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INDONESIA
journal of internal medicine
Published by Universitas Udayana
ISSN : -     EISSN : -     DOI : -
Core Subject : Health,
Medicine & Pharmacology
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Articles 9 Documents
 1 
Search results for , issue "Vol. 8, No. 1 Januari 2007" : 9 Documents clear
HUBUNGAN KONSUMSI PURIN DENGAN HIPERURISEMIA PADA SUKU BALI DI DAERAH PARIW ISATA PEDESAAN -, Hensen; Raka Putra, Tjokorda
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

Hyperuricemia is a condition of high consentration of uric acid in the blood. In most epidemiology study hyperuricemiais defined as level uric acid more than 7.0 mg/dl in men and more than 6.0 mg/dl in women. Hyperuricemia can be caused byseveral factors. Regarding the etiology hyperuricemia can be classified as primary, secondary and idiopathic hyperuricemia.Primary hyperuricemia related to genetic factor while secondary hyperuricemia caused by condition or other factors besidesgenetic factor such as high purin consumption, chronic kidney disease, certain drugs, alcohol and hypertension. To know theassociation between high purine diet and hyperuricemia, a cross sectional analytic study was conducted on Balinese in Ubudregion between Desember 2006 and January 2007. Sample study was Balinese age of 13 year old or above, agree to participateby informed consent. Descriptive statistic analysis on numeric data presented as mean mean ± SD, nominal and ordinal data inproportion. Inferential statistic analysis with bivariate simple logistic regression was performed and multiple logistic regressionwas used to know the independency of its association. Of 301 eligible samples, mean age was 40.85 ± 14.30 y.o, and 161 orang(53.5%) men and 139 (46.3%) women. Youngest age was 13 y.o and oldest was 85 y.o. Mean of purine consumption was 153.37± 77.83 mg/day and mean uric acid consentration was 5.14 ± 1.44 mg/dl with mean body mass index 22.57 ± 3.17 kg/m2.Prevalence of hyperuricemia on this study was 12%. High purine consumption was significantly associated with hyperuricemiaby analysis of prevalent ratio 22,82; CI 95% : 9.19 ? 56.66; p<0.001. On multivariate analysis with multiple logistic regressionhigh purin consumption also has independent association with hyperuricemia with prevalent ratio (PR) 57.30; IK 95% : 16.56 ?198.24; p < 0,001. Other factors that independently associated with hyperuricemia was obesity (PR : 7.21; IK 95% : 2.30 ? 22.60;p = 0.001), and chronic kidney disease stage 4 (PR : 74.73; IK 95% : 8.19 ? 681.60; p < 0.001). Age, alcohol consumption andchronic kidney disease stage 1 ? 3, hypertension not significantly associated with hyperuricemia in this population. Conclusion:high purine consumption was associated to hyperuricemia.
INSUFISIENSI ADRENAL PADA PASIEN DENGAN PENYAKIT KRITIS Mariadi, I Ketu; Gotera, Wira
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

Stress from many sources, including pain, fever, and hypotension, activates the hypothalamic-pituitary-adrenal (HPA)axis with the sustained secretion of corticotropin and cortisol. Increased glucocorticoid action is an essential component of thestress response, and even minor degrees of adrenal insufficiency can be fatal in the stressed host. HPA dysfunction is a commonand underdiagnosed disorder in the critically ill. We review the risk factors, pathophysiology, diagnostic approach, and managementof HPA dysfunction in the critically ill
MANIFESTASI DISFUNGSI BEBERAPA HORMON DARI SEORANG PENDERITA DENGAN RIWAYAT ADENOMA HIPOFISIS Haryant, Elizabet; Gotera, Wira
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

The sellar region is a site of various types of tumors. Pituitary adenomas are common neoplasms of the anterior pituitarygland. They arise from epithelial pituitary cells and account for 10-15% of all intracranial tumor. The remaining one-third ofpituitary adenomas is endocrinologically silent, known as nonfunctioning pituitary adenomas, and cause symptoms or signs dueto tumor growth. Incidence of pituitary adenomas is difficult to know with certainty because they are often asymptomatic;autopsy estimates range from 2.7 to 27%. There is not a predominance in either men or women. An increasing proportion ofpituitary adenomas are recognized in the elderly, raising the question of their optimal diagnosis and management. However, theadvent of the sophistical imaging systems for the brain such as the CT and MRI scans have greatly contributed to the earlydetection of these tumors. This is our reported case the occurrence of many endocrinology disorders with a pituitary adenoma. A79 year old male with a known pituitary macroadenoma, who presented with a chief complaint shortness of breath and took adouble dose of costison a view days ago. The related symptom also decreased libido and progressive impotence, mild coldintolerance and decreased appetite. Physical exam was notable for a BP of 180/115, pulse of 120 (with significant orthostaticchanges), pallor, bilateral gynecomastia He also complained of generalized fatigue and weakness. He had history at 1988 withCVA and got euthyrox for the hypotiroidsm. In 1998 was hospitalized on Danderyds Hospital with diagnosed adenoma pituitaryfrom the CT-Scan, and got trombyl 180 mg 2 x 1 tablet, triatec 4 x 5 mg, omeprazole 4 x 20 mg, duroferon 4 x 100 mg, and alsonibido 4 ml every 4 month. On 2005 he developed a severe and sudden headache, disorientation, weakness and fever. Thelaboratory result were testosteron 15 mmol/L (10-30 mmol/L), prolaktin 17 µg/L (normal 3-13 µg/L), tyrotrhopin TSH (thyroidstimulating hormone) 0,15 mE/L (normal 0.4-3.5 mE/L), S-IGF-I 57 µ/L (normal 85-220 µ/L) TSH 0,075 mE/L (normal 0.4-3.3mE/L), FT4 9 pmol/L (normal 8-16 pmol/L), kortisol 98 nmol/L (normal, 08.00 am; 200-700 nmol/L, 10.00 pm; 50-200 nmol/L),the echocardiografi was EF(ejection fraction) 35-40%, angiografi with striktur on proximal LAD. For the second CT-scan wasfounded the increasing size of the adenoma pituitary 3 x 4 centimeter. Because of the presence and the past history also supportingwith another laboratory and rontgen examination. The diagnosis of a clinically nonfunctioning pituitary adenoma with hypogonadismtipe was made, but now with conditions acute heart failure, pleural effusion and bronchopneumonia. Nonfunctional pituitaryadenomas, also called null-cell adenomas, are the most common macroadenomas (> 1 cm). Nonfunctional adenomas usuallypresent with local mass effects (e.g., optic chiasm compression), neurologic symptoms (cranial nerve III, IV and VI palsies) andpituitary hormone deficiencies (e.g., hypogonadism). Headache, nausea, vomiting, ophthalmoplegia and reduced level ofconsciousness, can occur in patients with large pituitary adenomas who suddenly deteriorate clinically. Pituitary apoplexy, a lifethreateningsudden hemorrhage or infarction of a pituitary adenoma characterized by severe. The majority of patients with pituitary adenomas present with signs and symptoms reflecting excess hormone production. This case illustrates one of the many type frompituitary adenoma and also the another conditions that can addition severity of the disease. The professional clinical examinationshould be done for decreasing the mortality
PERBANDINGAN BEBERAPA METODE DIAGNOSIS ANEMIA DEFISIENSI BESI: usaha mencari cara diagnosis yang tepat untuk penggunaan klinik Suega, Ketu; Bakta, I Made; Adnyan, Losen; Darmayuda, Tjok
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

Iron deficiency anemia (IDA) is the most widespread public health problems. In 1989 WHO report more than one third ofworlds population suffered from anemia and half of them with iron deficiency anemia. Iron deficiency anemia can cause reducedwork capacity in adults and impact motor and metal devolepment in children and adolescents. It also can increase risk of infection,mother mortality rate, affects cognition in adulescents girls and causes fatique in adult women. IDA may affect visual andauditory functioning and is weakly associated with poor cognitive development in children. The diagnosis of IDA requires properclinical manifestation, laboratory evidence and also others diagnostic test that support iron deficiency. There are some diagnostictests frequently use in clinical practice to diagnose IDA, such as the morphology of erytrosite, examination of serum iron andtotal iron binding capacity, examination of feritin serum, and bone marrow staining. Knowing the best of diagnostic methods canuse in clinical practice and also knowing the profile of IDA, can leads into better management of IDA in population. A diagnostictest was done in order to know the sensitivity and spesifity of erytrosite index, serum iron, TIBC, and feritin serum in dignosticIDA. The study was done at Internal Departement, Sanglah Hospital for 6 months, start from March 2003 until October 2003.The result is Feritin has the best sensitivity (90.6%) and specificity (90.6%) , with cut off point 35.4 µg/l. MCH as erytrosite indexhas sensitivity (84.4%) and specificity (75%) to diagnose IDA, the cut off point is 21.8 pg . Sensitivity and specificity of TIBC is81.3% and 83.8% with cutt off point 282 µg/l. Sensitivity and specificity saturation of transferin is 84.4% and 79.7% with cuttoff point 6%. Serum iron has sensitivity 75.0% and specificity 68.7% with cut off point 17 µg/l.
PENYAKIT MIELOPROLIFERATIF Putra Sedana, Made; Wulansari, T. Ivone
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

Myeloproliferative disorder (MPD) represent a group of disease marked by cellular proliferation of one or morehaematologic stem cells which include polycythemia vera, essential thrombocythemia, chronic idiopathic myelofibrosis withmyeloid metaplasia / MMM, hypereosinophillic syndrome / HES, unclassified myeloproliferative disease / U-Mpd, chronicmyelogenous leukemia / CML and chronic neutrophylic leukemia / CNL. The incidence and pathogenesis are still unknown.Chronicity which alterable to aggressive phase become acute leukemia and clonal cytogenetic abnormalities in erythroblast,neutrophyl, basophyl, macrophage, megakaryocytes and B-lymphocytes, but not in fibroblast are characteristics of the disease.Haematopoeisis is marked by autonomically growth and myeloid hyperplasia in bone marrow. Bone marrow aspiration showtrilineage hypercellularity. The complications include thrombotic phenomenon, micro and macrovascular arteries thrombosis,bleeding phenomenon, hypercatabolism and transformation into acute myelogenous leukemia / AML. Pseudocoagulopathy,pseudohyperkalemia, pseudohyperacydphosphatemia, pseudohypoglicemia and pseudohypoxemia can be seen.
HUBUNGAN FERITIN SERUM DENGAN KADAR IL-2 PADA PENDERITA ANEMIA DEFISIENSI BESI Losen Adnyan, I Wayan; Bakta, I Made; Suega, Ketut; Darmayuda, Tjok Gde
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

Iron deficiency anemia is one of the most common single nutrient deficiency in the world, impairs lymphocyte proliferationin humans and laboratory animals. The mechanisms are not fully understood. Cellular iron availability modulates the differentiationand proliferation of Th-1 and Th-2 subsets. Th-1 clones are very sensitive to treatment with antitransferrin receptor antibodies,resulting in inhibition of their DNA synthesis. Th-1-mediated immune effector function may be much more sensitive to changesin iron homeostasis in vivo. Th-1 produce IFN- and IL-2. The effects of iron deficiency on immunity remain controversial. Crosssectional study was performed to determine the relationship between iron status (serum ferritin) and IL-2 production in patientswith iron deficiency anemia. This relationship was assessed in 33 adult patients. Infection, malnutrition, malignancy, acute bleedingand using immunosuppressive medicines were excluded. Iron deficiency anemia was defined by Kerlin et al criteria. Serumferritin was measured by immunometric assay and IL-2 was measured by immunoassay solid phase ELISA. The mean of Hb was6.27 ± 2.19 g/dL, serum ferritin 30.07 ± 49.41, IL-2 2.26 ± 1.30. The most causes of this anemia were chronic bleeding i.e. pepticulcer, ancylostomiasis, menorrhagia, hemorrhoid and hematuria. There was not correlation between serum ferritin and IL-2 (r =0.118; p = 0.512). There was not correlation between Hb and IL-2 too (r = 0.220; p = 0.219). Lack of the correlation may be causedby some conditions i.e. without activated T cell, inadequately controlled the other trace elements or co-morbid diseases. Our datasupport that there is not correlation between serum ferritin, Hb and IL-2 production by lymphocyte without stimulation. Furtherprospective studies are needed to determine relationship between iron status and immune function.
PENDEKATAN DIAGNOSTIK DAN TERAPI DIARE KRONIS Wiryan, NGP Cilik; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

Diarrhea is defined as a change in bowel habit, with an increase in stool frequency or fluidity or both, more than 3 timesdaily or stool weight > 200 g/day. Acute diarrhoe if it is less than 2 weeks of duration, persistent if between 2-4 weeks in duration,and Chronic if it is more than 4 weeks in duration. Diarhoea is a common problem around the world. Chronic diarrhea morecompleksabout diagnosis and treatment than acute one. The pathophysiiological mechanisms chronic diarhoea divided into major grouposmotic, secretory and imflamtory. A carefull history will often suggest the diagnosis and direct investigations. Physical examinationmore usefull to measure the severity of diarhoe rather than suggest the cause of chronic diarhoea. Iinitial investigation includeblood test, serology for celiac ds, stool examinations. Small intestinal and colon ds need for enteroscopy, capsul endoscopy,sigmoidoscopy, colonoscopy, many test for non invasive for malabsorption. In specific clinical conditions need specific examinationtoo. Small Intestinal Bacterial Overgrowth can be diagnosed directly by culture from aspiration of duodenal fluid or indirectly byusing breath test. Bile acid malabsorption can be diagnosed by by measured bile acid radioactif labelled measured of metaboliteserum, and bile acid excretion. Lactose malabsorption can be diagnosed by lactose assay, breath test (hydrogen 14C Lactose and 13C lactose). Increasing orocaecal transit time diagnosed by using barium study, radionucleide scintygraphy, lactose hydrogenbreath test. Chronic diarrhoea due to increasing hormones producing tumours diagnosed by measured increasing level of hormonesin to serum. Investigations patients with chronic diarrhoea available in the ambulatory or hospitalised patients. Treatment ofchronic diarrhoea depends on the specific aetiology and may be curative, suppressive or empirical.
HUBUNGAN RESISTENSI INSULIN DENGAN KADAR NITRIC OXIDE PADA OBESITAS ABDOMINAL Cahjono, Heru; Gde Budhiarta, Anak Agung
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

Numerous studies that confirmed the important link between central obesity and endothelial dysfunction (ED) is furthersupported by the concept that insulin sensitivity is partly determined by the ability of endothelium to produce nitric oxide (NO).In this condition, HOMA-IR, the model which is a convenient means of evaluating insulin resistance has thus far been related toED. Nitric oxide plays important physiological roles in the endothelium, where free radical NO is synthesized from the aminoacid l-arginine by endothelial constitutive NO synthase (eNOS) and released. Endothelium-derived NO is a potent vasodilator aswell as an inhibitor of platelet aggregation and adhesion, and is associated with the development of cardiovascular disease (CVD)in the presence of endothelial dysfunction (ED), which plays an early and prominent role in atherosclerotic plaque formation. Weraised the question as to whether insulin resistance in the abdominal obesity group had association with NO levels contribute toaffect endothelial dysfuntion. Cross sectional study had been conducted during January until March 2007. The study involved 67employees at Sanglah Hospital with abdominal obesity using criteria for Asian people (male WC 90 cm; female WC 80 cm).Serum concentrations of NO metabolites were evaluated through the measurement of metabolic end products, ie, nitrite andnitrate, using enzymatic catalysis coupled with Griess reaction, Serum concentration of insulin was measured by immunoassaymethod. Plasma glucose, cholesterol, HDL-cholesterol, LDL-cholesterol and triglicerydes were determined by enzymatic procedureafter overnight fast. The study involved 45 female and 25 male subjects, 23-56 years of age. Insulin resistance had associationwith waist circumference (r=0,511; p <0,01) and there was no association between insulin resistance and NO titer (r=0,054;p<0,664) but after adjusted with ESR 20-30 mm/h r=-0,486; p<0,048. However, serum concentrations of NO did not have associationwith component of metabolic syndrome and neither did insulin resistance. The present data indicate there is no associationbetween insulin resistance and NO levels except for ESR 20-30 mm/h. This possibility is due to low grade chronic inflammationrole on the pathogenesis of endothelial dysfunction in obesity
KOMPLIKASI PASKA TRANSPLANTASI GINJAL Juliana, I Made; Sidharta Loekman, Jodi
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

Renal transplantation is the take over of kidney from healthy person and then be transplanted to the other person who hassevere and permanent kidney function disorder. Renal transplantation is the most effective treatment for terminal stage of chronickidney disease. The survival of patients who underwent renal transplantation depend on some factors including screening ofpatients, pretransplantation management, surgery technic and management of patients after renal transplantation. Complicationsafter renal transplantation devide to surgery complications and non surgery (medical) complications. Surgery complications aremayor complication such as bleeding and anaestesion drug effect and the other complications due to transplantation process.Medical complications are rejection (hyperacute, acute and chronic rejection), infection, cardiovascular disease, anemia,hypertension, diabetes mellitus, dislipidemia, hyperhomocysteinemia, malignancy, lymphoproliferative disease and psychologicaleffect. Rejection is the most important complication. If hyperacute rejection ocured, kidney transplant must be take over to avoidmore severe systemic inflammation respon. New generation of humanized IL-2 receptor antibody, daclizumab (zenapax) candecrease the incident of hyperacute rejection. Acute rejection can be treated with steroid, polyclonal antilymphocyte globulin,monoclonal antibody OKT3 and plasma exchange. Chronic rejection was difficult to treat. Immunosupresion agen have no muchrole because destroyed were occured. Prevention just to manage risk factors and then wait the other transplantation. For the othercomplications, the management based on etiology and the type of complication.

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