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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina E-Jurnal Medika Udayana E-Jurnal Udayana Medica JBN (Jurnal Bedah Nasional) ISM (Intisari Sains Medis) : Jurnal Kedokteran
I. B. Tjakra Wibawa Manuaba
Departemen Bedah Onkologi FK Udayana / RSUP Prof. Dr. I.G.N.G Ngoerah Denpasar, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology

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DESCRIPTION OF ALTERNATIVE MEDICINE HISTORY IN BREAST CANCER AND COLORECTAL CANCER PATIENT IN HOSPITALS IN DENPASAR Ni Made Suari Utami; Yudo Affandi; Gede Wara Samsarga; I Made Sindhu Satya Nugraha; I. B. Tjakra Wibawa Manuaba
Bali Journal of Medical and Health Sciences vol 1no2 2013
Publisher : Faculty of Medicine, Udayana University

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Abstract

Reluctance to get treatment is one of the reasons why cancer patients come at the advance stage to health care provider. Numerous information of alternative medicine seems to influence the patients to try alternative medicine and delay their treatment in hospital. A descriptive study is conducted in 2 hospitals in Denpasar to obtain the description of alternative medicine history in cancer patients, with breast cancer and colorectal cancer patients as samples. Total samples were 38 patients, with 23 of them (60.5%) have tried the alternative medicine, whereas 13 patients (56.52%) after visiting the health care provider. Among those who tried the alternative medicine, 14 patients (60.87%) seek this medicine because of their fear to the conventional medicine. The most popular method of alternative medicines is herbal medicine. Most of the patients got information about alternative medicines from people whom close to them such as their family, relatives, and neighbors. However, most of these patients, who have tried the alternative medicine, in the end came back to the health care provider/ hospital after they realized that the result of the alternative treatment did not improve their health condition. Keywords: alternative medicine, breast, colorectal, cancer
Hubungan Antara Ekspresi Cyclooxygenase-2 dan Gambaran Klinikopatologikal dari Kanker Kolorektal di RSUP Sanglah Gede Budhi Setiawan; Wayan Sudarsa; I.B. Tjakra Wibawa Manuaba
JBN (Jurnal Bedah Nasional) Vol 1 No 2 (2017): JBN (Jurnal Bedah Nasional)
Publisher : Program Studi Ilmu Bedah, Fakultas Kedokteran Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (451.265 KB) | DOI: 10.24843/JBN.2017.v01.i02.p04

Abstract

Tujuan: untuk menyelidiki hubungan dari ekspresi cyclooxygenase-2 (COX-2) dengan gambaran klinikopatologikal pasien dengan kanker kolorektal (CRC). Metode: ekspresi COX-2 diperiksa mengunakan imunohistokimia pada 46 pasien dengan kanker kolorektal, di Rumah Sakit Sanglah Denpasar, antara bulan September 2004 dan November 2005. Dilakukan analisis hubungan ekspresi COX-2 dengan gambaran klinikopatologikal. Hasil: pewarnaan COX-2 terekspresi pada 91,3% sampel. Ekspresi COX-2 sebesar 94,6%, dan 100% pada stadium III dan IV CRC, dan berkorelasi positif dengan tahap TNM dari CRC (Spearman’s rho 0,846, p<0,05). Ekspresi COX-2 100% pada CRC yang berdiferensiasi buruk dan berkorelasi positif (Spearman’s rho 0,456, p<0,05). Tidak ada korelasi antara ekspresi COX-2 dan usia pasien, jenis kelamin, lokasi tumor, dan jenis histopatologi CRC (p>0,05). Simpulan: ekspresi COX-2 diregulasi pada CRC, dan berhubungan dengan TNM, dan diferensiasi. Hasil ini lebih mendukung bukti bahwa COX-2 mungkin terlibat dalam karsinogenesis dari CRC.
PENGETAHUAN TENTANG SADARI PADA PASIEN KANKER PAYUDARA (CAMAMMAE) DI RUMAH SAKIT UMUM PUSAT SANGLAH DAN RUMAH SAKITPRIMA MEDIKA BALI NOVEMBER 2012 Sindhu Nugraha; Tjakra Wibawa Manuaba
Intisari Sains Medis Vol. 3 No. 1 (2015)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (463.517 KB) | DOI: 10.15562/ism.v3i1.61

Abstract

One of theearly inspectionto determinebreastcanceris sadari (periksa payudara sendiri). By doing sadari,patients will beable to knowifthere is alumporsomething that isabnormal. Sadarican be donealoneafter showerby standing infront of the mirror. Researchconducted in2 hospitalsin Denpasartogeta description of thepatient's knowledgeaboutbreastcancer.Resultsin gettingfrom 30breast cancer sampleswere4 patients(13.3%) breast cancer knowaboutsadari. Thenfrom 4breastcancerpatientsknowaboutsadari, 2 patients(50%) didsadari.The remainingsample of26 patients(86.7%) did not know aboutsadari. They got information aboutsadarifromfamily orfriends who'vehad breast cancer. Patientswho foundabnormalities from the examinationare usually notcameto the hospital, butthey didn’t care about it,socomein a bad state.
Faktor risiko yang mempengaruhi length of stay pasien kanker solid dengan febrile neutropenia pasca kemoterapi neoadjuvant/terapeutik di Ruang Isolasi RSUP Sanglah, Bali Ronald Natawidjaja; Ida Bagus Tjakra Wibawa Manuaba; Putu Anda Tusta Adiputra
Intisari Sains Medis Vol. 10 No. 1 (2019): (Available online 1 April 2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (354.727 KB) | DOI: 10.15562/ism.v10i1.367

Abstract

Background. Febrile neutropenia is a common complication in patient undergoing chemotherapy. Length Of Stay (LOS) is an important marker for disease severity and use of medical resources in febrile neutropenia. This study was done to find the risk factor affecting length of stay in solid cancer patients with febrile neutropenia post neoadjuvant/therapeutic chemotherapy.Method. This is a case control study without matching. Age ≥ 60 years, (Absolute Neutrofil Count) ANC level < 1,5 μL , comorbid,  Hb level <10 gr/dl, and albumin < 3 gr/dl, were related to LOS ( ≤ 5 days and > 5 days). Univariate (chi square) and multivariate (logistic regression) were used to analyse the statistic.Results. Forty six patients met inclusion-exclusion criteria were included in this study. ANC level in all patients were < 1,5 μL (100%). Hb level <10 gr/dl is statistically significant (P<0.05), whereas  age ≥ 60 years, and comorbid, albumin level < 3 gr/dl were not is statistically significant (P>0.05).Conclusion. Hb level < 10 gr/dl is the risk factor for LOS > 5 days in solid cancer patients with febrile neutropenia post neoadjuvant/therapeutic chemotherapy.
Ketepatan ultrasonografi dan mammografi dalam mendiagnosis wanita dengan kanker payudara di RSUP Sanglah Denpasar Cokorda Agung Abi Baruna; I. B Tjakra Wibawa Manuaba
Intisari Sains Medis Vol. 10 No. 3 (2019): (Available online: 1 December 2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (204.047 KB) | DOI: 10.15562/ism.v10i3.489

Abstract

Introduction: The high incidence of breast cancer in women, accompanied by delays in making contact with medical personnel and the absence of good early detection contribute to the very high mortality caused by breast cancer. Early detection using ultrasound and mammographic modalities plays an important role in the early diagnosis of breast cancer which will have an impact on the survival of patients. This study aims to compare the diagnostic values of ultrasonography and mammography compared with histopathological features in patients with breast cancer.Methods: This study used a diagnostic test design with a retrospective approach that compared sensitivity values, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio from mammography and ultrasonography to histopathological morphology in patients with breast cancer at Sanglah General Hospital Denpasar .Results: It can be seen that in the total sample, ultrasonography in the toal condition of the sample has a diagnostic value that is very similar to mammography in establishing a diagnosis of breast cancer. Whereas at the age of> 40 years mammography has a diagnostic test value that is far better than ultrasonography (sensitivity: 85.71; specificity: 83.33; PPV: 92.30; NPV: 76.92; LLR (+): 5, 14; LLR (-): 0.17).Conclusion: ultrasonography and mammography have almost the same precision in the whole sample, but mammography has a better diagnostic value compared to ultrasonography in people aged> 40 years.
Prevalensi dan gambaran karakteristik penderita kanker payudara di poliklinik bedah onkologi RSUP Sanglah, Bali, Indonesia tahun 2016 I Dewa Ayu Putu Mas Narisuari; Ida Bagus Tjakra Wibawa Manuaba
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (336.111 KB) | DOI: 10.15562/ism.v11i1.526

Abstract

Background: Breast cancer is a malignancy originating from breast tissue. In Indonesia, the prevalence rate of breast cancer is 0.5% or around 61,628, and the incidence of breast cancer in Bali reached 0.6% in 2013. The aetiology of breast cancers are multifactorial, and the main factor is still unknown. This study aims to determine the prevalence and characteristics of breast cancer patients in the Sanglah General Hospital oncology surgery clinic. Methods: This study was a descriptive cross-sectional study. The sample used was a patient suffering from breast cancer who visited Sanglah General Hospital's oncology surgical clinic, both outpatient and hospitalization in 2016 and was willing to submit informed consent. Variables assessed in this study were age, education level, jobs, symptoms, history of breast cancer, the staging of breast cancer, and type of medication. Data were analyzed using SPSS version 17 for Windows. Results: The results showed the dominant sociodemographic characteristics of respondents in the age range 41-50 years as many as 27 people (42.18%), had an education level equivalent to senior high school 27 people (42.18%), worked as private employees, and there were 23 entrepreneurs (35.93%) from 62 samples. Other characteristics obtained 55 people (85.94%) respondents experienced initial symptoms of lumps in the breast, 13 people (20.31%) respondents had a family history of breast cancer. A total of 13 patients (20.31%) claimed to use herbal medicine, and 7 (10.94%) admitted to undergoing alternative treatment other than treatment in Sanglah General Hospital, Bali, Indonesia. Only 43.75% decided to seek treatment for their own sake. The majority of patients, as many as 41 people (64.06%) were diagnosed in stage III.Conclusion: People living with Breast cancer at Sanglah Hospital have a younger age compared to the majority of breast cancer sufferers in the world. Lack of knowledge of women about breast cancer itself is one of the causes. Latar Belakang: Kanker payudara adalah keganasan yang berasal dari jaringan payudara. Di Indonesia kanker payudara merupakan kenker dengan angka prevalensi kejadian 0.5% atau sekitar 61.628 dan kejadian kanker payudara di Bali mencapai 0.6% pada tahun 2013. Penyebab kanker payudara termasuk multifaktorial yang belum diketahui penyebab utamanya. Penelitian ini bertujuan untuk mengetahui distribusi prevalensi gambaran karakteristik penderita kanker payudara di poliklinik bedah onkologi RSUP Sanglah.Metode: Penelitian ini merupakan penelitian observasional deskriptif cross-sectional. Sampel yang digunakan merupakan pasien yang menderita kanker payudara yang mengunjungi poliklinik bedah onkologi RSUP Sanglah baik rawat jalan maupun rawat inap pada tahun 2016 dan bersedia mengisi informed consent. Variabel yang dinilai dalam penelitian ini adalah usia, tingkat pendidikan, pekerjaan, gejala, riwayat kanker payudara, stadium kanker payudara, dan jenis pengobatan. Data dianalisis menggunakan SPSS versi 17 untuk Windows.Hasil: Hasil penelitian menunjukkan karakteristik sosiodemografi responden dominan berada pada rentang usia 41-50 tahun sebanyak 27 orang (42,18%), memiliki tingkat pendidikan setara Sekolah Menengah Atas (SMA) sebanyak 27 orang (42,18%), bekerja sebagai karyawan swasta dan wiraswasta sebanyak 23 orang (35,93%) dari 62 orang sampel. Karakteristik lain yang diperoleh, sebanyak 55 orang (85,94%) responden mengalami gejala awal berupa benjolan pada payudara, responden memiliki riwayat keluarga dengan kanker payudara sebanyak 13 orang (20,31%). Sebanyak 13 penderita (20,31%) mengaku menggunakan pengobatan herbal, dan 7 (10,94%) mengaku menjalani pengobatan alternatif selain pengobatan di RSUP. Hanya sebesar 43,75 % yang memutuskan berobat karena keinginan sendiri. Mayoritas penderita terdiagnosis padaa stadium III yaitu sebanyak 41 orang (64,06%).Kesimpulan: Penderita kanker payudara di RSUP Sanglah memiliki usia yang lebih muda jika dibandingkan dengan mayoritas penderita kanker payudara di dunia. Kurangnya pengetahuan wanita terhadap kanker payudara itu sendiri merupakan salah satu penyebabnya.
Hubungan antara Microvessel Density dan Lymphovascular Invasion dengan metastasis jauh pada pasien kanker payudara di RSUP Sanglah, Bali, Indonesia Trisye Septiawati; Ida Bagus Tjakra Wibawa Manuaba; Putu Anda Tusta Adiputra
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (361.717 KB) | DOI: 10.15562/ism.v11i3.823

Abstract

Background: Breast cancer is the most common malignant tumor in Indonesia, with a relative frequency of 18,6%. Mortality in breast cancer most are caused by distant metastasis, which then causes multiple organ failure. To start a metastatic process requires new blood vessels (angiogenesis) and infiltration of the lymphatic system. Both can be assessed through microvessel density and lymphovascular invasion. This study aims to determine the relationship between Microvessel Density and Lymphovascular Invasion with metastasis in breast cancer patients at Sanglah General Hospital, Bali, Indonesia.Methods: A cross-sectional analytic study was conducted at the oncology surgical clinic from January 2018 - March 2019. Of the 62 biopsy samples were stained using hematoxylin-eosin and were observed by one pathologist. MVD cut-off points are taken by calculating the mean and standard deviation. Bivariate analysis using Chi-Square Test and multivariate analysis using logistic regression test was used for statistical analysis. Data were analyzed using SPSS version 23 for Windows.Results: From the results of a bivariate analysis, it was found that the high MVD is correlated with distant metastasis (P = 0.001) and positive LVI with metastasis (P = 0.003). There is a relationship between high MVD and tumor size (P = 0,000).Conclusion: Multivariate analysis confirmed that high MVD and positive LVI were statistically related to the occurrence of metastasis in breast cancer patients. Latar Belakang: Kanker payudara merupakan salah satu jenis kanker terbanyak di Indonesia dengan frekuensi relatif sebesar 18,6%. Kematian pada kanker payudara sebagian besar disebabkan oleh metastasis jauh yang kemudian menyebabkan kegagalan organ multipel. Untuk memulai suatu proses metastasis diperlukan pembentukan pembuluh darah baru (angiogenesis) dan juga infiltrasi sistem limfatik. Kedua hal tersebut bisa dinilai melalui microvessel density dan lymphovascular invasion. Penelitian ini bertujuan untuk mengetahui hubungan antara Microvessel Density dan Lymphovascular Invasion dengan metastasis jauh pada pasien kanker payudara di RSUP Sanglah, Bali, Indonesia.Metode: Penelitian potong lintang analitik dilakukan pada poliklinik bedah onkologi selama Januari 2018–Maret 2019. Dari 62 sampel biopsi dilakukan pembacaan microvessel dan lymphovascular invasion yang telah lebih dulu diberikan pewarnaan hematoxylin eosin oleh 1 patologi anatomi. Cut off point MVD diambil dengan cara menghitung mean dan standar deviasi. Analisis bivariat dengan Uji Chi-Square dan analisis multivariat dengan menggunakan uji regresi logistik digunakan untuk analisis statistik. Data dianalisis dengan SPSS versi 23 untuk Windows.Hasil:  Dari hasil analisis bivariat didapatkan hubungan antara MVD yg tinggi dengan metastasis (P = 0,001) dan hubungan antara LVI positif dengan metastasis (P = 0,003). Terdapat hubungan antara MVD dengan ukuran tumor (P = 0,000).Simpulan: Analisis multivariat menegaskan bahwa MVD yang tinggi dan LVI positif berhubungan secara statistik dengan terjadinya metastasis pada pasien kanker payudara. 
Faktor Yang Mempengaruhi Rekurensi Pada Pasien Kanker Payudara Pasca Modified Radical Mastectomy di RSUP Prof. Dr. I G.N.G Ngoerah Made Revina Chandradewi; Ida Bagus Tjakra Wibawa Manuaba; Putu Anda Tusta Adiputra
Intisari Sains Medis Vol. 13 No. 3 (2022): (In Press 1 December 2022)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/ism.v13i3.1544

Abstract

Background: In Indonesia, the incidence of breast cancer is 42,1 per 100,000 people, whereas the average mortality rate is 17 per 100,000 people. 8-10% of women with breast cancer will experience locoregional recurrence, and 15-30% may develop distant metastases. This study aimed to examine if cancer subtypes, histological grading, and LVI were linked with breast cancer recurrence in patients after Modified Radical Mastectomy at Prof. RSUP. Dr. I G.N.G. Ngoerah. Methods: Medical record data are used as the study data source to discover the factors that impact breast cancer recurrence in patients who have had a modified radical mastectomy. This research was done using a sequential sampling method. This study's sample utilized inclusion and exclusion criteria to generate 363 patients. The data obtained were analyzed using SPSS ver 22. Results: The results revealed that 327 patients, or 90.1%, did not have a recurrence, whereas 36 patients, or 9.9%, did. There were 50 Luminal A subtype patients, 127 Luminal B subtype patients, 61 Luminal-Her2 subtype patients, 65 Her2 subtype patients, and 60 TNBC subtype patients. 231 individuals were found to have a negative LVI, whereas 132 patients had a positive LVI. Forty-seven individuals were diagnosed with grade I, 174 with grade II, and 142 with grade III. Breast cancer recurrence was significantly impacted by LVI (p<0.05). Conclusion: LVI is strongly related to breast cancer recurrence in patients undergoing Modified Radical Mastectomy, but subtype and histological grading are not.   Latar Belakang: Angka kejadian kanker untuk kanker payudara di Indonesia sebesar 42,1 per 100.000 penduduk dengan rata-rata kematian sebesar 17 per 100.000 penduduk. Antara 8-10% wanita yang didiagnosis dengan kanker payudara akan mengalami kekambuhan locoregional dan 15-30% akan mengalami metastasis jauh. Tujuan penelitian ini dilakukan yaitu untuk mengetahui apakah subtipe kanker, grading histopatologi dan LVI menjadi faktor yang berhubungan dengan terjadinya rekurensi kanker payudara pada pasien pasca Modified Radical Mastectomy di RSUP Prof. Dr. I G.N.G Ngoerah. Metode: Desain penelitian cross sectional digunakan dalam penelitian ini, dimana data rekam medis menjadi sumber data penelitian. Penelitian menggunakan pengambilan sampel secara konsekutif. Sampel dalam penelitian menggunakan kriteria inklusi dan eksklusi dan diperoleh jumlah sampel 363 pasien. Data yang didapatkan dianalisis dengan menggunakan SPSS ver 22. Hasil: Hasil penelitian menunjukkan sebanyak 327 pasien atau sebesar 90,1% tidak rekuren, sedangkan 36 pasien atau sebesar 9,9% mengalami rekurensi. Terdapat 50 pasien dengan subtipe Luminal A, 127 pasien dengan subtipe Luminal B, 61 pasien dengan subtipe Luminal-Her2, 65 pasien dengan subtipe Her2, dan 60 pasien dengan subtipe TNBC. Dari 231 pasien didapatkan dalam kategori LVI negatif, sedangkan 132 pasien memiliki LVI positif. Sebanyak 47 pasien didapatkan dengan grade I, 174 pasien dengan dengan grade II, dan 142 pasien memiliki grade III. LVI memiliki pengaruh signifikan (p<0,05) terhadap rekurensi kanker payudara. Simpulan: LVI berhubungan signifikan terhadap rekurensi kanker payudara pada pasien pasca Modified Radical Mastectomy, sedangkan subtipe dan grading histopatologis tidak.
Co-Authors A. Winata, A. Albert Simon Cokorda Agung Abi Baruna Gede Wara Samsarga Samsarga Herman Saputra I Dewa Ayu Putu Mas Narisuari I Gusti Putu Benediktus Bosman Ariesta I Made Sindhu S Nugraha I Made Sindhu Satya Nugraha I W. Sudarsa I Wayan Putu Sutirta Yasa IGAN Ciptadi Permana Wijaya Made Revina Chandradewi Ni Made Suari Utami Ni Putu Prema Rossalia Nyoman Intan Permatahati Wiguna Putu Anda Tusta Adiputra Ronald Natawidjaja Setiawan, I Gede Budhi Sindhu Nugraha Sri Maliawan Tjokorda Gde Bagus Mahadewa Trisye Septiawati Yudo Affandi