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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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EFUSI PLEURA MALIGNA: DIAGNOSIS DAN PENATALAKSANAAN TERKINI Ngurah Rai, I B
journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

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Abstract

Malignant pleural effusions (MPE) are an important complication for patients with intra and extrathoracic malignancies.MPE are also a complication of far advanced malignancies or as the initial manifestations of an underlying malignancy, withmore than 150.000 cases/year in America. Median survival after diagnosis of an MPE is about 4 months. Although almost everytumor can cause it, more than 75% of MPE caused by malignancies at lung, breast, ovaries, mesotheliomas and lymphomas. Thestandard management approach begins with a diagnostic and or therapeutic thoracentesis. New imaging modalities help us todiagnose MPE, however positive cytologic conÞ rmation is necessary to establish a diagnosis. But, there are difÞ culties to Þ nd theetiology and deal with rapid recurrences of MPE. It is where several biomarkers took place in diagnosing MPE. Managementsof an MPE remain palliative. Several options include thoracenteses, pleurodesis, continuous outpatient drainage with indwellingcatheter, and pleuroperitoneal shunting. Recent studies focused on molecular marker and inß ammatory cytokine as a diagnostictool and target therapy for MPE. Many studies look for the role of EGFR (Epidermal Growth Factor Receptor), MCP-1 (monocytechemoattractant protein-1), VEGF (vascular endothelial growth factor), and TNF-  in diagnosing and possibly treat MPE.
PENGARUH SPIRONOLAKTON SEBAGAI TERAPI TAMBAHAN ACE INHIBITOR DAN/ATAU ANGIOTENSIN RECEPTOR BLOCKERS TERHADAP ALBUMINURIA PADA PENYAKIT GINJAL KRONIK PRADIALITIK STUDI KLINIS ACAK TERKONTROL BUTA GANDA -, Yuriawantini; Suwitra, Ketu; Raka Widiana, I Gde; Sidharta Loekman, Jodi; Sudhan, Wayan; Kandarini, Yenny
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Recently studies suggest that aldosterone contributes to progressive kidney disease. This has raised the possibility ofusing aldosterone antagonist in CKD. To evaluate effects of spironolactone 25 mg/day on albuminuria in CKD patients, thirtyCKD patients were enrolled in randomized double blind placebo controlled study. Permutted block randomization was done toreceive spironolactone 25 mg/day or placebo as control in addition to ACE inhibitors and/or ARBs. Albuminuria and bloodpressure were examined at baseline and 12 weeks. Albuminuria was measured as urinary albumin:creatinine ration and comparedas primary out come. During this study 15 patient were received conventional therapy and spironolactone 25 mg/day and 15patient were received placebo. One of patient dropped-out after 4 weeks due to hiperkalemia in spironolactone group and one ofpatient in the control group lost to follow-up. After 12 weeks of therapy, in spironolactone group albuminuria was decreased from510 (180.0 ? 798.0) to 254.0 (40.3 ? 491.8) mg/g, MD, 187.0 (29.0 ? 332.3) mg/g, p= 0.035 and in control group from 804.0 (52.0? 1126.0) to 637.0 (99.0 ? 1098.8) mg/g MD -10.5 (-186.5-86.0) mg/g, p= 0.490. There was significant difference of decreamentof albuminuria in both groups (Z=-0.69, p=0.046). There were no statistically different of serum potassium levels and bloodpressure in both groups after treatment. Baseline aldosterone levels were not significantly correlated with albuminuria (r = -0.128,p = 0.499). As Conclusion in this study is spironolactone reduces albuminuria in pradialytic CKD patients
PENGARUH VITAMIN C TERHADAP KADAR SERUM FERITIN PADA PASIEN GAGAL GINJAL KRONIK DENGAN HEMODILISIS REGULER Wiryani, Cilik; Suwitra, Ketut
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Abstract

Hyperferitinemia in chronic kidney disease patients with regular hemodyalisis may caused by repeated transfusion,excessive iron supplementations, and also inß ammation. Increasing of serum feritin level doesn!t depend on iron reservecapacity. Hemodialysis patients with no supplementations may lead to several antioxidant components deÞ ciency. Qualitative andquantitative of vitamin C deÞ ciency may also occur, thus administration 1 " 1.5 gram/week or 300 mg of vitamin C parenterallyevery dialysis session was recommended in order to compensate subclinical deÞ ciency.This study determine whether administration of vitamin C (500 mg, in NaCl 0.9%, every session of hemodialysis in 8weeks) can decrease serum feritin level in chronic kidney disease patients with regular hemodialysis. Randomized clinical trial,single-blind of 38 chronic kidney disease patients with regular hemodialysis was recruited based on inclusion and exclusioncriteria. Randomization in group with treatment was done with permuted block randomization. Mean of serum feritin before andafter treatment in every group was compared and analysed with Man-Whitney U test. SigniÞ cancy level () was with p less than0.05 (p < 0.05).The result of median and mean for decreasing of serum feritin in group with treatment of 500 mg, vitamin C is 0.00(-227.00 " 218.00) and 77.85 ± 383.25, respectively. While the result of median and mean for decreasing of serum feritincontrol group is 32.00 (-14.00 " 108.00) and 65.85 ± 209.6, respectively. On the analysis indicates median of serum feritinin group with treatment of vitamin C had less 32 points depends with control group (p = 0.84), Thus, there was no signiÞ cantdifference (p > 0.05) between two groups. From Anova analysis for gender, there was signiÞ cant effect in decreasing of serumferitin level (p < 0.05).There was no decreasing of serum feritin level after administration of 500 mg, vitamin C in chronic kidney diseasepatients with regular hemodialysis, and sex had signiÞ cant effect in alteration of serum feritin level.
HEPATIC ISCHEMIA REPERFUSION INJURY IN SEPSIS: BASIS PATHOGENIC MECHANISMS Suryadarma, I Gusti Agung
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Hepatic ischemia reperfusion injury is a complex patho-physiology with a number contributing factors. Ischemia insultcan lead to sublethal cell injury, which is aggravated by the formation of reactive oxygen from various intracellular sources duringreperfusion. In addition, formation of proinflammatory mediators and the recruitment and activation of macrophages, neutrophiland lymphocyte can further enhance the injury. Microcirculatory disturbances lead to underperfused areas in the liver and maycause ischemic injury. Hepatic IR injury involves interaction between different cell types and a variety of cellular and molecularmechanisms including kupffer cells activation, formation of ROS, release of cytokines and chemokines, neutrophil recruitment,mitochondrial permeability transition and pH paradox. There are two distinct phase of liver injury after warm ischemic reperfusion,such as early phases and followed by late phases. Clinical presentation of hepatic ischemic reperfusion injury in sepsis, includingsepsis-associated cholestasis, hepatitis ischemic, cholangitis lenta and progressive sclerosing cholangitis
THE ROLE OF NEOPTERIN AS A NOVEL BIOMARKER FOR REDUCED KIDNEY FUNCTION: A COMMUNITY BASED STUDY Widiana, G Raka; Suwitra, K; Effendi, Imam
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Abstract

Cardiovascular disease is a major complication for patents with reduced kidney function. Neopterin is well known as abiomarker for cardiovascular disease, however it is not clear whether it is associated with reduced kidney function. Study wascarried out in a Legian Kuta village a tourist town in Bali. Samples were underwent a series of interview, physical examinationand were taken blood samples for neoperin and creatinine tests. Neoptein concentrations were tested for its normal distributionand associated with C-G formula for estimated glomerular filtration rate. Cut-off value for prediction of reduced renal functionwas rested using ROC curve, and calculated for sensitivity, specificity.Seventy nine samples were selected through cluster random sampling from 284 residents (177 males and 107 females)with age 46 ± 10 years, body weight 67 ± 13 kg and height 162 ± 9 cm. It was shown that neopterin concentration was normallydistributed (K-S Z = 1.175, p = 0.126), with mean 6.66 ± 3.35 ng/ml and e-GFR was 89 ± 25 ml/mnt. There was significantnegatively correlation between neopterin concentrations and e-GFR (R = -0.26, Rsq = 0.068, p = 0.021), using regressionequation it was revealed that every 1 unit increased of neopterin concentrations produce 1.42 decrease of e-GFR. Using ROCcurve, neopterin was accurately detect reduced kidney function defined as e-GFR of 60 ml/mnt or less (AUC = 0.88; 95%CI0.74 to 1.00; SE = 0.07; p = 0.02). Using 7.46 ng/ml as cut-off value for normal neopterin concentrations, it was showed thatsensitivity and specificity were 100% and 72% to detect the presence of reduced kidney function, consecutively. Neopterin maybe used as a novel biomarker for reduced kidney function, for its role in the pathogenesis of cardiorenal syndrome in generalpopulation.
SEORANG WANITA DENGAN URTIKARIA KRONIK IDIOPATIK Suryana, Ketut; Suastika Adiguna, Made
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Urticaria is characterized by red edematous plaques surrounded by a clear or red halo. The lesions are round or oval andmay become polycyclic when confluent. They usually multiple and vary from 1 mm to several centimeters in diameter. They canoccur at any site of the body and are typically associated with itching and sometimes burning. Skin returns to its normalappearances usually within 1-24 hours. Urticaria is sometimes accompanied by angioedema, in which the edematous processextends into the deep dermis and / or subcutaneous tissues. While patient with urticaria usually have symptoms confined to theskin they may have concomitant systemic manifestations. Urticaria is termed acute when episode less than 6 weeks, it’s termedchronic when episode persist longer. Chronic urticaria / angioedema, the syndrome last and average of 3-5 years, with 20%patients still symptomatic at 40 years. The syndrome is frustrating to patient and clinician alike in death a search for an exogenouscause is futile in the majority of patients. However in recent year its has been demonstrated that many patients involved idiopathicchronic urticaria (80% of the chronic type urticaria). The incidence of idiopathic chronic urticaria was 3% population. Thediagnosis, there is no the specific approach. Mostly based on clinical history and several laboratory procedure and in certaincondition need skin biopsy. The management; allergen avoidance, medicamentosa symptomatically. The first line; non sedatingsecond-generation AH-1 and in a several case add by antihistamine AH-2. in severe case sometimes need the corticosteroids oranother immunosuppressive.
ASOSIASI ANTARA POLUSI UDARA DENGAN IgE TOTAL SERUM DAN TES FAAL PARU PADA POLISI LALU LINTAS Fahimi, Mukti; Dharma S, Bayu; Fetarayani, Deasy; Baskoro, Ari; Soegiarto, Gatot; Effendi, Chairul
journal of internal medicine Vol. 13, No. 1 Januari 2012
Publisher : journal of internal medicine

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Abstract

Ambient air pollution often associated with allergic diseases and impaired respiratory function. Total serum IgE levels was  one  of  the  diagnostic  tools  to  establish  an  allergic  diseases while  lung  function  test was  standard  examination to establish alteration in lung function. Trafc police ofcers were often assigned on the highway is one of the mostvulnerable population against exposure to air pollution. Aim of this study isto know the association between air pollution on total serum IgE levels and lung function in trafc police ofcers compared to staff police ofcer as control.This is anobservational analysis study with cross sectional design.There were 60 police ofcers as a subject, divided in two groups.Thirty subjects as exposured groups and 30 subjects as control group. Air pollution was measured by Pollutant StandardIndex (PSI)/ Indeks Standar Pencemar Udara (ISPU) method. Independent  t-test and Mann-Whitney  test were used  to analyze differences between variabel. Spearman test was used to analyze correlation and strength between variabel.There were no signicant differences in total IgE serum levels between groups (p = 0.301). There were signicant differencesin FEV1 (%p) (p = 0.015), FVC (%p) (p = 0.000) and spyrometry result (p = 0.001). There was no signicant differencein FEV1/FVC ratio (p = 0.573). There were negative weak association between air polution and FEV1 (%p) (r = -0.298;p=0.021) and between air pollution and spyrometry result (r = -0.380; p = 0.003). There was negative moderate associationbetween air pollution and FVC (%p) (r = -0.409; p = 0.001). There was no association between air pollution and FEV1/FVC ratio (r = 0.058; p = 0.662). There was signicant association between air pollution and impaired respiratory functionbut there was no association between air pollution and total serum IgE levels.
EFFECT OF POLYETHERSULFONE COMPARED TO CELULLOSE DIACETATE DIALYZER MEMBRANE ON SERUM INTERLEUKIN-6 AND C-REACTIVE PROTEIN LEVES IN HEMODIALYSIS Raka Widiana, I Gde
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Synthetic dialyzer membrane is considered to have greater biocompatibility properties than cellulose based dialyzermembrane. This study is aiming to determine whether the use of polyethersulfone synthetic dialyzer (PES) membrane producelower inflammatory (IL-6 and CRP) response compared to celullose diacetate (CDA).Study samples were selected consecutively from all kidney failure patients who were undergoing routine HD at HDcenters in Denpasar Mayoralty. Thirty HD patients consisted of 15 with PES (11 males and 4 females, aged 45 ±10 years) and 15patients with CDA (8 males and 7 females, aged 48 ±13 years) were included in this study.A significant increase of plasma IL-6 per 1000 monocytes (Z=-4.103, p=0.003), from18.56±21.00 pg/dl before HD to56.00±105.41 pg/dl after HD among two groups was found. When the increase of plasma IL-6 per 1000 monocytes duringhemodialysis was compared bewteen the two groups, a significant higher increase of plasma IL-6 per 1000 monocytes in CDAgroup compared to PES group (71.47±142.51 pg/dl versus 3.38±4.46 pg/dl, Z=-2.883, p=0.003). There was no significant increaseof plasma hs-CRP levels before-after HD among both groups. Also, there was no significant difference of plasma hs-CRPchanges during HD between the two groups. Using multivariate ANCOVA, a consistent effect between the two membrane (F=18.401,p=0.000) on logistic transformed of plasma IL-6 per 1000 monocytes changes. However, this effect was not significant (F=1.937,p=0.176) on logistic transformed of plasma hs-CRP changes. It was found that plasma levels of pre HD albumin related to logistictransformed of plasma IL-6 per1000 monocytes (F=5.610, p=0.026), however, there were no relationship between HD factor(KT/V) and HD age (months), with logistic transformed of plasma IL-6 per 1000 monocytes changes.Increament of plasma IL-6 levels per 1000 monocytes during HD is smaller, however, changes of plasma hs-CRP levelsduring HD is similar among HD patients with PES than CDA membrane. In addition, plasma levels of pre HD albumin may affectplasma IL-6 changes during HD.
PREVALENSI SINDROMA METABOLIK PADA POPULASI PENDUDUK BALI, INDONESIA Dwipayana, M Pande; Suastika, K; Saraswati, IMR; Gotera, W; Budhiarta, AAG; -, Sutanegara; Gunadi, IGN; Badjra Nadha, K; Wita, W; Rina, K; Santoso, A; Kajiwara, N; Taniguchi, H
journal of internal medicine Vol. 12, No. 1 Januari 2011
Publisher : journal of internal medicine

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Abstract

An epidemiological study on metabolic syndrome (MS) in seven villages population of Bali (6 villages and 1 suburban),Indonesia have been conducted. One thousand eight hundred fourty (age, 13 " 100 year; M/F, 972/868) subjects were recruitedin the study. Criteria for obesity was based on WHO for Asia PaciÞ c population (2000) and for MS based on a joint statement ofIDF, NHLBI, AHA, WHF, and IAS (2009). The prevalence of central obesity based on waist circumference (WC) was 35% (M,27.5%; F, 43.4%) and MS was 18.2% (M, 16.6%; F, 20.0%).Waist circumference, as a central role in metabolic syndrome, hassigniÞ cant correlation with other components of metabolic syndrome, i.e. diastolic blood pressure (R = 0.129; p &lt; 0.001), fastingblood glucose (R = 0.088; p &lt; 0.001), HDL cholesterol (R = -0.066; p = 0.006), triglyceride (R = 0.349; p &lt; 0.001), and totalcholesterol (R = 0.179; p &lt; 0.001).Of the study could be concluded as follow: the prevalence of obesityand MS were relativelyhigh; Waist circumference was correlated with other components of metabolic syndrome and the best parameter for predictingmetabolic syndrome.
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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