53 research outputs found

    Basic principles and diagnostic of colposcopy

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    ABSTRACTThe colposcope is an optical system that offers illumination and magnifications between 10 and 16 times. Colposcopy is the diagnostic test to evaluate patients with an abnormal cervical cytological smear, abnormal VIA (visual inspection with acetic acid application) or VILI (visual inspection with Lugo’s Iodine application), abnormal appearing cervix and directing biopsies. The colposcopic examination of the cervix starts with “General Assessment” to immediately recognize the level of examination reliability. Examination should assessed for three variables: 1) adequate or inadequate, with the reason given; 2) squamocolumnar junction visibility; and 3) transformation zone type. Colposcopic features and patterns will correspond with underlying specific histological features. The greater the expertise and experience of the colposcopist, the greater the confidence in the assessment of the atypical transformation zone (TZ). For practical purposes, the most important aspect is always the recognition or exclusion of underlying actual invasive disease. The presence or absence of precancerous lesions can confirm with colposcopy

    Analisis faktor risiko kegagalan persalinan pervaginam pada ibu-ibu hamil dengan riwayat seksio Caesar kehamilan sebelumnya

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    ABSTRACT Heru Pradjatmo - Risk factors of the faiture of vaginal delivery after previous Cesarean section history. Objective: To know factors influencing the success rate of vaginal delivery after previous Cesarean section history. Methods: Historical cohort Setting: Sardjito General Hospital Yogyakarta Participants: Women who delivered her child in Sardjito General Hospital between the year 1997 to 2001, and had previous Cesarean section history. Their delivery would be vaginally or recesarean section. The factors which were predicted affect the success of the vaginal delivery will be analyzed. The significance level of Odd Ratio was determined by logistic regression analysis. Results: There were 275 pregnant women with previous Cesarean section history reviewed, 110 (40%) patients successfully delivered the fetus vaginally and 165 (60%) patients unsuccessfully delivered the fetus vaginally and were undergone Cesarean section. Several factors that might influence the success of vaginal delivery were analyzed: place (OR =0.97CI 0.58-1.65), age of the mother (OR =0.74CI 0.431.29), mother body length (OR =1.15CI 0.66-2.0), education of the mother (OR =1.41CI 0.74-2.69), pregnancy interval (OR =0.83CI 0.47-1.461, number of antenatal care (OR =4.40CI 0.45-35.85), gestational age (OR =0.52CI 0.24-1.12), fetal presentation (OR =0.61CI 0.24-1.57), fetal body weight (OR =0.43CI 0.21-0.89), history of vaginal delivery (OR =0.86CI 0.51-1.43). Conclusions: It seems that only fetal body weight had significant influence to the success of the vaginal delivery after previous Caesarean section history. Anyhow, this result is appropriate to encourage a possible trial of vaginal delivery in almost all patients with a previous low-segment Caesarean section. Key words: Caesarean Section History, trial vaginal delivery, re-Caesarean Sectio

    Hubungan Jarak Tumit-lbujari Kaki Dengan Berat Badan Bayi Baru Lahir

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    ABSTRACT Heru Pradjatmo -Relationship between toe-heel length and body weight of newborn babies Relationships between toe-heel length and body weight among newborn babies have been investigated. Five hundred and eighty eight infants were divided into two groups. The first group (training set) consisting of 293 cases was used to obtain the correlation between toe-heel length and body weight quantitatively defining mathematical functions (linear regression). Correlation coefficient was obtained by least squares method. The second group (test set) consisting of 295 cases was used to test whether the mathematical function could be generalized. Mathematical function describing the relationship between toe-heel length and body weight was Y= 77.854X - 2695.6 with correlation coefficient.r = 0.7887. Results of the test with the second group for estimating the body weight showed statistically no significant difference with the actual body weight (P > 0.05). Key words: toe-heel length - body weight - newborn babies - breech presentation - perinatal mortalit

    PRESERVASI FERTILITAS PADA PENDERITA KANKER

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    PRESERVASI FERTILITAS PADA PENDERITA KANKER*Heru Pradjatmo1ABSTRACTBackground: Young women who survive from cancer as candidates to face reproductive problemsassociated with cytotoxic cancer therapy. Side effects that alter the quality of life becomes unacceptable.Advances in reproductive medicine enables previously infertile women can obtain offspring.Objective: To recognize the effort that can be done to prevent adverse effects on fertility patients due tocancer therapyMethod: Literature studyResult and Discussion: In general, women age 40 years or less with cancer who received chemotherapy tobe likely ovarian function will cease. Studies show that many technique performed before chemotherapyallows women to have babies would be greater. Women prior to treat chemotherapy should be consultedto physicians in the field of reproductive and endocrinology for fertility preservation methods to deal withoncologist who take care the patient. All methods that can be performed should be included in counselingand all counseling and treatment including possible complications should be documented and recorded.Keywords : infertility, chemotherapy, adverse effect, preservationABSTRAKLatar Belakang: Perempuan muda yang survive dari penyakit kanker menjadi kandidat menghadapimasalah reproduksi berkaitan dengan terapi kanker yang bersifat sitotoksik. Sehingga efek samping yangmerubah kualitas kehidupan menjadi tidak dapat diterima. Kemajuan dalam kedokteran reproduksimemungkinkan wanita yang sebelumnya infertil akibat prngobatan penyakit kanker sekarang dapatmemperoleh keturunan.Tujuan: Untuk memahami upaya yang dapat dilakukan untuk mencegah terjadinya efek samping terhadapfertilitas penderita akibat terapi kanker.Metode: Studi literaturHasil dan Pembahasan: Secara umum perempuan penderita kanker sampai umur 40 tahun yangmendapat kemoterapi kemungkinan dapat berhenti fungsi ovariumnya. Studi menunjukkan bahwabeberapa teknik yang dilakukan sebelum kemoterapi memungkinkan wanita memperoleh keturunan lebihbesar. Seharusnya sebelum terapi dikonsulkan ke dokter dibidang reproduksi untuk metode preservasifertilitas dengan kesepakatan ahli onkologi yang menangani. Semua metode yang dapat dilakukan harusdimasukkan dalam konseling. Semua konseling dan pengobatan termasuk komplikasi yang mungkin terjadiseharusnya di dokumentasikan dan dicatat.Kata Kunci: infertilitas, khemoterapi, efek samping, preservasi1 Bagian Obstretika & Ginekologi Fakultas Kedokteran UGM/RSUP Dr. Sardjito Yogyakarta* Dipresentasikan pada seminar in vitro maturation (IVM) in vitro fertilization andlaparoskopic surgery, Yogyakarta, 8-9 November 201

    Perbandingan Angka Ketahanan Hidup Penderita Kanker Ovarium yang Mendapat Terapi Regimen Kemoterapi Paclitaxel-Carboplatin dan Vyclophosphamide-Adriamycin-Cisplatin di RSUP Dr. Sardjito: Studi retrospektif Januari 2014-Desember 2018

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    Latar Belakang: Kanker merupakan penyebab kematian kedua terbanyak setelah penyakit kardiovaskular dan lebih dari 70% kematian yang disebabkan oleh kanker terjadi di negara berkembang. Kanker ovarium merupakan kanker terbanyak kesembilan pada wanita dan menjadi kanker dengan mortalitas ke-5 terbanyak, yaitu 8,6 per 100.000.Tujuan: Menilai angka ketahanan hidup penderita kanker ovarium yang diberikan kemoterapi dengan regimen Paclitaxel- Carboplatin dibandingkan dengan regimen Cyclophospamide-Adriamicyn-Cisplatin di RSUP Sardjito.Metode: Penelitian ini merupakan penelitian observasional dengan rancangan studi analisis angka ketahanan hidup (survival rate) dari penderita kanker ovarium. Data akan diambil secara retrospektif dari rekam medis pasien kanker ovarium yang berobat ke RSUP dr. Sardjito kemudian ditelusuri riwayat kematiannya.Hasil dan Pembahasan: Terdapat 353 penderita kanker ovarium yang dilakukan kemoterapi, terdiri dari 265 subjek yang diterapi PC dan 88 subjek yang diterapi dengan CAP. Dari analisis bivariat didapatkan bahwa regimen kemoterapi PC dan CAP tidak memengaruhi angka ketahanan hidup (HR=1,15, p=0,64, CI95%=0,64-2,05).Usia <50 tahun (HR=0,42, p=0,01, CI95%=0,23-0,77), stadium klinis awal (HR=0,27,   p=0,00,   CI95%=0,14-0,49), dan CA125 pasca kemoterapi <70 U/mL (HR=0,21,        p=0,00,      CI95%=0,11-0,41) merupakan faktor protektif terhadap angka ketahanan hidup penderita kanker ovarium. Analisis multivariat dengan angka ketahanan hidup (cox’s regression) menunjukkan bahwa faktor yang dapat meningkatkan angka ketahanan hidup adalah stadium klinis awal (HR=0,45,   p=0,04,   CI95%=0,18-0,91)  dan CA125 pasca kemoterapi (HR=0,33, p=0,01, CI95%=0,15-0,74).Kesimpulan: Tidak ada perbedaan bermakna antara regimen kemoterapi PC dan CAP dengan angka ketahanan hidup penderita kanker ovarium yang dirawat di RSUP dr. Sardjito selama tahun 2014-2018. Faktor- faktor yang dapat meningkatkan angka ketahanan hidup pasien kanker ovarium adalah stadium klinis awal dan CA125 pasca kemoterapi <70 U/mL. Kata Kunci: Angka ketahanan hidup; kanker ovarium; regimen paclitaxel dan carboplatin; regimen cyclophosphamide, adriamycin, cisplatin

    Hubungan antara Modified Glasgow Prognostic Score (mGPS) dengan Stadium dan Derajat Diferensiasi Kanker Ovarium

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    Background: Prognostic factors for ovarian cancer include residual tumor and chemotherapy response, but these parameters are not sufficient to predict ovarian cancer prognoses. A new approach such as mGPS that use a combination of CRP and albumin can be used to assess an inflammatory response. With mGPS, an elevated CRP value and hypoalbuminemia are poor prognosis. Objective: To investigate the effect of mGPS on histopathologic staging and grading of ovarian cancer.Method: The study design was a cross sectional study. The population of this study were patients with suspected ovarian cancer who underwent laparotomy surgical staging at RSUP Dr. Sardjito. The samples were patients with suspected ovarian cancer that have examined the hs-CRP level and albumin level preoperative,then underwent laparotomy surgical staging with histopathological results epithelial ovarian cancer. Data were analyzed using Chi Square test and logistic regression.Results and Discussion: there were 57 subjects with epithelial ovarian cancer consisting of 25 subjects (43.86%) with high mGPS and 32 subjects (56.14%) with low mGPS. The value of mGPS is associated with the stage of ovarian cancer (p = 0.000; RP = 4.000 CI 95% = 2.195 – 7.289). The results of the multivariate analysis showed that the most important factor in determining the stage was mGPS (p = 0.000; RP = 3.818 95% CI = 1.544-6.092). While the most important factor in determining histopathologic grading of ovarian cancer was the type of ovarian tumor (p = 0.000; RP = 7.339 95% CI = 4.960-9.718).Conclusion: There was an association between mGPS and the stage of ovarian cancer. The histopathologic grading was not influenced by mGPS, but was influenced by the type of ovarian tumor.Keywords: mGPS; Stage; Histopathologic grading; Ovarian Cancer; Epithelial Typ

    Hubungan Nilai Rasio Neutrofil-Limfosit Pra Pembedahan dengan Prognosis Kanker Ovarium Jenis Epitelial di RSUP Dr. Sardjito

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    LATAR BELAKANG: Kanker ovarium merupakan salah satu keganasan pada perempuan yang paling sering dan mematikan. Angka kejadian kanker ovarium di Indonesia mencapai 15 per 100.000 dan menempati urutan kelima penyebab kematian terbanyak akibat kanker pada wanita di Indonesia. Lebih dari 75% pasien kanker ovarium terdiagnosis pada stadium lanjut. Setelah menjalani tatalaksana primer, 50% pasien akan mengalami rekurensi dalam waktu 1 tahun, dan angka 5 years survival rate kurang dari 50%. Secara umum, prognosis kanker ovarium epitelial secara independen dipengaruhi oleh stadium, tipe dan derajat histologis, serta diameter residu maksimum setelah operasi sitoreduktif. Rasio neutrofil-limfosit (RNL), suatu prediktor status inflamasi, telah terbukti menjadi penanda prognostik yang efektif untuk sebagian keganasan, termasuk keganasan ovarium. Nilai RNL yang tinggi menggambarkan kecenderungan peningkatan inflamasi pro-tumor dan penurunan kapasitas imun anti-tumor.TUJUAN: Mengetahui hubungan antara Rasio Neutrofil-Limfosit (RNL) pra pembedahan primer dengan prognosis kanker ovarium epitelial pada pasien kanker ovarium di RSUP Dr. Sardjito, Yogyakarta.METODE: Penelitian ini merupakan penelitian uji prognosis dengan rancangan kohort retrospektif yang melibatkan 106 penderita kanker ovarium di RSUP Sardjito yang memenuhi kriteria inklusi. Sumber data berasal dari data sekunder yang diambil dari Instalasi Catatan Medik (ICM) dalam kurun waktu Januari 2016 sampai dengan Maret 2019.HASIL: Dari 106 subjek, didapatkan rerata usia pasien adalah 48.58 dengan 69.8% subjek merupakan multipara. Sebanyak 50.94% subyek didapatkan dalam stadium lanjut (III dan IV) dan 71.7% merupakan tumor high grade. Risiko relatif subyek dengan RNL ≥ 3,1 yang mengalami Progression Free Survival (PFS) 3.1 dan stadium lanjut berhubungan dengan PFS secara klinis maupun statistik. KESIMPULAN: RNL pra pembedahan > 3.1 berhubungan dengan kejadian PFS 3.1 dan stadium lanjut mengalami PFS < 12 bulan.KATA KUNCI: Kanker ovarium epitelial, Rasio Neutrofil-Limfosit, progression free survival

    Quality of life of cervical cancer patient with support from nuclear family and extended family in Dr. Sardjito general hospital, Yogyakarta Indonesia: a comparative study

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    Background: Nature of the disease, side effect from treatments such as surgery, chemotherapy, and chemo radiation reduce the patient’s quality of life. Thus, the family support is substantial in cancer patient treatment. Aim of this study was comparing the quality of life of patients with cervical cancer in support of the nuclear family and extended family at Dr. Sardjito hospital Yogyakarta, Indonesia.Methods: The study population were all cervical cancer patients treated with chemotherapy in Dr. Sardjito general hospital, Yogyakarta, Indonesia from October to November 2016. Samples were collected using purposive sampling to obtain 62 respondents, 30 respondents for nuclear family group and 32 for extended family group. The study instruments were family support questionnaire, EORTC QLQ-C30 Indonesian version, and EORTC QLQ-C24 were translated to Indonesian. The quality of life was assessed during chemotherapy.Results: Quality of life for cervical cancer patient from supportive family had mean >50. The respective mean of general health status for patients from supportive nuclear and extended family were 76.28±21.434 and 67.82±22.017. Nearly all items in symptom, multi-item and single-item scales had mean 50. The respective mean of general health status for patients from unsupportive nuclear and extended family were 70.83±20.972 and 75.00±8.33. Nearly all items in symptom, multi-item and single-item scales had mean <50, except items fatigue and sore. Several items of quality of life had p<0.05, which were constipation (p=0.049), and financial problem (p=0.045).Conclusions: There was no significant difference between quality of life of cervical cancer patients with support from nuclear and extended families. However, in ‘financial problem’ item, nuclear family had better quality of life while in contrast, extended family had better quality of life in ‘constipation’ item. Family education program needed because several domains of quality of life is still low and requires family involvement in treatment

    Status gizi sebagai faktor prognosis penderita karsinoma endometrium

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    Background: In Indonesia, endometrial cancer is the third gynaecologic cancer after cervical and ovarian cancers. Various factors affect the survival of the patients, however, which factors affect the survival of endometrial carcinoma patients in Dr. Sardjito Hospital remain unclear. A research is therefore needed in order to determine the survival and the prognostic factors.Objective: To investigate the prognostic factors that affect the survival of endometrial carcinoma patients who had been admitted to Dr. Sardjito Hospital.Method: The study design was retrospective cohort. The subjects were patients with endometrial carcinoma who were treated in Dr. Sardjito Hospital from 1st of January 2006 until 31st of December 2011. Kaplan-Meier analysis was performed to analyze several factors that influenced the survival of the patients. The differences of survival were analyzed with log rank test while the prognostic factors influencing the survival were analyzed using Cox regression.Results: 68 endometrial carcinoma patients were recruited as the subjects for the study. The median survival of endometrial carcinoma patients 52 months for those on early stage and 17 months on advanced stage (p≤0.01). The prognostic factors affecting survival that has been found statistically and clinically significant was the stage of the disease (p=0.002; HR=6.175; 95% CI=1.1980 to 19.25). Meanwhile, the nutritional status of patients with low, normal, and high BMIs score showed increased survival rate as indicated by the HR values of 1; 0.768; and 0.311 respectively.Conclusion: The prognostic factor that was clinically and statistically significant influenced the survival was the stage of the disease, while the nutritional status of patients was found clinically significant as the prognostic survival of the patients

    Hubungan Response Time Seksio Sesarea Emergensi Kategori 1 dengan Luaran Perinatal di RSUP Dr.Sardjito

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    Background: Caesarean section is often applied as a preventif efoort against the continued effects of perinatal asphyxia. The cesarean section (SC) in pregnant woman can be performed in a planned manner with various indications or performed by emergency (emergency) on maternal or fetal indications and or both.Objective: To study the association of response time in category I emergency caesarean section with perinatal outcomes in Dr. Sardjito hospital and the average response time of category 1 emergency cesarean section in Dr. Sardjito hospital.Method: This study uses retrospective cohort. Category 1 CS with an indication of fetal accordance with the inclusion criteria was recorded from 1st January 2012 until 31th July 2016, then we find the response time mean as the cut off point of this study to compare with their perinatal outcomes.Result and Discussion: There were 155 cases out of 386 of emergency CS category 1 met the inclusion criteria during the period 1st January 2012 to 31th July 2016. From the data obtained, the average response time of category 1 emergency CS was 115±52 minutes (35 - 360 minutes). We found no significant differences in perinatal outcomes in the group’s response time ≥115 minutes with a value of p>0.05 on the Apgar score, CPAP, infant mortality, ventilator, NICU care, MAS and HIE than those category 1 emergency CS with a response time <115 minutes. From multivariate analysis, general anaesthesia was statistically significant against perinatal outcomes Apgar score <7 at 5 minutes with (p=0.044). Prematurity in the multivariate analysis was statistically significant against perinatal outcomes Apgar score ≤3 at 1 minute with (p=0.040), Apgar score <7 at 5 minutes with (p=0.025) and the use of CPAP with (p=0.009).Conclusions: Response time category 1 emergency cesarean section in this study did not affect perinatal outcomes. General anesthesia effect on perinatal outcomes Apgar score <7 at 5 minutes, whereas the prematurity effect on perinatal outcomes Apgar score ≤3 at 1 minute, Apgar score <7 at 5 minutes and the use of CPAP.Keywords: category 1 emergency caesarean section, response time, fetal distres
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