti-GPIIb/IIIa and anti-GPIb/IX antibodies are two major antibodies spesific for platelets and megakaryocytes. The diversity of clinical characteristics and therapeutic responses have been thought to be influenced by heterogeneity of spesific glycoprotein complexes. However, there has been no published data regarding either antiplatelet antibodies profile or response rates to corticosteroid, in adult patients with primary ITP.Objectives: To determine antiplatelet glycoprotein antibodies profile in adult patients with primary ITP and to compare the response rate to corticosteroid referring to the profile.Methods: This study is a cross sectional study in adult patients with primary ITP who visited Hematology Clinics in Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia, in a period of March to October 2013. The tests to determine the auto antibodies against the platelet GPIIb/IIIa and GPIb/IX surface antigens were performed by a direct MAIPA technique.Results: A total of 40 patients who were diagnosed as primary ITP have been enrolled into the study. The subjects of the study were divided in two groups, 10 subjects with newly diagnosed ITP, and 30 subjects with persistent or chronic ITP. Most of the subjects were female (82.5 %) with the median age was 24,5 (17-55) years old.. Seventy (??) subjects had ITP Bleeding Score (IBLS) 2.. In a persistent/chronic ITP group (n= 30), the proportion of anti-GPIIb/IIIa was 20 / 30 (66,67 %) with the median optical density (OD) was 0,461 (0,093-2,116) and the proportion of anti-GPIb/IX was 25/30 (83.33%) with the median OD was 0,507 (0,190-1,924). Meanwhile, in a newly diagnosed ITP group (n=10) the proportion of anti-GPIIb/IIIa was 7/10 (70%) with the mean OD was 0,802 ± 0,71 and the proportion of anti-GPIb/IX was 8/10 (80%) with the mean OD 0,82 ± 0,57. The response rates to corticosteroid were as follows: 42.5 % of the subjects achieved complete response, 45 % achieved response, and 12.5 % achieved no response. Comparison between the subjects with and without anti-GPIIb/IIIa and anti-GPIb/IX antibodies showed similarity response rates to prednisone.Conclusion: Sincemost of patients with primary ITP had anti GPIIb/IIIa and anti GPIb/IX antibodies, those antibodies may support a diagnosis of primary ITP. Since no differences in terms of the response rates to corticosteroid between subjects with and without anti-GPIIb/IIIa and anti-GPIb/IX antibodies, those antibodies can not be used as a predictor of the treatment DisclosuresSukrisman:Division of Hematology Medical Oncology: Other: Colleague.

Management of Sigmoid Cancer In dr Cipto Mangunkusumo Hospital during 2008–2011

&#x0D; &#x0D; &#x0D; A retrospective analysis was performed to sigmoid cancer cases in the digestive surgery division of Cipto Mangunkusumo Hospital during the period of 2008–2011. Fifty–two cases were analyzed for metastases, stages and histopathology; mortality and morbidity were calculated for anastomotic leakage, 3–year survival, and incidence of local recurrence. Three–year survival analysis was performed using Kaplan–Meier based on staging and histopathology. The overall operative mortality was 1.9%, and the anastomotic leakage incidence was 8.1%. The incidence of local recurrence was 9.1%. The 3–year survival rates based on Dukes Staging were as follows: 100% survival for Dukes A, 95.5% for Dukes B and 61.1% for Dukes C and 0% for Dukes C. The 3–year survival rates in sigmoid cancer according to histopathology were 73.5% for well differentiated, 63.6% for moderately differentiated and 100% for poorly differentiated (sample size was one patient, could not be assessed), with 50% survival for mucinous histopathology. The overall survival in this sigmoid cancer study was 69.2%.&#x0D; &#x0D; &#x0D;

Implementation, its termination phase of Japan-Indonesia collaborative and future studies of breast cancer

Breast cancer remains a problem bothfor comtries with high incidence andfor countries with low inciclence, due to limited knowledge in its pathogenesis and clinicopathological management. The Japan-Indonesia Joint Stucly on the Etiology ancl Clinicopathology of Breast Cancer has been conducted since /988 to 1996. The project has been supported by the grants for International Research projects ort Cancer of the Ministry of Eclucatiott and Culture, Japan with the approvaL by the Dean. Partial support has been providetl by the Indoneskm Cancer Foundation. The sttdy has been designed in two phases: three foLd studies inclurling epidemiological, clinical antl histopathological aspects were invesTigated during the first batch (3 years), which was extended in the seconcl batch (3 years) with the emphasis onfurther nutritionnl analysis. The research management has been applied based on 5-phase project management (2 phases of pkuming: defining and planning and 3 phases of implementation: organizing, controlling and closing or termiruttion), with adjustment to scientific research proiect. Since the proiect was set up in two phnses, the research manngenxent phnses have been applied in two cycles' The implementation has deah with organizirtg thz relevant teams, including Nagoya City University, Nagoya University, Nagoya anrl Cancer Institute, Tbkyo ancl lJniversity of Indonesia antl Dr Cipto Mangunkusumo Hospital, Jakarta. Appreciable results have been achieved during the fi.rst batch of study and therefore tlie grant has been extended to allow further nutritional analyrsis. The mulridisciplinary team has been able to pursL.e basic teamwork and macle great attempts to achieve high performing stage. Significant resuLts have been discwsed in the first One-day Symposium and a Monograph has been published at the encl of the first batch of stu4y. Accorclingly, results of the second batch of study with the emphnsis of fnrther nutritionaL analysis will be discussecl in the second One-clay Symposium and published in the second Monograph. The closing or tennination phase of the project will be arranged in the combination o.f the inclusion ancl the integration types. The'fortner would allow the institutionaLization of the collaboratitte research on breast cancer in multidiscipLinary setting and the latter would encourage the on-going research project as organized in lffirent groups anl clepartments. The future studies have beetr planned for setting up both further nutritional analysis basetl on field ep,iclemiological sturly and further clinicopathological study inclucling molecular patholo gical study,

Histopathological aspects of breast cancer in relation to some epidemiological risk factors

Penelitian epidemiologik dengan cara kasus kontrol pada 300 kasus kanker payudara di Rumah Sakit Dr. Cipto Mangunkusumo, telah dilakukan pada tahun 1989-1991. Dengan menggunakan klasifikasi yang dianjurkan oleh Japanese Breast Cancer Society, gam­ baran histopatologik kanker payudara menunjukkan bahwa dari tipe karsinoma duktus invasif, jenis skirus ditemukan pada 147 kasus ( 49%), jenis padat tubuler pada 79 kasus ( 26.33%) dan jenis pa pilotubuler pada 39 kasus ( 13%). Sedang dengan menggunakan klasi­ fikasi WHO ( 1981), ditemukan 265 kasus ( 88.33%) invasif duktus karsinoma, karsinoma invasif lobuler pada 7 kasus ( 2.33%), karsinoma moduler pada 17 kasus ( 5.68%), karsinoma adenoid kistik pada 1 kasus (0.33%), penyakit Paget pada puting 2 kasus (0.67%) dan 4 kasus pada karsinoma noninvasif adalah karsinoma duktal insitu. Analisa terhadap faktor-faktor risiko yang bermakna pada kanker payudara wanita Indonesia menunjukkan bahwa faktor-faktor: aktivitas seksual dini, tinggal di daerah perkotaan, trauma payudara, obesitas ( kegemukan), haid pertama/menarche yang terlambat, siklus haid yang tidak teratur, menopause, konsumsi makanan berlemak dan yang mengandung santan dapat meningkatkan risiko. Juga telah dianalisa hubungan antara faktor-faktor risiko yang bermakna tersebut dengan jenis histopatologik. Hasilnya menunjukkan bahwa Konsumsi makanan bersantan meningkatkan kemungkinan jenis karsinoma duktus invasif. Pengaruh tersebut berhubungan dengan ketiga subtipe histologik, yaitu papiler tubuler; solid tubuler dan skirus. Konsumsi minuman dengan santan/air kelapa dan sayuran segar menurunkan kemungkinan jenis tersebut, dengan sifat tidak bergantung kepada subtipe histologik. Abstract Case control epidemiological study of 300 breast cancer cases from Dr. Cipro Mangunkusumo Hospital has been performed in 1989-1991. By applying the Japanese Breast Cancer Society classification, the histopathological pattern of breast cancer showed that from the invasive ductal carcinoma type, scirrhous type was found in 147 cases (49%), solid-tubular type in 79 cases ( 26.33%) and papilotubular type in 39 cases ( 13%). According to WHO classification ( 1981); they were diagnosed as: invasive ductal carcinoma in 265 cases ( 88.33%), invasive lobular carcinoma in 7 cases ( 2.33%), medullary carcinoma in 17 cases ( 5.68%), adenoid cystic carcinoma in 1 case (0.33%), pure Paget's disease of the nipple in 2 cases (0.67%) and 4 cases ( 1.33%) of the noninvasive carcinoma were ductal carcinoma in situ. Analysis of the significant risk factors among the Indonesian female breast cancer revealed that thefollowing factors: living at urban area, young sexual activity, trauma, obesity, late menarche, irregular cycle, menopause, fatty diet and coconut milk con­ taining food consumption increased the risk. Relationship of the risk factors to histopathological types has been stastistically analyzed. The results showed that increased possibility to have the invasive ductal carcinoma was related to consumption of coconut milk containing food. The effect was related to the three histological subtypes, namely: papillary tubular, solid tubular and scirrhous types. Coconut milk drinks and fresh vegetables showed decreasing effect, which was irrespective to subtypes. Keywords: Breast cancer, histopathological, epidemiological, risk factors .