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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Rino Alvani Gani
Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo General National Hospital, Jakarta
Medicine & Pharmacology

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Relationship Between Vascular Endothelial Growth Factor and Severity of Hepatocellular Carcinoma Arles - -; Rino Alvani Gani; Ari Fahrial Syam; Hamzah Shatri
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 2 (2015): VOLUME 16, NUMBER 2, August 2015
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (568.663 KB) | DOI: 10.24871/162201567-72

Abstract

Background: Severity of hepatocellular carcinoma (HCC) that is assessed using Barcelona Clinic Liver Cancer (BCLC) classification is a main prognostic factor of hepatocellular carcinoma. Assessment of the serum level of Vascular Endothelial Growth Factor (VEGF) is considered to reflect the severity of HCC. However, there is still no fundamental basis of the association of severity of HCC with the serum VEGF level. The objective of this study is to know the relationship between serum VEGF levels with the severity of HCC by assessing the average difference of serum VEGF level in various severity of HCC.Method: This study was a cross sectional study to identify the association between serum VEGF levels with the severity of HCC based on BCLC classification. This study was performed in Cipto Mangunkusumo Hospital between January and May 2015. Statistical tests used to evaluate the association between serum VEGF level with BCLC classification was one-way ANOVA analysis, and continued with post hoc Tukey Schaffe analysis.Results: A total of 61 subjects with HCC were included into this study. In this study, we did not find subjects with stage 0 BCLC. The average of serum VEGF level in stage A BCLC was 288.26 ± 156.6 pg/mL; stage B BCLC: 434 ± 164.8 pg/mL; stage C BCLC: 785.57 ± 194.25 pg/mL; stage D BCLC: 1537.97 ± 660.62 pg/mL. One-way ANOVA analysis showed significant difference (P 0.001) between serum VEGF level and HCC severity based on BCLC classification. Post hoc Tukey Schaffe analysis showed the presence of significant difference between stage A and C BCLC (p 0.05) and stage A and D BCLC (p 0.001), stage B and D BCLC (p 0.001), and stage C and D BCLC (p 0.001). There was no significant difference between stage A and B BCLC, and between stage B and C BCLC.Conclusion: It was found that serum VEGF level increased in accordance to the HCC severity based on BCLC classification, particularly for stage B BCLC and above.
Effect of Coconut Milk Supplementation to Nutritional Status Parameters in Liver Cirrhosis Patients Suwito Indra; Rino Alvani Gani; Ari Fahrial Syam; Hamzah Shatri
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 2 (2015): VOLUME 16, NUMBER 2, August 2015
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (158.169 KB) | DOI: 10.24871/162201578-85

Abstract

Background: Liver cirrhosis is on of health problems in Indonesia. Decreasing number of liver cells in cirrhosis cause some complications, one of which is malnutrition. In Indonesia, coconut milk is one of nutrients sources which quite popular. Coconut milk is thought to have hepatoprotective effect and be able to be eliminated by cirrhosis patients. A study about effect of coconut milk supplementation to nutritional status parameters in liver cirrhosis patients is really needed.Method: This study is a randomized controlled trial with parallel design. This study is conducted in Cipto Mangunkusumo Hospital Jakarta from February to March 2014. Patients are given late night snack (LNS) in form of agar that contained 25 grams of sugar and additional 50 cc coconut milk in group I (experimental group) and additional drink that contained 25 grams of sugar in group II (control group). Variables that measured to look changes in nutritional status between the two groups are triceps skinfold thickness (TSF), mid arm muscle circumference (MAMC), body mass index (BMI), body fat mass (BFM), prealbumin levels and serum albumin levels.Results: A total of 35 patients with liver cirrhosis in this study to the completion. There are three parameters of nutritional status that increasing better in the group receiving a LNS from combination of carbohydrates and coconut milk, compared to group receiving carbohydrates alone. Those three parameters are mean (SD) MAMC with amount of 9.41 (6.43) mm in group I and 4.68 (5.76) mm in group II, p = 0.028. Median (range) BFM changes 0.67 (-2.47-3.80) kg in group I and 0.21 (-4.96-1.99) kg in group II, p=0,373. Mean (SD) serum albumin level change 0.17 (0.31) g/dL in group I and 0.07 (0.41) g/dL in group II, p = 0,426. There is an increase in the TSF measurement in all subjects after one month of LNS supplementation, but not found any significant differences of TSF changes between the two groups. While the measurement of BMI and serum prealbumin did not show any significant changes after treatment in all subjects research.Conclusion: One month LNS 200 kkal supplementation with combination of carbohydrates and coconut milk have a better effect on the improvement of nutritional status in patients with liver cirrhosis, compared to carbohydrates alone. This shown by the better parameters of MAMC, BFM and increased serum albumin in group I, compared to group II.
Co-Authors Ari Fahrial Syam Arles - - Hamzah Shatri Hamzah Shatri Suwito Indra