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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 162 Documents
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EVALUASI PROSPEKTIF KADAR NEUTROPHIL GELATINASE- ASSOCIATED LIPOCALIN URIN DAN KREATININ SERUM PASIEN ACUTE KIDNEY INJURY PASKA PEMBEDAHAN Arya Nugrah, Putu; Sudhana, I Wayan
journal of internal medicine Vol. 13, No. 1 Januari 2012
Publisher : journal of internal medicine

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Abstract

Acute Kidney Injury (AKI) is a common clinical nding that produces some serious health problem. Since the previouslydecades, the identication of AKI clinical practically based on laboratory test as Blood Urea Nitrogen (BUN) and Serum Creatinin (SC). Unfortunatelly, SC is not a reliable indicator of AKI in acute phase. Neutrophil Gelatinase-AssociatedLipocalin (NGAL) is promisingly for an early biomarker of ischemic kidney injury. After performing the inclusion criteriaand exclusion criteria, samples are underwent the operation then admitted to the ICU ward. Samples were followed andunderwent serially laboratory examination of urine NGAL, SC and urine output according to the timetable of the research.Mean concentration of SC before operation and hour 0 hour, 6 hours, and 24 hours after operation for non AKI patientswere as follow 0.83 ± 0.19 mg/dl; 0.83 ± 0.19 mg/dl; 0.89 ± 0.18 mg/dl; and 0.88 ± 0.25 mg/dl. And for AKI patients were0.86 ± 0.21; 0.81 ± 0.20 mg/dl; 1.01 ± 0.20 mg/dl; and 1.84 ± 0.75 mg/dl. Mean concentration of urine NGAL on 0 hour, 3hours, and 6 hours post operation non AKI patients were as follows 26.0 ± 27.7 ng/l; 24.4 ± 23.0 ng/l; and 32.6 ± 42.4 ng/l.While in AKI patients were 809.4 ± 379.0 ng/l; 732.0 ± 450.0 ng/l; and 651.4 ± 432.0 ng/l. The elevated concentration ofurine NGAL among cases of AKI occurred earlier than the elevated concentration of SC.
HUBUNGAN ANTARA STADIUM KEGANASAN NON-HEMATOLOGI DENGAN D-DIMER SEBAGAI INDIKATOR KEJADIAN TROMBOSIS Wantera, I Putu; Bakta, I Made
journal of internal medicine Vol. 10, No. 1 Januari 2009
Publisher : journal of internal medicine

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Abstract

Thrombotic complications are among the most common causes of death in patients with malignancy. D-dimer level is apersistent hemostatic activity sign and a predictor of a repeated thrombosis. This study was cross sectional study to knowcorrelationthe level of D-dimer with the clinical stages of non-hematologic malignancy.Forty three consecutive patients with non-hematologic malignancy. All patients underwent D-dimer testing. The relationshipsbetween D-dimer and stages of non-hematologic malignancy were analised by spearman correlation.43 patients with non-hematologic malignancy, 8 (18.6%) were in stage II with median D-dimer 445.0 mg/dL (226.25 Ð 959.25), 28(65%) were in stage III with median D-dimer 1012.0 mg/dL (454.00 Ð 1632.75), 7 (16.3%) were in stage IV with median Ddimer666.0 mg/dL (590.00 Ð 1721.00). Of 43 patients, 5 (11.6%) were with nasopharynx malignancy and median D-dimer level628.0 mg/dL (380.00 Ð 3214.50); 19 (44.2%) were with cervix malignancy and median D-dimer 849.0 mg/dL (344.00 Ð 1458.00);7 (16.3%) were with mammae malignancy and median D-dimer 617.0 mg/dL (380.75 Ð 1370.75); 4 (9.3%) were with lungmalignancy and median D-dimer 1758.0 mg/dL (897.00 Ð 4361.00); 8 (18.6%) were with other malignancies and median D-dimer675.3 mg/dL (412.0 Ð 1208.50). Median D-dimer levels had a tendency to increase as the stages of non hematologic malignancywere higher. However, D-dimer had no correlation to stages of non hematologic malignancy (correlation spearman 0.157; p=0.313 ).There is no correlation between D-dimer level and stages of non hematologic malignancies as an indicator of thrombosis.But there was a tendency of increasing level of D-dimer as the stages were increasing
KESULITAN DIAGNOSIS DAN TERAPI PADA LIMFOMA PANKREAS DISERTAI SINDROMA KAUDA EQUINA Ridwan, Muhammad; Dharmayuda, Tjokorda Gde
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Lymphoma, part of non-Hodgkin’s lymphoma, is a rare malignancy in pancreas. Its clinicalpresentations and supporting laboratory and imaging results are similar to those of pancreas adenocarcinoma.Apart from pancreas, extranodal type of non-Hodgkin can involve many other organs including bone marrows,nervous system, and kidneys. Treatment should be focused on emergency priority and the underlying cause. Inthis case report, we have documented a 44 year-old man who initially presented jaundice and abdominal massand then diagnosed with pancreas tumor. However, pathology anatomy and histochemistry examinations ofperipancreas tissue biopsy and indicated a non-hodgkin lymphoma of pancreas, in form of diffuse large B celllymphoma, intermediate grade. The patient was developing cauda equina syndrome a week after laparotomy.Discussion among team suggested that both conditions may have the same root: lymphoma. The patient wasthen put on CHOP regiments of chemotherapy program and later, also underwent a spinal decompressionprocedure. Overall, jaundice, abdominal mass and other related symptoms subsided, and quality of lifeimproved, although some cauda equina symptoms remained.
HUBUNGAN C-REACTIVE PROTEIN DENGAN PEMANJANGAN PROTHROMBIN TIME PADA PASIEN SIROSIS HATI YANG MENGALAMI PERDARAHAN SALURAN MAKANAN BAGIAN ATAS Mariadi, IK; Wibawa, IDN; Purwadi, N; Suryadarma, IGA
journal of internal medicine Vol. 12, No. 1 Januari 2011
Publisher : journal of internal medicine

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Abstract

Bacterial infections are common complications in cirrhosis, and cause the systemic in! ammation process. The natureof the relationship between gastrointestinal bleeding and infection in cirrhosis has not been clari" ed. Infection is associatedwith failure to control variceal bleeding and early variceal rebleeding in these patients. Bacterial infections, and particularlyendotoxemia, have been shown to activate the coagulation system and generally to interfere with hemostasis. We performedcross-sectional analytic study in cirrhosis patients with upper gastrointestinal bleeding to assess whether there are any associationbetween in! ammation process (CRP) with defect in haemostatic system (prolongation in prothrombin time). Forty-nine patientswere evaluated, 37 (75.5%) out of these were male and the rest were female. Ninteen out of this with in! ammation process and30 without in! ammation process. Fourteen out of 19 patients (73.7%) in in! ammation group have prolongation on prothrombintime and 12 out of 30 patients (40%) in non in! ammation group have prolongation on prothrombin time. The difference of thisproportion statistically signi" cant (Chi-square test X2: 5.29; p = 0.021). The CRP also have positive correlation with prolongationin prothrombin time (Spearman correlation R = 0.390; p = 0.006). In conclusion there is signi" cant association between CRP andprothrombin time in cirrhosis patients with upper gastrointestinal bleeding.
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
HUBUNGAN ANTARA BEBERAPA PARAMETER ANEMIA DAN LAJU FILTRASI GLOMERULUS PADA PENYAKIT GINJAL KRONIK PRADIALISIS Paramita Ayu, Nyoman; Suega, Ketut; Raka Widiana, Gede
journal of internal medicine Vol. 11, No. 3 September 2010
Publisher : journal of internal medicine

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Abstract

Anemia is one of chronic kidney disease (CKD) complication and it affects many organs including cardiovascular. Earlydetection and evaluation are important to prevent more serious complications. There is scarce data with regard about correlationbetween anemia and glomerulus ltration rate (GFR) in pradialysis CKD.Aim of this study is to determine correlation between anemia parameters and GFR, also prevalence of anemia in pradialysisCKD in Sanglah Hospital, Denpasar-Bali. An analytical cross sectional study was carried out in Sanglah Hospital. Samples wereselected through simple random sampling.Eighty samples (58 males and 22 females, aged 54 ± 10 years) were included. Prevalence of anemia, serum iron belowthan 50 ug/dl, transferrin saturation below than 20% and erythropoietin below than 5 mIU/ml was 41.3%, 25%, 20%, and 25%respectively. Using Pearson?s analysis, there were signicant correlation between haemoglobin (r = 0.76, p = 0.00) and serumiron (r = 0.29, p = 0.01) with LFG. Using linier regression entering those variables into model, it found formula haemoglobin= 7.63 + 0.13GFR (R-square = 0.58, p = 0.00) and serum iron = 54.71 + 0.48GFR (R-square = 0.08, p = 0.01). There wassignicant correlation between haemoglobin and serum iron with LFG. Forty one percent pradialysis CKD patients had anemiacomplication.
TES PROVOKASI (TP) SEBAGAI UPAYA PENDEKATAN DIAGNOSIS DUGAAN ALERGI OBAT PADA SEORANG PENDERITA TB PARU YANG DITERAPI DENGAN OBAT ANTI TUBERKULOSA KATEGORI I Duarsa, Reny S.P.; Suryana, Ketut
journal of internal medicine Vol. 7, No. 3 September 2006
Publisher : journal of internal medicine

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Abstract

Drug allergy is an unpredictable adverse reaction which is based on immunologic reaction. This event accounts foraround 5 to 10 % of the total number of adverse reaction to drug events. Diagnostic approaches to drug allergy are based ondetailed anamnestic questions, chronology of events, physical diagnostics and are also supported by other examinations such asskin prick test, skin patch test, radioallergosorbens test (RAST) and drug provocation test (DPT). DPT is still the gold standard fordrug allergy test and is done if other tests cannot confirm a significant conclusion. Nonetheless, this procedure is a dangerouscourse of action. Hence close coordination with intensive care unit and retaining informed consent should be done ahead of time.In this paper, we will examine a specific case in which DPT test is used to find out the drug which had caused an allergic reaction.It is shown in this paper, we are able to conduct a safe diagnostic procedure as long as we take into consideration the risk andbenefit for each patient. In this paper, we also point out about indication, contraindication, when to perform the test, test method,interval - dose, test preparation, and what kind of conclusion could be taken from the test.
OSTEOPOROSIS PATOGENESIS DIAGNOSIS DAN PENANGANAN TERKINI Kawiyana, I Ketut Sik
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Abstract

Osteoporosis is a bone metabolic disease, which is characterized by decreased bone mass due to reduced bone matrixand mineral, accompanied by micro architecture derangement of the bone tissue. Hence, in this disorder the bone has the tendencyto fracture due to low bone quality. Cell which responsible for bone formation is osteoblast, whereas osteoclast is responsible forbone resorption. In osteoporosis, bone turn over is abnormalwhichbone resorption is greater than bone formation. Thereforedirect factors for osteoporosis are number and activity of osteoclast in resorbing bone, and they are influenced by mediators andthe mediators depends on estrogen level. Number and activity of osteoclast cell are greater than number and activity of osteoblastcell in osteoporosis. This imbalance causes decreasing bone mass. The pathogenesis of osteoporosis has been discussed by showingthe recent theories related to increase of osteoclast cellÕs differentiation and activity due to: estrogen hormon deficiency,cytokine factor and axial loading. Several means in diagnosing the risks for osteoporosis and itÕs current managements based onitÕs pathogenesis have been mentioned too.
PENGARUH PROPOLIS TERHADAP SEKRESI INTERLEUKIN-12 PADA SUPERNATAN KULTUR MAKROFAG DARI PENDERITA TUBERKULOSIS PARU YANG DIINFEKSI Mycobacterium tuberculosis Linawati, Made; Bagiada, Made
journal of internal medicine Vol. 10, No. 1 Januari 2009
Publisher : journal of internal medicine

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Abstract

The uses of adjuvan imunotherapy has attract the attention tuberculosis treatment, because of the increasing patientpersentage in antituberculosis agent. Propolis is bee glue, contain of caffeic acid phenethyl ester (CAPE) that assumeimmunomodulator activities. The aim of this study were to assess the role of propolis to interleukin 12 secretion in macrophagesculture from pulmonary tuberculosis patient that infected with Mycobacterium tuberculosis (M tb). This study was true experimentalusing post test only control group design, with sampel from peripheral blood mononuclear cells (PBMC) of lung tuberculosispatient that divided into 3 groups within 6 replication. Group I as control group without M tb infection and propolis intervention;group II treatment group with M tb infection only; and group III treatment with M tb infection and propolis intervention.Interleukin 12 secretion were measured 48 hours post M.tb infection. Result showed that means of interleukin 12 secretion atthese groups are 11 pg/ml; 23.33 pg/ml; 37 pg/ml in which intervention of propolis 10 mg/ml before M tb infection could increaseinterleukin 12 consentration significanly (p< 0.05) compared with control group and group with infection of M tb only. Weconclude that propolis could increases macrophages activities with in increase secretion of interleukin 12.
HIPONATREMIA PADA SEORANG PENDERITA DENGAN KECURIGAAN INSUFISIENSI ADRENAL Sri Yenny, Luh Gede; Gotera, Wira
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 135 mmol perliter. Hyponatremia can be associated with low, normal, or high tonicity. One cause of hyponatremia is adrenalinsufficiency. Serum sodium concentration is regulated by stimulation of thirst, secretion of ADH, feedbackmechanisms of the renin-angiotensin-aldosterone system, and variations in renal handling of filtered sodium.Increases in serum osmolarity above the normal range (280-300 mOsm/kg) stimulate hypothalamicosmoreceptors, which, in turn, cause an increase in thirst and in circulating levels of ADH. ADH increases freewater reabsorption from the urine, yielding urine of low volume and relatively high osmolarity and, as a result,returning serum osmolarity to normal. Aldosterone, synthesized by the adrenal cortex, is regulated primarily byserum potassium but also is released in response to hypovolemia through the renin-angiotensin-aldosterone axis.Aldosterone causes absorption of sodium at the distal renal tubule.In this report, patient is male, 64 years old, with probable adrenal insufficiency. Patient have very lowrespond to sodium teraphy. The sodium level increased and have good respond after corticosteroid teraphy.Patient have low level of cortisol serum (18,60 ?/dl) in critically ill condition.The possibility of adrenal insufficiency is of crucial importance in critically ill patients. If the diagnosisis missed, the patient will probably die. In such patients, a blood sample for the measurement of plasma cortisoland corticotropin should be obtained, a short corticotropin test (see below) should be performed, and immediatehigh-dose cortisol therapy should be considered or instituted. A plasma cortisol value in the normal range doesnot rule out adrenal insufficiency in an acutely ill patient. On the basis of a recent study of plasma cortisolconcentrations in patients with sepsis or trauma, a plasma cortisol value of more than 25 ?g per deciliter in apatient requiring intensive care probably rules out adrenal insufficiency, but a safe cutoff value is unknown.

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