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All Journal BALI MEDICAL JOURNAL (BMJ) E-Jurnal Medika Udayana Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Electronic Journal of Graph Theory and Applications (EJGTA) The Indonesian Biomedical Journal JBN (Jurnal Bedah Nasional) ISM (Intisari Sains Medis) : Jurnal Kedokteran Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) Indonesian Journal of Cancer
I W. Sudarsa
Department Of Surgery, Division Of Oncologic Surgery, Faculty Of Medicine Udayana University/Sanglah General Hospital Bali-Indonesia
Biochemistry, Genetics & Molecular Biology Electrical & Electronics Engineering Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Hyaluronic Acid Caused of Wider Epithelialization Compare to Normal Saline in Severe Diabetic Ulcer Sudarsa, I W; Semadi, I N; Riasa, N P
BALI MEDICAL JOURNAL Volume 1, Number 1, January-April 2012
Publisher : BALI MEDICAL JOURNAL

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Objectives: Diabetic ulcer, one of chronic complications of diabetes mellitus (DM), showed a high morbidity and mortality rate. The main treatment modality for diabetic ulcer was debridement, followed by wound treatment as local control to promote wound healing. This study aims to compare efficacy of hyaluronic acid (HA) and 0.9% sodium chloride (NaCl) in severe diabetic ulcus two after debridement. Method: This study was a randomized clinical study to compare the efficacy of HA and NaCl 0.9% in severe diabetic ulcer two weeks post debridement. Thirty six severe diabetic ulcer (Wagner ?3) samples were collected using consecutive sampling method and divided into 2 treatment groups: standard wound treatment using NaCl 0.9% and using hyaluronic acid. T-independent test was applied for statistical analysis data and  p<0.05 was consider a statisticalle significant. Results: The two treatment groups showed insignificant difference in characteristics and laboratory findings. The mean tissue epithelialization width after two weeks of wound treatment using NaCl 0.9% was 17,22 ± 3,25 and using HA was 27,33 ± 2,43. Statistical analysis using t-independent test showed t = 10.59, p = 0.001 for both treatment groups. Conclusions: HA improves wound healing rate in severe diabetic ulcer 2 weeks post debridement compared to 0.9% NaCl.
Clinical Initial Response of Neoadjuvant Chemotheraphy in Triple Negative, HER-2, and Luminal Types of Breast Cancer in Denpasar (A Preliminary Study) Yarso, K. Y.; Sudarsa, I W; Wibawa-Manuaba, I B. T
BALI MEDICAL JOURNAL Volume 1, Number 1, January-April 2012
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Objectives: Triple Negative, Luminal, HER-2 subtypes of breast cancer are markers to predict behavior, aggressiveness, and response to chemotherapy. The aim of this study is to understand character and response to standard neoadjuvant chemotherapy in different subtypes of breast cancer. Method: This is a descriptive study of breast cancer subtypes. From 687 patients (2003-2010) 351 patients have IHC data which divided into 3 groups, Triple negative, Luminal, and HER-2. We used 10% as a cut off point for ER, PR, while 30% & positive 3 for HER-2. We determined initial clinical response after 3 cycles of neoadjuvant chemotherapy although only 77 got standard neoadjuvant chemotherapy and had clinical response data. We used 50% diameters depreciation & no metastasis as cut off point for respond group. Results: There were 116 (33%) Triple Negative, 60 (17%) HER-2, and 175 (50%) Luminal Subtypes. The mean of age for 351 patients are 48.32 (23-82) years. In this study, it was obtained that no significant difference of means of age (p=0.24) in these 3 groups. Triple negative group significantly more advance in grade if compared with the other two groups (p=0.02). HER-2 group had highest response with standard neoadjuvant chemotherapy (50%), Luminal group had (49%), and Triple negative group had only (15%) response. One pCR in HER-2 group. There were no difference ages in subtypes.  Triple negative has more advances in grade. HER-2 group has highest response to standard neoadjuvant chemotherapy and Triple negative has lowest response to standard neoadjuvant chemotherapy.
Association of P16 Expression with Clinicopathological Features of Oral Cavity Squamous Cell Carcinoma Patients in Bali Ampur, O. Y.; Sudarsa, I Wayan; Suryawisesa, Ida Bagus
BALI MEDICAL JOURNAL Vol 5 No 3 (2016)
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Background: Oral cavity cancer is considered as a major health problem worldwide and has been associated with high recurrence rate and poor prognosis. Oral cavity squamous cell carcinoma (OCSCC) in Sanglah General Hospital Denpasar contributed to 71.7% of all head and neck cancer from 2002-2011 with an increasing trend annually. Advances in our understanding of OCSCC have not improved the outcome in OCSCC management significantly. Therefore, many studies have focused on the roles of biomolecular markers in OCSCC. One of biomolecular marker that has been the focus of many OCSCC studies is p16. Method: This was an analytic cross sectional study with 31 samples to determine the association of p16 expression with age group, tumor location, stage, and grade in OCSCC. Data was analyzed descriptively and the association between variables were evaluated with Chi-Square or Fisher’s Exact Test with a p value
High Ki-67 and Vascular Endothelial Growth Factor (VEGF) Protein Expression as Negative Predictive Factor for Combined Neoadjuvant Chemotherapy in Young Age Stage III Breast Cancer Sudarsa, I. W.; Manuaba, I. B. Tjakra W.; Maliawan, Sri; Sutirtayasa, I. W. P.
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Background: Breast cancer was, in general, a heterogeneous disease with diverse biological characteristics, types, subtypes and clinical behavior. Its treatment and management need to be personalized and individualized. Breast cancer in young ages, although rare, is usually a unique and more aggressive cancer associated with poorer prognosis. The combination of young age and advanced stages of breast cancer would make this particular breast cancer harder to treat and cure. Unfortunately, majority of Breast Cancer Patients in Bali were in younger ages, and at advanced stages, that the mainstay of treatment was neo adjuvant chemotherapy followed by other treatment modalities. Improve prognosis only, those patients who had had a complete pathological response involving primary tumor and regional lymph nodes in the axilla. Several factors had been studied and contributed to breast cancer response to combined neo-adjuvant chemotherapy. Usually, younger patients, was associated with high proliferation rate represented by Ki-67 and early distant metastasis represented by VEGF, which also had role as prognostic markers. The purpose of this study was to determine whether high Ki-67 and VEGF expression correlate with response to NAC and hence, they would be important predictive factors for response to NAC. Method: This study was a cross-sectional and a nested case-control study of stage III breast cancers affecting patients 40 years of age or less, at Sanglah General Hospital and Prima Medika Hospital, conducted from September 1st, 2012 until March 31st, 2014. Clinical and pathology reports were traced and recorded from both hospitals; routine Immunohistochemistry (IHC) examinations were performed by both pathology labs. Statistical analysis was performed using Chi-Square test, Odds Ratio (OR), and logistic regression analysis with p
DIAGNOSTIC VALIDITY OF CYTOLOGICAL IMPRINT IN THYROID FOLLICULAR NEOPLASM Pustaka, I G. N.; Sudarsa, I W.; Golden, and N.
BALI MEDICAL JOURNAL Vol 2 No 3 (2013): Vol.2, No.3, September-December 2013
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Background: Preoperative fine needle aspiration biopsy/FNAB examination, imprint cytology and frozen section intraoperative has big implications for diagnosis and surgical strategy of thyroid nodules with follicular neoplasm cytology. FNAB and frozen section has its limitations, it is difficult to detect the presence of capsular and/or vascular invasion of thyroid follicular carcinoma. Whereas imprint cytology can preserve cellular overview (especially the cell nucleus), including the capsular and/or vascular invasion. In addition, imprint cytology is faster than frozen section. Frozen section examination could not indicate the presence of capsular and/or vascular invasion in most cases so that imprint cytology is used to replace frozen section as an alternative. Method: This research is a diagnostic test study using a descriptive design. This is a prospective study to assess the sensitivity, specificity, NPV, and PPV of imprint cytology in patients with thyroid follicular neoplasm cytology. Results: In our study; sensitivity, specificity, PPV, NPV, and accuracy of imprint cytology for follicular neoplasm was found as 84.21%, 95.45%, 94.12%, 87.50% and 90.24% respectively. The outcome was based on likelihood ratio value of 18.21 and the ROC curve, area under the curve obtained at 0.879 and Kappa value of 0.802. Conclusion: Imprint cytology has a value of a good diagnostic validity in the diagnosis of follicular neoplasm of thyroid nodules with sensitivity and specifity values of 84.21% and 95.45%. Imprint cytology is a technique that is simple, inexpensive, and has good reliability so that it can be used instead of frozen section.
Association of P53 Protein Overexpression with Clinicopathological Features of Oral Squamous Cell Carcinoma Patients in Bali Winata, A.; Manuaba, I. B. Tjakra. W.; Sudarsa,, I. W.; Mahadewa, Tjok G. B.
BALI MEDICAL JOURNAL Vol 5 No 1 (2016)
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Background: Oral cancer was a major health problem with a high incidence rate worldwide. Oral Squamous Cell Carcinoma (OSCC) in Bali, ranked as the second most common cancer after cervix carcinoma. Our understanding of OSCC hasn’t yielded a satisfactory clinical outcome; therefore, further studies about the role of biomolecular markers in OSCC are still needed. One of the biomolecular markers for prognosis and predictor for OSCC that has been a topic of research to date is p53. Method: This is a cross-sectional analytical study of 36 samples to determine the correlation between p53 overexpression with age group, tumor location, tumor stage, and tumor grade in OSCC patients. Data was processed descriptive and analytical using Chi-Square/Fisher 's Exact Test methods with a significance value of p
THE RISK FACTOR OF NEUTROPENIA ON LOCALLY ADVANCED BREAST CANCER PATIENTS TREATED WITH FIRST CYCLE CYCLOPHOSPHAMIDE, DOXORUBICINE, 5- FLUOROURACIL CHEMOTHERAPY AT SANGLAH GENERAL HOSPITAL DENPASAR, BALI-INDONESIA Keswara, M.A.; Sudarsa, I.W.; Golden, N.
BALI MEDICAL JOURNAL Volume 1, Number 3, September-December 2012
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Objective: Breast cancer is the most common type of cancer found in women, in the United States breast cancer is the number one cancer in women and the second highest cause of cancer deaths after lung cancer. This study aims to determine the incidence of neutropenia and tested several clinical risk factors of neutropenia in locally advance breast cancer/LABC patients who obtain first cycle cyclophosphamide, doxorubicine, 5-fluorouracil neoadjuvant chemotherapy at Sanglah Hospital in Denpasar. Method: The study was a prospective cohort involving 62 LABC patients conducted between February to June 2012. Clinical factors such as age, chronic obstructive pulmonary disease, hypertension, nutritional status, and hemoglobin levels in patients were recorded. Neutrophil level were recorded on day 7 and 12 of first cycle neoadjuvant chemotherapy. Bivariate analysis was done to see the strengths of each risk factor for neutropenia followed by multivariate logistic regression analysis to determine the most significant risk factor for the occurrence of neutropenia. Relative risk with 95% confidence interval was recorded. The level of significance was set at value  of less than 0,05. Results: Neutropenia was found in 17 patients (27,4%). Bivariate analysis showed that age older than 60 years old, hypotensive, under nourished, and anemic are significant risk factors of neutropenia. However, in multivariate logistic regression age (RR 20,225; 95% CI 1,804-226,776) and nutritional status (RR 35,328; 95% CI 3,108-401,524) remained significant clinical risk factors of neutropenia. Conclusion: Neutropenia incidence was 27,4%. Patients older than 60 years old and under nourished status are the significant clinical factors causing neutropenia and can be used as a predictor to predict neutropenia.
OVEREKSPRESI HER-2 SEBAGAI FAKTOR RISIKO TERJADINYA METASTASIS OTAK PADA PASIEN KANKER PAYUDARA Theodore Dharma Tedjamartono; I Wayan Sudarsa; Arif Winata; Ni Gst Ayu Agung Manik Yuliawati Wetan
E-Jurnal Medika Udayana Vol 9 No 9 (2020): Vol 9 No 09(2020): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2020.V09.i9.P10

Abstract

ABSTRAK Angka kejadian metastasis otak pada kanker payudara semakin meningkat dan mengindikasikan perburukan prognosis. Di estimasikan 10-30 % pasien dengan kanker payudara terdiagnosis dengan metastasis otak. Kanker payudara sub tipe overekspresi HER-2 merupakan sub tipe yang sangat agresif serta memiliki risiko tinggi dalam terjadinya metastasis ke otak. Jika kita mampu mendeteksi kejadian metasatasis otak lebih dini maka kita bisa memberikan intervensi yang meningkatkan kelangsungan hidup pasien. Penelitian ini merupakan penelitian analitik yang menggunakan rancangan case-control menggunakan data sekunder dari rekam medis di RSUP Sanglah dengan teknik simple random sampling. Sampel yang diambil adalah pasien Kanker Payudara Stadium IV yang pernah dirawat di RSUP Sanglah dari tahun 2015 – 2016. Pada 40 sampel penelitian yang dibagi menjadi kelompok kasus dan kontrol didapatkan rentang usia pasien yaitu 27 – 63 tahun dengan rerata usia 48 ±SB tahun. Ca mammae sinistra merupakan kasus terbanyak (57,5%), kemudian ca mammae dextra (37,5%) dan ca mammae bilateral (5%). Dari Grading didapatkan Grade II (50%), Grade III (42,5%), dan Grade I (7,5%). Dari Pemeriksaan HER-2 didapatkan hasil Overekspresi HER-2ditemukan pada 37,5% sampel. Insiden dari overekspresi HER-2 pada kasus metastasis otak adalah 55%. Pada analisis regresi logistic didapatkan overekspresi HER-2 berhubungan signifikan terhadap metastasis otak dengan nilai p=0,012. Dari uji chi square, didapatkan hasil overekspresi HER-2 berhubungan signifikan terhadap metastasis otak dengan nilai p=0,027. Kesimpulan dari hasil penelitian ini adalah pada pasien kanker payudara dengan overekspresi HER-2 4,889 kali lebih berisiko untuk menjadi metastasis otak dibandingkan dengan pasien HER-2 negatif. Kata kunci: Her-2, Overekspresi, Kanker Payudara, Metastasis Otak
KANKER PAYUDARA PADA WANITA USIA MUDA DI BAGIAN BEDAH ONKOLOGI RUMAH SAKIT UMUM PUSAT SANGLAH DENPASAR TAHUN 2002 – 2012 Ni Made Dian Hartaningsih; I Wayan Sudarsa
E-Jurnal Medika Udayana vol 3 no 6 (2014):e-jurnal medika udayana
Publisher : Universitas Udayana

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Penelitian ini bertujuan untuk mengetahui prevalensi kanker payudara pada wanita muda usia < 40 tahun, distribusi berdasarkan diagnosis histopatologi, stadium dan gradedari tahun 2002 – 2012.Penelitian ini merupakan penelitian deskriptif dengan desain potong lintang (crosssectional) dimana menggunakan data sekunder berupa catatan diagnosis dan rekammedis pasien kanker payudara dari Rumah Sakit Umum Pusat Sanglah Denpasar sejak2002 – 2012 yang dikumpulkan pada bulan November 2013. Variabel yang dinilai padapenelitian ini meliputi prevalensi, gambaran histopatologi, stadium dan grade padawanita muda penderita kanker payudara dengan usia < 40 tahun.Hasil penelitian menunjukkan selama periode 2002-2012 tercatat 22,7% (199 kasus)kanker payudara pada usia muda dengan jumlah kasus terbanyak terdapat padakelompok usia 35 – 39 tahun sebesar 57,8% (115 kasus). Diagnosis histopatologiterbanyak sebesar 81,9% (163 kasus) adalah tipe karsinoma duktal invasif. Stadium IIIB (36,7% atau 73 kasus) dan Grade II (46,2% atau 92 kasus) menempati angkaterbanyak selama periode tersebut. Dapat disimpulkan bahwa jumlah kasus kanker payudara pada usia muda dalam studiini cukup tinggi jika dibandingkan dengan kelompok usia lain yakni sebesar 22,7 %,mayoritas kasus terjadi pada kelompok usia 36-40 tahun, karsinoma duktal invasifmerupakan diagnosis histopatologi terbanyak, dan Stadium III B maupun grade IImenempati jumlah terbanyak pada periode tersebut.  
PERSENTASE KASUS TRIPLE NEGATIVE BREAST CANCER DI RUMAH SAKIT UMUM PUSAT (RSUP) SANGLAH TAHUN 2006-2013: STUDI DESKRIPTIF Ni Luh Putu Harta Wedari; I Wayan Sudarsa
E-Jurnal Medika Udayana vol 4 no 8(2015):e-jurnal medika udayana
Publisher : Universitas Udayana

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TRIPLE NEGATIVE BREAST CANCER CASE PERCENTAGE AT SANGLAH GENERAL HOSPITAL IN THE YEAR OF 2006-2013: A DESCRIPTIVE STUDY World Health Organization predicts that there will be a surge in breast cancer patients in Indonesia up to seven times by 2030. Bali Province ranked second highest breast cancer patients diagnosed in Indonesia, which is based on the data in Sanglah General Hospital, every year there were 200 new cases. This research is a descriptive study with secondary data of triple negative breast cancer inpatients in the Department of Surgical Oncology, Sanglah General Hospital from 2006 until 2013. The percentage of triple negative breast cancer case is 14,28 %, 32%, 75 % in 2007, 2008, and 2009 respectively. Number of cases continued to rise in 2010 amounted to 51.85 %, then decreased in 2011 to 16.67 % but no cases in 2013. Most age groups diagnosed as triple negative breast cancer is 41-45 years which the bigest percentage is 33.34%. The number of triple negative breast cancer among other types of breast cancer has increased with the most age groups diagnosed is 41-45 years old.
Co-Authors A. Winata, A. Arif Winata Bharata, Made Dwi Yoga Budi Heryanto Desak Made Wihandani Faisal Susanto Gede Andry Nicolas Andry Nicolas Hendry Irawan I B. T Wibawa-Manuaba I G. N. Pustaka I G. P. Supadmanaba I Gusti Ayu Sri Mahendra Dewi I Gusti Ngurah Gde Dwi Aryanata I Ketut Wiargitha I Made Jawi I Nyoman Semadi I Wayan Ari Sumardika I Wayan Niryana I Wayan Putu Sutirta Yasa I. B. Tjakra Wibawa Manuaba Ida Bagus Made Suryawisesa K Tangking Widarsa K. Y. Yarso Kendarini, Ni Putu Yenny M.A. Keswara Maheswari, Luh Putu Dewanda Manuaba, Ida Bagus Tjakra Wibawa Ni Gst Ayu Agung Manik Yuliawati Wetan Ni Luh Putu Harta Wedari Ni Made Dian Hartaningsih Ni Made Mahastuti Ni Nyoman Ayu Dewi Ni Putu Sriwidyani Nyoman Golden Nyoman Putu Riasa O. Y. Ampur, O. Y. Paskarani, Putu Erika Patriawan, Putu Pattipeilohy, Allen Anderson Pertiwi, Putu Febry Krisna Prayuda, Prayuda Putu Anda Tusta Adiputra Putu Ayu Kartika Putri Saraswati Selvy Musdalifah Setiawan, I Gede Budhi Sri Maliawan Suryawisesa, Ida Bagus Made Theodore Dharma Tedjamartono Tjokorda Gde Bagus Mahadewa Yasa, I Nyoman Wawan Tirtha