Nutritional Status and Quality of Life in Breast Cancer Patients in Karawaci General Hospital

Cancer is related to a deterioration of nutritional status and quality of life (Qol), but the extent of these conditions in patients with breast cancer has not been studied well. Malnutrition is prevalent among cancer patients and maybe correlated with altered quality of life. The aim of this study is to evaluate the association of QoL and nutritional status after breast cancer diagnosed. Nutritional status was evaluated with Patient Generated Subjective Global Assessment and QoL using Short form 36 (SF-36) and also with the specific module for breast cancer patients. A consecutive sampleof twenty two patients diagnosed with breast cancer was evaluated. The associations of QoL with stadium and nutrition status were evaluated using T-test analysis. The mean of body mass index was 21.3 kg/m2. Fifty percent patient have menopause. Most patients were stage II (77.3%), the others stage III (18.2%) and stage I (4.5%). Sixty eight point two percent had risk of malnutrition. The stadium of tumor was significantly related to physical functioning (p < 0.000), physical limitation (p < 0.024), emotional limitation (p < 0.013), well-being (p < 0.020), health changes (p < 0.010). Thestatus of nutrition was significantly related to physical functioning (p < 0.001), loss of energy (p < 0.010) and general health (p <0.005). For Conclusion, the status of nutrition breast cancer patients were related to QoL especially physical functioning, loss of energy and general health after they were diagnosed

Diffuse Large B Cell Lymphoma, Bilateral Lower Extremity Lymphedema, and Ulcerated Inguinal Lymph Node

Lymphedema (LE) is a chronic medical condition characterized by lymphatic fluid retention, resulting in tissue swelling. There are two general classifications of LE; primary and secondary which are based on two mechanisms; lymphatic obstruction and lymphatic interruption. The most common cause of LE in the developing world is secondary to an infection known as filariasis. Cancer including Hodgkin and non-Hodgkin lymphomas; and its treatment are some causes of secondary LE. LE also could maintain the persistence of an occult localization of lymphoma. This case illustration describes a female, 57 year-old with stage II lymphedema of both legs, bilateral inguinal lymphadenopathies that were biopsied. The filarial blood examination was negative. Biopsies showed diffuse large B-cell lymphoma

Proximal Jejunal Diverticle: Cause of Upper Gastrointestinal Bleeding

Five percents of patient presenting with gastrointestinal (GI) bleeding, the etiology of bleeding could not be found by upper endoscopy and colonoscopy. Almost 75% of which, the abnormality is detected in small bowel. One of the etiologies in small bowel bleeding is jejunal diverticle. In this paper, we reported a female, 38 years old, came with upper GI bleeding since one month ago. She had undergone several diagnostic procedures, such as abdominal ultrasound, abdominal computed tomography scan (CT-scan), upper and lower endoscopy, but there were no conclusion to explain the cause of bleeding. However, barium follow through examination found a diverticle, pouch-like shape, at jejunal proximal projection. Then, she underwent surgical treatment. Small intestine bleeding is best investigated by capsule endoscopy and double balloon enteroscopy. However, in limited conditions, small bowel follow through can be used to screen the source of bleeding in small intestine. The specific diagnosis of small intestine diverticle is possible by radiologic contrast study using various form of barium. Small bowel diverticle does not require surgical treatment, unless refractory symptoms or complications occur. Jejunal diverticle is one of sources in small intestinal bleeding. Small bowel follow through can still be used to diagnose jejunal diverticle

Approach for Diagnostic and Treatment of Achalasia

Achalasia is a rare motor disorder of the esophagus and lower esophageal sphincter. The incidence is approximately 1/100,000 per year and the prevalence rate is 10/100,000. Achalasia is quite difficult to establishbecause the symptoms might be insidious and therefore not many people come to seek medical attention until it deteriorates to final stage of the disease. There are several modalities that can be used as diagnostic toolssuch as manometry, barium esophagogram, esophagoduodenoscopy, esophageal CT-scan, until the recent one, high-resolution manometry that can classify achalasia into three different types. The treatment options are the pharmacologic intervention, endoscopic treatment, minimal invasive surgery, and radical surgery.We reported a case of 20 year old female with achalasia who came with dysphagia symptom since three years before. The diagnosis was made by historytaking, physical examination and barium meal and esophagogastroduodenoscopy. The patient underwent pneumatic dilatation and since then the symptom was relieved

Clinical Characteristics and Microbiological Profiles of Community-Acquired Intra-Abdominal Infections

Background: Intra-abdominal infections (IAIs) have different aspects to consider. One important aspectis the microbiological analyses, especially in the era of broad spread of resistant microorganisms. The studywas designed to describe the clinical characteristics and microbiological profiles of community acquired IAIs. Method: An observational study was performed on medical records of 12 months period (January toDecember 2013) in a General Hospital, Karawaci, Tangerang. Adult patients undergoing surgery for IAIs with positive microbiological culture and identification of microorganisms were included. Data collected were clinical characteristics and microbiological profiles and wereanalyzed statisticallyusing the SPSS version 17. Results: In 12 months period of study, 17 patients of IAIs with a total of 17 intra peritoneal specimens were collected. A total of six microorganisms were cultured. All the IAIs were monomicrobial, with aerobicmicroorganism dominantly Gram-negative bacilli. The dominant microorganism was Escherichia coli (E.coli), found in 58.8% of IAIs. The most common site was appendix (41.2%), and none from small intestine. Thesusceptibility test found that piperacillin tazobactam, tigecycline, meropenem and amikacin were the most activeantimicrobial against E. coli. Multi-drug resistant (MDR) E. coli in this study was 40%. The MDR E. coli had66.6% resistance to levofloxacin and ciprofloxacin, 66.6% susceptibility to ceftriaxone and ceftazidime, and100.0% susceptibility to amikacin. Conclusion: The most common site of community-acquired IAIs was appendix (41.2%). E. coli is still adominant microorganism with the MDR E. coli proportion of 40%

Nosocomial Clostridium Difficile Diarrhea in Patient with Malignancy

Clostridium difficile (C. difficile) is the main pathogen causing antibiotics associated diarrhea and colitis. This bacterium increases with hospitalization with incidence of 20-60 cases per 100,000 patients/day. C. difficile is gram positive bacilli which produce toxins in 2,700 cases in every 100,000 exposures to particular antibiotics, such as clindamycin, cephalosporin, and ampicillin. These antibiotics disrupt the intestinal normal flora and predispose to colonization of C. difficile. This case described a 53-year old male patient with squamous cell carcinoma in his left ear who came to Department of Internal Medicine, Cipto Mangunkusumo Hospital, with the complain of diarrhea since two weeks after one month hospitalization in Department of Ear, Nose, and Throat. The characteristics of the diarrhea were 10 times per day ± 100 mL, watery consistency, green yellowish in color, and no blood in the feces. Additionally, the patient also complained of pain in all parts of his stomach, especially in the epigastric area. Earlier, patient was given ceftazidime for 30 days of hospitalization. The serology examination of C. difficile in the feces showed positive result (titer = 0.790 and control = 0.190). During the colonoscopy examination, pancolitis was found and the pathologic anatomy result was found appropriate for infective colitis. Thereafter, antibiotic administration was ceased and metronidazole was administered intravenously three times a day. The diarrhea stopped after seven days and the patient was discharged

Koagulasi Intravaskuler Diseminata Pada Kanker

Disseminated Intravascular Coagulation is one of thrombosis manifestation other than venous thromboembolism, which onset is acute and has slight different clinical manifestation that tends to be chronic. Pathogenesis of the DIC in hematology Malignancy is caused by the activation of fibrinolytic pathway by tumor cells. In solid tumor the pathogenesis is mainly because of the activation of cogulation factor by tissue factor expressed by tumor cells. Thediagnosis of DIC in cancer still needs further validation from the International society of thrombosis and hemostasisand Japanese society hematology criteria in cancer subjects. The principle of therapy for DIC in cancer patients is management of the cancer itself as the underlying etiology with the target is remission. The uses of anticoagulant therapy needs further clinical trial in the future. Coagulation factor and platelet transfusion can be given if there is significant bleeding.Koagulasi intravaskuler diseminata (KID) adalah manifestasi trombosis lain selain tromboemboli vena yang bersifat akut. Pada pasien kanker gambarannya sedikit berbeda, yaitu cenderung bersifat kronik, tergantung pada jenis kankernya. Patogenesis KID pada keganasan hematologi adalah akibat fibrinolisis yang meningkat. Sedangkan pada tumor solid terjadi akibat aktivasi faktor koagulasi oleh faktor jaringan yang diekspresikan oleh sel kanker. Diagnosis KID pada kanker masih memerlukan validasi kriteria dari perhimpunan trombosis hemostasis Internasional dan Jepang pada kelompok pasien kanker. Prinsip terapi KID pada kanker adalah tata laksana kanker yang menjadi penyebab, dengan target remisi penyakit. Pemberian antikoagulan memerlukan uji klinis menggunakan populasi pasien kanker. Transfusi faktor koagulasi dan atau trombosit hanya diberikan apabila terdapat perdarahan yang bermakna

Tuberkulosis Payudara Primer sebagai Diagnosis Banding Massa Payudara

Dilaporkan kasus seorang pasien perempuan berusia 40 tahun dengan TB payudara primer, suatu bentuk TB ekstra-paru yang jarang dijumpai. Keluhan berupa benjolan payudara kanan sejak 2 minggu dan pembesaran kelenjar getah Bening aksila kanan. Ultrasonografi menemukan abses dan pembesaran kelenjar getah Bening. Biopsi abses menemukan gambaran infeksi Mycobacterium tuberculosis. Setelah pengobatan anti-TB selama 6 bulan, abses membaik. Gambaran klinis TB payudara bervariasi dan memiliki kemiripan dengan beberapa penyakit lainnya. TB payudara merupakan salah satu diagnosis alternatif massa payudara di daerah dengan insidens TB tinggi