The effects of duration of mesenteric artery ligation to the ratio of TNF-α/IL-10 in a rat model of acute mesenteric ischemia (AMI)

The mortality rate of acute mesenteric ischemia (AMI) is high due to the delay in diagnosis.Determination of potent biomarker for early AMI is the key in reducing the mortality. As aproinflammatory cytokine, the level of TNF-α might be affected during the ischemia andreperfusion, with the prediction duration of 60-120 min. High TNF-α level may stimulatethe upregulation of IL-10 as an inhibitor of TNF-α. This provides a new opportunity forearly diagnosis of AMI by measuring the ratio between those two cytokines. The purposeof this study was to investigate the effect of duration of the mesenteric artery to theratio of TNF-α/IL-10 in a AMI rat model. This was an experimental study using Wistarrat. We performed mesenteric artery in 28 male rats to produce an AMI model, withligation duration of 0, 30, 60, 90, 120, 150, and 180 minutes. At the end of ligation,blood samples were taken for measurement of TNF-α and IL-10 level using ELISA. For themicroscopic examination of tissue necrosis, intestinal organ samples were taken and madeinto paraffin blocks and stained using Haematoxylin-Eosin. TNF-α increased in minute 120compared to other treatment groups (p<0.05). IL-10 increased in minute 180 comparedto control group (p<0.05). Microscopic examination showed that the duration of ligationaffects the structure and morphology of intestinal mucosa characterized by discolorationof organs along with increasing the ligation duration. Ligation of the superior mesentericartery was found to be significantly increased the TNF-α level and to be compensated byincreasing IL-10. It is assumed that when the IL-10 level, that has protective effect as aninhibitor, higher than TNF-α level as a proinflammatory cytokine on duration 150 minutes,it means no more inflammatory or cells is dead. Therefore TNF-α/IL-10 ratio can be usedas a biomarker candidate of prognosic factor management of AMI

Handsewn perineal rectosigmoidectomy (Altemeier) for complete full-thickness rectal prolapse: a case study

Rectal prolapse is a condition in which the entire rectal wall layers protrude through the anal canal. This condition rarely occurs, and the management is still a challenge for both clinician and patient. Rectal prolapse management can be done transabdominally or transperineally. Full-thickness rectal prolapse in principle should have more attention to the rectum function and anal sphincter to prevent recurrence and erectile dysfunction. The Altemeier transperineal recto-sigmoid resection has become the most common for surgical management of rectal prolapse.We report four cases of rectal prolapse, two males and two females with chief complaints had lumps out from their anus. All patients displayed comorbidities. We performed the handsewn Altemeier procedure. All surgeries resulted in minimal intraoperative bleeding. Patients experienced neither incontinence, postoperative fistula, bleeding nor infection. One month after surgery, no patients experienced a recurrence of their complaints.Handsewn Perineal rectosigmoidectomy for the treatment of complete full-thickness rectal prolapse in patients who are having comorbidity can be considered to be an alternative treatment because the procedure is relatively more accessible, safe, and has fewer complications

Assessing downgrading of esophageal adenocarcinoma after neoadjuvant chemotherapy: a case report Indrasto Histopaedianto1, Adeodatus Yuda Handaya2*, Hendro Wartatmo2

Esophageal carcinoma, squamous cell carcinoma, and adenocarcinoma, are a deadly serious malignancy. The delay in diagnosis due to the lack of specific symptoms in the early stages of the disease and the nature of esophageal cancer is very aggressive lead to a poor prognosis with a survival rate of small. Current management of esophageal cancer is recommended multimodal approach in the form of neoadjuvant chemotherapy or combined radiochemotherapy (CRT) and with surgery. In this article, multimodality treatment using chemotherapy and surgery on esophageal adenocarcinoma was reported. A 52-year-old male presented with a total obstruction of the esophagus and was planned to perform temporary gastrostomy for chemotherapy preparation. Gastrostomy found a solid and fixed tumor located in the gastroesophageal junction, with the size of 7 x 6 x 5 cm3. He underwent a chemotherapy using the regimen of 8 cycles paclitaxel without radiotherapy due to the long queue of radiotherapy schedule. After chemotherapy, we re-evaluated and planned to perform surgical removal of the tumor. During surgery, we found a total obstruction along with fibrosis of the esophagus but found no tumor/mass. We performed partial esophagectomy and end to side anastomosis using anastomosis end to side using the CDH25 circular stapler. Surgery was carried out by the thoracoabdominal approach. The patient was discharged on day 12 in a stable condition and was undergoing soft diet. We planned to evaluate the patient using Carcinoembryonic Antigen (CEA) test and Positron Emission Tomography (PET) scan. In conclusion, multimodality treatment using chemotherapy and surgery on a case of one-third distal esophageal adenocarcinoma provides good results

Transcystic versus transcholedochal laparoscopic common bile duct exploration: Choosing the right approach – A Case Series

Laparoscopic common bile duct exploration (LCBDE) is a relevant therapeutic option in managing cholecysto-choledocholithiasis. The success of this procedure is highly dependent on selecting an appropriate method, either transcystic or transcoledocal. Intraoperative choledochoscopy proves its importance in evaluating the condition of the choledochal duct and sphincter of Oddi. In this case series, we report 2 cases of patients with complaints of right upper abdominal pain and jaundice. Both patients were diagnosed with multiple cholecysto-choledocholithiasis at Dr. Sardjito Hospital, Yogyakarta. The interventional measures applied to both patients were transcystic and transcoledocal exploration. In the first patient, the transcystic method was chosen because the cystic duct was widening up to 9 mm in diameter. While in the second patient, the transcoledocal method was taken because the diameter of the cystic duct was still within normal limits. The duration of surgery in transcystic surgery was shorter than in transcoledocal surgery, with a time ratio of 129 minutes versus 162 minutes. Postoperatively, both patients were discharged on the second day after the procedure, and both experienced recovery without any significant complications. Overall, LCBDE has been shown to be safe to perform. The one-stage surgical approach has been shown to reduce the risk of complications, cost, and duration of treatment required. The choice between the transcystic or transcoledocal method should be based on each patient’s clinical condition

Detecting miRNAs expression as the early prognostic factor for patients with colorectal cancer in Dr. Sardjito Hospital Yogyakarta : A preliminary study

Background: Colorectal cancer (CRC) is the third highest-ranked cancer and causes high mortality in patients with a low survival rate. The lack of sensitivity and specificity of clinical and other diagnostic modalities results in a higher mortality rate. Therefore, the exploration of potential early biomarkers for CRCs is necessary. Objective: We aimed to evaluate the local expressions of potential tumor suppressor and oncogenic miRNAs in CRC patients in Indonesia. Methods: This retrospective cohort study involving thirty-one colorectal carcinoma patients at Dr. Sardjito Hospital Yogyakarta from January 2014-December 2017. Total RNA was isolated, and the expressions of miR-21, miR-92a, miR-96, miR-26b, miR144, and miR-195 were measured by real-time quantitative PCR. The correlation between miRNAs and other predictors was determined by Spearman correlation, and the association of miRNA expression and other clinical parameters used logistic regression. Results: The local expression of miR-195 decreased significantly in the tumor sites. In contrast, miR-21 activity tends to increase in the local tumor. Meanwhile, the expressions for miR-92a, miR-96, miR26b, and miR-144 in the same subjects were non-significant. MiR-195 was also significantly associated to cancer stage (r=-0.570, p=0.001) with significant odds ratio (OR=0.892, 95% CI=0.804–0.990, p=0.031). Conclusion: Our study was the first to report aberrant expressions of miRNA-21, miRNA-195, miRNA-92a, miRNA-26b, miRNA-96, and miRNA-144 in Indonesian CRC patients. The tumor suppressor miRNA-195 expression was superior among others to serve as an early biomarker in detecting and predicting CRC disease progression

Deteksi Dini dan Atasi 31 Penyakit Bedah Saluran Cerna (Digestif)

Saluran cerna adalah salah satu organ sangat penting bagi manusia, yang berperan dalam proses transportasi makanan, pencernaan dan memberikan nutrisi pada sel untuk menunjang kehidupan organ-organ vital pada tubuh. Penyakit saluran cerna sangat beragam dan sering kali penyakit ini tidak terdeteksi sejak dini, sehingga faktor resiko dan penanganan yang tepat serta optimal tidak dapat dilakukan sedari dini

Assessing downgrading of esophageal adenocarcinoma after neoadjuvant chemotherapy: a case report

Esophageal carcinoma, squamous cell carcinoma, and adenocarcinoma, are a deadly serious malignancy. The delay in diagnosis due to the lack of specific symptoms in the early stages of the disease and the nature of esophageal cancer is very aggressive lead to a poor prognosis with a survival rate of small. Current management of esophageal cancer is recommended multimodal approach in the form of neoadjuvant chemotherapy or combined radiochemotherapy (CRT) and with surgery. In this article, multimodality treatment using chemotherapy and surgery on esophageal adenocarcinoma was reported. A 52-year-old male presented with a total obstruction of the esophagus and was planned to perform temporary gastrostomy for chemotherapy preparation. Gastrostomy found a solid and fixed tumor located in the gastroesophageal junction, with the size of 7 x 6 x 5 cm3. He underwent a chemotherapy using the regimen of 8 cycles paclitaxel without radiotherapy due to the long queue of radiotherapy schedule. After chemotherapy, we re-evaluated and planned to perform surgical removal of the tumor. During surgery, we found a total obstruction along with fibrosis of the esophagus but found no tumor/mass. We performed partial esophagectomy and end to side anastomosis using anastomosis end to side using the CDH25 circular stapler. Surgery was carried out by the thoracoabdominal approach. The patient was discharged on day 12 in a stable condition and was undergoing soft diet. We planned to evaluate the patient using Carcinoembryonic Antigen (CEA) test and Positron Emission Tomography (PET) scan. In conclusion, multimodality treatment using chemotherapy and surgery on a case of one-third distal esophageal adenocarcinoma provides good results

Adherence to preoperative hand hygiene and sterile gowning technique among consultant surgeons, surgical residents, and nurses: a pilot study at an academic medical center in Indonesia

Abstract Background Healthcare-associated infections (HAI) is a major problem for patient safety and surgical site infection (SSI) is a type of HAI and the most common form of infection related to surgical health care. Transmission of microorganisms can be minimized by aseptic procedures. The main objective of this study is to compare adherence to preoperative sterile gowning and hand hygiene technique among consultant surgeons, surgical residents, and nurses. Methods This research was conducted by observing the implementation of the pre-operative sterile gowning and hand hygiene technique of abdominal surgery by consultant surgeons, surgical residents, and nurses using aseptic instrument tests of the Objective Structured Clinical Examination (OSCE) Faculty of Medicine Universitas Gadjah Mada from August 10, 2018 to September 10, 2018. Observations were made when participants performed hand scrubbing, gowning, and donning the gloves procedures. The observer completed mobile online forms, so that the medical personnel under observation did not know that they were being observed. Results Twelve consultant surgeons, 16 surgical residents, and 12 nurses were observed. All of the medical personnel showed a good score with total percentage mean 83.58%. The highest total mean score was achieved by consultant surgeons (86.39%), but mean score did not vary significantly between medical personnel (p = .091). In the hand scrubbing procedure, scrub the nail and palm using brush side and the skin of hand and arm using sponge side, in both hands had the lowest mean score (1.82 ± 1.152 of the maximum score of 4). While in the gowning procedure, taking and unfolding the sterile gown had the lowest mean score (1.97 ± .158 of the maximum score of 2). In the donning the glove procedure, grasping left glove with right hand and putting the glove over the left hand in opposite direction procedure had the lowest mean score (1.97 ± .158 of the maximum score of 2). Conclusions The mean score of each group of health personnel in each section showed good results. Comparison of hand hygiene and gowning procedure performance between groups of health personnel did not show significant differences. However, larger scale research is needed after this pilot study

Aloe Gel Enhances Angiogenesis in Healing of Diabetic Wound

BACKGROUND: Diabetic micro and macroangiophathy lead to the incident of diabetic foot ulcers characterized by an increased number of circulating endothelial cells (CECs) and decreased function of endothelial progenitor cells (EPCs). This fact is correlated with ischemia and diabetic wound healing failure. Aloe vera gel is known to be able to stimulate vascular endothelial growth factor (VEGF) expression and activity by enhancing nitric oxide (NO) production as a result of nitric oxide synthase (NOS) enzyme activity. Aloe vera is a potential target to enhancing angiogenesis in wound healing. OBJECTIVE: The objective of this study was to explore the major role of Aloe vera gel in wound healing of diabetic ulcers by increasing the level of EPCs, VEGF, and endothelial nitric oxide synthase (eNOS), as well as by reducing the level of CECs involved in angiogenesis process of diabetic ulcers healing. METHODS: The experimental groups was divided into five subgroups consisting of non diabetic wistar rats, diabetic rats without oral administration of aloe gel, and treatment subgroup (diabetic rats) with 30, 60 and 120 mg/day of aloe gel doses for 14 days. All subgroups were wounded and daily observation was done on the wounds areas. Measurement of the number of EPCs (CD34), and CECs (CD45 and CD146) was done by flow cytometry, followed by measurement of VEGF and eNOS expression on dermal tissue by immunohistochemical method on day 0 and day 14 after treatment. The quantitative data were analyzed by One-Way ANOVA and Linear Regression, with a confidence interval 5% and significance level (p<0.05) using SPSS 16 software to compare the difference and correlation between wound diameters, number of EPCs and CECs as well as the levels of VEGF and eNOS. RESULTS: The results of this study showed that aloe gel oral treatment in diabetic wistar rats was able to accelerate the wound healing process. It was shown by significant reduction of wound diameter (0.27±0.02); the increased number of CECs (0.42±0.57), respectively (p<0.05). On the other hand, the wound diameter and eNOS indicators showed significant differences at the dose of 60 mg, while the number of EPCs and CECs and the level of VEGF showed significantly different results at a dose of 120 mg. Aloe gel oral therapy showed a positive indication of wound healing acceleration at the optimum dose range 60-120 mg a day. CONCLUSIONS: Aloe gel is potential to be a herbal therapy candidate for diabetic wound healing through enhancing EPCs homing, decreasing the CECs number, and stimulating the increase of VEGF and eNOS levels,hence proving to be a dominant factor in the angiogenesis process. KEYWORDS: aloe gel, diabetes, wound healing, angiogenesis

Aloe Gel Enhances Angiogenesis in Healing of Diabetic Wound

BACKGROUND: Diabetic micro and macroangiophathy lead to the incident of diabetic foot ulcers characterized by an increased number of circulating endothelial cells (CECs) and decreased function of endothelial progenitor cells (EPCs). This fact is correlated with ischemia and diabetic wound healing failure. Aloe vera gel is known to be able to stimulate vascular endothelial growth factor (VEGF) expression and activity by enhancing nitric oxide (NO) production as a result of nitric oxide synthase (NOS) enzyme activity. Aloe vera is a potential target to enhancing angiogenesis in wound healing.OBJECTIVE: The objective of this study was to explore the major role of Aloe vera gel in wound healing of diabetic ulcers by increasing the level of EPCs, VEGF, and endothelial nitric oxide synthase (eNOS), as well as by reducing the level of CECs involved in angiogenesis process of diabetic ulcers healing.METHODS: The experimental groups was divided into five subgroups consisting of non diabetic wistar rats, diabetic rats without oral administration of aloe gel, and treatment subgroup (diabetic rats) with 30, 60 and 120 mg/day of aloe gel doses for 14 days. All subgroups were wounded and daily observation was done on the wounds areas. Measurement of the number of EPCs (CD34), and CECs (CD45 and CD146) was done by flowcytometry, followed by measurement of VEGF and eNOS expression on dermal tissue by immunohistochemical method on day 0 and day 14 after treatment. The quantitative data were analyzed by One-Way ANOVA and Linear Regression, with a cofidence interval 5% and significance level (p<0.05) using SPSS 16 software to compare the difference and correlation between wound diameters, number of EPCs and CECs as well as the levels of VEGF and eNOS.RESULTS: The results of this study showed that aloe gel oral treatment in diabetic wistar rats was able to accelerate the wound healing process. It was shown by significant reduction of wound diameter (0.27±0.02); the increased number of CECs (0.42±0.57), respectively (p<0.05). On the other hand, the wound diameter and eNOS indicators showed significant differences at the dose of 60 mg, while the number of EPCs and CECs and the level of VEGF showed significantly different results at a dose of 120 mg. Aloe gel oral therapy showed a positive indication of wound healing acceleration at the optimum dose range 60-120 mg a day.CONCLUSIONS: Aloe gel is potential to be a herbal therapy candidate for diabetic wound healing through enhancing EPCs homing, decreasing the CECs number, and stimulating the increase of VEGF and eNOS levels,hence proving to be a dominant factor in the angiogenesis process.KEYWORDS: aloe gel, diabetes, wound healing, angiogenesi