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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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PROFIL ALBUMINURIA DAN KADAR sVCAM-1 PADA PENDERITA DIABETEES MELITUS TIPE 2 C, Wibisono; A, Fajar; A, Tjokroprawiro; A, Soetjahjo; A, Pranoto; S, Adi; S, Murtiwi
journal of internal medicine Vol. 13, No. 1 Januari 2012
Publisher : journal of internal medicine

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Abstract

Vascular complications develop progressively from 5 ? 40 years after the onset of diabetes, although they may appearearlier in type 2 diabetes when associated with a periode of undiagnosed diabetes and impaired glucose tolerance.Endothelial dysfunction is the proposed site of both micro vascular and macro vascular complications in diabetes.Endothelial dysfunction has been documented in both type1 and type 2 diabetes and is present in the insulin resistancesyndrome and in pre diabetes. There were will likely be a subsequent increased burden of vascular complications ofdiabetes, including diabetic nephropathy (DN). It is predicted that 25% of newly diagnosed patient with type 2 diabeteswill develop early stage DN within the next 10 years. Advanced Glycation End Products (AGEs), which accumulate indiabetic vasculature, result in enhanced expression of endothelial cell-associated Vascular Cell Adhesion Molecule-1(VCAM-1) as well release of a soluble form of VCAM-1 (sVCAM-1) into culture supernatants. We hypothesized thatsVCAM-1 in diabetic plasma might reect early vascular perturbation in diabetic vasculopathy. The aims of this studyis to know the prol of sVCAM-1 and albuminuria in type 2 diabetes. A cross sectional study to measure sVCAM-1andalbuminuria. Descriptive statistical analysis used to know the prol of sVCAM-1 and albuminuria. Of the 69 diabeticsubjects (31 males, 38 Females) with mean age of 57.4 ± 4.8 years, normoalbuminuria 39 subjects, microalbuminuria 23and macroalbuminuria 7 patients, and sVCAM-1 was 0.614 ± 0.177. The levels of sVCAM-1 plasma is increased alongwith stage of albuminuria. There was an increase of sVCAM-1 level along with stage of albuminuria.
DIAGNOSIS DAN PENATALAKSANAAN ARTRITIS SEPTIK Dary, I Wayan; Raka Putra, Tjokorda
journal of internal medicine Vol. 10, No. 1 Januari 2009
Publisher : journal of internal medicine

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Abstract

Septic arthritis which caused by bacterial infection is a serious disease and still as challenge to physician because theprognosis has not improved significantly over the past two decades. The route of spread infection to joint through hematogenousor other routes include direct inoculation through joint prosthetic. The most often aetiology is Staphylococcus aureus. The processof native joint infection can be divided into three steps: bacterial colonization, establishing an infection, and induction ofhost inflammatory response. The diagnosis of septic arthritis rests on isolation of the pathogen from joint fluid. If we find classicsign and symptoms associated septic arthritis should not to delay the diagnosis of septic arthritis. Once septic arthritis is suspectedand the proper sample for microbiologic studies are collected, appropriate antibiotic treatment and adequate joint drainage shouldbegin immediately. The aim management of septic arthritis mainly are joint decompression, joint sterilization, and reserve jointfunction. Sterilization joint with empirical antibiotic based on gram stain and co-morbid disease and than adjusted base onbaterial culture result. Antibiotic should be administrated intravenously at least 2 weeks than continued orally. Joint decompressioncan be achieved by a variety methods include closed-needle aspiration, tidal irrigation, arthroscopy, and arthrotomy. Prophylacticuse of antibiotics is controversial for events posing a risk of haematogenous bacterial arthritis through transientbacteraemia. Prognosis of septic arthritis is poor since a permanent reduction in joint function is seen in approximately 30% ofpatients.
PERAN HIPOKSIA PADA PATOGENESIS PENYAKIT GINJAL Sastrawan, I Gede Pande; Suwitra, Ketut
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Chronic kidney disease is a current major worldwide health problem with an increasing prevalency.Kidney is a sensitive organ with hypoxic condition relate to its high tubular epithelial cells and vascular oxygenconsumption. Chronic peritubular ischemia may occur through several interrelating mechanisms. The activationof local renin-angiotensin system, angiotensin II, could induce hypoxia by means of hemodinamic and nonhemodinamicmechanisms.Anemia in renal disease could accelerate the decline of renal function through the induction oftubulointerstitial hypoxia. Non Steroidal Anti Inflamatory Drugs (NSAID) could evoke renal medullar hypoxiaby its regional hypoperfusion mechanism and the escalation of tubular transport. The Outer region of renalmedulla and tubulus are main target of hypoxic renal damage. The mechanism of hypoxia induced AcuteKidney Disease involves renal vascular and tubulus through the reduction of blood flow and the increasing oftubular oxygen demands. The Patofisiology of hypoxia induced chronic kidney disease occurs bytubulointerstitial damage which induce fibrogenesis, causing interference of peritubular blood flow and oxygenconsumption.
HUBUNGAN ANTARA DERAJAT BERAT INFEKSI VIRUS DENGUE DAN KADAR NATRIUM SERUM Agung Budiyasa, Dewa Gde; Parwati Merati, K Tuti
journal of internal medicine Vol. 12, No. 1 Januari 2011
Publisher : journal of internal medicine

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Abstract

Dengue Viral (DV) infection has been a big problem on the world (WHO, 2005). One of the factors that can inß uencesuccesfull of the DV infection treatment was correction for hyponatremia as one of the factors caused dengue encephalopathy.Hyponatremia cause by plasma leakage, the more severe plasma leakage the more severe hyponatremia. The aim of this study toknow association between degree of severity of DV infection and natrium serum concentration, correlation between two signsof plasma leakage (albumin concentration and hematocrit) with serum natrium concentration. Analytic cross sectional designbe applied for DV infection patients who admitted at Internal Medicine Department of Sanglah General Hospital on November! December 2010. Pearson correlation test showed signiÞ cant correlation between albumin and serum natrium (p = 0.018, r =0.254), no signiÞ cant correlation between hematocrit and natrium serum (p = 0.861, r = 0.019). Linear regression showed pvalue for albumin 0.495 and degree of severity of DV infection 0.000, so variable that can predict natrium serum concentrationwas degree of severity of DV infection, stated with formula y = 134,515 - 2,664x. The conclusion we found there was negativeassociation between degree of severity of DV infection and natrium serum concentration which signiÞ cant between DF and DHF.But among degree of DHF there were just tendention that the more severe degree of severity of DHF the lower serum natriumconcentration. There was signiÞ cant correlation between albumin and natrium serum concentration, but albumin can"t predictnatrium serum concentration. No signiÞ cant correlation between natrium serum concentration and hematocrit. We suggest tomeasure natrium serum concentration to antisipate worsening of DV infection, and better be performed for serial examination.
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
PENDEKATAN DIAGNOSIS DAN TERAPI FIBROSIS HATI Anom S, Tjok Istri; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 11, No. 1 Januari 2010
Publisher : journal of internal medicine

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Abstract

Liver Þ brosis is the excessive accumulation of extracellular matrix proteins including collagen that occurs in most typesof chronic liver. The gold standard to assess disease severity of liver Þ brosis is liver biopsy, despite noninvasive methodsavailable today. A noninvasive tool (Þ bro scan) has been developed these days. This tool is similar to ultrasound in assessingliver elasticity. There are three methods frequently used to assess liver Þ brosis, Ishak score, Metavir score, and Desmet/Scheuerstaging system. The principles of antiÞ brotic therapy are: (a) to treat primary disease; (b) to reduce inß ammation responseor to avoid stimulation of stellate cell activation; (c) to reduce stellate cell activation; (d) to neutralize proliferation response,Þ brogenic response, contractic response, and/or stellate cell proinß ammation; (e) to stimulate apoptosis of stellate cell; and (f) toincrease degradation of Þ brotic tissue.
PENANGANAN DISPEPSIA PADA LANJUT USIA Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 7, No. 3 September 2006
Publisher : journal of internal medicine

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Abstract

In elderly patients with dyspeptic syndrome, organic causes more prevalence rather than fungsional related disorders. Theuse of Nonsteroid Anti Inflammatory Drugs (NSAIDs) and H. pylori infection play as important role as causes of organicdyspepsia in eldery patients. There are some changes in upper gastrointestinal tract which is related to aging process, especially inmucosal defance mechanism. The changes in aggressive factors are only a few. Diagnostic approach with endoscopic examinationis necessary in eldery patients with dyspeptic syndrome to role out the possibility of organic origin. The management of dyspepsiain eldery patients needs comprehensive approach because clinical presentation usually asymptomatic, the use of polypharmacy,co-morbidity, and the probability of organic origin as a cause needs to be proved since the beginning.
APLIKASI KLINIS RETIKULOSIT Suega, Ketut
journal of internal medicine Vol. 11, No. 3 September 2010
Publisher : journal of internal medicine

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Abstract

Reticulocytes are immature nonnucleated erythrocytes that are released from the bone marrow following enucleation ofthe normoblast. Under the in! uence of erythropoietin, committed erythroid progenitor cells divide and differentiate through aseries of stages, giving rise basophilic normoblasts, polychromatophilic normoblasts, and orthochromic normoblastsin sequence.Reticulocytes are similar to mature red blood cells, except that they retain functioning polyribosomes and continue to synthesizehemoglobin. Because the reticulocyte stage of erythroid differentiation only lasts a few days, the number of reticulocytes in theblood is a useful clinical indicator of the rate of erythropoiesis. Reticulocytes exist in the circulation for only 1 ? 2 days and signalthe marrow erythropoietic activity 3 ? 4 days after iron was actively incorporated into haemoglobin. Early changes in reticulocytecount may simply re! ect the release of immature reticulocytes from the marrow rather than the true expansion of erythropoiesis.Reticulocyte counts have once again acquired great interest and importance following the introduction of instruments that usedyes speci" c for RNA. This has resulted in precise and accurate counts even at low reticulocyte concentrations The latestgeneration of automated analyzer provides additional information on reticulocytes, such as the immature reticulocyte fraction(IRF) and other reticulocyt indices, eg, mean reticulocyte volume (MCVr) and mean reticulocyte haemoglobin content (CHr).To date, the most widely studied of the reticulocyte indices is the CHr. The hemoglobin content is considered to be constantthroughout the lifetime of erythrocytes and circulating reticulocytes1 unless structural changes take place that compromise theamount of cytoplasm or cause cellular fragmentation. The normal value for the ! owcytometry method can range from 1% to2% depending on the cut off point used to separate reticulocytes from the normal red blood cell population. Since reticulocyteenumeration provides information about the bone marrow activity and the effectiveness of red blood cell production, it is crucialin the clinical application of reticulocytes parameters to aid the diagnosis of anemic patients, and for monitoring bone marrowtransplantation patients, patients undergoing therapy with marrow toxic drugs, and patients being treated for anemia
PERKEMBANGAN TERKINI DALAM DIAGNOSIS DAN PENATALAKSANAAN IRRITABEL BOWEL SYNDROME Mariadi, I Ketut; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) motility and sensory disorder that ischaracterized by abdominal pain/discomfort, bloating and altered bowel habit. The disease accounts for hugecosts for both patients and health-care systems and worsens significantly patients’ quality of life. Diagnosis isbased on the identification of symptoms according to Manning, Rome I and Rome II criteria and the most recentRome III criteria and exclusion of alarm indicators. The treatment of IBS is centred on an excellent doctor–patient relationship along with drugs targeting the predominant symptom, especially during exacerbations. Thisreview aim to explain new ctriteria to diagnose IBS and to conduct a systematic evidence-based review ofpharmacological therapies currently used, or in clinical development, for the treatment of IBS
HUBUNGAN ANTARA KADAR ADIPONEKTIN PLASMA DAN RESISTENSI INSULIN PADA PENDUDUK ASLI DESA TENGANAN PEGRINGSINGAN - KARANGASEM Putrawan, Ida Bagus Putu; Suastika, Ketut
journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

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Abstract

The association between plasma adiponectin level and insulin resistance (IR), diabetes mellitus (DM)-2, hypertension,and cardiovascular disease have been reported previously. Adiponectin is expressed and produced by adipocyte cells, and playscritical role in the glucose metabolism. IR in the adipose cells increases lipolysis and release free fatty acid (FFA). Furthermore,inactivation of mitochondrial pyruvat dehydrogenase and Þ nally decreases glucose uptake through disturbance of insulin receptorsignaling.To investigate the association between plasma adiponectin level and IR that was calculated by HOMA-IR, a cross sectionalanalytic study was conducted in Tenganan region, Bali from December 2007 to January 2008. As many as 80 participants whoseage was 18 ! 65 years old were involved.The study involved 38 (47.5%) males and 42 (52.5%) females whose mean of waist circumference (WC) was 78.03± 10.88 cm, mean of plasma glucosa was 91.73 ± 8.84 mg/dl, median of insulin was 2.70 (2.00 ! 17.90)  IU/ml, median ofHOMA-IR was 0.67 (0.38 ! 3.71), mean of HDL cholesterol was 58.93 ± 13.73 mg/dl, and mean of triglycerides was 145.64± 67.97 mg/dl, systolic blood pressure (SBP) was 70 ! 180 mmHg, and diastolic blood pressure (DBP) was 50 ! 100 mmHg. Inthis study, we found signiÞ cant correlation between plasma adiponectin level and IR (r = -0.370; p < 0.001). IR also signiÞ cantlycorrelation with central obesity (r = 0.361; p < 0.001), body mass index (BMI) (r = 0.381; p < 0.001), plasma HDL level (r =-0.327; p= 0.002), TG (r = 0.255; p = 0.011), and SBP (r = 0.198; p = 0.039). On multivariate analysis with multiple logisticregression, only central obesity has independent association with IR (B = 1.641; p = 0.023). Central obesity and sex weresigniÞ cantly inß uential to the plasma adiponektin level (ß = -1.542; p = 0.035) dan (ß = 2.865; p < 0.001) respectively in whichmean of the plasma adiponectin level in female (5.610 ± 2.815) was signiÞ cantly higher than that of male (3.365 ± 2.365; MD= -2.245; p < 0.001). Mean difference to plasma adiponectin level was signiÞ cantly inß uential of the plasma HDL level dan TG(MD = -10.500; p < 0.001) and (MD = 35.075; p = 0.020) respectively

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