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Marcellus Simadibrata
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Medicine & Pharmacology

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Diagnosis and Management of Klatskin Tumor Dicky Levenus Tahapary; Rudy Hidayat; Achmad Fauzi; Marcellus Simadibrata
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 1, April 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/111201044-50

Abstract

Klatskin tumor is a cholangiocarcinoma in bifurcatio areas and related to poor prognosis. Surgery is the only curative method, but endoscopy also has a role in diagnostic as well as therapeutic measures. This report shall discuss a case of Klatskin tumor in which to establish diagnosis, multimodal imaging using ultrasonography, computed tomography, endoscopic retrograde cholangiopancreatography (ERCP), and tumor markers were used. For palliative therapeutic measures in this case, placement of plastic stents by ERCP was performed. The procedure ERCP with stents placement can be an option in the management of Klatskin tumor, in which surgery is not possible to be conducted. Keywords: Klatskin tumor, ERCP, stent, diagnosis, management
Management of Duodenal Ulcer with Gastroesophageal Reflux Disease (GERD) with Intravenous Pantoprazole Ari Fahrial Syam; Murdani Abdullah; Marcellus Simadibrata; Dadang Makmun; Chudahman Manan; Daldiyono Hardjodisasto
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 4, NUMBER 1, April 2003
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/41200326-28

Abstract

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. Keywords: peptic ulcer, upper gastrointestinal bleeding, proton pump inhibitors, pantoprazole
A 17-Years Old Man of Colitis Tuberculosis with Fistula Perianal Paulus Kusnanto; Marcellus Simadibrata; Ari Fahrial Syam; Achmad Fauzi; Murdani Abdullah; Dadang Makmun; Chudahman Manan; Daldiyono Daldiyono; Abdul Aziz Rani; Ening Krisnuhoni
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 9, ISSUE 3, December 2008
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/932008103-106

Abstract

Tuberculosis (TB) remains to be one of the most common problems in developing countries such as Indonesia. It can involve many organs including gastrointestinal tracts. Colonic tuberculosis is an ancient disease and has long been recognized. However, it is sometimes difficult to make early diagnosis due to its nonspecific signs and symptoms. Perianal granulomas or perianal fistula presents some degree of diagnostic difficulty. A spectrum of diseases can produce granulomas in perianal region and perineum. Most are infectious or inflammatory diseases. Standard histological diagnosis often less significant to clarify the etiology and treatment will vary from one to another disease entity. In this report, we present a case 17-years old man with colitis TB and fistula perianal, in which the initial diagnostic workup suggested Crohn’s disease. Mantoux test, Acid Fast Bacilli test on fecal examination and polymerase chain reaction analysis revealed negative result. The chest X-ray was normal; while the fistulography X-ray: revealed 2 orifices in rectosigmoid area. The colonoscopy revealed mucosa edema with ulceration in rectosigmoid and pedincular polyp in the caecum. Initial colonoscopy diagnosis was Crohn’s disease with differential diagnosis colitis ulcerative, colitis TB, colitis infection. results of direct or post homogenizes examination (Ziel–Nielsen staining) revealed that no acid-fast bacilli was found. Multiple biopsies were done, which indicated  mucosa edema with ulceration in rectosigmoid area, pedincular polyp in the caecum, and surrounded by fistula perianal; while histopathological examination showed inflammatory-caseating-epithelioid-granulomas and giant cells (Langhans datia cell) caused by tuberculosis. It highlights the need for awareness of intestinal TB along with the differential diagnosis of chronic intestinal disease. Standard regimen of antituberculosis treatment was given and the patient showed good clinical response. Keywords: Crohn’s disease, caseating epithelioid granuloma, giant cell, colitis TB, perianal fistula
Colitis Tuberculosis Budi Tan Oto; Ahmad Fauzi; Ari Fahrial Syam; Marcellus Simadibrata; Murdani Abdullah; Dadang Makmun; Chudahman Manan; Abdul Aziz Rani; Daldiyono Daldiyono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 3, December 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1132010143-149

Abstract

Tuberculosis (TB) is a significant public health problem worldwide. Indonesia is a country with the third highest prevalence of TB in the world after China and India. TB infection can attack all organs of the human body. TB in digestive system is one of the extrapulmonary TB manifestations and comprises of 3- 16% of all extrapulmonary TB cases. This type of TB may affect digestive system, peritoneum, mesentery lymphatic glands, liver, and spleen. Digestive system is affected in 66-75% of patients with abdominal TB. The ileocaecal region is most commonly affected. The manifestation of abdominal TB is not specific. Precise diagnostic approach and supporting results are needed to determine final diagnosis. However, there is no single examination adequate enough to diagnose abdominal TB. If the diagnosis can be established early, this disease could then be managed with conventional anti-TB drugs. Treatment for both 6-9 months period and 18-24 months period has been proven effective in management of extrapulmonary TB. In countries with high abdominal TB prevalence, initiation of anti-TB therapy is allowed if there are the clinical features present. Diagnosis can be determined when the patient has therapeutic response against the the anti-TB treatment.   Keywords: tuberculosis, colitis, extrapulmonary, antituberculosis drugs
Proportion and Factors Associated with Zinc Deficiency in Acute Diarrhea Patients Budi Tan Oto; Marcellus Simadibrata; Drupadi Harnopidjati Singh Dillon; Siti Setiati
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 2, August 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (532.494 KB) | DOI: 10.24871/122201172-78

Abstract

Background: Zinc may affect the intestinal immune response. No data has been available on zinc deficiency in adult patients with diarrhea, especially for Indonesian population. Zinc metabolism, etiologies, pathogenesis and clinical course of diarrhea may have various effects on zinc concentration in different population. This study aimed to determine the proportion of zinc deficiency in patients with acute diarrhea, including its associated factors. Method: A cross-sectional study was conducted in patients with acute diarrhea at outpatient clinics and emergency wards of four hospitals between August 2010 and March 2011. A serum zinc concentration of 10.7 µmol/L was set as cut-off value for zinc deficiency. Data was analyzed by using Chi-square test. Results: There were 101 subjects, 54.5% were female, the median age was 26 years, median duration of acute diarrhea was 5 days, and the median frequency was 6 times/day. About 95% patients had nutritional status of subjective global assessment (SGA) A and the mean value of body mass index was 19.3 ± 0.70 kg/m2. Approximately 88.1% patients had severe infective diarrhea based on hydration status. About 69.3% patients were zinc deficient with the mean serum zinc concentration of 9.26 ± 2.95 µ mol/L. We found a significant correlation between the severity of diarrhea and zinc deficiency in patients with acute diarrhea. Conclusion: The proportion of zinc deficiency in acute diarrhea patients was quite large although the mean serum zinc level was still below the National Health and Nutrition Examination Survey (NHANES) reference value. The severity of diarrhea has been proven to be significant that affects zinc deficiency in acute diarrhea patients. Keywords: zinc deficiency, acute diarrhea, adult
Through-the-scope Polyethylene Balloon Dilations in Benign Corrosive Esophageal Stricture Complicated with Temporomandibular Joint Dislocation Elli Arsita; Achmad Fauzi; Jeffri Gunawan; Kaka Renaldi; Ari Fahrial Syam; Murdani Abdullah; Marcellus Simadibrata; Dadang Makmun; Chudahman Manan; Abdul Aziz Rani; Daldiyono Daldiyono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 1, April 2012
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (715.391 KB) | DOI: 10.24871/131201261-67

Abstract

Esophageal dilation is a non-surgical management for anatomic and functional abnormalities causing both benign and malignant esophageal stricture. The basic goals of stricture dilation include safe and efficacious lumenal enlargement plus prevention of restenosis. These could be achieved using through- the-scope (TTS) balloon dilations, ranged in diameter of 4 to 40 mm, they will allow dilation of previously inaccessible strictures in the esophagus, stomach, small bowel, and colon. There are 5,000–15,000 cases of stricture due to ingestion of corrosive substances in United States every year. The following case would demonstrate a 28-year-old male with depressive disorder who attempted a suicide by ingesting corrosive substances two months before admission. Subsequently he started having difficulty in swallowing even soft foods. The complaint was gradually increasing until a month before admission he went through endoscopic examination and a corrosive esophageal stricture found. Hence after, he underwent dilation using Savary bouginage with fluoroscopy and through-the-scope (TTS) balloon dilations. The patient underwent a series of dilation treatment and demonstrated vigorous improvement. Problems raised as the patient was complicated with temporomandibular joint (TMJ) dislocation due to traumatic injury after ingesting corrosive substances. The consideration in management of esophageal stricture with complications will be discussed further in this article. Keywords: esophageal stricture, corrosive substances, dysphagia, temporomandibular joint dislocation, through-the-scope polyethylene balloon dilation
Antibiotic Associated Diarrhea in Hospitalized Adult Patien Marcellus Simadibrata; Lie Khie Chen; Diana Aulia; Ina Sutanto Timan
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 1 (2018): VOLUME 19, NUMBER 1, April 2018
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (335.97 KB) | DOI: 10.24871/19120187-9

Abstract

Background: Antibiotic associated diarrhea (AAD) occurs from the first initiation until 2 months of the end of antibiotic treatment. The aims of this study were to know the incidence of AAD, Clostridium difficile infectionand other gastrointestinal symptoms in hospitalized adult patients.Method: The study is a cross sectional study. We studied the antibiotic associated diarrhea (AAD), Clostridiumdifficile infection and other gastrointestinal symptoms in patients who were admited in Cipto Mangunkusumo Hospital. Inclusion were male or female, age 18-75 years old, patients started receiving antibiotics maximal 2x 24 hours prior to hospitalization, gave written informed consent.Results: The incidence of AAD was 11.5%. The incidence of Clostridium difficile infection was 15.4%. The upper gastrointestinal symptom was present on 20 (38.5%) patients. Lower abdominal symptom was present on 10 (19.2%) patients.Conclusion: The Incidence of AAD and Clostridium difficile infection were 11.5% and 15.4% respectively.The clinical manifestations of AAD were diarrhea, other upper and lower abdominal symptoms.
Advanced Gastric Cancer in a Young Patient Ryan Ranitya; Ari Fahrial Syam; Murdani Abdullah; Marcellus Simadibrata; Vera Yuwono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 4, ISSUE 3, December 2003
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/432003100-102

Abstract

Gastric cancer remains the second most common cancer in the world, and is usually found in men, especially those over 50 years of age. The diagnosis is made by endoscopic biopsy. The high frequency of late diagnosis or advanced stages accounts for the overall poor prognosis for this tumor. Surgery is the most frequently employed modality for both cure and palliation. However, most patients present with advanced disease that is incurable. We reported a rare case of young female patient aged 23 years old with advanced gastric carcinoma. The main clinical features were epigastric discomfort, vomiting, and weight loss. An abdominal mass was palpable on physical examination. Endoscopy showed a giant tumor mass causing gastric outlet obstruction, nodular lesion, ulcerative and hemorrhagic. The histopathologic examination revealed mucinous gastric carcinoma. Palliative resection could not be performed because the tumor tightly adhered to adjacent structures. Jejunostomy was performed to allow enteral nutrition. Best supportive care is very important to improve the quality of life. Keywords: Gastric cancer, young patient
Management of Constipation Toman L Toruan; Ari Fahrial Syam; Marcellus Simadibrata; Murdani Abdullah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 1, April 2005
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/61200516-21

Abstract

Constipation is the most ignored complaint by doctors and unfortunately, it requires urgent management due to the decreased quality of life. Most cases are functional constipation but there is also a great number of constipation due to organic abnormalities. In an attempt to manage the patient properly, we should put our emphasis on excellent knowledge of pathophysiology of constipation.By using the colonic transit time test, we could determine the type of constipation, which would have an effect on therapy. In most cases, constipation has a good response to high fiber diet and additional laxative medication and surgical therapy is seldom required unless complications have occurred. There is also a suggestion for preventing constipation may be caused by opioid usage. Keywords: Constipation, colonic transit time test, high fiber diet, laxatives
Eosinophilic Esophagitis T Yuli Pramana; Marcellus Simadibrata
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8 ISSUE 2 August 2007
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/82200748-52

Abstract

The frequency of eosinophilic esophagitis (EE) cases is increasing along with increased understanding among doctors about EE. In the beginning, EE is mostly found in children population. It was first reported in adults by Landres on 1978. The prominent EE symptoms in adults are dysphagia and solid food impaction. Endoscopic examination reveals mucous ring of esophagus, white plaque on the mucosa. The diagnosis is supported by positive result of eosinophils, which forms infiltration on the mucosaof 20 eosinophils/ high power field in the distal or middle esophagus. Treatment by using diet and corticosteroid, either topical or systemic, shows adequate results. Immunomodulator treatment is promising, but it needs further investigation with larger sample. No consensus have been reached for EE, therefore it may affect the diagnosis, treatment and epidemiology data.   Keywords: esophagus, eosinophil, dysphagia, ring of esophagus
Co-Authors Aan Santi Abdul Aziz Rani ACHMAD FAUZI Adang Bachtiar Adjeg Tarius Agi Satria Putranto Ahmad Fauzi Ahmad Soefyani Ali Imron Yusuf Ana Mira Lubis Andree Kurniawan Andri Sulaiman Angga Pramudita Anna Mira Lubis Ari F Syam Ari Fahrial Syam Arief Hakiki Armen Armen Arnold Hasahatan Harahap Arshita Auliana Arya Govinda Aziz Rani Badriul Hegar Bambang Sutopo Bona Adhista Bradley Jimmy Waleleng Budi Tan Oto Budiman Sudjatmika Ceva W. Pitoyo Chatarina Umbul Wahyuni Chudahman Manan Chudahman Manan Dadang Makmun Daldiyono Daldiyono Daldiyono Hardjodisasto Daldiyono Hardjodisastro Daniel Gunawan Dasril Nizam David Reinhard Sumantri Samosir Deddy Gunawanjati Dharmika Djojoningrat Diah Rini Handjari Diana Aulia Diany N Taher Dicky Levenus Tahapary Didi Kurniadhi Djulzasri Albar Dolly Dolven Kansera Drupadi Harnopidjati Singh Dillon Dyah Ratna Budiani Ekowati Rahajeng Elizabeth Merry Wintery Elli Arsita Endang Susalit Ening Krisnuhoni Epistel Pangujian Simatupang FJW Ten Kate Fransiska Hardi Gerie Amarendra GNJ Tytgat Guntur Darmawan Haryanto Surya Helsi Helsi Herdiman T Pohan Hery Djagat Purnomo Hotmen Sijabat Ilham Ahmadi Ina Susianti Timan Ina Sutanto Timan Indah S. Widyahening Indra Marki Irfan Maulani Irsan Hasan Iskandar A Ivo Novita Sah Bandar Iwan Ariawan Jacobus Albertus Jane Estherina Jeffri Gunawan Jeffry Beta Tenggara Joseph JY Sung Juferdy Kurniawan Julwan Pribadi Kaka Renaldi Katharina Setyawati Kharia Utia Khie Chen Kie Chen L A Lesmana Laurentius Lesmana Lianda Siregar Lies Luthariana Loli J Simanjuntak Lusy Erawati Lydia D Simatupang M Purnomo Isnaeni Moch Ikhsan Mokoagow Murdani Abdulah Murdani Abdullah Nata Pratama Nisan Soeheri Noto Dwimartutie Novie Rahmawati Zirta Nur Rasyid Nurmiati Amir Pamela Abineno Parlindungan Siregar Paulus Kusnanto Paulus Simadibrata Poerniati Koes Andrijani Prima Yuriandro Rabbinu Rangga Pribadi Raden Nur Ista Ralph Girson Gunarsa Ratu Ratih Kusumayanti Riadi Wirawan Riahdo Saragih Rino A Gani Rino Alvani Gani Rizki Yaruntradhani Rolan Sitompul Rudolf Simadibrata Rudy Hidayat Ryan Ranitya Salius Silih Sedijono Sedijono Seri Mei Maya Ulina Simon Salim Siti Setiati Steven Sumantri Suryantini Suryantini Suzana Ndraha Suzanna Ndraha Syarif Hidayat Syarif Hidayat T Yuli Pramana Teguh Karyadi Tengku Riza Zarzani N Tjahjadi Robert Tedjasaputra Toman L Toruan Tommy P Sibuea Tony Loho Tri Hapsoro Guno Tri Juli Edi T Unggul Budihusodo Vera D Yoewono Vera Yuwono