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INDONESIA
journal of internal medicine
Published by Universitas Udayana
ISSN : -     EISSN : -     DOI : -
Core Subject : Health,
Medicine & Pharmacology
Arjuna Subject : -
Articles 162 Documents
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MIELOMA MULTIPEL TIPE IgA: LAPORAN LIMA KASUS Bakta, I Made
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Abstract

Five cases of IgA MM (IgA multiple myeloma) have been reported. All cases showed clinical features of MM ingeneral. Increase of immunogloblulin fraction, characteristically showed M-spike in beta region, associated with high level ofIgA in serum. Plasma cell > 10% in marrow were found, with end-organ lesions, known as CRAB (hypercalcemia, renal failure,anemia and bone lesions). Anemia and bone lesions have been found in all cases. All cases fulfiled diagnostic criteria of Kyle andGreip and International Multiple Myeloma Working Group, as well. Stage III of Durie and Salmon staging system was found inall cases. Only one case could be classified in a newer staging system, International Staging System. Case no. 5 could be classifiedas stage II. Conventional regiment with melphalan and prednison has been given to the cases. Partial remission has been achievedin case no.1, no. 4, and no. 5.It could be concluded that the clinical features of IgA MM are the same as IgG MM. In laboratory findings, M-spike wasfound in beta-region in serum protein electrophoresis (SPE) of all IgA MM cases, other than in gamma-region as in IgG MM. Thelevel of IgA in serum was also higher than IgG.
ASPEK PULMONOLOGIS INFEKSI OPORTUNISTIK PADA INFEKSI HIV/AIDS Agustriadi, Ommy; Sutha, Ida Bagus
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Human Immunodeficiency Virus (HIV) known as etiologic agent for AIDS (Acquired Immunodeficiency Syndrome), inwhich followed or accompanied by certain opportunistic infections and malignancies. Perhaps the most important reason for thefrequent development of diverse pulmonary complications in HIV/AIDS relates to the fact that the lung is chronically exposed toboth infectious or non-infectious airborne agents (exogenously) and hematogenously spread agents (endogenously) through anexpansive surface area consisting of millions of units called alveoli, that infected alveolar macrophages and lymphocytes.The mechanisms that may play role of defected lung defend mechanisms were direct effect of HIV that infected and killcells cause damaged to the effector cells and shifted cells function from immunostimulative to immunosupressive, then impairedmigration capacity of lymphocytes, monocytes or netrophils to lung. In turn, the opportunistic infections easily developed.In almost 65% AIDS patients also accompanied with oppportunistic infections in the lung. Pneumocystis cariniipneumoniae was the most often, followed by M. tuberculosis infection, bacterial and fungal pneumoniae respectively. Whereas,viral pneumoniae was rare
FAKTOR RISIKO TERKAIT PERDARAHAN VARISES ESOFAGUS BERULANG PADA PENDERITA SIROSIS HATI Vidyani, Amie; Vianto, Denny; W, Budi; Kholili, Ulfa; Maimunah, Ummi; Sugihartono, Titong; Purbayu, Herry; Boedi Setiawan, Poernomo; A Nusi, Iswan; Adi, Pangestu
journal of internal medicine Vol. 12, No. 3 September 2011
Publisher : journal of internal medicine

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Abstract

Recurrent esophageal varices bleeding  in  liver cirrhosis  increase  the morbidity and mortality. 50 ! 60% patients with Esophageal Varricess (EV) will experience recurrent bleeding, 30% or one third of them will experience recurrent bleeding one year after diagnosis of EV. Mostly recurrent bleeding will be found at 6 weeks until 6 months after the Þ rst bleeding. Prevention of recurrent bleeding is important for survival. The aim of this research to know the risk factors of recurrent EV bleeding in liver cirrhotic patients and the onset of recurrent bleeding after the Þ rst endoscopy. This is a  cross sectional study. Thirty Þ ve decompensated liver cirrhosis patients that fulÞ ll the inclusion and exclusion criteria participated in this study. After the Þ rst endoscopy, the risk factors are written, consist of sex, age, ascites, degree of varices, history of LVE/STE the severity of liver disease, and history of consuming gastric iritating drugs. The patients followed for six months to evaluated  the occurence of  recurrent bleeding. We used Pearson Chi-Square  test  for statistic analysis  (signiÞ cant  if p < 0.05). SPSS 17 were used to statistic calculation. Statistic analytical showed signiÞ cant correlation (p = 0.006; OR = 8.889; CI: 1.803 ! 43.820). On  the other hand sex, age, degree of EV, history of STE/LVE showed non signiÞ cant correlation. The main risk factor of recurrent EV in liver cirrhosis is the severity of liver disease.
PROFIL ANALISIS BATU SALURAN KENCING DI INSTALASI LABORATORIUM KLINIK RSUP SANGLAH DENPASAR Rasmika Dewi, Dewa Ayu Putu; Ngurah Subawa, Anak Agung
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Urolithiasis is a pathological condition that is caused by the formation of hard mass like stone along theurinary tract. Identification of the urinary stones can be done through chemical analysis or using of infraredspectroscopy. The semiquantitative methods used to analyze are titrimetric and colorimetric. This study wascross sectional whose results were descriptive. The data used in this study was 113 urinary stone analysisrecords taken from Routine Clinic of Laboratory Clinic Installation at Sanglah Hospital in period January untilDecember 2007 (one year). The prevalence of urolithiasis in males were more than females (4:1) and it wasmostly occur in age range 40-60 years old of both sexes. Generally, more than one kind of stone compositionswere found in a patient of urolithiasis, the dominant was calcium oxalate.
HUBUNGAN HIPERURISEMIA DAN FRACTION URIC ACID CLEARANCE DI DESA TENGANAN PEGRINGSINGAN KARANGASEM BALI Kurniari, Pande Ketut; Kambayana, Gde; Raka Putra, Tjokorda
journal of internal medicine Vol. 12, No. 2 Mei 2011
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. Hyperuricemiacan be caused by inceased of uric acid metabolism (overproduction), decreased of urine uric acid excretion (underexcretion),or mix of both. Fraction Uric Acid Clearance (FUAC) is one of the method used to differentiate either hyperuricemia caused byoverproduction or underexcretion. The aim of this studi is to determine the prevalence of hyperuricemia, means value of FUACand association between hyperuricemia and FUAC in Tenganan Pegringsingan Karangasem region Bali.A cross sectional analytic study was conducted on Balinesse in Tenganan Pegringsingan Karangasem region. Samplestudy was Balinese at age of 13 years old or above, agree to participate by informed consent. Descriptive statistic analysis onnumeric data presented as mean mean ± SD, nominal and ordinal data in proportion. Pearson?s correlation method is used incomparing the correlation between hyperuricemia and FUAC. Of 100 eligible samples, mean age was 37.20 ± 13.59 y.o, 51(51%) men and 49 (49%) women. Youngest age was 13 y.o and oldest was 69 y.o. Mean of blood uric acid level was 5.69 ± 1.43mg/dl. Prevalence of hyperuricemia on this study was 28%, 21% men and 7% women. Means value of FUAC is 6.41 + 1.99%;6.94 + 2.01% in normal uric acid level and 5.04 ± 1.1% in hyperuricemia. There is close correlation between hyperuricemia andFUAC (r = 0.43; p = 0.00)
TERAPI 2-ADRENERGIK KERJA PANJANG PADA TATALAKSANA PENYAKIT PARU OBSTRUKTIF KRONIK Putrawan, Ida Bagus; Ngurah Rai, Ida Bagus
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease, characterized by airflow limitationthat is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory responseof the lung to noxious particle or gases. There is a chronic inflammation that leads to fixed narrowing of small airways andalveolar wall destruction (emphysema). This characterized by increased number of alveolar macrophages, neutrophils and cytotoxicT-lymphocytes, and the release of multiple inflammatory mediators. A high level of oxidative stress may amplify thisinflammation. There is also increased elastolysis and evidence for involvement of several elastolytic enzymes, including serineproteases, cathepsins and matrix metalloproteinasses. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelinesrecommend a stepwise approach to disease management, with bronchodilators being the mainstay of treatment. 2-Adrenergicagonists induce bronchodilatation through stimulation of 2-receptors, leading to an increase in cyclic adenosine monophosphate.In addition to prolonged bronchodilatation, long-acting 2-agonists (LABAs) exert other effects that may be of clinicalrelevance. These include inhibition of airway smooth-muscle cell proliferation and inflammatory mediator release, as well asnonsmooth-muscle effects, such as stimulation of mucociliary transport, cytoprotection of the respiratory mucosa, and attenuationof neutrophil recruitment and activation.
PREVALENSI DAN RISIKO MEROKOK TERHADAP PENYAKIT PARU DI POLIKLINIK PARU RUMAH SAKIT UMUM PUSAT SANGLAH DENPASAR Sajinadiyasa, I G K; Bagiada, I M; Ngurah Rai, I B
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Abstract

Cigarette smoking is the single largest preventable cause of premature death in the world today. Estimates of the numberof yearly deaths from smoking-related causes exceed 400,000 (about one-sixth of all deaths). About 23% of the U.S. populationin the year 2000 smoked, and another 22% used to smoke. United Kingdom reported 12.5 million of adult smokers in 2003 (about26% of UK population). Indonesia also reported very high prevalence of cigarette smoking (about 50 ! 70%). While in Tengananvillage, Bali, smoking prevalence reported about 26.3%. Smoking cessation is the key point in managing patients with tobaccorelated diseases, especially lung diseases.We conducted a cross sectional study to Þ nd out smoking prevalence and smoking contributions to lung diseases amongpatients in pulmonology outpatient clinic of Sanglah hospital, Bali. Among 108 patients, we found 77 patients (71.3%) exposedto cigarette smoking. Among these patients, we found 11 (10.2%) patients still smoking, 55 (50.9%) were ex-smokers, and 11(10.2%) were passive smoker. Among active smokers and ex-smokers, we found 34 patients (31.5%) were light smoker, 25(2.1%) were moderate smoker, and 7 (6.5%) were heavy smoker according to Brinkman index. The most frequent lung problemfound in this study was lung TB (42.6%), while smoking exposure happens in 76.1% patients. As the conclusion, smokingprevalence is high among patients come to pulmonology outpatient clinic of Sanglah hospital.
HUBUNGAN ANTARA PRODUK KALSIUM X FOSFAT SERUM DENGAN PENYAKIT ARTERI PERIFER PADA PASIEN HEMODIALISIS REGULER DI RSUP SANGLAH DENPASAR Wulandari, Dewi Catur; Raka Widiana, I G; SL, Jodi; Sudhana, I W; Suwitra, Ketut
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Peripheral Arterial Occlusive Disease (PAOD) is common among patients undergoing hemodialysis (HD). In the generalpopulation, DM, male, cigarette smoking, advanced age, hypertension and dyslipidemia are the most important risk factorsfor PAOD. Recently, some studies in patients with regular HD found evidences that PAOD associated with increase of calciumand phosphate serum level and increase of Ca.P product due to secondary hyperparatiroidism. A cross-sectional study was doneon 46 regular HD patients to evaluate prevalence of PAOD among patients who are undergoing regular HD and their associationbetween Ca.P product. Morning fasting plasma were taken for lipid profile, blood sugar, blood urea nitrogen, serum creatinin,albumin level, Ca, inorganic P. Ankle-brachial index (ABI) of blood pressure as measured after dialysis session using Va-SeraVS-100. Fourty six (26 males, 20 females) regular HD patients, age 50.95 ± 9.90 years, duration of HD 27.7 ± 22 months wereincluded in this study. Using ABI < 0.9 as cut off value for the presence of PAOD, 15.2% had PAOD. Means of Ca serum levelwas 9.04 ± 0.76 mg/dl, phosphate serum level was 56.48 ± 23.90 mg/dl. Using 55 or more as cut off value for abnormal concentrationof Ca.P product, 47.7% patients had abnormal Ca.P product. Three of 21 patients with Ca.P 55 had PAOD and 4 of 23patients with Ca.P < 55 had PAOD ( OR 0.79 with 95% CI : 0.15 ? 4.04 for patients with Ca.P < 55 ). Using logistic regression tocontrol Ca and P levels, Ca.P 55 tend to associate with increased risk of PAOD (OR 6.22 ; 95% CI : 0.23 ? 167.71)More than fifteen percent of patients with regular HD had PAOD. More than fourty seven percent of patients had abnormal Ca.P.Patients with Ca.P 55 tend to associated with increased risk of PAOD (OR 6.22 ; 95% CI : 0.23 ? 167.71)
DEEP VEIN THROMBOSIS SEBAGAI MANIFESTASI SINDROMA PARANEOPLASTIK DARI KANKER PARU Suega, Ketut
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Abstract

Thrombotic event in patient with cancer is a common feature in contrary to the presentation of thombotic disordersthat part of para neoplastic syndrome as a solely initial symptom of an occult malignancy. The underlying mechanism thatassociating between cancer and thrombosis as well as between cancer and paraneoplastic syndrome is not clearly understoodyet. One of those cancers that frequently associated with paraneoplastic syndrome is lung cancer. We reported a 46 years oldwoman that presents initially because of a swollen left leg and tenderness along the leg. Other examinations within normalfinding including normal chest x ray. In approximately a year later, the patient experiences disturbing cough with blood streak,accompany with shortness of breath. She was also complaining of sharp chest pain especially when taking a deep breath.After several examinations performed such as bronchoscopy with bronchial washing, transthoracal biopsy, sonographic study,echocardiography, chest CT scan, this patient was finally diagnose of having advanced lung malignancy. Histologic finding wascomfirm with adeno carcinoma poorly differentiated. He was treated under 6 concecutive cycles of gemzitabin combined withcarboplatin. Despite completed chemotherapy treatment, she became worst and died because of respiratory failure
KORELASI ANTARA BRACHIAL-ANKLE PULSE WAVE VELOCITY DAN PROFIL LIPID PADA PASIEN DIABETES GERIATRIK Ratna Saraswati, Made; Suka Aryana, IGP; Astika, Nym; Kuswardani, Tuty; Suastika, K
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Brachial-ankle pulse wave velocity (baPWV) is an indicator of limb arterial stiffness. Dislipidemia is a major risk factorof atherosclerosis and may worsen baPWV by increasing the blood viscosity. This study aims to know the correlation betweenbaPWV and the lipid profile in diabetic geriatric patients. Cross sectional analytic study has conducted in geriatric polyclinic,Sanglah hospital. Pulse wave velocity was measured using an automatic device (Fukuda VS 1000). Lipid profile were taken beforetest was done. Data was expressed in mean + SD, analyzed by t-test compare mean and Pearson correlation by using SPSS 11.0.There were 61 patients involved, 40 (65.6%) male and 21 (34.4%) female, age between 60-82 (mean 67.23 + 5.79) years old.Cholesterol total level, LDL-C, HDL-C, and triglyceride were vary among subject, range (means + SD) as 96-312 (198.7 + 42.3)mg/dL, 54-314 (133.2 + 40.4) mg/dL, 27-67 (45,5 + 9.0) mg/dL, and 51-438 (138.6 + 80.0) mg/dL, respectively. BaPWV on theright limbs were between 920-2260 (1605.4 + 228.5) cm/sec, on the left limbs were 870-2240 (1628.0 + 274.8) cm/sec, and meanright/left limbs baPWV were 895-2240 (1616.7 + 241.8) cm/sec. A significant correlation were found between triglyceride leveland the left baPWV (r = 0.3, p = 0.019), while no significant correlation were found on the right side and mean r/l. There weresignificant difference of left limb baPWV among high (>150 mg/dL) and normal triglyceride level group (<150 mg/dL, accordingATP-III). Brachial-ankle pulse wave velocity correlated positively with triglyceride level in diabetic geriatric patients.

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