Splenectomy in Liver Cirrhosis with Splenomegaly and Hypersplenism

Spleen is a “mysterious” organ since with unique functions, and might be related to other pathology in the human body. Splenomegaly and hypersplenism can manifest following the development of portal hypertension in liver cirrhosis through fibrogenesis, immune and microenvironment dysregulation. Cirrhotic patients are generally considered as immunocompromised and prone to infections. Splenectomy in cirrhotic patients has produced concern over decrease immunity and elevated risk of infection, namely overwhelming post splenectomy pneumococcal sepsis. This review discus the splenectomy effect to the liver and how it can play a role in cirrhotic patients with portal hypertension without readily available access to liver transplantation

The use of inferior gluteus perforator (IGAP) flap reconstruction for vaginal metastasis of rectal cancer: a case report

Vaginal metastasis from colorectal adenocarcinoma can occur months after the resection of the primary tumor. Most of the time, bleeding is the bothersome symptom. The optimal treatment involves surgical excision followed by reconstruction to prevent the lymphatic networks in the rectovaginal septum serving as a potential route of spread. There have been a number of successful vaginal reconstructive options reported. We describe a 32-year-old woman who had previously undergone an abdominoperineal resection for rectal cancer and was now suffering with rectal adenocarcinoma vaginal metastases. An inferior gluteus perforator flap (IGAP) repair was carried out following posterior vaginectomy after a comprehensive multidisciplinary examination. This flap can be used to address perineal dead space as well as to reconstruct the neovaginal area, eliminating the need for a second flap and significantly reducing donor morbidity. The lesson from this case is that vaginal metastases can still develop even after the primary colorectal tumor has been removed. One-step surgical excision and perineal repair can result in an enhanced quality of life and a good prognosis

Perioperative nutrition : ERAS special group discussion

Nutrition is one of the vital role in improving the healing and recovery after surgery, either preoperative (before surgery), intraoperative (during surgery), or postoperative (after surgery). The Enhanced Recovery After Surgery (ERAS) Society has published a multidisciplinary approach to perioperative care aimed at achieved early recovery for patients undergoing major surgery

Utilization of video-based learning media in Biology Lessons at MAN 1 Semarang

This research was carried out for aiming of producing learning media using the Quizizz platform; Knowing student responses and reactions regarding the use of video-based learning media and the Quizizz platform; and Knowing student learning outcomes from using video- and Quizizz-based learning media. The method used in research is Research and Development (R and D). The subjects in this study were students of class 10 MIPA 5 MAN 1 Semarang City totaling 36 students consisting of 11 boys and 21 girls. In this research, the implementation of R and D method research has 7 stages, namely potential and problems; data collection; product design; design validation; design revisions; product trials; analysis, and reporting. The results of this study indicate that: The application of video-based learning media and the Quizizz platform is classified as adequate; Video-based learning media and the Quizizz platform are well received; After the application of video-based learning media, the average value of student learning outcomes increased as enough criteria.   Abstrak Penelitian ini dilaksanakan bertujuan untuk : Menghasilkan media pembelajaran dengan menggunakan platform Quizizz yang valid; Mengetahui respon dan tanggapan siswa mengenai penggunaan media pembelajaran berbasis Video dan platform Quizizz; Mengetahui hasil belajar siswa dari penggunaan media pembelajaran berbasis Video dan Quizizz. Metode yang digunakan pada penelitian adalah Research and Development (R and D). Subjek pada penelitian ini adalah siswa kelas 10 MIPA 5 MAN 1 Kota Semarang berjumlah 36 siswa terdiri dari 11 laki laki dan 21 perempuan. Pelaksanaan pada penelitian metode R and D memiliki 7 tahapan menurut Sugiyono dalam bukunya yang berjudul “Metode Penelitian Kuantitatif, Kualitatif dan R and D”), yaitu potensi dan masalah; pengumpulan data; desain produk; validasi desain; revisi desain; uji coba produk; analisis dan pelaporan. Hasil penelitian ini menunjukkan bahwa: Penerapan media pembelajaran berbasis video dan platform Quizizz tergolong kriteria cukup; Media pembelajaran berbasis video dan platform Quzizz diterima dan ditanggapi dengan baik oleh siswa; Setelah penerapan media pembelajaran berbasis video nilai rata-rata hasil belajar siswa meningkat dan tergolong kriteria cukup. Kata Kunci: Biologi; media pembelajaran; pembelajaran audio-visua

Non functional adrenocortical carcinoma

Adrenocortical carcinoma is a rare disease with an incidence of approximately 1-2 per million populations per year. The main symptoms are abdominal mass with or without endocrine dysfunction. However, there are difficulties in the diagnosis and treatment of this case due to its unspecific clinical presentation which sometimes require additional diagnostic methods such as immunohistochemistry. The prognosis is often poor, especially when it’s impossible to resect the entire tumor. We present one case of adrenocortical carcinoma in RSCM which was diagnosed through immunohistochemistry examination postoperatively in patient with giant intra-abdominal tumor (mesenteric cyst). (Med J Indones 2008; 17: 203-9) Keywords: Adrenocortical carcinoma, giant intra-abdominal tumor, mesenteric cyst, immunohistochemistry, resectio

Validation of simplified predictive score for postoperative mortality after pancreaticoduodenectomy

Background: Pancreaticoduodenectomy has long been associated with high rates of morbidity and mortality. The key to a better postoperative outcome is a good patient selection. The aim of this study was to develop a simplified preoperative predictive score for postoperative mortality after pancreaticoduodenectomy.Methods: Patients who underwent elective pancreaticoduodenectomy from 1995 to 2012 were identified from the Division of Digestive Surgery database. Bivariate analysis and multivariate logistic regression analysis identified prediction of morbidity and mortality. ROC curve estimation is use to determined the cut-off value of the predictive score.Results: Of 138 patients who underwent pancreaticoduodenectomy, 27 patients (19.6%) died. The predictor of mortality are serum total bilirubin ≥ 10 mg/dL, serum  creatinin ≥ 1.3 mg/dL, hematocrit ≤ 30%, serum albumin ≤ 3.0 g/dL and ASA status ≥ 3, with assign score 1, 1, 2, 1, 1, respectively. The cut-off value was 4 with 96% sensitivity and 91% specificity. The area under the receiver operator characteristic curve was 0.974 (SE 0.011; p &lt; 0.001), which demonstrated a reasonable predictive value for the score.Conclusion: A total score of 4 or more is associated with increased postoperative mortality in patients underwent pancreaticoduodenectomy.</p

Nano-Androcerum Nano-Androcerum: Inovasi Wound Healing Gel Dari Nanopartikel Daun Binahong dan Kayu Manis Sebagai Akselerator Regenerasi Sel Pada Luka Kronis

Luka kronis merupakan bentuk kerusakan jaringan pada kulit akibat infeksi, trauma berulang, dan sebab sistemik seperti diabetes mellitus serta membutuhkan waktu lama untuk sembuh. Luka akan memicu mekanisme regenerasi sel yang meliputi tiga fase utama: inflamasi, proliferasi, dan pembentukan jaringan, tetapi adanya luka kronis akan menghambat penyembuhan luka (wound healing). Saat ini penggunaan obat sintesis masih menjadi pilihan utama, sedangkan pemanfaatan bahan alam sebagai obat untuk luka masih jarang dioptimalkan menjadi sediaan farmasetis. Selain itu, sifat fisikokimia bahan alam menyebabkan bioaktifnya sulit untuk menembus jaringan kulit. Pengembangan teknologi formulasi sediaan perlu dilakukan untuk mengoptimalkan potensi dari bahan alam dalam menunjang efektivitas pengobatan luka kronis. Formulasi sediaan nano gel dapat menjadi solusi untuk mengatasi hal tersebut. Nano Gel memiliki keunggulan seperti ukuran partikel kecil, lebih stabil, tidak lengket, memiliki efek pendinginan pada kulit dan secara estetika lebih disukai. Kandungan flavonoid dari daun binahong (Anredera corifolia) diketahui memiliki aktivitas antiinflamasi dengan menghambat enzim siklooksigenase dan lipoksigenase. Disamping itu kandungan sinamaldehid dari kayu manis (Cinnamomum verum) dapat mempercepat regenerasi sel dengan meningkatkan proses angiogenesis melalui up-regulation sinyal jalur PI3K dan MAPK serta telah terbukti memiliki aktivitas melawan bakteri gram positif dan gram negatif. Kombinasi kedua tanaman tersebut berpotensi mempercepat regenerasi sel pada luka melalui aktivitas antimikroba, mengurangi inflamasi dan meningkatkan proses angiogenesis. Formulasi nano gel akan membantu meningkatkan penetrasi bioaktif dan bentuk gel berperan sebagai wound dressing yang dapat melindungi luka dari kontaminasi. Dengan demikian, formulasi nano gel kombinasi sinergis dari aktivitas kedua tanaman tersebut diharapkan mampu menunjang dan mempercepat proses wound healing

Pre operative radiation for icteric type hepatocellular carcinoma A case report

<p>Hepatocellular Carcinoma (HCC) is still a leading health problem worldwide, due to its correlation with HBV and HCV infection and its management which is strongly dependent on patient’s condition and tumor extension. Surgery, with liver resection or liver transplantation offer a good survival rate as a primary management of such cancer. But since liver resection must consider some aspect of liver function and tumor size, and liver transplantation was not a choice in Indonesia, many treatment modalities has been developed which can be used to overcome this problem, such as tumor ablation, transarterial chemo embolization (TACE), chemotherapy and radiotherapy. With the development of conformal radiotherapy, the hepatitis induced radiation therapy could be minimized. This paper present a case of conformal radiation therapy utilization in icteric type HCC in Dr. Cipto Mangunkusumo Hospital, Jakarta. Hepatic resection was planned for this patient. <em><strong>(Med J Indones 2008; 17: 255-8)</strong></em></p><p><strong>Keywords:</strong><em> Hepatocellular Carcinoma, icteric type, radiation therapy, conformal radiotherapy</em></p