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Medicina
Published by Universitas Udayana
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Core Subject : Health,
Medicine & Pharmacology
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Articles 234 Documents
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PRESCRIPTION AND ADEQUACY OF HEMODIALYSIS Widiana, I Gde Raka
Medicina Vol 44 No 1 (2013): Januari 2013
Publisher : Medicina

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Abstract

Physiologically, uremic syndrome is a pollutional phenomenone of body fluid caused by uremic substance retention due to failing kidney. Hemodialysis (HD) is a substitution therapy to replace native kidney to filter out the toxic substances. The clearance capacity can be measured using urea kinetic modeling, where urea is used as a marker. Prescription of HD will produced prescribed KT/V, namely the amount of HD doses given. On the other hand delivered KT/V is real clearance effect occurred in the body. Each component of dialysis machine can be adjusted to produce adequate delivered KT/V. This KT/V has also to be adjusted with weekly frequency of HD and residual function of the native kidney. Value of KT/V in each HD session according the consensus has to be attained in order the patient live a better life longer
ASPEK PSIKIATRI PADA PENYAKIT PARKINSON Grantika, Putu Agus; Westa, Wayan; Samatra, DPG Purwa
Medicina Vol 46 No 1 (2015): Januari 2015
Publisher : Medicina

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Abstract

Penyakit Parkinson merupakan suatu kelainan degeneratif sistem saraf pusat yang disebabkan olehaktivitas neuron dopaminergik yang sangat berkurang, terutama di daerah pars kompakta dari nigrasubstantia. Penyakit Parkinson menampilkan gejala motor dan gejala nonmotor yang meliputi berbagaidomain termasuk gejala-gejala di bidang psikiatri.Gejala psikiatri pada penyakit Parkinson seringterjadi bahkan pada tahap awal penyakit, dan memiliki konsekuensi penting terhadap kualitas hidupdan fungsi sehari-hari. Gejala psikiatri yang paling sering muncul pada penyakit Parkinson adalahpsikosis,  depresi,  dan  kecemasan. Patofisiologi  gangguan neuropsikiatri  ini  sangat  kompleks  danmultifaktorial, melibatkan proses neurodegeneratif, mekanisme psikologis dan efek yang berkaitandengan pengobatan farmakologis. [MEDICINA 2015;46:28-32].Parkinson?s disease is a degenerative disorder of the central nervous systemdue togreatly reduced ofthe activity of dopaminergic neurons, especially pars compacta area in the substantia nigra. Parkinson?sdisease show motor and non-motor symptoms that include a variety of domains, including psychiatricsymptoms. Psychiatric symptoms in Parkinson?s disease often occur in the early stages of disease, andhas important consequences for the quality of life and daily functioning. The most frequent psychiatricsymptoms appear in Parkinson?s disease are psychosis, depression, and anxiety. Pathophysiology ofneuropsychiatric disorders are complex and multifactorial,  involving neuro degenerative processes,psychological mechanisms and associated with the effects of pharmacological treatment. [MEDICINA2015;46:28-32].
POSSESSION, REVIEW FROM CULTURAL AND PSYCHIATRY Sri Diniari, Ni Ketut; Hanati, Nyoman
Medicina Vol 43 No 1 (2012): Januari 2012
Publisher : Medicina

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Abstract

Possession is a culture related syndrome, commonly found in Indonesia including Bali. We can see this event in religion and cultural ceremony and at other times at school, home, and in society. This syndrome consist of temporary loss of self identification and environment awareness; in several events a person acts as if he/she was controlled by other being, magic force, spirit or ‘other forces’. There are still several different opinions about trance-possession, whether it is related to certain culture or is a part of mental disorder. DSM-IV-TR and PPDGJ-III defined trance-possession as mental disorder (dissociative) for involuntary possession, if it is not a common activity, and if it is not a part of religion or cultural event. (MEDICINA 2012;43:37-40).
Anestesi epidural pada pasien modified radical mastectomy dengan gagal jantung kongestif Anthonio, Jim; Krisna, IB; Widnyana, IMG
Medicina Vol 47 No 1 (2016): Januari 2016
Publisher : Medicina

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Abstract

Pasien gagal jantung kongestif (GJK) yang membutuhkan tindakan bedah sering timbul penyulit dengan prognosis yang buruk karena GJK dapat meningkatkan risiko mortalitas pasca-operasi. Penggunaan anestesi regional dengan blok epidural neuroaksial pada pasien GJK dengan memperhatikan efek blok simpatis dan risiko penurunan systemic vascular resistance atau risiko yang bisa terjadi dapat kita lakukan dengan menggunakan dosis rendah serta menjaga kecukupan volume intravaskular. Perempuan berumur 56 tahun yang terdiagnosis localized advance breast cancer kiri direncanakan modified radical mastectomy. Pasien juga menderita GJK fungsional klas III ec hipertensi kronis dan diabetes melitus dengan hipokinetik global. Penderita diberi premedikasi midazolam 1 mg, ketamin 20 mg dan fentanil 25 mcg kemudian dilakukan pemasangan alat monitoring, arteri line, kateter vena sentral, serta dilakukan anestesi epidural dengan kateter epidural di vertebra torakal IV-V menggunakan jarum touhy 18G dengan panjang kateter di ruang epidural 5 cm. Regimen anestesi epidural yang digunakan adalah levobupivacain 0,5% volume 8 mL. Operasi selama 2 jam 50 menit, posisi head up 45 derajat, hemodinamik selama operasi stabil dengan topangan norepinefrin 0,05-0,1 mcg/KgBB/menit dan dobutamin 5 mcg/KgBB/menit. Anestesi epidural merupakan tehnik anestesi yang dapat dilakukan pada pasien GJK dengan hipokinetik global, penurunan fungsi ventrikel kiri berat (fraksi ejeksi 32%) dan fungsional klas III Patient with congestive heart failure (CHF) that need surgery has a possibility of complication that can increase mortality rate after surgery. The use of regional anesthesia with neuroaxial epidural block in CHF patient is considered safe, decreases the risk of systemic vascular resistance, we can use low dose and maintain adequate intravascular volume. Female, 56 years old, with diagnose of left localized advance breast cancer, scheduled for modified radical mastectomy. She had CHF functional class III caused by chronic hypertension accompanied by diabetes mellitus and global hypokinetic. Midazolam 1 mg, ketamin 20 mg, and fentanyl 25 mcg was given as premedication patient, followed by inplace monitoring tools, insertion arterial line, and central venous catheter. Epidural catheter was placed between thoracal vertebrae IV and V, with epidural anesthesia regimen of levobupivacain 0.5% 8 mL. Duration of surgery was 2 hours and 50 minutes, with 45 degree head up position. The intraoperative hemodynamic parameters was stable and supported by norepinephrine 0.05-0.1 mcg/KgBW/minute and dobutamine 5 mcg/KgBW/minute. This case report proved that epidural anesthesia technique could be used for patient with CHF with global hypokinetic, severe decreased of left ventricle function (EF 32%) and functional class III.
BLOK INFRAKLAVIKULAR KONTINYU SEBAGAI MANAJEMEN NYERI AKUT PASCAOPERASI EKSTREMITAS ATAS Astuti, Sri; Widnyana, I Made Gede
Medicina Vol 45 No 1 (2014): Januari 2014
Publisher : Medicina

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Abstract

Seorang laki-laki 39 tahun mengeluh nyeri berat pada tangan kanan setelah kecelakaan lalulintas.Pada pemeriksaan rontgen didapat fraktur dan dislokasi sendi radiocarpal kanan. Tidak ditemukankelainan pada pemeriksaan fisik dan penunjang. Segera dilakukan operasi reduksi terbuka dan eksternal fiksasi, dikelola dengan anestesi blok infraklavikula pemasangan kateter kontinyu denganbantuan USG. Selama operasi dengan anestesi lokal bupivakain 0,5% 10 ml + epinephrine 1/400.000 dan lidokain 2 % + epinephrine 1/400.000 menghasilkan anestesi yang cukup selama operasi.Pascaoperasi dengan analgesia blok kontinyu  infraklavikula bupivakain 0,125 % 4 ml/jam dengan syringe pump. Kateter dipertahankan selama 3 hari, hari keempat dilanjutkan parasetamol oral dan hari kelima pasien pulang tanpa keluhan nyeri. [MEDICINA. 2014;45:47-51].
CLINICAL SPECTRUM OF DENGUE FEVER AND DENGUE HEMORRHAGIC FEVER AMONG CHILDREN AT SANGLAH HOSPITAL DENPASAR: A THREE-YEAR RETROSPECTIVE STUDY Kanya Wati, Dyah; Arhana, BNP
Medicina Vol 38 No 2 (2007): Mei 2007
Publisher : Medicina

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Abstract

Spondilitis tuberculosis merupakan fokus sekunder infeksi tuberculosis yang mengenai tulang belakang. Keterlibatan tulang belakang akan dapat memperberat morbiditas karena adanya potensi defsit neurologis dan deformitas yang permanent. Diagnosis ditegakkan berdasarkan klinis, laboratories, imaging, bakteriologis dan histopathologis. Sampai saat ini belum ada therapi definitif yang baku. Masih ada kontroversi antara terapi konservative dengan pembedahan. Telah dikembangkan metode total treatment yang merupakan gabungan terapi konservatif dan tindakan operatif berdasarkan identifikasi masalah yang dihadapi masing ? masing penderita.Therapi pembedahan dapat berupa radikal atau middle path, Study of spectrum of dengue fever and dengue hemorrhagic fever on children at Sanglah General Hospital Denpasar was done in 2005.Data were collected from medical records. Subject of this study were patients of dengue fever (DF) and dengue hemorrhagic fever (DHF) who were admitted to the pediatric department of Sanglah hospital from 1 January 2002 until 31 December 2004. There were 837 patients diagnosed, 582 were eligible to inclusion; 303 (52.1%) males and 279 (47.9%) females. Most of them were diagnosed with DF 417 (71.6%), DHF 95 (16.3%), and DHF with shock 70 (12.0%). Five patients (0.8%) died because of DHF with shock in three years and 4 of them were females. Patients mostly came on the fourth day 337 (57.9%). Vomiting 283 (48.6%), 66 (11.3%) was the major symptom of patients with DF and DHF respectively, hepatomegaly 61(10.5%) and abdominal pain 59 (10.1%) were major symptoms of DHF with shock. Hemorrhagic manifestation was petechiae; 310 (53.3%) of DF, 63 (10.8%) of DHF, 42 (7.2%) of DHF with shock. From laboratories result, leukopenia and thrombocytopenia were major findings. The number of patients with DF and DHF reached the peak level in March in three years. The conclusion of this study is DF AND DHF mostly occur in males. Hepatomegali, abdominal pain and vomiting are major clinical symptoms. Petechiae is the major hemorrhagic manifestation. Leukopenia and trombositopenia are majority laboratories findings in patients with DF and DHF. Peak level of patients is in March in three years.
DIAGNOSIS DAN PENATALAKSANAAN KARSINOMA PAPILARI TIROID VARIAN FOLIKULAR Pranitasari, Ni Putu Oktaviani Rinika; Sudipta, Made
Medicina Vol 46 No 2 (2015): Mei 2015
Publisher : Medicina

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Abstract

Karsinoma papilari tiroid varian folikular merupakan varian karsinoma papilari tiroid yang ditandaiarsitektur folikular namun memiliki karakteristik gambaran nuklear seperti pada karsinoma papilariklasik. Diagnosis karsinoma papilari tiorid varian folikular menggunakan biopsi aspirasi jarum halussering menunjukkan hasil negatif palsu karena tumpang tindih dengan gambaran sitomorfologineoplasma folikular sehingga berdampak pada pemilihan tindakan pembedahan. Pada laporan kasusini dilaporkan seorang perempuan usia 14 tahun dengan nodul tiroid yang muncul sejak 3 tahun yanglalu. Pasien tidak pernah mendapat radiasi daerah kepala leher dan tidak ada anggota keluarga yangmenderita pembesaran kelenjar tiroid. Biopsi aspirasi jarum halus preoperasi pada nodul tiroidmenunjukkan neoplasma folikular. Hasil ultrasonografi leher menunjukkan massa solid berukuran <4 cm, terbatas pada tiroid dan tidak ditemukan pembesaran kelenjar getah bening servikal.Pemeriksaan foto toraks tidak menunjukkan metastasis paru. Berdasarkan kriteria Shaha makapasien ini termasuk dalam kelompok karsinoma tiroid risiko rendah sehingga pilihan pembedahanadalah ismolobektomi. Hasil histopatologi spesimen pembedahan menunjukkan karsinoma papilaritiroid varian folikular dan pilihan terapi selanjutnya adalah observasi gejala kekambuhan sertapemberian levotiroksin intraoral sebagai terapi supresi TSH. Pasien ini memiliki prognosis yangbaik. [MEDICINA 2015;46:126-9].Variant follicular of papillary thyroid carcinoma is the most variant of papillary thyroid carcinomawhich is identified with follicular architecture but also have characteristic of nuclear feature likeclassic papillary carcinoma. The diagnosis of variant follicular papillary thyroid carcinoma using fineneedle aspiration biopsy often showed false negative result due to overlapping cytomorphologic featureof follicular neoplasm, so it has impact to type of surgery. We reported a case of a 14 years old girl withlump on neck since 3 years ago. Patient never has history of head and neck radiation exposure beforeand there were no family members with symptom of lump on the neck. Fine needle aspiration biopsypreoperative of thyroid nodule indicates of follicular neoplasm. Neck ultrasonography showed solidmass size less than 4 cm, limited to the thyroid gland and no enlargement of cervical lymph node.Thorax X-ray showed no pulmonary tumor metastasis. According to Shaha classification, this patientwas categorized to mild risk of thyroid carcinoma and the choise of surgery was isthmolobectomy.Histopathology finding of post operative specimen showed variant follicular of papillary thyroidcarcinoma. Observation of the recurrence and levothyroxin intraoral was given as TSH suppressiontherapy. This patient has a good prognoses. [MEDICINA 2015;46:126-9].
Perbedaan Ekspresi P16INK4a dan HPVL1 pada Cervical Intraepithelial Neoplasia 1, Cervical Intraepithelial Neoplasia 2, Cervical Intraepithelial Neoplasia 3 dan Squamous Cell Carcinoma Serviks Uteri Elizabeth Padang, Arlene; Laksmi, Luh Yeni; **, Moestikaningsih; Widiana, Gede Raka
Medicina Vol 44 No 2 (2013): Mei 2013
Publisher : Medicina

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Abstract

Human papillomavirus (HPV) memegang peranan penting dalam proses karsinogenesis kanker serviksuteri; namun hanya sebagian kecil wanita yang terinfeksi tersebut akan berkembang menjadi kankerserviks yang invasif. Cervical intraepithelial neoplasia (CIN) merupakan spektrum dari lesi servikalyang mewakili lesi prekursor dari squamous cell carcinoma (SCC) serviks uteri yang dikategorikanmenjadi CIN1, CIN2, CIN3. Interaksi protein HPV (E6 dan E7) dengan protein pengatur selular (pRbdan p53) akan menyebabkan up regulation protein P16INK4a. P16INK4a merupakan tumor supresorprotein cyclin dependen kinase inhibitor yang menghambat cyclin dependent kinase 4 dan 6 yangmerupakan produk dari gen INK4a yang terlibat dalam fosforilasi protein retinoblastoma (pRb).Human papillomavirus-late 1 (HPVL1) merupakan protein kapsid yang terekspresi pada saat awalfase produktif karsinogenesis serviks uteri. Tujuan dari penelitian ini adalah untuk mengetahuiperbedaan ekspresi protein P16INK4a dan HPVL1 pada CIN1, CIN2, CIN3, dan SCC serviks uteri,dimana ekspresi P16INK4a dapat membantu untuk membedakan berbagai derajat displasia serviksuteri dan ekspresi HPVL1 dapat membantu untuk memprediksi progresivitas dari berbagai derajatdisplasia serviks uteri, sehingga penanganan pasien menjadi lebih tepat. [MEDICINA 2013;44:77-81].
REDUCTION OF NUTRIENT STATUS NASOPHARYNGEAL CANCER PATIENTS AFTER RADIOTHERAPY WITH COBALT - 60 IN SANGLAH HOSPITAL Sudiasa, Putu; Tjekeg, Made; Puteri, AA Sagung Puteri
Medicina Vol 43 No 3 (2012): September 2012
Publisher : Medicina

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Abstract

Nowadays radioterapy is still a standard treatment for nasopharyngeal cancer. Treatment with radiotherapy and or chemotherapy can effect the nutrient status of patients. Body Mass Index ( BMI ) is an indicator of a  nutrient status measurement. BMI is expressed as body weight in kilograms divided by height squared in meters size. The objective of this study is to define the alteration of nutrient status in nasopharyngeal cancer patients with who underwent radiotherapy with Cobalt -60. With pre-post test single group method. The result showed significant decrease (P<0,05) of body weight a[er radiotherapy, i.e from 59.01 (SD 14.30) kg to 52.51 (SD 14.24) kg. Body mass index (BMI) prior to radiotherapy  22.42 ( SD 4.35 ) kg/m2  and  a[er radiotherapy 19.89 ( SD 4,23) kg/m2. It was concluded that there is a significant nutrient status reduction in nasopharyngeal cancer patients a[er radiotherapy with Cobalt-60
Seorang penderita leukemia mieloid kronik dengan komplikasi efusi pleura Jauwerissa, Ria; Suega, Ketut
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Abstract

Leukemia mieloid kronik (LMK) adalah kelainan mieloproliferatif yang ditandai dengan peningkatan proliferasi sel granulositik, dengan prevalens 20% dari kejadian leukemia. Efusi pleura pada LMK merupakan komplikasi yang jarang ditemukan, dengan patofisiologi yang belum jelas, dan merupakan faktor prognostik yang buruk pada LMK. Kasus adalah lelaki, 24 tahun, didiagnosis dengan LMK transformasi akut dengan komplikasi efusi pleura, diterapi dengan hidroksiurea dan evakuasi cairan pleura. Pasien mengalami komplikasi pneumonia dan meninggal. [MEDICINA.2016;50(3)71-75]

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