Acta Medica Indonesiana

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The Role of Intensive Insulin Therapy in Increasing Superoxide Dismutase (SOD) and Normalizing Hyperglycemia in Critically Ill Patients.
(2009-04-25) Wiryana, Made
Aim: to find out the difference between intensive insulin therapy and conventional insulin therapy in influencing the increase of superoxide dismutase (SOD), decrease of cytokine production (TNF-alpha and IL-6), increase of albumin level, and occurrence of SIRS. Methods: the study design was randomized pre and post control group design involving 40 adult patients admitted to the ICU of Sanglah Hospital, Denpasar. The study subjects were randomly allocated into two groups: the first group to receive intensive insulin therapy in which blood glucose was set at a level between 80 - 110 mg/dL; the second group to receive conventional insulin therapy, which was given if the blood glucose level exceeded 215 mg/dL and to be maintained at the level of between 180 - 200 mg/dL. Results: this study showed: (1) There was a significant increase of SOD in the group receiving intensive insulin therapy as compared to the conventional insulin therapy (370.70 vs. 98.50 U/gHb, p=0.001), (2) There was no significant decrease in the TNF-alpha level, (3) There was a significant decrease of IL-6 level (10.25 vs. 2.02; p=0.023); (4) There was a significant decrease in the event of SIRS (10% vs. 45%, p=0.000) in the intensive insulin therapy group as compared to the conventional insulin therapy group. Conclusion: increase of insulin dose in the intensive insulin therapy can maintain blood glucose at normoglycemic level between 80 - 110 mg/dL faster than that in the conventional insulin therapy. On the other hand, intensive insulin therapy can increase the SOD level, decrease IL-6 level, and decrease the events of SIRS in the ICU critically ill patients compared to conventional insulin therapy.
Does insulin resistance correlate with routine blood examination? A review on erythrocytes of obese patients.
(2009-04-25) Asdie, Rizka Humardewayanti; Sa'adah,; Jazakillah, Setyowati; Sinorita, Hemi
Aim: to identify whether hyperinsulinemia/insulin resistance affects the hematologic parameter of routine blood, especially the erythrocytes. Methods: cross sectional study was conducted on seventy one non-smoking obese patients who were not pregnant, not having lactating period, aged >22 years of age and visited the outpatient clinic of Endocrinology and outpatient clinic of Kidney and Hypertension division at the department of Internal Medicine Dr. Sardjito Hospital, Yogyakarta. Patients with cerebrovascular and blood disease; taking drugs affecting blood e.g.: cytostatics, and erythropoietin; and patients taking insulin, beta blocker, or steroids were excluded. Data on age, gender, body weight, and body height were recorded. Examinations on fasting blood glucose, fasting insulin, total cholesterol, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), and routine blood were performed in the condition of ten hours of fasting. All laboratory examination was conducted at Prodia Laboratory, Yogyakarta. Results: of seventy one obese patients, 51.5% were male, and 9.1% were diagnosed with diabetes mellitus (DM) during the study and the mean age was 47.09+5.74 years, the mean body mass index was 28.07+4.07 kg/m2, the mean of hemoglobin level was 13.75+1.57 g%; the mean of leukocyte count was 7.86+1.19 103/mm3; erythrocytes count was 4.93+0.44 106/mm3; platelet count 300.28+80.57 103/mm3; and hematocrite count 41.23+4.28. There were very weak and statistically insignificant negative correlation between Log HOMA IR and erythrocytes (r= -0.048; p=0.693) Conclusion: this study demonstrates that insulin resistance has a very weak correlation with erythrocytes counts and it is statistically insignificant.
Expression of NF-kB and COX-2 in Young Versus Older Patients with Sporadic Colorectal Cancer.
(2009-04-25) Suharti, Catharina; van Gorp, Eric C M; Dolmans, Wil M V; Groen, Jan; Hadisaputro, Suharyo; Djokomoeljanto, Robert J; Dme, Osterhaus Ab; van der Meer, Jos W M; Aged
Aim: to investigate which recent infection could have caused the present dengue-like symptoms, in adult patients clinically fulfilling the WHO criteria for dengue, in which serologically were not confirmed for dengue virus infections. Methods: prospective study. During an outbreak of dengue (between May 1995 and May 1996) 118 consecutive adults (>13 years) suspected by the WHO 1997 case definition of DF or DHF were investigated. Patients were examined for history of illness, physical and laboratory findings consisting of full blood counts, prothrombin time (PT), activated partial thromboplastin time (aPTT), liver function (bilirubin, ASAT, ALAT), renal function (creatinine), and serological assays included dengue, hantavirus, chikungunya, R. typhi, R. tsutsugamuchi, rubella virus, influenza A virus, and leptospira. Results: in 58 of the total 118 patients, recent dengue virus infection was serologically confirmed. In 20 of the remaining 60 patients, we found serological evidence of another recent infection: hantavirus (5), chikungunya virus (2), R. typhi (5), R. tsutsugamuchi (2), rubella virus (3), influenza A virus (1), and leptospira (2). No evidence for recent infection with any of the mentioned agents was detected in the remaining 40 specimens. Conclusion: we conclude that based on clinical characteristics alone, it is not easy to diagnose dengue. Specific laboratory tests to differentiate dengue from other febrile illnesses are needed. Among these, in Indonesia hantavirus infection should be considered as well.
Molecular mechanism on healing process of peptic ulcer.
(2009-04-25) Syam, Ari Fahrial; Sadikin, Mohammad; Wanandi, Septelia Inawati; Rani, Abdul Aziz
Ulcer healing process is an intricate and active process including reconstruction process of mucosa through formation of granulation tissue. Granulation tissue formation takes place by means of formation of ulcer base, formation of blood vessel (angiogenesis) and re-establishment of glandular architecture. The process of granulation tissue formation on the ulcer base takes place 48-72 hours after ulceration process occurs. These three phases involve various genes grouped according to their activated time, i.e. the initial response genes, intermediate response gene and late response genes. Initial response genes are activated in 30 minutes to 2 hours time, e.g EGF-R, c-fos, c-jun, egr-1, Sp-1, TFF-2/SP. Intermediate response genes are activated for 6 hours to 2 days, eg EGF, bFGF, PDGF and VEGF. Late response genes are activated for 14 days, e.g. HGF, ITF, c-met/HGF-R.
Expression of NF-kB and COX-2 in Young Versus Older Patients with Sporadic Colorectal Cancer.
(2009-04-25) Abdullah, Murdani; Sudoyo, Aru W; Pranowo, Bethy S; Rini, Diah; Sutrisna, Bambang; Rani, A Aziz
Aim: to distinguish the expression of NF-kB and COX-2 between young and older group of sporadic colorectal cancer patients. Methods: this was a comparative study between sporadic CRC patients aged 40 years or younger and patients aged 60 years or more. Expression of NF-kB and COX-2 were assessed by immunohistochemical method using rabbit polyclonal antibodies against human p65 NF-kB and COX-2 proteins. Results: there were 98 cases of sporadic colorectal cancers between 1999 and 2007 obtained from the Department of Anatomical Pathology, Faculty of Medicine University of Indonesia, Jakarta and Department of Anatomical Pathology, Faculty of Medicine Padjajaran University, Bandung. There were 60 patients aged 60 years or more and 38 patients aged 40 years or less. Most tumors were located in the distal colon. Positive expression of NF-kB was found in 72 (73.5%) cases, whereas COX-2 expression was found in 48 (49.0%) cases. No significant difference of NF-kB and COX-2 expression between young and older patients. Conclusion: the expression of nuclear factor kB (NF-kB) in Indonesian patients with sporadic colorectal cancer was high. However, cyclooxygenase-2 (COX-2) was only expressed in half of patients. There was no significant difference of NF-kB and COX-2 expressions between patients aged 40 years or less and patients aged 60 years or more. Further studies are needed to elaborate the role of inflammation in sporadic colorectal carcinogenesis.
An open pilot study of the efficacy and safety of polygeline in adult subjects with dengue haemorrhagic Fever.
(2009-04-25) Pohan, Herdiman T; Lie, Khie Chen; Santoso, Widayat Djoko; Eppy,; Dengue-analysis
Aim: to observe the efficacy and safety of Polygeline colloid (Haemaccel) in adults with stage I - II of dengue haemorrhagic fever (DHF). Methods: an open, non-comparative clinical trial. The subjects were male or female between 17 - 55 years old, who fulfilled the criteria of stage I or II of DHF according to WHO and selected with consecutive sampling. Fluid treatments were given following this protocol: polygeline i.v. infusion: 500 ml over first 6 hours and continued with 500 ml for the next 18 hours, and maintained to 1000 mL/24 hours from day-2 until maximum day-5. Ringer's lactate infusion: 1000 mL/18 hours from the first day to maximum day-5, as maintenance. Efficacy and safety of polygeline colloid were evaluated using initial stabilization of haematocrite level, measured as percentage of clinical trial subject who has stabilization of haemodynamic status based on serial haematocrite levels examinations, total parenteral fluid required and length of hospitalization. Statisticial analysis was done using ANOVA test and post hoc analysis using Turkey test. Results: there were 43 subjects who completely participated in this study and included in analysis. From baseline levels, haematocrite decreased in first 6 hours during fluid treatment. This decrement persisted in 48 hours of observation. Statistical analysis with ANOVA test showed the significant differences of haematocrite level during observation (Sum of square between groups 495 and within group 4845, p= 0.000). Post hoc analysis with Turkey test showed significant differences of haematocrite level from baseline level to 48, 72 and 96 hours during observation periods. Conclusion: this pilot study showed that polygeline colloid was a safe initial fluid treatment and can be used for maintaining fluid adequacy in adults with stage I-II of DHF.
Pregnancy in a woman with uncorrected tetralogy of fallot.
(2009-04-25) Sinto, Robert; Nasution, Sally Aman
Tetralogy of Fallot (ToF) is the most common form of cyanotic congenital heart disease after 1 year of age, with overall incidence approaching 10% of all congenital heart disease. Natural survival (i.e. without corrective procedure) into the fourth decade is extremely rare (only about 3%), but there is a tendency of increasing number of women with cyanotic congenital heart disease living 3 to 4 decades and are becoming pregnant. Because of significant physiology adaptation and changes, pregnancy and delivery process are troublesome for mostly unhealthy women, including those with uncorrected ToF. For ToF patients, it remains an important cause of maternal morbidity (62,5%), and even mortality (10%) and has significant effects on fetal outcome. Discussed below a case of pregnancy in a 28 year old woman with uncorrected ToF, was diagnosed to have pneumonia, ToF-class III-IV of New York Heart Association, secondary polycythemia caused by hypoxia, and uncompensated metabolic acidosis on 25th week pregnancy. Through delicate medical care, patient's condition improvement can be seen. Patient decided to continue the pregnancy. Without optimal either obstetrical or medical management, prognosis of pregnancy in patient with uncorrected ToF is poor.
The difference between mean plasma levels of von Willebrand factor and platelet aggregation in type 2 diabetes mellitus with and without peripheral vascular disease at sardjito general hospital, yogyakarta.
(2009-04-25) Renaldi, Olly; Asdie, Rizka H; Sinorita, Hemi; Pramono, Bowo; Purnomo, Luthfan B
Aim: to determine the differences in mean plasma values of von Willebrand factor and platelet aggregation in type 2 DM patient with or without peripheral arterial disease. Methods: this is a cross-sectional study, conducted from August to December 2006, in Dr. Sardjito General Hospital Yogyakarta, on type 2 DM patients, aged 50 years and above, and signed the informed consent. The exclusion criteria are cardiac failure, renal insufficiency (creatinine clearance <30 ml/minute), malignancy, acute disease, decrease hepatic function, having ulcer or DM gangrene, amputation, taking multivitamine and/or antiplatelet, and smoking. All samples that matched inclusion criteria were divided into 2 groups: with peripheral arterial disease and without peripheral arterial disease. The data of subjects are presented as mean and standard deviation and proportion. Variables with numeric data are analized with the student t-test for normal distribution and with Mann-Whitney U-test for abnormal distribution. Significancy limit was set at p value of <0,05. Statistical analysis was done by using SPSS 11.5 software. Results: there were 17 subjects having PVD. There were no significantly differences of mean vWF plasma levels (140.544 + 76,137% vs. 133.325 + 53,246%) and platelet aggregation (87.741 + 19.886% vs. 93.981 + 10.138%) between type 2 DM with and without PVD (p >0.05). Conclusion: there were no statistically difference in mean vWF plasma levels and platelet aggregation between type 2 diabetes mellitus with and without PVD.
Gestational transient thyrotoxicosis.
(2009-04-25) Albaar, M Taha; Adam, John M F
Gestational transient thyrotoxicosis refers to non-autoimmune hyperthyroidism in pregnant women and it is associated with hyperemesis gravidarum. During pregnancy, there are some alterations in thyroid gland, such as elevation of thyroxine binding globulin, increased iodium clearance in kidneys, and stimulation of thyroid gland by human chorionic gonadotropin. Hitherto, the pathophysiology underlying the development of gestational transient thyrotoxicosis has not been fully recognized. Studies showed that human chorionic gonadotropin, an agonist of thyroid stimulating hormone, may stimulate thyroid stimulating hormone receptor, leading to increased thyroid hormone. Diagnosis of gestational transient thyrotoxicosis is established based on inexistence history of previous hyperthyroidism, elevation of thyroid hormone, absence of hyperthyroid abnormalities signs on physical examination (such as: enlargement of thyroid gland, exophthalmia), and the absent of positive thyroid autoantibody. Generally, gestational transient thyrotoxicosis does not require medication, unless if hyperemesis gravidarum is present, thus the patient has to be hospitalized to receive intravenous rehydration, electrolyte correction and antiemetic medication. On cases with worsened or prolonged symptoms, anti-thyroid agents such as short term propiltiourasil is needed.
Adrenal incidentaloma.
(2009-04-25) Ridho, Fenny Elvina; Adam, Fabiola M S; Adam, John M F
Adrenal Incidentaloma is an adrenal tumor, which is unidentified before the imaging procedures conducted for an abnormality which is initially unforeseen as an adrenal disease. Symptoms and/or clinical signs of adrenal tumor do not have to be present prior to a diagnosis. Adrenal Incidentaloma can be divided into non-hypersecreting adrenal adenoma, hypersecreting tumor, primary adrenal carcinoma, other adrenal mass, and metastases. The majority of adrenal tumor is non-hypersecreting adrenal adenoma, but it is always considered as hypersecreting tumor until proven otherwise. Some conditions that can be found due to hormonal activity of adrenal incidentaloma is subclinical Cushing's syndrome, pheochromocytoma, aldosteronoma (Conn's disease), and several tumors which secrete androgen and sex hormone. Diagnostic approach of adrenal incidentaloma is focused on two main problems, which are, whether the lesion is hormonally active even though lacking characteristic clinical signs, and whether the lesion is benign or malignant; thus it needs hormonal and radiologic evaluation, even a fine needle biopsy. The management for adrenal incidentaloma includes surgical removal for hormonally active adrenal tumors, or inactive tumors with size less than 4 cm. Monitoring of tumor's hormone level and size are necessary for non-hypersecreting tumor without surgical removal.
Recent progressions in stem cell research: breakthroughs achieved and challenges faced.
(2009-01-05) Tani, Jowy; Umbas, Rainy
Stem cell studies have been conducted to study characteristics of stem cells, to develop better techniques for patient-specific stem cell lines generation, and to explore the therapeutic potential of stem cells. Techniques that enable efficient generation of new stem cell lines would facilitate research and allow generation of patient-specific stem cell lines for transplantation therapy. Somatic-Cell Nuclear Transfer (SCNT), which involves injection of donor cell nucleus into enucleated ovum, is the standard technique for new embryonic stem (ES) cell lines generation; presently its efficiency is low. A newer technique, pluripotent stem cell induction, reprograms somatic cells into induced pluripotent stem (iPS) cells by introducing certain factors into somatic cells. While certain adult stem cell treatments have been investigated on human participants, most ES cell or iPS cell treatments were still experimented on animal models. Recently, therapeutic potential of stem cell for several disorders was demonstrated. Researchers demonstrated stem cell's potential for treating hematologic disorders by correcting sickle cell anemia in rat model with iPS cells. Its potential role in treating cardiovascular disorder was demonstrated as injection of damaged rat heart with human ES cells derived cardiomyocyte plus "prosurvival" cocktail improved heart function. It might also treat nervous system disorders; injected into brain, ES cells derived neurons replace some loss cells in stroke rats and iPS cells derived neurons improved Parkinsonian syndrome in rats. Progress was also seen in other aspects of regenerative medicine. To overcome controversies caused by embryo destruction for obtaining ES cells, single blastomer stem cell derivation, Cdx2-inactivation, and parthenogenesis were proposed. All ES cell, iPS cell, and adult stem cell research should be continued with support from all sides.
Prevention and management of coronary artery disease in patients with diabetes mellitus.
(2009-01-05) Majid, Abdul
Diabetes mellitus (DM) is a common medical problem and a major risk factor for the development of atherosclerotic coronary artery disease (CAD). Coronary artery disease is highly prevalent and is the major cause of morbidity and mortality in diabetic patients. Patients with CAD and prediabetic states should undergo lifestyle modifications aimed at preventing DM. In patients with CAD and DM, routine use of aspirin and an angiotensin-converting enzyme inhibitor (ACE-I)-unless contraindicated or not tolerated-and strict glycemic, blood pressure, and lipid control are strongly recommended. Intense insulin therapy might be needed for glycemic control, and high-dose statin therapy might be needed for lipid control. For blood pressure control, ACE-Is and angiotensin receptor blockers are considered as first-line therapy. The outcomes after revascularization in diabetic patients are usually worse compared with non-diabetic patients. Advances in PCI include the use of drug-eluting stents and adjunctive drug therapies, such as abciximab. Glycemic control is an important determinant of outcome after revascularization in diabetic patients. Improvements in PCI and coronary artery bypass graft surgery are leading to better results in diabetic patients, and clinical trials are presently comparing contemporary PCI with surgery.
Correlation Between Lower-extremity Functional Status and Obesity in Type-II Diabetic Patients with and without Peripheral Arterial Disease at Dr. Sardjito Central General Hospital, Yogyakarta.
(2009-01-05) Wangi, Harakati; Asdie, Rizka Humardewayanti
Aim: to recognize the correlation between lower-extremity functional status and obesity in patients with type-2 DM with PAD complication (with and without peripheral arterial disease). Methods: the study was a cross-sectional study conducted at Outpatients Clinic of Internal Medicine, Dr. Sardjito Central General Hospital in August-December 2006. Fifty-five subjects who were patients with type-2 DM aged more than 50 years agreed to participate and were eligible for the study; while the exclusion criteria included smoking, diabetic ulcer or gangrene, history of amputation due to diabetic ulcer or gangrene. The diagnosis of PAD was based on Ankle Brachial Index < 0.90. Results: mean age was 62.53 +/- 6.82 years old and mean value of BMI was 24.26 +/- 3.57 kg/m2, 18 subjects (32.7%) were obese. The proportion of obese subjects with PAD was higher compared to the non-obese subjects (41% vs. 27%, p = 0.372). Lower-extremity functional status of type-2 diabetic patients either with or without PAD in obese subjects needs longer period of time (7.17 +/- 1.74 minute and 6.94 +/- 1.48 minute vs. 5.13 +/- 1.47 minute and 4.58 +/- 1.17 minute, p < 0.05 and p < 0.001). Conclusion: the functional status of lower extremities in obese patients with DM is poorer than the non-obese subjects.
Genetics of graves' disease: the lost concept.
(2009-01-05) Sibarani, Roy Panusunan
A key issue of Really Significant Genes (RSG) that caused Graves Disease is unresolved. RSGs are considered likely major contributors to genetic risk for a disease. These genes should be strongly linked within families and they could become clinically useful as predictors of disease. Some Graves Disease susceptibility genes have been identified. The first identified was the Human-Leucocyte-Antigen DR (HLA-DR) gene locus, then a non-HLA genes as cytotoxic T lymphocyte antigen (CTLA-4), CD40, protein tyrosine phosphatase-22 (PTPN22), thyroglobulin, and thyroid-stimulating hormone receptor (TSHR) gene. The sites observed in different populations were not always the same. With the completion of the HapMap, which provided the geography of thousands single nucleotide polymorphisms (SNPs), the search of more minor associated genes started again although studies never revealed stronger candidates, meanwhile, the role of the environment in disease development remains poorly understood. The importance of the environment with the mechanisms involved including genetic factors is needed to be decided.
Hypoadiponectinemia: a risk factor for metabolic syndrome.
(2009-01-05) Renaldi, Olly; Pramono, Bowo; Sinorita, Hemi; Purnomo, Luthfan Budi; Asdie, Rizka Humardewayanti; Asdie, Ahmad H
Aim: to find out correlation between plasma adiponectin levels, insulin resistance and IDF criteria of Mets Patients. Methods: a case-control study was conducted on Native Javanese people from June 2006 to Januari 2007 in Outpatients Clinic of Dr Sardjito Hospital. The case group involved patients aged between 20 to 55 years old. The diagnosis of metabolic syndrome was confirmed according to IDF criteria. Patients without metabolic syndrome with matching age and sex,were taken as control group. Results: there were significant differences between case andh control group for BMI (body mass index) (30.2 +/- 4.1 vs 26.9 +/- 4.7 kg/m2), waist circumference (93.5 +/- 7.9 vs 84.4 +/- 11.5 cm), triglyceride (207.4 +/- 101.8 vs. 119.3 +/- 71.5 mg/dL) , HDL cholesterol (48.6 +/- 9.4 vs. 59.9 +/- 11.8m g/dL), systolic blood pressure (132.8 +/- 17.9mmHg vs 120.6 +/- 13.5 mmHg) and diastolic blood pressure (83.8 +/- 8.5 mmHg vs. 79.4 +/- 10.7), fasting blood glucose (128.3 +/- 40.8 mg/dL vs. 100.7 +/- 29.4 mg/dL), HOMA index (6.7 +/- 17.4 vs. 2.0 +/- 2.0) and adiponectin levels (3.8 +/- 1.4 vs. 5.9 +/- 2.5), respectively. For metabolic syndrome, hypoadiponectinemia showed the OR value of 6.0 (95% CI 2.13 to 16.98); insulin resistance showed the OR value of 5.7 (95% CI 1.3 to 25.02), after adjustment for waist circumference, TG, HLD, blood pressure, fasting blood glucose. Conclusion: hypoadiponectinemia and insulin resistance represent independent risk factors for metabolic syndrome development.
Clinical Picture, Insulin Resistance, and Adipocytokines Profiles of Nonalcoholic Steatohepatitis (NASH) Patients in Indonesia.
(2009-01-05) Lesmana, C Rinaldi; Lesmana, Laurentius A; Akbar, Nurul; Gani, Rino A; Simandjuntak, W; Oemardi, Maryantoro; Soejono, Czeresna H; Marwoto, Wirasmi; Juwono, Vera
Aim: to know the clinical picture of subjects with NASH in Jakarta, Indonesia and the prevalence of insulin resistance, TNF-a, and adiponectin levels among them. Methods: this was a comparative cross-sectional study between patients with histopathologically confirmed NASH and normal subjects. The population of study was patients with fatty liver without history or significant consumption of ethanol. Patients were consecutively enrolled in the study if the ultrasonography showed fatty liver appearance with or without increased liver transaminases. Results: thirty patients and thirty normal subjects were recruited between February 2005 and January 2006. Median age of the patients was 45 years while the median age of the control group was 32 years. More than 80% of the patients were overweight (BMI 23-25 kg/m2) and obese (BMI > 25 kg/m2). Increased alanine aminotransaminase levels were found in almost two thirds of the patients. Other comorbidities included hypertension, hypertriglyceridemia, and type-2 diabetes mellitus. In patients with NASH, fasting insulin level, insulin resistance, and TNF-a level were significantly higher, whereas adiponectin level was significantly lower than the control group. Conclusion: most of the metabolic syndrome determinants were found in patients with NASH. HOMA-IR and TNF-alpha levels in subjects with NASH are higher than those in controls. Adiponectin levels in subjects with NASH are lower than those in controls. Further epidemiological studies are still needed to elaborate the causal relationship of insulin resistance and cytokine profiles to the development of NASH in Indonesia.
Pulmonary involvement predicts mortality in severe leptospirosis patients.
(2009-01-05) Budiono, Eko; Sumardi,; Riyanto, Bambang Sigit; Hisyam, Barmawi; Hartopo, Anggoro Budi
Aim: to evaluate the influence of pulmonary involvement at admission in predicting mortality among patients with severe leptospirosis. Methods: reprospective cohort study from medical record registry in Dr. Sardjito Hospital, Yogyakarta from 2003 to 2007. Pulmonary involvement was defined by the presence of pulmonary infiltrate, consolidation or pleural effusion in thorax radiography. Pulmonary edema was excluded. Admission data were collected. Follow-up records were noted until patients were discharded or died. The correlation between predictors (some patient characteristics on admission) and outcome (mortality) were evaluated using univariate analysis, and then proceeded to multivariable logistic regression analysis. P < 0.05 is considered statistically significant. Results: sixty patients with severe leptospirosis as a main diagnosis were evaluated. Fifty-five subjects were eligible for analysis, male patients 37 (67.3%) and mean age 42 +/- 15 years old. Pulmonary involvement was presence in 7 patients (12.7%). In univariate analysis only the presence of meningismus and pulmonary involvement were associated with mortality (p=0.001 and 0.006 respectively). In multivariable logistic regression, pulmonary involvement was independently a strong predictor of mortality (OR 9.9 95% CI (1.17 - 84.03), p=0.035). Conclusion: pulmonary involvement at admission is a strong predictor of mortality among patients with severe leptospirosis.
Metastasis of testicular carcinoma in the inguinal region.
(2009-01-05) Hamid, Agus Rizal Ah; Umbas, Rainy
A standard protocol for the management of inguinal metastasis from testicular cancer still has not yet been established. Metastasis of testicular cancer to inguinal lymph node rarely occurs, particularly in patients without any prior surgery in inguinal and scrotal region. Daugaard reported 2% incidence of inguinal metastasis for stage 1 testicular cancer in 5-year period. We reported a case of inguinal metastasis from residual testicular cancer with a large size of mass. The case had also been counted as advanced stage since it had further metastasis to the lungs. For this case, surgical treatment of residual tumor excision had been performed prior to the chemotherapy considering a quite large size of tumor mass, which may easily bleed and causing anemia to the patient. Furthermore, we considered that chemotherapy treatment prior to surgical excision will only provide partial effect on the tumor. After the surgery, a 4-cycle combined chemotherapy was administered despite the delay of chemotherapy treatment resulting in residual mass in inguinal region. In fact, the post-surgical chemotherapy treatment in this case has demonstrated relatively good response.
Addison's Diseases.
(2009-01-05) Harbuwono, Dante Saksono; Tarigan, Tri Juli Edi; Suyono, Slamet; Subekti, Imam
The degree of radiographic abnormalities and postural instability in patients with knee osteoarthritis.
(2009-01-05) Tarigan, Tri Juli Edi; Kasjmir, Yoga Iwanoff; Atmakusuma, Djumhana; Lydia, Aida; Bashiruddin, Jenni; Kusumawijaya, Kahar; Prihartono, Joedo
Aim: to determine the degree of radiographic abnormalities based on Kellgren-Lawrence criteria, to determine posturography features in patients with knee OA. Methods: ninety nine subjects were recruited by consecutive sampling at the outpatient clinic of Internal Medicine in Cipto Mangunkusumo Hospital. History taking and physical examination including rheumatology examination were conducted, followed by knee radiographic examination in weight bearing and 30 degree skyline position. A cross sectional design was performed to evaluate the variable results for degree of radiolographic abnormalites and posturography results. Results: the subjects were 79.8% women and 20.2% men, mostly >/= 60 year-old (78.8%), with low education 76.8%, BMI >/= 23 74.7%, mean value of active VAS was 5.4, mean value of passive VAS 2.8. Mild radiographic abnormality was found in 77.8% subjects, and the others were severe, i.e. 22.2%. There were increase in length of postural sway, increase of postural sway velocity, and increase in area of postural sway in patients with knee OA compared with normal subjects with 40-60 years old. Conclusion: there is an increase in nearly all variables of posturography in patients with knee OA.

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