Preliminary Report: Clinical Characteristic, Hematologic Response and Gene Mutation of Patients with Chronic Phase Chronic Myeloid Leukemia (CML) to Imatinib at Cipto Mangunkusumo National Hospital (RSUPN CM)

Leukemia Granulositik Kronik (LGK) disebabkan oleh gen BCR-Abl domaintyrosin kinase, produk dari kromosom Philadelphia. Imatinib mesylate merupakan inhibitor selektif terhadap kinase tersebut. Di Indonesia, data mengenai karakteristik pasien LGK fase kronik, respons hematologi terhadap imatinib, dan mutasi gen masih jarang ditemukan. Metode dan desain: studi potong lintang ini menggunakan data rekam medik pasien yang didiagnosis sebagai LGK fase kronik dengan BCR-ABL positif yang berobat ke Poliklinik Teratai Departemen Ilmu Penyakit Dalam Rumah Sakit Cipto Mangunkusumo selama Januari Desember 2009.Hasil: dalam periode 1 tahun studi, peneliti mengikutsertakan 20 pasien LGK fase kronik yang memiliki BCR-ABL positif dengan median umur 36 tahun (13-62 tahun). Pasien laki-laki lebih banyak dibandingkan dengan perempuan (12 vs 7) dengan rasio 1,7: 1. Sebanyak tujuh pasien (36,8%) berasal dari suku Jawa. Dilaporkan juga karakteristik pasien adalah 15 orang berada pada fase kronik (78,9%); 3 pasien berada pada fase akselerasi (15,8%) sementara 1 pasien mengalami krisis blast (5,3%); 12 pasien (63,2%) ditemui adanya splenomegali; dan 5 dari 11 pasien dilaporkan memiliki skor Sokal yang rendah. Berdasarkan hasil laboratorium didapati nilai median hemoglobin 9,9 g/dL (5-14 g/dL); leukosit 73.000/uL (4.100-332.000/uL) dan nilai median trombosit 481.000/uL (263.000/uL-1.116.000/uL); nilai median kadar basofil di darah perifer 1% (1-10%) dengan nilai median sel blast di perifer adalah 1% (0-22%). Selama studi, respons hematologik komplet dalam 3 bulan dicapai oleh 10 dari 19 pasien (52,6%), termasuk di antaranya 1 pasien yang mengalami fase akselerasi dan 1 pasien yang lain mengalami krisis blast. Sebanyak 18 pasien (94,7%) telah diobati dengan hydrea sebelum mendapat terapi Imatinib, sementara 1 pasien (5,3%) tidak pernah mendapatkan pengobatan apapun sebelumnya.Kesimpulan: didapati nilai median usia pasien LGK fase kronik adalah 36 tahun, sebagian besar adalah laki-laki. Sebanyak enam puluh tiga persen pasien memiliki splenomegali. Dilaporkan juga nilai median leukosit adalah 73.000/uL (4.100-332.000/uL) dengan nilai median sel blast di darah perifer sebanyak 1% (0-22%). Respons hematologik komplet dalam 3 bulan dicapai oleh 52,6% pasien

Cardiac Tamponade Due to Liver Amebiasis Rupture

Amebiasis is common cases in Asia, Africa, and South Africa. Liver amebiasis has become a serious problem worldwide especially in health and social aspect. The protozoa named Entamoeba histolytica was easily found in area with poor sanitation, low socioeconomic status, and poor nutrition status. The incidence of amebiasis in several hospitals in Indonesia is 5-15% per year. Epidemiological observation showed the comparison of incidence among male and female population and it was approximately 3 : 1 until 22 : 1 with male predominance. The potential age suffered from amebiasis is around 20 - 50 years old. The route of infection spread to oral-fecal and oral-anal-fecal. The most common complication is abscess rupture (5-15.6%). Rupture may be located in pleural cavity, pericardial cavity, lung, bowel, intraperitoneal, and skin. Rupture of liver amebias spread to pleural and pericardial cavity is a rare case and frequently under reported. This case report illustrates a 40-year-old male with cardiac tamponade due to rupture of liver amebiasis. Patient's was admitted with chief complaint of shortness of breath, positive Beck's triad, hepatomegaly, pleural effusion, liver abscess on sonography and swinging of heart on echocardiography. This patient was treated with metronidazole as a drug of choice, and pericardiocentesis for the cardiac tamponade

Tuberculous Peritonitis Presenting Acute Recurrent Pancreatitis

Tuberculosis (TB), one of the oldest diseases known to affect humans, is a major cause of death worldwide. TB is still a major problem in Indonesia. This disease, which is caused by bacteria of the Mycobacterium tuberculosis, usually affects the lungs, although other organs are involved in up to one- third of cases. Approximately 95% cases of TB and 98% death because of TB occur in developing country. Gastrointestinal tuberculosis is uncommon, making up 3.5% of extrapulmonary cases in the United States. This kind of TB may involve gastrointestinal tract, peritoneal, lymph nodes, or solid intraabdominal organs (viscera). A 17 years old male admitted to hospital with TB peritonitis presenting unusual clinical manifestation. At the first admission patients was diagnosed with acute pancreatitis based on elevation of amylase and lipase level up to 285 and 2,046 U/L and after finishing further examination, patients suffered from tuberculous peritonitis which based on literature manifested some gastrointestinal disorders. Diagnostic confirmation was accomplished by conducting serum-ascites albumin gradient (SAAG) of < 1.1 g/dL, peritoneal thickening and the presence of ascites with fine mobile septations on ultrasound, positive polymerase chain reaction (PCR) TB from ascitic fluid. Patients received conventional antitubercular therapy for 12 months of rifampicin, isoniazid, pyrazinamide, and ethambutol. The addition of corticosteroids for the first two or three months of treatment may reduce the incidence of late complications arising from adhesive disease, such as small bowel obstruction