Giant Condyloma Acuminatum in a Woman with AIDS

Objective: To describe a case of Giant Condyloma Acuminatum with aspect of HIV and some concerns about the CD4. Result: We describe 2 cases, the first case is a giant Condyloma in HIV patient and the second case is a giant Condyloma in pregnant woman. The patient in the first case was a 40-year-old woman with AIDS (CD4 is 290) who was undergoing anti-retroviral therapy. She was found to have a giant condyloma acuminatum of the vulva. Electrocautery excision was performed, and afterwards the quality of life has improved significantly. The second case patient is a 30-year-old G4P3A0 woman with a giant condyloma acuminatum. She was 30 weeks pregnant with a single fetus. On the external genitalia there was a giant condyloma mass on the vulva extending towards the peri-anal area, obstructing the introitus. The electrocautery excision was performed. She was discharged from the hospital on the second day in good condition. She had a spontaneous delivery after reaching full term. Conclusion: Although the giant Condyloma Acuminatum is combined with HIV, but it’s not as difficult as imagined because the tumor’s base is not wide, but shaped like inverted mushroom and it is not necessary to do local flap reconstruction. [Indones J Obstet Gynecol 2012; 36-4: 206-10] Keywords: electrocautery excision, giant condyloma acuminatum, surgery in AID

Survival Rate of Cervical Cancer in National Referral Hospital in 2012 - 2014

Background: cervical cancer is the third leading cause of female deaths worldwide, and it is the leading cause of female deaths in developing countries. A routine survival evaluation is required to imply the result of the treatment. The aim of this study was to determine the cervical cancer patient survival rate at the Cipto Mangunkusumo hospital as national referral hospital in Indonesia. Methods: our retrospective cohort study utilized the medical records of cervical cancer patients from 2012 to 2014 using total population sampling method. The data analysis was conducted using the Kaplan-Meier curve, log rank test and Cox regression to determine significant associations between variables. Results: there were 1,303 subjects with overall survival rates of cervical cancer up to the fifth year of 76%, 65%, 59%, 43% and 34%, respectively, with a median survival of 1,316 days. There were significant differences of hazard ratio for cancer stage variables (p<0.001), and the Cox regression analysis showed that the factor affecting survival was  cancer stage. Conclusion: the 5-year cervical cancer survival rate at the Cipto Mangunkusumo hospital from 2012 to 2014 was 34%

Characteristics, Management and Survival Rate of Ovarian Germ Cell Tumor: Karakteristik, Manajmen dan Tingkat Kesintasan Ovarian Germ Cell Tumor

Abstract Objective:To determine the prevalence of malignant ovarian germ cell tumour in term of characteristics, management, and 3-year survival rate in Dr. Cipto Mangunkusumo Hospital Jakarta from 2011 to 2013. Methods: This is a cross-sectional study. Secondary data were collected from medical record as well as interviewing patients through phone call or home visit. Results: We collected data from 24 subjects. As many as 54.2% of subjects were between 20 to 40 year old, and 58.3% was single. Around 83.3% of the subjects came with chief complaint of abdominal enlargement. Histopathology finding confirmed dysgerminoma in 50% subjects, mixed ovarian germ cell tumour in 25%, endodermal sinus tumour or yolk sac tumour in 16.7%, and immature teratoma in 8.3%. Half of the cases were found in stage I. The primary therapy was conservative surgical staging and adjuvant chemotherapy.In 2 subjects with dysgerminoma, neoadjuvant chemotherapy (bleomycin, etoposide, cisplatin, and cyclophosphamide-cisplatin regimen) resulted in a good response. The 3-year survival rate was 83.3% in dysgerminoma, 100% in mixed ovarian germ cell tumour, and 50% in immature teratoma. Conclusion: In malignant ovarian germ cell tumour, conservative surgical staging followed by a complete course of chemotherapy is the treatment of choice with 3-year survival rate exceeding 70%. Keywords: dysgerminoma, non-epithelial ovarian tumour,ovarian germ cell tumour, survival &nbsp; Abstrak Tujuan : Mengetahui sebaran meliputi karateristik, penatalaksanaan dan kesintasan 3 tahun pasien tumor ganas sel germinal ovarium di RSCM tahun 2011 – 2013. Metode : Penelitian ini menggunakan studi potong lintang dengan mengambil data sekunder dari rekam medis dan mewawancarai pasien atau keluarga pasien via telepon atau kunjugan rumah. Hasil : Pada penelitian ini, dari 24 subjek penelitian, 54,2% ditemukan pada usia 20-40 tahun dan 58,3% subjek belum menikah. Sebanyak 83,3% datang dengan keluhan perut membesar. Secara histopatologi didapatkan jenis disgeminoma, tumor sel germinal campuran, sinus endodermal (yolk sac) dan teratoma imatur dengan proporsi masing-masing 50%, 25%, 16,7% dan 8,3%, sebagian besar kasus (50%) ditemukan pada stadium I. Conservative surgical staging dan kemoterapi adjuvan tatalaksana pilihan. Terdapat 2 subjek jenis disgerminoma yang diberikan dengan kemoterapi neoadjuvan (regimenbleomycin, etoposide, cisplatin dan cyclophosmide-cisplatin) memberikan respon yang baik. Kesintasan ≥ 3 tahun pada jenis disgerminoma mencapai 83,3%, pada tumor sel germinal campuran 100% dan pada teratoma imatur mencapai 50%. Kesimpulan : Pada tumor ganas sel germinal ovarium conservative surgical staging diikuti kemoterapi lengkap merupakan pilihan terapi dengan kesintasan ≥ 3 tahun mencapai &gt; 70%. Kata kunci : disgerminoma,kesintasan, tumor ovarium non epithelial, tumor sel germinal ovarium

Prevalence of Appendical Metastasis in Primary Surgery of Ovarian Epithelial Cancer: Prevalensi Metastasis Apendiks Pada Bedah Primer Kanker Epitel Ovarium

Objective: To determine the prevalence of metastasis to appendix from primary surgery of ovarian epithelial cancer at National General Hospital Dr. Cipto Mangunkusumo (RSCM), Indonesia.Methods: A cross sectional study was done using ovarian epithelial cancer patient medical record whose primary ovarian cancer and appendectomy surgery were conducted on July to December 2019 at RSCM. Patients without appendix histopatology result and previous chemotherapy were excluded in this study. Consecutive method and random sampling were used in this study.Results: : A total of 80 subjects were included in this study. Subjects have average age of 48 years old. Out of all samples, 43 samples (53.8%) were defined as stage I patient, 7 subjects (8.8%) as stage II, 30 subjects (37.5%) as stage III, and none as stage IV. Appendectomy were done and eight subjects (10%) experienced metastasis to appendix. A total of 19 subjects (23.8%) had chronic appendicitis and 53 subjects (66.3%) did not have metastasis to the appendix. Among eight subjects having appendix involvement, 4 had mucinous histology, 2 serous, and 2 endometrioid. Six out of eight were diagnosed at clinical stage III and two were diagnosed at stage I.Conclusion: The prevalence of appendix metastases from primary surgery in ovarian epithelial cancer at RSCM was 10%. Based on this research, appendectomy can be considered on ovarian cancer surgeryKeywords: &nbsp;&nbsp;&nbsp;appendix, metastasis, ovarian cancer. &nbsp; Abstrak Tujuan: Mengetahui prevalensi metastasis kanker epitelial ovarium ke apendiks pada pembedahan primer kanker epitelial ovarium di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo (RSCM), Indonesia. Metode: Penelitian ini merupakan studi potong lintang menggunakan data rekam medis pasien kanker ovarium epitelial yang menjalani pembedahan primer dan apendiktomi pada bulan Juli hingga Desember 2019 di RSCM Pasien tanpa histopatologi apendiks atau pernah dilakukan kemoterapi sebelumnya dieksklusi dari penelitian. Digunakan metode pengambilan sampel secara acak. Hasil: Didapatkan 80 subjek penelitian yang diikutsertakan dalam penelitian. Dari 80 subjek penelitian, didapatkan rerata usia 48 tahun. Sebanyak 43 subjek (53,8%) didiagnosis dengan stadium I, 7 subjek (8,8%) sebagai stadium II, 30 subjek (37,5%) stadium III. Dari 80 subjek yang menjalani apendiktomi, didapatkan 8 subjek (10%) anak sebar ke apendiks, 19 subjek (23,8 %) apendisitis kronis, 53 subjek (66,3%) tidak terdapat anak sebar. Dari 8 subjek yang terdapat anak sebar ke apendiks dengan temuan histologi 4 musinosum, 2 serosum, 2 endometroid. Sebanyak enam dari delapan subjek terdiagnosis pada stadium klinis stadium III dan dua lainnya pada stadium klinis satu. Kesimpulan: Prevalensi metastasis apendiks pada operasi primer kanker ovarium epitelial di RSCM adalah sebesar 10%. Berdasarkan hasil penelitian ini, apendektomi dapat dipertimbangkan dilakukan pada pembedahan baik stadium awal maupun stadium lanjut.Kata kunci: , apendiks , kanker ovarium, metastati

Post-operative Recovery Assessment of Urinary Tract Dysfunction Following Radical Hysterectomy for Cervical Cancer Patients

Abstract Objectives: To assess the length of recovery phase in urinary tract dysfunction following radical hysterectomy for cervical cancer patients in Ciptomangunkusumo Hospital. Methods: This survey study was conducted in Cipto Mangunkusumo Hospital from September 2016 to May 2017. Subjects were cervical cancer patients from stage IA2 to IIA2 underwent radical hysterectomy. Suprapubic catheter (SPC) was inserted to observe the urine production after procedure. Patients were then directed for bladder training protocol involving clamping and opening SPC. Sensation of bladder fullness followed by spontaneous micturition were recorded. Measurement of post voiding residual (PVR) urine volume after spontaneous micturition until less than 100 mL was considered as resolution of urinary tract dysfunction. The average days of every achieved phase were then calculated. Results: Twenty-nine subjects underwent radical hysterectomy during observation period. But only 21 subjects continued the bladder training protocol and recorded for the recovery phases. The average time needed to obtain sensation of bladder fullness and spontaneous micturition were 7.57 ± 4.78 days (median 5 days, minimum 3 days,  maximum 22 days)and  8 ± 5.21 days (median 6 days, minimum 3 days, maximum 23 days). The objective PVR urine became less than 100mL was obtained after 21.42 ± 18 days (median 18 days, minimum 7 days, maximum 74 days). Conslusion: Following radical hysterectomy, recording the recovery phase of urinary tract dysfuction is essential to ensure complete resolution. Complete resolution of the urinary dysfunction is achieved after 21.42±18 days in average (median 18 days, minimum 7 days, maximum 74 days). Keywords: cervical cancer, radical hysterectomy, urinary tract dysfunction, post voiding residual volume.   Abstrak Tujuan: Menilai masa pemulihan disfungsi saluran kemih setelah histerektomi radikal pada pasien kanker serviks di RSUPN Ciptomangunkusumo. Metode: Studi survei dilakukan di RSUPN Cipto Mangunkusumo dari September 2016 hingga Mei 2017. Subjek penelitian terdiri dari pasien kanker serviks stadium IA2 hingga IIA2 yang menjalani histerektomi radikal. Kateter suprapubik (SPC) digunakan sebagai alat untuk memantau produksi urin pasca operasi. Pasien diinstruksikan untuk mengikuti protokol bladder training yaitu melalui prosedur menutup dan membuka kateter. Rasa sensasi ingin berkemih dan berkemih spontan. Pengukuran residu volume urin pasca berkemih dibawah 100mL dianggap merupakan indikator pemulihan disfungsi saluran kemih. Rata-rata hari dari setiap fase kemudian dihitung. Hasil: Dua puluh sembilan subjek didapatkan selama penelitian. Namun, hanya 21 subjek yang dapat mengikuti protocol bladder traning dan dicatat perkembangan pemulihannya. Rata-rata hari yang diperlukan untuk merasakan sensasi berkemih dan berkemih spontan adalah 7,57 ± 4.78 hari (median 5 hari, minimum 3 hari, dan maksimum 22 hari) dan 8 ± 5.21 hari. (median 6 hari, minimum 3 hari dan maksimum 23 hari) Rata-rata hari untuk mencapai residu urin di bawah 100 mL adalah 21.42 ± 18 (median 18 hari, minimum 7 hari, dan maksimum 74 hari). Kesimpulan: Setelah prosedur histerektomi radikal, pencatatan masa pemulihan penting untuk dipantau untuk memastikan pemulihan lengkap. Rata-rata hari yang diperlukan untuk pemulihan adalah 21.42 ± 18 hari (median 18 hari, minimum 7 hari, dan maksimum 74 hari). Kata kunci: kanker serviks, histerektomi radikal, disfungsi saluran kemih, volume residu paska berkemih

Efficacy and Safety of Cryotherapy in "See and Treat" Program in Jakarta Primary Health Centre

Objective: To evaluate the efficacy and safety of cryotherapy in "See and Treat" program in Jakarta Primary Health Care. Method: Using descriptive cross-sectional design, data from medical records were taken with total sampling method. We took the VIA result, cryotherapy procedure, first-marriage age, number of marriage, parity, smoking habit, and the use of contraception. Data were analyzed univariately. Result: Of 86 data, the percentage of cryotherapy to change from positive to negative of VIA result was 90.70%. We did not find the progressivity to invasive cancer. Conclusion: Cryotherapy is effective to manage the cervical precancerous lesion in "See and Treat" program. [Indones J Obstet Gynecol 2016; 4-4: 227-233] Keywords: cryotherapy, Indonesia, see and treat, visual inspection of acetic acid (VIA

Agreement Test of Documentation of Visual Inspection with Acetic Acid “DoVIA†and Colposcopy findings as a Screening Tool for Cervical Cancer: Kesesuaian Hasil Tes Dokumentasi Inspeksi Visual dengan Asam Asetat (DoVIA) dan Kolposkopi sebagai Alat Skrining untuk Kanker Servik

Abstract Objective: To find out the suitability of Documentation of Visual Inspection with Acetic Acid (DoVIA) result compare to colposcopy result as a method of cervical cancer screening. &nbsp; &nbsp; Method: This is a descriptive study using cross sectional design that took place from April 2017 until March 2019. One hundred eighty two sampels of documentation photographs taken by the researcher were included. The photographs were reviewed by the 3 selected reviewers: oncology and gynecology consultant, obstetry and gynecology resident, and general practitioner that were trained about DoVIA and colposcopy. The review was based on kappa test which assessed the sharpness, squamo-columnar junction and white epitel visualization on the cervix. Results: Kappa score on DoVIA versus colposcopy was 0,717 (good). Inter-rater test was performed to assess consistency and the result was 0,764 (good) between consultant and resident, 0,703 (good) between consultant and general practitioner. Conclusion: Kappa test of IVA documentation â€DoVIA†gives a good kappa value, so that it is expected to be an alternative screening for precancerous lesions. Keyword: cervical cancer screening, VIA, DoVIA, colposcopy, mini colposcopy &nbsp; Abstrak Tujuan: Untuk menemukan kesesuaian antara dokumentasi hasil inspeksi visual dengan asam asetat (DoVIA) dibanding dengan hasil kolposkopi sebagai metode skrining kanker serviks. Metode Penelitian deskripsi ini menggunakan desain cross sectional yang telah dilakukan sejak April 2017 hingga Maret 2019. Seratus delapan puluh dua sampel dokumentasi telah diambil oleh peneliti telah dimasukkan menjadi sampel. Hasil dokumentasi telah dinilai oleh 3 penilai yang terdiri dari konsultan onkologi dan ginekologi, residen obstetri dan ginekologi, dan dokter umum yang telah dilatih untuk DoVIA dan kolposkopi. Hasil penilaian dilakukan berdasarkan kappa untuk menilai ketajaman, sambungan skuamos kolumner dan visualisasi lesi putih di serviks Hasil Skor kappa pada DoVIA dibanding kolposkopi adalah 0,717 (baik). Hasil prbandingan penilaian antar penilai yang ditunjukkan untuk menilai konsistensi dan hasil adalah 0,764 (baik) antara konsultan dan residen, 0,703 (baik) antara konsultan dan dokter umum. Kesimpulan Tes kappa pada dokumentasi IVA (DoVIA) memberikan hasil kappa baik, sehingga DoVIA diharapkan dapat menjadi alternatif skrining untuk lesi prakanker. &nbsp; Kata kunci : skrining kanker serviks, IVA, DoVIA, kolposkopi, minikolposkop

The Need for Laparoscopic Ovarian Transposition in Young Patients with Cervical Cancer Undergoing Radiotherapy

Maintaining the quality of life by preserving ovarian function in premenopausal patients with cervical cancer undergoing radiation is crucial. This can be accomplished with a simple and safe laparoscopic ovarian transposition procedure. This procedure aims to move the ovary out of the irradiation field, protecting it from direct radiation and irreversible damage and preserving its function. However, this procedure is often forgotten and seldom offered to patients. This review aims to lay stress on and reconsider the importance of laparoscopic ovarian transposition as a simple, safe, and extremely useful procedure. The biological effects of radiation are described briefly and several studies are evaluated, which reveal that this procedure has more benefits than risks

Postradiotherapy Outcome on Cervical Cancer Stage IIIB Patients with and without Paraaortic Lymph Nodes Enlargement: Hasil Pascadiadioterapi pada Pasien Kanker Serviks Stadium IIIB dengan dan tanpa Pembesaran Nodus Paraaorta

Objective : To determine whether there are differences in clinical response after radiotherapy and 1 year survival in patients with advanced cervical cancer with and without enlargement of PALN.Method : An observational analytic study using a retrospective cohort method was done using consecutive sampling. The subjects of this study were all women with a primary diagnosis of stages IIB to IVB cervical cancer who came to the gynecological oncology clinic of Dr. Cipto Mangunkusumo National General Hospital and underwent MRI examination before undergoing treatment in January 2016 to May 2017Results: Among 76 subjects studied, there were 4 (5.1%) subjects who had enlarged PALN. There were no significant differences between the enlargement status of PALN and age (p = 0.829), age of first sexual intercourse (p = 0.33), parity (p = 0.642), mass diameter (p = 0.777). Patients with PALN enlargement have 2.13 times risk of having negative radiotherapy outcome (p = 0.02, OR 2.13, CI95% 1.12 – 4.07). There was no difference in 1-year survival between patients with and without enlargement of PALN (median 201 vs. 293, p = 0.072).Conclusion: Patients with PALN enlargement have increased risk of having negative radiotherapy outcome (p &lt; 0.05). There were no differences in 1 year survival between patients with advanced cervical cancer with enlargement PALN.Keywords : cervical cancer,&nbsp; lymph node enlargement, paraaortic, radiotherapy. &nbsp; Abstrak Tujuan: Mengetahui adakah perbedaan respon klinis pascaradioterapi dan kesintasan 1 tahun pada pasien kanker serviks stadium lanjut dengan pembesaran KGB paraaorta dibandingkan tanpa pembesaran KGB paraaorta.Metode: Penelitian ini merupakan penelitian analitik observasional dengan menggunakan metode kohort retrospektif. Pengambilan sampel dilakukan dengan cara pengambilan sampel berturut-turut. Subyek penelitian ini adalah semua perempuan dengan diagnosis primer kanker serviks stadium IIB hingga IVB yang datang ke poliklinik Onkologi Ginekologi RSUPN Dr. Cipto Mangunkusumo dan menjalani pemeriksaan MRI sebelum dilakukan terapi pada bulan Januari 2016 hingga Mei 2017.Hasil: Dari 76 subjek yang diteliti, didapatkan sebanyak 4 (5,1%) subyek yang mengalami pembesaran KGB paraaorta. Tidak didapatkan perbedaan yang bermakna antara status pembesaran KGB paraaorta dan usia (p = 0,829), usia hubungan seksual pertama (p = 0,333), paritas (p = 0,642), dan diameter massa (p = 0,777). Pasien dengan pembesaran KGB paraaorta memiliki risiko 2,13 kali lipat (p = 0,02, OR 2,13, IK95% 1,12-4,07) memiliki risiko respon terapi negatif. Tidak terdapat perbedaan kesintasan 1 tahun antara pembesaran KGB paraaorta dan tidak (median 201 vs. 293, p = 0,072).Kesimpulan Pasien dengan pembesaran KGB paraaorta memiliki risiko lebih tinggi mengalami respon radioterapi negatif. (p &lt; 0,05). Tidak terdapat kesintasan 1 tahun antara pasien kanker serviks stadium lanjut dengan dan tanpa pembesaran KGB.Kata kunci: kanker serviks, &nbsp;paraaorta, &nbsp;pembesaran KGB, radioterapi