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

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

Malignant bilateral ovarian steroid cell tumor without androgenic manifestation: an unusual finding

Steroid cell tumor is a rarest ovarian neoplasm, classified as a pure stromal tumor and mostly is unilateral. Even though this tumor can exhibit malignant behavior but the morphology of cells showed benign characteristics which can become a diagnosis pitfall especially in the frozen section. Moreover patient without any hormonal imbalance or virilizing signs could make the diagnosis process more difficult. Here we reported a case bilateral steroid cell tumor of the ovary in a 42 y.o. unmarried woman without any virilization or hirsutism symptoms. Abdominal ultrasonography and computed tomography (CT) scan revealed a right ovarian solid tumor accompanied by ascites and right pleural effusion. There was significantly increased of Ca 125 level (1138 U/mL) and normal level of testosterone (0.10 ng/mL). Frozen section was done from the right ovarium mass and ascites fluid, the result was benign. From the total abdominal hysterectomy and bilateral salpingo-oophorectomy tissues,  histological picture showed diffuse and nests tumor separated by thin fibrous connective tissue with small round centered nuclei, mild atypia, and abundant pale cytoplasm. Large area of necrosis was found especially in the right ovarian tumor, tumor implant to the right fallopian tube and in the uterine serous layer. Periodic acid-Schiff (PAS) stain was negative in more than half tumor cells population. Immunostaining for Melan-A and Calretinin were focally positive, with Ki-67 labeling index ± 5%, and negative for cytokeratin 7 (CK7), cytokeratin 20 (CK20) and smooth muscle actin (SMA). Based on the tumor size, necrosis area, tumor implantation, and immunohistochemistry profiles, we conclude that were malignant steroid cell tumor. Currently, the patient is undergoing postoperative recovery and planned for platinum-based chemotherapy. A careful correlation between clinical and radiological findings, as well as histopathological results, is always essential, as is amply demonstrated by this particular case

Surgical Management for Resistant Gestational Throphoblastic Neoplasia: Yogyakarta Experience

Gestational trophoblastic neoplasia (GTN) is a highly responsive to chemotherapy, but sometimes can be resistant, or relapse and require salvage chemotherapy with or without surgery.  We use descriptive studies with case series to determine prognosis patient GTN with chemotherapy resistant manage with surgical procedure in Sardjito Hospital, Yogyakarta. GTN-resistant chemotherapy patients that undergoing hysterectomy showed significant decreases in hCG levels. Hysterectomy also help us to stop vaginal bleeding. However, complications from continuous bleeding can worsen patient condition. The decision to take a hysterectomy action varies depending on the patient's condition. At the Sardjito hospital, the patient was diagnosed with the fastest hysterectomy within the first 12 hours of treatment due to continuous bleeding, and shortly after 4 years of treatment with 5 different types of chemotherapy

HUBUNGAN PEMBERIAN MAKANAN PENDAMPING ASI SECARA DINI TERHADAP KEJADIAN DIARE PADA BAYI USIA 0-6 BULAN DI PUSKESMAS KOPELMA DARUSSALAM BANDA ACEH

Diare sampai saat ini masih menjadi penyebab utama kesakitan dan kematian pada bayi dan anak-anak, diantaranya akibat pemberian Makanan Pendamping Air Susu Ibu (MP-ASI) yang terlalu dini dan tidak tepat. Tujuan dari penelitian ini adalah mengetahui adanya hubungan pemberian MP-ASI secara dini terhadap kejadian diare pada bayi usia 0-6 bulan di Puskesmas Kopelma Darussalam. Jenis penelitian bersifat analitik observasional. Metode penelitian yang digunakan adalah metode survei dengan pendekatan cross sectional. Populasi dalam penelitian ini adalah ibu yang mempunyai bayi yang berusia 0-6 bulan di wilayah kerja Puskesmas Kopelma Darussalam pada bulan Oktober- Desember tabun 2011 dengan sampel sebanyak 40 ibu. Teknik pengambilan sampel dengan accidental sampling. Pengambilan data dilakukan dengan penyebaran kuesioner dan wawancara kepada ibu bayi. Uji statistik yang digunakan adalah Chi-Square untuk mengetahui hubungan antara variabel bebas dengan variabel terikat. Hasil penelitian didapatkan bahwa responden terbanyak adalah ibu yang memberikan MP-ASI secara dini pada bayi usia 0-6 bulan (62,5%). Jenis MP-ASI yang sering diberikan pada pada bayi usia 0-6 bulan ialah susu formula(27,5%). Jumlah kejadian diare pada bayi usia 0-6 bulan sebanyak 18 kasus (45%).Hasil penelitian menunjukkan bahwa ada hubungan antara pemberian MP-ASI secara dini (p = 0,014, RR= 3,00) dengan kejadian diare pada bayi usia 0-6 bulan. Hal ini menunjukkan bahwa bayi yang diberikan MP-ASI secara dini mempunyai risiko 3kali lebih besar untuk terpapar diare dibanding dengan bayi yang tidak diberi MP- ASI.Kata kunci : MP-ASI, bayi usia 0-6 bulan, diar