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Accuracy of Intraoperative Frozen Section in Diagnosing Malignancy of Ovarian Neoplasm Utami, Tofan W; Iskandar, Jasmine; Tanamas, Gregorius; Jamtani, Mona; Nuranna, Laila; Nuryanto, Kartiwa H
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 3, July 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To evaluate the accuracy of frozen section for ovarian neoplasm in our hospital. Method: A retrospective evaluation was conducted on medical records of patients with ovarian neoplasms who underwent a frozen section laparotomy between the years 2008 and 2013 at Dr. Cipto Mangunkusumo Hospital. Records with incomplete data on frozen section or paraffin block report were excluded. Criteria for frozen section laparotomy in our facility was based on a malignancy score of equal to or more than 6. Frozen section reports were compared to paraffin block report based on benign, borderline, or malignant cases. Result: From 139 patients with ovarian neoplasm, only 91 patients fulfilled the inclusion and exclusion criteria. Frozen section examination revealed benign cases was 15.4%, borderline cases was 15.4%, and malignant cases was 69.2%. Based on histopathological type, clear cell cystoadenocarcinoma was the most commonly observed histotype (19.8%). The sensitivity of frozen section for benign, borderline, and malignancy cases respectively was 81.8%, 76.9%, 91.0%. The specificity of frozen section for benign, borderline, and malignancy case respectively was 93.8%, 94.8%, 91.6%. Conclusion: We found that the accuracy of intraoperative frozen section in our facility is adequate to diagnose ovarian neoplasm and can be used to assist in determining the extent of surgical management. [Indones J Obstet Gynecol 2015; 3: 161-164] Keywords: frozen section, ovarian neoplasm, paraffin block, sensitivity, specitificity

Efficacy and Safety of Cryotherapy in "See and Treat" Program in Jakarta Primary Health Centre Lestari, Linda; Purwoto, Gatot; Nuranna, Laila
Indonesian Journal of Obstetrics and Gynecology Volume 4, No. 4, October 2016
Publisher : Indonesian Socety of Obstetrics and Gynecology

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)

CD133, CD44, and ALDH1A1 as cancer stem cell markers and prognostic factors in epithelial ovarian cancer Andrijono, Andrijono; Sutrisna, Bambang; Harahap, Alida Roswita; Kanoko, Mpu; Nuranna, Laila; Siregar, Budiningsih; Wulandari, Dewi; Pelupessy, Nugraha Utama
Medical Journal of Indonesia Vol 28, No 1 (2019): March
Publisher : Faculty of Medicine Universitas Indonesia

BACKGROUND Ovarian cancer is a heterogeneous disease, and most patients are diagnosed at an advanced stage. Epithelial ovarian cancer type II is characterized by rapid tumor growth and is genetically more labile than type I. This study was aimed to demonstrate the prognostic value of CSC by using the markers CD133, CD44, and ALDH1A1 in EOC.METHODS Clinicopathological and demographic data were collected from medical records. The markers CD133, CD44, and ALDH1A1 were examined with flow cytometry and immunohistochemistry. Cancer stem cell (CSC) marker expression in patients with ovarian cancer types I and II were related to chemotherapy and survival. In multivariate analysis, the prognosis model was tested for ten months.RESULTS The largest demographic consisted of patients aged ≥45 years, with stage I, poor differentiation, and type II, of which there were 40 samples (72.7%), 23 samples (41.8%), 30 samples (54.5%), and 16 samples (29.1%), respectively. There is a high correlation between the 10-month chemotherapy response and the 4 variables, i.e., age ≥45 years, type II, stage III–IV, and CD44, with an ROC of 80.75% and a post-test probability of 82.5%. Using the ROC curve, the highest chemoresistance score was 0.841, based on the combination of CSCs markers and clinicopathological factors, that is stage III–IV, age ≥45 years, poor differentiation, type II, negative CD133, high CD44, and high ALDH1A1.CONCLUSIONS CSC (CD133, CD44, and ALDH1A1) markers and clinicopathological factors are prognostic of epithelial ovarian cancer.

Accuracy of Intraoperative Frozen Section in Diagnosing Malignancy of Ovarian Neoplasm Utami, Tofan W; Iskandar, Jasmine; Tanamas, Gregorius; Jamtani, Mona; Nuranna, Laila; Nuryanto, Kartiwa H
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 3, July 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To evaluate the accuracy of frozen section for ovarian neoplasm in our hospital. Method: A retrospective evaluation was conducted on medical records of patients with ovarian neoplasms who underwent a frozen section laparotomy between the years 2008 and 2013 at Dr. Cipto Mangunkusumo Hospital. Records with incomplete data on frozen section or paraffin block report were excluded. Criteria for frozen section laparotomy in our facility was based on a malignancy score of equal to or more than 6. Frozen section reports were compared to paraffin block report based on benign, borderline, or malignant cases. Result: From 139 patients with ovarian neoplasm, only 91 patients fulfilled the inclusion and exclusion criteria. Frozen section examination revealed benign cases was 15.4%, borderline cases was 15.4%, and malignant cases was 69.2%. Based on histopathological type, clear cell cystoadenocarcinoma was the most commonly observed histotype (19.8%). The sensitivity of frozen section for benign, borderline, and malignancy cases respectively was 81.8%, 76.9%, 91.0%. The specificity of frozen section for benign, borderline, and malignancy case respectively was 93.8%, 94.8%, 91.6%. Conclusion: We found that the accuracy of intraoperative frozen section in our facility is adequate to diagnose ovarian neoplasm and can be used to assist in determining the extent of surgical management. [Indones J Obstet Gynecol 2015; 3: 161-164] Keywords: frozen section, ovarian neoplasm, paraffin block, sensitivity, specitificity

Giant Condyloma Acuminatum in a Woman with AIDS Nuranna, Laila
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 4, October 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

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 AIDS

Papsmear Examination for Diagnosing PreCancer Lesion in Invisible SquamoColumnar Junction Nuranna, Laila; Daud, Sulaeman; Purwoto, Gatot; Winarto, Hariyono; Nuryanto, Kartiwa H
Indonesian Journal of Obstetrics and Gynecology Volume. 4, No.3, July 2016
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To know the concealed pre-cancer lesion in women with invisible squamo-columnar junction (SCJ) by Papsmear examination. Method: This study was a descriptive cross-sectional design starting from August 2014 to March 2015 at several Public Health Cares in Jakarta. A total of 1,682 subjects were screened by Acetoacetate Visual Inspection (AVI) examination. After the data was collected, the process was continued by verification, editing, and coding. The descriptive analysis showed the percentage of SCJ in age distribution, the percentage of AVI examination based on SCJ, and the percentage of Papsmear examination in invisible SCJ according to negative AVI result. Result: There were 1,484 (88.2%) women with the visible SCJ and 198 (11.8%) women with invisible SCJ. The percentage of invisible SCJ in the menopausal women group was 122 (61,6%); meanwhile, in the non-menopausal women group, it was 76 (38.4%). Almost half of the percentage from visible SCJ was found in menopausal women group 45.8% (103/225 women). The positive AVI result was 4 (7.1%) in the menopausal women group and 52 (92.9%) in non-menopausal women group. The result of Papsmear examination with invisible SCJ were 197 (100%) normal. Conclusion: Almost half of visible SCJ was found in menopausal women group. Most of positive AVI result was found in the nonmenopausal women group. All women with the invisible SCJ have a normal Papsmear result. Keywords: acetoacetate visual inspection, papsmear, pre-cancer lesion, squamo-columnar junction

Efficacy and Safety of Cryotherapy in "See and Treat" Program in Jakarta Primary Health Centre Lestari, Linda; Purwoto, Gatot; Nuranna, Laila
Indonesian Journal of Obstetrics and Gynecology Volume 4, No. 4, October 2016
Publisher : Indonesian Socety of Obstetrics and Gynecology

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)

The Association between Menstrual Disorder and Work Disturbance among Employees Nuranna, Laila; Abdullah, Iftikar; Kayika, I. Putu G.; Pratama, Gita
Indonesian Journal of Obstetrics and Gynecology Volume 6. No. 1. January 2018
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To investigate the association between menstrualdisorders including each menstrual cycle disorder, durationand volume of menstrual bleeding disorder, menstrual intervaldisorder, and another disorder that related to menstruationagainst disruption of work among employees.Methods: This study used a cross sectional design. Samplerandomization with winpepi® software for Windows 7®. Dataanalysis using SPSS 24® software for Windows 7®.Results: A total of 150 subjects were recruited in this study. Theprevalence of menstrual disorder was 87%, menstrual cycledisorder 3%. Menstrual volume disorder 31%, 15% menstrualabnormalities, 83% menstrual pain disorder and premenstrualsyndrome 71%. Prevalence of work disturbance was 49% formild disturbance, 47% for moderate disturbance and severework disturbance by 4%. There was a relationship betweenmenstrual volume disorder, hypermenorrhoea, and menstrual /dysmenorrhoea pain to occupational disruption among theemployee at RSCM (p <0.001). The submission of the proposedleaves due to menstrual disorder in the proposed permit for1 day by 73%.Conclusion: The prevalence of severe work disturbance due tomenstruation is not high but can lead to disruption in runningjobs and activities. However, it is important to be a concern so thatthe employees get good management and care.Keywords: employee, menstrual leave, menstrual disorder, prevalence,work disturbance

Changes in Cortisol Levels before and after Supportive Psychotherapy in Patients with Comorbid Cervical Cancer Distress with Depression Type Nuranna, Laila; Nuryanto, Kartiwa H; Andriansyah, Andriansyah; Elvira, Sylvia D; Sutrisna, Bambang
Indonesian Journal of Obstetrics and Gynecology Volume 6 No. 3 July 2018
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To prove the success of supportive psychotherapy thatwas provided as a distress therapy on advanced cervical cancer.Knowing the prevalence of distress type of depression in patientwith epithelial cervical cancer, proving the benefits of psychotherapysupportive for distress can decreasing cortisol level in cervicalcancer patient, can assess distress thermometer score, HAM-D17score and scoring incident predictors of distress with depressiontype.Methods: There were 32 subjects from 71 advanced cervical cancerpatients had mild-moderate depression. Then randomizationblocking was performed to determine a subject who entered thetreatment group (n = 16) who got supportive psychotherapy orcontrol group who got common psychotherapy (n = 16). All ofparticipants assessed the distress level with cortisol value, distressthermometer score, and HAM-D17 score before and after they gotsupportive psychotherapy.Results: After the intervention of psychotherapy in the treatmentgroup decreased HAM-D17 score, the average decline 7.53 (SB 3.34).The mean decreasing in the control group was 3.98 (SB 2.85). Thereis a significant difference in mean reduction in HAM-D17 scores ontreatment and control groups with p = 0.003 (p <0.005). There wasdecreasing blood cortisol level in the treatment group amounted to39.43, while the control group there was a drop of 1.59. The reductionof cortisol level in the treatment group and the control has a pvalue0.302. After got supportive psychotherapy, found a decreasingthe average value of the thermometer distress in the treatmentgroup 3.02 and the control group 2.51, with a p value more than0.492.Conclusion: There were 45% of cervical cancer patients in the clinicexperiencing distress disorder with depressive type. The bloodcortisol level could be decreased by giving supportive psychotherapywith a mean decrease of 39.43 nmol/l. There was a significantreduction in the level of depression (HAM-D17 score) of 7.53 pointsand distress thermometer impairment by 3 points after givensupportive psychotherapy. Obtained scoring predictors for theoccurrence of distress type of depression in patients with advancedcervical cancer with a sensitivity of 46.15% and a specificity of89.47%.[Indones J Obstet Gynecol 2018; 6-3: 179-187]Keywords: cervical cancer, cortisol, distress, distress thermometer,HAM-D17 score

Post-operative Recovery Assessment of Urinary Tract Dysfunction Following Radical Hysterectomy for Cervical Cancer Patients Nuranna, Laila; Kusuma, Sang A F Adi
Indonesian Journal of Obstetrics and Gynecology Volume 6 No. 4 October 2018
Publisher : Indonesian Socety of Obstetrics and Gynecology

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.

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