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Sunarto Sunarto

Department of Child Health, Universitas Gadjah Mada Medical School/Dr. Sardjito Hospital, Yogyakarta, Central Java

Author-ID : 3473068

Health Professions Medicine & Pharmacology

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Articles

Pericarditis and Pleuritis Caused by Extramedullary Plasmacytoma A. Samik Wahab; Sunarto Sunarto; Utomo Utomo
Paediatrica Indonesiana Vol 30 No 11-12 (1990): November - December 1990
Publisher : Indonesian Pediatric Society

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The following illustrates a case study of a 9 years-old girl with combined pericarditis and pleuritis caused by solitary extramedullary plasmacytoma. Pericardiocentesis and permanent thoracocentesis were performed, both yielded serohemorrhagic and serous fluid in succession. In the beginning etiological diagnosis was made on the basis of the clinical pattern for tuberculosis infection and growth of three species of bacteria for bacterial infections and candida species for candidiasis. The initial treatment was in accordance with the etiological diagnosis mentioned above. The final diagnosis was establish in the fourth month after the discovery of plasmacytoma in the pleural fluid and CT scan examination disclosing masses in the right lung. Accordingly, cytostatic therapy was started. The result of therapy was very good, exudation into the pleural and pericardia/ sac regressed gradually and eventually ceased completely. According to the literature the prognosis of these neop/asma is good.

Takayasu 's Disease A. Samik Wahab; Sunarto Sunarto; Aris Soebardi; Ryna Harlistyanti
Paediatrica Indonesiana Vol 30 No 11-12 (1990): November - December 1990
Publisher : Indonesian Pediatric Society

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A fourteen years old girl developed Takayasu 's arteritis (pulseless disease) since six months prior to investigation. This unusual form of arteritis is common in Japan and Korea but has rarely been reported in individuals born in the United States. In Indonesian literatu;e it has never been documented so far. The etiology is unclear. The literature currently but forward the hypothesis of an autoimmune basis and treatment with steroid. Although a tuberculin sensitization pathogenesis has been suggested, a close temporal relationship with the onset of a tuberculous process has not previously been documented. The likelihood of uncovering tuberculin sensitivity or active tuberculosis in patients with Takayasu, arteritis is substantially higher than in the general population in all countries analyzed. The natural history of his arteritis is highly variable. The adolescent described in this paper has demonstrated no response either to antituberculosis therapy, or to heparin and corticosteroid as suggested by Ishikawa, 1987. The patient died on the 59th day of hospitalization after getting syncopal attacks followed by shock.

Prenatal Diagnosis of Thalassemia Sunarto Sunarto
Paediatrica Indonesiana Vol 33 No 7-8 (1993): July - August 1993
Publisher : Indonesian Pediatric Society

Thalassemia is an individual as well as a community health problem in some countries. It causes a lifelong suffering for the affected individuals. There is no treatment other than supportive, i.e. regular transfusions and removal of iron overload from the body. Only by such continuous and expensive treatment thalassemic patients can-generally achieve nearly normal health, but the health burden of such therapy for a large number of thalassemic patients is unaffordable by the affected communities. Prevention of the births of thalassemic babies is the choice for controlling the thalassemia and has been successful in many countries. For this purpose reliable and time accurate prenatal diagnosis is a conditio sine qua non. Blood fetal sampling is safe and can be done after 16 weeks gestation, amniocentesis after 14 weeks, and even chorionic villi sampling as early as 8 weeks gestation. In vitro globin synthesis analysis applied to the fetal blood sample is very reliable to measure the rate of synthesis of the globin chains that make up the hemoglobin. The-DNA analysis of the fibroblasts obtained by amniocentesis or of the chorionic villus sample is very sensitive and specific for the diagnosis of the genetic disorder in thalassemias. By involving the prenatal diagnosis, the birth of B-homozygous thalassemia has decreased by up to 90%.

Thrombocytopenia in Dengue Hemorrhagic Fever Sunarto Sunarto; Sutaryo Sutaryo
Paediatrica Indonesiana Vol 32 No 3-4 (1992): March - April 1992
Publisher : Indonesian Pediatric Society

According to WHO thrombocytopenia is one of the diagnostic criteria of DHF. On the other hand many studies have reported DHF cases without evidence of thrombocytopenia. One hundred fifty nine DHF out of485 suspected cases were assessed for their platelet counts. Diagnosis of DHF was established based on the WHO criteria, and confirmed by the hemagglutination inhibition test. The platelet counts were done serially and intensively by phase contrast microscope from the first day of hospitalization until the patient's discharge. In 77 patients thrombocytopenia appeared for the first time during hospitalization. Mild thrombocytopenia appeared in almost all of these cases before thrombocyte count of 100,000 reached. Seventy two patients had shown thrombocytopenia on the day of admission. No thrombocytopenia was found on the second day of illness, the earliest time of the detection of thrombocytopenia was on the Jrri and the latest was on the 8th day of illness. Thrombocytopenia lasted 1-5 days. It is concluded that many DHF diagnosis would have been missed if the thrombocyte investigation had not been done serially and intensively. Mild thrombocytopenia in DHF suspected patients should call attention to do platelet investigation intensively in those cases.

Aids in Infants and Children Sunarto Sunarto
Paediatrica Indonesiana Vol 32 No 11-12 (1992): November - December 1992
Publisher : Indonesian Pediatric Society

Children are infected by HIV, 80% vertically, from HIV infected mothetS mostly near or at delivery. Because heterosexual transmission of HIV among adults is more and more important it is estimated that at the end of this century there will be totally more than 10 million HIV infected children. Three quarters of HIV-infected babies show non specific symptoms at the early phase, including failure to thrive, chronic diarrhea, recurrent bacterial injections, mucocutanous infection. Cytotropism of HIV to neroe cells resul.ts tn inflammation, neroe cell damage and neuronal loss. Progressive neurologic abnormalities and developmental milestone regression or developmental retardation will be the results. Pneumocystics carinii infection has worse prognosis than lymphocytic interstitial pneumonia which more commonly occurred in HIV injected children. Diarrhea is a troublesome problem in children with AIDS. Kaposi's sarcoma and secondary cancer are rare in pediatric AIDS. Anemia and thrombocytopenia is common among AIDS children. In developing countries children with AIDS die within the year following the appearance of the symptoms, whereas asymptomatic HIV-injected children will live longer with high risk of recurrent and opportunistic injections. The hallmark of AIDS in children is the same as in adults,iI.e. the decrease of the number and function of CD4 lymphocytes. This in turn influences the junctions of other immunocompetent cells and loss of immunity is the result. Many things are still unexplainable in children AIDS.

Co-Authors A. Samik Wahab Aris Soebardi Ryna Harlistyanti Sutaryo Sutaryo Utomo Utomo

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