Colorectal Polyp Evaluation Management and Its Role in Gastrointestinal Tract Malignancy

Colorectal polyp is one of important factors that have roles in developing Malignancy of lower gastrointestinal tract. Adenomatous polyp is the most common colorectal polyps and it has been known as a lesion precursor for transformation process in developing gastrointestinal Malignancy. Such transformation is known as adenocarcinoma sequence, a long-term process which usually does not elaborate any symptoms and remains asymptomatic. Since most colorectal polyps are asymptomatic, they are usually undiscovered at the time of diagnosis and results to the increasing case of Malignancy especially the colorectal cancer. Considering that colorectal cancer still becomes one of the most common causes of death and morbidity worldwide, early detection and elimination of colorectal polyp may have a significant role in preventing lower gastrointestinal tract Malignancy

Clinical Profile and Outcome of Non-Variceal Upper Gastrointestinal Bleeding in Relation to Timing of Endoscopic Procedure in Patients Undergoing Elective Endoscopy

Background: Endoscopy is the most accurate method for diagnosing the source of upper gastrointestinal bleeding. This study was aimed to evaluate the correlation between the timing of elective endoscopy and the length of hospital stay, the amount of transfusion given and incidence of recurrent bleeding or patient mortality. Method: A retrospective study was conducted in all patients with non-variceal upper gastrointestinal bleeding who had experienced elective endoscopy at Cipto Mangunkusumo Hospital between January 2007 and August 2008. Identification of clinical risk using clinical Rockall score was performed at the emergency room. Persistent bleeding, recurrent bleeding, surgical treatment and death were the outcome variables. Statistical analysis was performed using Chi-square/fisher exact test and linear regression. Results: There were 40 eligible cases with mean age of 53 ± 13 years; the greatest occurrence was at the age group of 50-59 years (12%), male (52.5%) and those who had clinical symptom of melena (52.5%). Twenty seven (67.5%) patients had Rockall score of 1-3 points and 13 (32.5%) had 4-6 points. There was only one patient who had adherent clots (Forrest grade II B). Endoscopy results revealed that the most common cause of bleeding was gastric ulcer, which occurred in 12 (30%) patients. There was no correlation between the timing of endoscopic procedures and outcome variable; however the length of hospital stay had a significant correlation with timing of endoscopic procedures. Conclusion: Elective endoscopy does not affect the variables of mortality and recurrent bleeding; however, it affects the length of hospital stay. Further prospective studies are required to find causal relation between them

Conductance asymmetry in point-contacts on epitaxial thin films of Ba(Fe0.92_{0.92}Co0.08_{0.08})2_2As2_2

Point-contact spectroscopy is a powerful tool for probing superconductors. One of the most common observations in the point-contact spectra on the recently discovered ferropnictide superconductors is a large conductance asymmetry with respect to voltage across the point-contact. In this paper we show that the antisymmetric part of the point-contact spectrum between a silver tip and an epitaxial thin film of Ba(Fe$_{0.92}$Co$_{0.08}$)$_2$As$_2$ shows certain unique features. These features have an interesting evolution with increasing temperature up to a temperature that is 30% larger than the critical temperature $T_c$ of the superconductor. We argue that this evolution can be associated with the rich normal state properties of these materials.Comment: 4 pages, 2 figure

Management of Duodenal Ulcer with Gastroesophageal Reflux Disease (GERD) with Intravenous Pantoprazole

Proton pump inhibitors (PPIs) are the most effective anti secretory drugs available for controlling gastric acid acidity and volume. They are the drug of choice in the treatment for gastro esophageal reflux disease (GERD), Helicobacter pylori eradication, peptic ulcer and non steroidal anti-inflammatory drug (NSAID) gastropathy: For acute cases, an intravenous PPI is needed, especially for hospitalized patient. Recently, intravenous pantoprazole represents an alternative to intravenous histamine-2 receptor antagonists. We observed 2 patients who were treated with pantoprazole for duodenal ulcer, where one case had a complication of bleeding with a history of long term use of NSAID. After two weeks of treatment with pantoprazole, significant lesion healing from endoscopy findings was achieved in both cases

Gelatinization properties of sago and wheat flour mixtures

Gelatinization or pasting properties of sago-wheat flour mixtures (10-50% sago) were studied for mixtures of sago-high protein wheat flour (HPW), sago-medium protein wheat tlour (MPW) and sago-low protein wheat flour (LPW). Gelatinization temperature (TG)increased as the sago portion in HPW, MPW and LPW increased. The peak temperature (Tp) and peak viscosity (Vp) increased with increasing sago in the sago-wheat mixtures. The setback values (5B) in sago-LPW mixtures were higher than in sago-HPW and sago-MPW mixtures. The setback viscosities (Vs) were not much different for any mixtures or control flours. The breakdown viscosities (VB) increased with increased sago in the mixtures. The breakdown value (BD) increased with increased sago in the sago-wheat mixtures

The Causes of Upper Gastrointestinal Bleeding in the National Referral Hospital: Evaluation on Upper Gastrointestinal Tract Endoscopic Result in Five Years Period

Backgrounds: Gastrointestinal bleeding such as hematemesis or melena are common conditions in clinical practice and endoscopic service. The mortality rate due to gastrointestinal bleeding is relatively high. In this study, we evaluate the causes of hematemesis melena for the last 5 years and the factors associated with the bleeding. Methods: The study was done retrospectively. We obtained data from medical record of patients that performed endoscopy of upper gastrointestinal tract in Division of Gastroenterology, Department of Internal medicine, Cipto Mangunkusumo hospital (Jakarta, Indonesia) during the period of 2001 to 2005. Results: Of 4.154 patients who underwent upper gastrointestinal tract endoscopy from 2001 to 2005, we found that 837 patients (20.1%) were due to upper gastrointestinal bleeding. They were 552 male (65.9%) and 285 female patients (34.1%). Mean age of male patients was 52.7 ± 15.82 years, while for female patients was 54.46 ± 17.6 years. Of 837 patients who came due to hematemesis were 150 patients (17.9%), melena were 310 patients (37.8%), both melena and hematemesis were 371 patients (44.3%), 557 cases (66.5 %) due to non varices. Endoscopic results showed that 280 cases (33.4%) were due to esophageal varices. In general, this study had demonstrated that esophageal varices was the most frequent cause of upper gastrointestinal bleeding. We found 229 cases of esophageal varices were coincidence with portal hypertensive gastropathy. While ulcer was found in 225 cases (26.9%) and most of them were gastric ulcer (51.1%). Of gastrointestinal bleeding caused by esophageal varices, most were grade III in 138 cases (49.3%). The incidence of bleeding of bleeding were found more frequently in patients age group of 40 - 60 years (389 cases; 46.5%), > 60 years (305 cases; 36.2%), < 40 years (242 cases; 16.8%). The causes of bleeding in patients whose age > 60 years, most were caused by ulcer (37.4%). In this study, we also found that cancer as the cause of gastrointestinal bleeding in 26 cases (3.1%). Gastrointestinal cancer comprised of gastric cancer in 15 cases (57.7%), duodenal cancer in 7 cases (26.9%), and esophageal cancer in 4 patients (15.4%). Conclusion: The most frequent cause of upper gastrointestinal bleeding was esophageal varices and usually had reached stage III. The non variceal cause of bleeding was gastric cancer. Upper gastrointestinal Malignancy was also found to be the etiology of bleeding in this study

Demographical Distribution on the Incidence of Helicobacter Pylori Infection in Jakarta: Obtaining Samples From 5 Municipalities

Background: Currently, the hospital-based studies on Helicobacter pylori (H. pylori) have demonstrated that the incidence of H. pylori infection tends to decline in Indonesia. On the other hand, no population-based study has ever been conducted. Therefore, our study was performed to evaluate the true incidence of H. pylori found among the population.Method: This study was a surveillance using cross-sectional design. The samples used in our study were randomly selected from 1,645 samples including those from five municapalities of Special Capital Region of Jakarta in 2006. Immunochromatographic test (ICT) was utilized to establish the diagnosis of H. pylori infection. The test has demonstrated high sensitivity and specificity for Indonesian populationResults: The seroprevalence of H. pylori infection among 310 patients was 52.3% (162 out of 310 patients) with mean age of 43.48 + 10.45 years. There was no difference regarding seroprevalence in both groups of < 40 year and > 40 years of age (52.3% and 52.2%). The highest prevalence of H. pylori infection was found in West Jakarta (66.1%); while the lowest prevalence was found in South Jakarta (41.0%). The incidence of H.pylori infection between those who were alcoholic was equal to those who were not alcoholic (46.2% vs. 52.5%).Similar result was also found between smokers and non-smokers (53.8% vs. 51.8%).Conclusion: In this study, we found that H. pylori seroprevalence remains high in the population. Various seroprevalence of H.pylori infection were found among five municipalities in Jakarta

Upper Gastrointestinal Malignancy Among Dyspepsia Patients in Cipto Mangunkusumo Hospital Jakarta

Background: Upper gastrointestinal (GI) Malignancy was still a health problem in all over the world. The prevalence of the upper GI Malignancy vary among Asian countries. Data from Indonesia was scarcely reported. The aim of this study is to determine the frequency of upper GI Malignancy among dyspepsia patients who underwent esophagoduodenoscopy (EGD) procedure. Method: This is a retrospectives study from subject with dyspepsia that had underwent upper GI endoscopy at the Department of Internal Medicine Cipto Mangunkusumo hospital from January 2005 to December 2007. All complete data from medical report and histopathology appearance will be recorded. Results: Out of 2,116 subjects underwent endoscopy due to dyspepsia, 110 (5.19%) subjects was diagnosed as cancer. This upper GI Malignancy consisted of gastric cancer in 63 (2.97%) cases, esophageal cancer 32 (1.51%) and duodenal cancer 15 (0.71%). The mean ages of the subjects was 53.36 ± 10.97 years, age less than 45 years was 20 (18.20%) subjects, more than 45 years was 90 (81.18%), male 71 (64.50%) subjects, female 39 (35.50%). Most of them had alarm signs 96 (87.30%). Histopathology finding showed adeno-carcinoma in 75 (68.20%) cases, signet ring cell carcinoma in 14 (12.70%), squamous cell carcinoma in 8 (7.30%), others in 13 (11.80%). Out of 59 gastric cancer, 48 (76.20%) cases was located at distal part while the rest 11 (17.50%) cases was located at the proximal gaster, and 4 (6.30%) in diffuse. By the ethnics founded Javanese 37 (33.60%) subjects, Betawinese 22 (20.00%), Sundanese 12 (10.90%) and Batak 13 (11.80%). Conclusions: Upper GI Malignancy was found in five percent of subjects with dyspepsia who undergo colonoscopy. The three most frequent Malignancies were gastric carcinoma, esophageal carcinoma, and duodenal carcinoma respectively. Most of gastric adenocarcinoma was located at distal stomach

Clinical Effects of an Amino Acid and Glucose Solution in Non-surgical Gastrointestinal Patients of Internal Medicine

Background: This study was performed to assess the efficacy and safety of intravenous amino acid and glucose solution with electrolytes in non-surgical gastrointestinal patients. Method: This single, open, and pre-post study was conducted in the internal medicine ward at Cipto Mangunkusumo Hospital between June 2007 and March 2008. Patients were administered solution of amino acid, glucose, and electrolytes via peripheral vein at a dose of 1000 mL/day for one week period. Non-operative gastroenterology patients with age between 16 and 65 years were eligible in this study; patients were excluded if they had diabetes mellitus, severe hepatic or renal dysfunction, electrolyte disturbance, and obesity. The data were analyzed by paired t-test and McNemar test using SPSS version 16. Results: Fifteen patients consisted of 8 (53.5%) female, mean age was 38.47 ± 14.73 years. The body mass index (BMI) at screening was 14.50 ± 2.11 kg/m2. Patients\u27 BMI increased in day-1, day-3, and day- 7 into 14.5; 14.58; 14.80 kg/m2, respectively (p < 0.05). The increasing of prealbumin, albumin, transferin, and total protein were 7.30 mg/dL vs 11.16 mg/dL; p = 0.018; 2.71 g/dL vs 3.12 g/dL; p = 0.024; 102.37 mg/dL vs 141.95 mg/dL; p = 0.016; 6.24 g/dL vs 6.85 g/dL; p = 0.019, respectively. The clinical symptoms of nausea and weakness in patients decreased from 53.3% to 6.7%; p = 0.016, and 66.7% to 6.7%; p = 0.004. Conclusion: This parenteral nutrition solution was effective to improve clinical nutrition parameters

Serial Cases of Combining ESWL and ERCP Procedures in Management Chronic Pancreatitis and Difficult Bile Duct Stones

Extracorporeal shock wave lithotripsy (ESWL) has an established role in the management of pancreaticductalcalculiandasfurthertreatmentmodalityforlargeordifficultcomplicatedcommon bile duct(CBD)stones. Combinedwithminimally invasive endoscopic procedure suchasendoscopic retrogradecholangio-pancreatography(ERCP),it has replaced open surgeryas theinitial form of therapy. ESWL has also proved to bean effective therapyin treating intrahepaticstones that are refractory toroutine endoscopic extraction.Inthese serialcaseswe presentthree caseswhichusing combinedESWLandERCP procedurestotreatchronicpancreatitispainandgiantCBDstonethat presentinggoodresultsonfollowupwithoutanycomplication