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"Latar Belakang: Karsinoma pankreas umumnya merupakan adenokarsinoma duktus dari pankreas, karena lebih dari 90% tumor pankreas berasal dari epitel duktus dan memiliki angka mortalitas tinggi. Adenokarsinoma pankreas menyebabkan berbagai gejala akibat obstruksi duktus biliaris dan duktus pankreatikus serta hipermetabolisme terkait perubahan metabolik pada kanker. Tindakan kuratif meliputi pembedahan menyebabkan perubahan anatomi fisiologik saluran cerna dan dapat menimbulkan berbagai komplikasi gastrointestinal yang menyebabkan malnutrisi pada pasien. Perubahan metabolik, gejala penyakit, dan tatalaksana adenokarsinoma pankreas dapat menyebabkan malnutrisi dan kaheksia kanker. Terapi nutrisi perioperatif yang adekuat akan menghasilkan outome bedah yang baik, menurunkan morbiditas dan mortalitas pascabedah, dan meningkatkan kualitas hidup pasien. Metode: Laporan serial kasus ini menguraikan empat kasus adenokarsinoma pankreas, yaitu dua kasus adenokarsinoma papila Vateri, satu kasus adenokarsinoma papila Vateri yang sudah infiltrasi ke duodenum, dan satu kasus adenokarsinoma pankreas dari kaput sampai kauda. Keempat pasien serial kasus tergolong kaheksia kanker. Pembedahan pada keempat kasus disesuaikan dengan lokasi dan metastasis kanker. Terapi nutrisi pada serial kasus ini dilakukan sesuai dengan pedoman terapi nutrisi perioperatif. Seluruh pasien mendapat terapi nutrisi mulai dari masa prabedah hingga pascabedah dengan pemberian energi dan makronutrien ditingkatkan bertahap sesuai dengan kondisi klinis dan toleransi pasien. Suplementasi mikronutrien juga diberikan kepada keempat pasien. Pemantauan pasien meliputi keluhan subjektif, hemodinamik, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan, dan kapasitas fungsional. Hasil: Selama pemantauan di RS, keempat pasien menunjukkan perbaikan klinis, peningkatan toleransi asupan, outcome bedah yang baik, serta perbaikan kapasitas fungsional dan hasil laboratorium. Kesimpulan: Terapi nutrisi perioperatif pada keempat pasien berperan penting dalam menunjang perbaikan klinis, dan outcome bedah, serta mendukung terapi pada kasus kanker pankreas.

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Background: Pancreatic cancer usually refers to ductal adenocarcinomas of the pancreas, since more than 90% of the tumors are ductal epithelium origin and have high mortality rate. Pancreatic adenocarcinoma causes various symptoms resulted from ductal biliary and pancreatic ducts obstruction, along with hypermetabolism related to metabolic alteration in cancer. Curative management involves surgery will make changes in gastrointestinal anatomy and physiology, and cause various gastrointestinal complication that will lead to malnutrition. Metabolic changes, symptoms of the disease and pancreatic adenocarcinoma therapy will cause malnutrition and cancer cachexia. Adequate perioperative nutrition will have good surgery outcome, reduce postoperative morbidity and mortality and increase patients quality of life.

Methods: This serial case report described four cases of pancreatic adenocarcinoma consist of two cases with adenocarcinoma of the papilla of Vater, one case with adenocarcinoma of the papilla of Vater with duodenum infiltration, and one case with pancreatic adenocarcinoma from head to tail. All patients classified as cancer cachexia. Surgery was carried out corresponds to cancer location and metastasis. Nutrition therapy in this serial case report was conducted in accordance to perioperative nutrition therapy guideline. All patients received nutrition support from preoperative to postoperative with gradual increased of energy and macronutrient adjusted to the clinical condition and food tolerance of the patients. Micronutrients supplementation was given to all patients. Monitoring included patients complaints, hemodynamic, food analysis and intake tolerance, laboratory results, anthropometry, fluid balance and functional capacity.

Results: During monitoring in the hospital, all patients showed improve clinical outcomes, increased food intake tolerance, good surgery outcomes, and improved functional capacity, and laboratory results.

Conclusion: Perioperative nutrition therapy in all patients play an important role in supporting clinical outcome improvement, surgery outcomes, and therapy in pancreatic cancer."

"CA 19-9 merefleksikan derajat keparahan adenokarsinoma kaput pankreas ditunjukkan oleh beberapa studi berhasil menemukan korelasi peningkatan CA 19-9 dengan resektabilitas adenokarsinoma kaput pankreas. Penelitian ini bertujuan melakukan evaluasi hubungan dan nilai diagnostik CA 19-9 dalam memprediksi resektabilitas adenokarsinoma kaput pankreas. Penelitian dilakukan secara potong lintang mengambil data dari rekam medis Rumah Sakit dr. Cipto Mangunkusumo tahun 2016–2019. Pasien terdiagnosis adenokarsinoma kaput pankreas secara histopatologis atau pencitraan abdomen, berusia ≤65 tahun, dan memiliki catatan pemeriksaan kadar CA 19-9 diikutsertakan dalam penelitian ini. Selain kadar CA 19-9, peneliti juga menilai factor terkait operabilitas. Tercatat 54 subjek dengan rerata usia 53,78±11,13 tahun. Ditemukan adanya korelasi positif (0,850) dan signifikan antara tingginya kadar CA 19- 9 dengan resektabilitas tumor kaput pankreas. Untuk operabilitas, ditemukan perbedaan bermakna kadar CA 19-9, albumin, dan skor Karnofsky pada kelompok pasien tumor kaput pankreas resectable dan unresectable. Titik potong kadar CA 19-9 tercatat sebesar 140,65 U/mL, dengan sensitivitas sebesar 82,76% (64,23%–94,15%), spesifisitas sebesar 72,00% (50,61%–87,93%), dan AUC sebesar 0,784. CA 19-9 berhubungan secara signifikan dengan resektabilitas tumor kaput pankreas. CA 19-9 memiliki nilai diagnostik yang baik dalam mempredisksi resektabilitas tumor ini.

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This study would like to evaluate the relationship and diagnostic value of CA 19-9 in predicting the resectability of pancreatic head carcinoma. The cross-sectional study took data from the medical records at dr Cipto Mangunkusumo Hospital in 2015–2019. Patients diagnosed with pancreatic head carcinoma based on histopathologic or abdominal imaging, aged ≤75 years, and who had a recorded CA level of 19-9 were enrolled in the study. The investigators also assessed parameters of operability. Of 54 patients with similar characteristics were enrolled, with a mean age of 53.78 ± 11.13 years. It was found that there was a positive (0.850) and significant correlation between high levels of CA 19-9 and unresectable pancreatic head carcinoma. We found significant differences in levels of CA 19-9, albumin, and Karnofsky score in the resectable and unresectable groups of pancreatic head carcinoma. The cut-off point for CA 19-9 levels was 140.65 U / mL, with a sensitivity of 82.76% (64.23%-94.15%), specificity of 72.00% (50.61%-87.93 %), and AUC of 0.784. CA 19-9 was significantly associated with the pancreatic head carcinoma resectability. CA 19-9 has a good diagnostic value in predicting the resectability of these tumors."

"Keganasan pankreas merupakan keganasan dengan angka kematian yang tinggi, dengan Adenokarsinoma Duktal Pankreas/Pancreatic Ductal Adenocarcinoma (PDAC) mencakup 85-90% kasus. PDAC memiliki perjalanan penyakit yang sangat agresif, dan seringkali baru terdiagnosis pada stadium lanjut. Penegakan diagnosis pasti PDAC seringkali hanya dapat dilakukan melalui sediaan terbatas baik berupa biopsi maupun endoscopic ultrasound-guided fine-needle aspiration/EUS-FNA. Salah satu tantangannya adalah membedakan PDAC dari jaringan pankreas non-neoplastik/reaktif. Penelitian ini akan membahas mengenai peran von Hippel-Lindau gene product/pVHL dalam membedakan PDAC dengan jaringan pankreas non-neoplastik, serta hubungannya dengan profil klinikopatologiradira PDAC. Penelitian ini merupakan penelitian observasional analitik dengan desain cross-sectional pada kasus PDAC dan jaringan pankreas non-neoplastik yang dilakukan di RSCM pada sampel yang diperoleh pada bulan Januari 2012 hingga September 2023. Sampel penelitian dibagi menjadi 2 kelompok besar, yaitu kelompok PDAC dan pankreas non-neoplastik. Pemilihan sampel dilakukan dengan menggunakan simple random sampling dari kasus-kasus yang memenuhi kriteria inklusi dan tidak termasuk dalam kriteria eksklusi. Dilakukan pulasan imunohistokimia pVHL dan perhitungan Histoscore/H-score serta penentuan cut-offnya untuk membagi ekspresi pVHL menjadi tinggi dan rendah dan hubungannya dengan PDAC dan non-neoplastik, serta profil klinikopatologi pada kelompok PDAC. Penelitian ini menunjukkan tidak terdapat perbedaan ekspresi pVHL pada kelompok PDAC dan non-neoplastik, dan staging pN memiliki hubungan bermakna dengan ekspresi pVHL pada PDAC. Ekspresi pVHL yang rendah lebih banyak ditemukan pada PDAC berdiferensiasi sedang, tidak ditemukan invasi limfovaskular maupun invasi perineural, memiliki batas sayatan yang tidak bebas, memiliki staging pT2, pN0, M0, dan kesintasan > 7 bulan. Sebaliknya, ekspresi pVHL yang tinggi juga lebih banyak ditemukan pada PDAC berdiferensiasi sedang, ditemukan invasi limfovaskular, tidak ditemukan invasi perineural, status batas sayatan yang bebas, staging pT2 dan pT3, pN1 dan pN2, M0, dengan kesintasan ≤ 7 bulan. Temuan ini berbeda dengan penelitian sebelumnya yang mendapati hilangnya ekspresi pVHL pada tumor PDAC, dan sebaliknya pada duktus pankreas non-neoplastik. Hal ini kemungkinan disebabkan oleh perbedaan klon antibodi yang digunakan pada penelitian ini dibandingkan dengan penelitian sebelumnya. Klon antibodi yang digunakan adalah VHL40, sedangkan penelitian-penelitian sebelumnya menggunakan klon FL-181 yang berikatan dengan asam amino yang berbeda dan memiliki klonalitas yang berbeda pula. Selain itu, pada PDAC dapat terjadi mutasi pada gen VHL yang menghasilkan protein VHL yang non-fungsional yang kemungkinan masih dapat terdeteksi dengan ikatan antigen-antibodi pada penelitian ini. 

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Pancreatic malignancy is a malignancy with a high mortality rate, with Pancreatic Ductal Adenocarcinoma (PDAC) accounting for 85-90% of cases. PDAC has a very aggressive disease course, and is often only diagnosed at an advanced stage. Establishing a definite diagnosis of PDAC can often only be done through limited sample from biopsy or endoscopic ultrasound-guided fine-needle aspiration/EUS-FNA. In such limited sample, differentiating PDAC from non-neoplastic/reactive pancreatic tissue can be challenging. This research will discuss the role of von Hippel-Lindau gene product/pVHL in PDAC and non-neoplastic pancreatic tissue, as well as their relationship with PDAC pathological factors. This research is an analytical observational study with a cross-sectional design on cases of PDAC and non-neoplastic pancreatic tissue conducted at RSCM on samples obtained from January 2012 to September 2023. The research samples were divided into 2 large groups, namely the PDAC and non-neoplastic pancreatic groups. Sample selection was carried out using simple random sampling from cases that met the inclusion criteria and were not included in the exclusion criteria. Immunohistochemistry of pVHL was performed along with calculation of Histoscore/H-score and determination of cut-offs to divide pVHL expression into high and low and its relationship with PDAC and non-neoplastic, as well as pathological factors in the PDAC group. This study shows that there is no difference in pVHL expression in the PDAC and non-neoplastic groups, and pN staging has a significant relationship with pVHL expression in PDAC. Low pVHL expression is more often found in moderately differentiated PDAC, no lymphovascular invasion or perineural invasion, non-free incision margins, staging pT2, pN0, M0, and survival > 7 months. In contrast, high pVHL expression was also found more frequently in moderately differentiated PDAC, lymphovascular invasion was found, no perineural invasion was found, free incision margin status, pT2 and pT3 staging, pN1 and pN2, M0, with survival ≤ 7 months. This finding is different from previous studies which found loss of pVHL expression in PDAC tumors, and vice versa. This difference in results is likely due to differences in the antibody clones used in this study compared to previous studies. The antibody clone used was VHL40, whereas previous studies used the FL-181 clone which binds to different amino acids and has different clonality. In addition, in PDAC there is a mutation in the VHL gene which may produce a non-functional VHL protein that still be detectable by antigen-antibody binding in this study."

"CA 19-9 merefleksikan derajat keparahan adenokarsinoma kaput pankreas ditunjukkan oleh beberapa studi berhasil menemukan korelasi peningkatan CA 19-9 dengan resektabilitas adenokarsinoma kaput pankreas. Penelitian ini bertujuan melakukan evaluasi hubungan dan nilai diagnostik CA 19-9 dalam memprediksi resektabilitas adenokarsinoma kaput pankreas. Penelitian dilakukan secara potong lintang mengambil data dari rekam medis Rumah Sakit dr. Cipto Mangunkusumo tahun 2016–2019. Pasien terdiagnosis adenokarsinoma kaput pankreas secara histopatologis atau pencitraan abdomen, berusia ≤65 tahun, dan memiliki catatan pemeriksaan kadar CA 19-9 diikutsertakan dalam penelitian ini. Selain kadar CA 19-9, peneliti juga menilai factor terkait operabilitas. Tercatat 54 subjek dengan rerata usia 53,78±11,13 tahun. Ditemukan adanya korelasi positif (0,850) dan signifikan antara tingginya kadar CA 19-9 dengan resektabilitas tumor kaput pankreas. Untuk operabilitas, ditemukan perbedaan bermakna kadar CA 19-9, albumin, dan skor Karnofsky pada kelompok pasien tumor kaput pankreas resectable dan unresectable. Titik potong kadar CA 19-9 tercatat sebesar 140,65 U/mL, dengan sensitivitas sebesar 82,76% (64,23%–94,15%), spesifisitas sebesar 72,00% (50,61%–87,93%), dan AUC sebesar 0,784. CA 19-9 berhubungan secara signifikan dengan resektabilitas tumor kaput pankreas. CA 19-9 memiliki nilai diagnostik yang baik dalam mempredisksi resektabilitas tumor ini.

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CA 19-9 reflects the degree of severity of pancreatic head adenocarcinoma shown by several studies to find a correlation of elevated CA 19-9 with resectability of pancreatic head adenocarcinoma. This study aimed to evaluate the relationship and diagnostic value of CA 19-9 in predicting resectability of pancreatic head adenocarcinoma. The study was conducted in a cross-sectional manner, taking data from the medical records of dr. Cipto Mangunkusumo 2016–2019. Patients diagnosed with adenocarcinoma of the head of the pancreas by histopathologic or abdominal imaging, aged ≤65 years, and who had a record CA level of 19-9 were included in this study. In addition to CA levels of 19-9, the investigators also assessed operability-related factors. There were 54 subjects with a mean age of 53.78 ± 11.13 years. Found a positive correlation (0, 850) and significant between high levels of CA 19-9 with resectability of head tumors of the pancreas. For operability, there were significant differences in CA 19-9 levels, albumin, and Karnofsky scores in the resectable and unresectable group of pancreatic head tumors. The cut-off point for CA 19-9 levels was recorded at 140.65 U / mL, with a sensitivity of 82.76% (64.23% -94.15%), a specificity of 72.00% (50.61% -87.93 %), and AUC of 0.784. CA 19-9 was significantly associated with pancreatic head tumor resectability. CA 19-9 has a good diagnostic value in predicting the resectability of these tumors. The cut-off point for CA 19-9 levels was 140.65 U / mL, with a sensitivity of 82.76% (64.23% -94.15%), a specificity of 72.00% (50.61% -87.93 %), and AUC of 0.784. CA 19-9 was significantly associated with pancreatic head tumor resectability. CA 19-9 has a good diagnostic value in predicting the resectability of these tumors. The cut-off point for CA 19-9 levels was 140.65 U / mL, with a sensitivity of 82.76% (64.23% -94.15%), a specificity of 72.00% (50.61% -87.93 %), and AUC of 0.784. CA 19-9 was significantly associated with pancreatic head tumor resectability. CA 19-9 has a good diagnostic value in predicting the resectability of these tumors"

"CA 19-9 merefleksikan derajat keparahan adenokarsinoma kaput pankreas ditunjukkan oleh beberapa studi berhasil menemukan korelasi peningkatan CA 19-9 dengan resektabilitas adenokarsinoma kaput pankreas. Penelitian ini bertujuan melakukan evaluasi hubungan dan nilai diagnostik CA 19-9 dalam memprediksi resektabilitas adenokarsinoma kaput pankreas. Penelitian dilakukan secara potong lintang mengambil data dari rekam medis Rumah Sakit dr. Cipto Mangunkusumo tahun 2016–2019. Pasien terdiagnosis adenokarsinoma kaput pankreas secara histopatologis atau pencitraan abdomen, berusia ≤65 tahun, dan memiliki catatan pemeriksaan kadar CA 19-9 diikutsertakan dalam penelitian ini. Selain kadar CA 19-9, peneliti juga menilai factor terkait operabilitas. Tercatat 54 subjek dengan rerata usia 53,78±11,13 tahun. Ditemukan adanya korelasi positif (0,850) dan signifikan antara tingginya kadar CA 19-9 dengan resektabilitas tumor kaput pankreas. Untuk operabilitas, ditemukan perbedaan bermakna kadar CA 19-9, albumin, dan skor Karnofsky pada kelompok pasien tumor kaput pankreas resectable dan unresectable. Titik potong kadar CA 19-9 tercatat sebesar 140,65 U/mL, dengan sensitivitas sebesar 82,76% (64,23%–94,15%), spesifisitas sebesar 72,00% (50,61%–87,93%), dan AUC sebesar 0,784. CA 19-9 berhubungan secara signifikan dengan resektabilitas tumor kaput pankreas. CA 19-9 memiliki nilai diagnostik yang baik dalam mempredisksi resektabilitas tumor ini.

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This study would like to evaluate the relationship and diagnostic value of CA 19-9 in predicting the resectability of pancreatic head carcinoma. The cross-sectional study took data from the medical records at dr Cipto Mangunkusumo Hospital in 2015–2019. Patients diagnosed with pancreatic head carcinoma based on histopathologic or abdominal imaging, aged ≤75 years, and who had a recorded CA level of 19-9 were enrolled in the study. The investigators also assessed parameters of operability. Of 54 patients with similar characteristics were enrolled, with a mean age of 53.78 ± 11.13 years. It was found that there was a positive (0.850) and significant correlation between high levels of CA 19-9 and unresectable pancreatic head carcinoma. We found significant differences in levels of CA 19-9, albumin, and Karnofsky score in the resectable and unresectable groups of pancreatic head carcinoma. The cut-off point for CA 19-9 levels was 140.65 U / mL, with a sensitivity of 82.76% (64.23%-94.15%), specificity of 72.00% (50.61%-87.93 %), and AUC of 0.784. CA 19-9 was significantly associated with the pancreatic head carcinoma resectability. CA 19-9 has a good diagnostic value in predicting the resectability of these tumors."

"Latar Belakang: Penyakit keganasan urogenital merupakan spektrum penyakit yang luas, dengan penatalaksanaan mulai dari observasi dan pemantauan ketat hingga pembedahan ekstirpatif mayor. Risiko malnutrisi praoperatif akibat kanker dan pascaoperatif akibat stres pembedahan akan meningkatkan risiko morbiditas dan mortalitas. Terapi nutrisi perioperatif yang adekuat bertujuan untuk menunjang perbaikan klinis dan status nutrisi, mendukung proses pemulihan, menurunkan risiko komplikasi pascaoperasi, serta menurunkan lama rawat di rumah sakit. Metode: Laporan serial kasus ini menyajikan empat kasus kanker urogenital, terdiri dari dua kasus kanker buli, satu kasus kanker ginjal, dan satu kasus kanker penis. Tiga kasus termasuk kaheksia kanker, dan satu kasus termasuk pra-kaheksia. Seluruh pasien menjalani pembedahan urologi mayor dengan anestesi umum dan epidural. Terapi nutrisi perioperatif yang diberikan antara lain carbohydrate loading, nutrisi enteral dini pascaoperasi, serta pemberian nutrisi secara bertahap berdasarkan kondisi klinis. Dilakukan pemantauan yang meliputi keluhan klinis, antropometri, pemeriksaan fisik, hasil laboratorium, dan analisis asupan. Hasil: Dua pasien mengalami ileus paralitik pascaoperasi dengan satu pasien di antaranya membutuhkan nutrisi parenteral total, dan dapat teratasi dalam 7 hari pascaoperasi. Satu pasien mengalami hiperglikemia reaktif dan diberikan terapi insulin, dapat teratasi dalam 7 hari pascaoperasi. Satu pasien mengalami perlambatan penyembuhan luka dan memiliki masa rawat pascaoperasi paling lama. Pasien yang mengalami ileus paralitik membutuhkan waktu lebih lama untuk mencapai target kalori 80 , namun seluruh pasien telah dapat mencapai target tersebut dalam 7 hari pascaoperasi. Lama perawatan pascaoperasi bervariasi, sekitar 10-27 hari. Kesimpulan: Terapi nutrisi perioperatif yang diberikan pada keempat pasien menunjang perbaikan klinis dan status nutrisi, mendukung proses pemulihan, menurunkan risiko komplikasi pascaoperasi, serta menurunkan lama rawat di rumah sakit.

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Background: Genitourinary malignancy represents a broad spectrum of disease, with treatments ranging from watchful waiting to major extirpative surgery. The risk of preoperative malnutrition due to cancer and postoperatively due to surgical stress will increase the risk of morbidity and mortality. An adequate perioperative nutrition therapy aims to support clinical and nutritional status improvement, hasten the recovery process, reduce the risk of postoperative complications, and decrease the length of hospital stay.

Method This case series report presents four cases of genitourinary cancers, consist of two cases of bladder cancer, one case of kidney cancer, and one case of penile cancer. Three cases are classified into cancer cachexia, and one case of pre cachexia. All patients had undergone major urological surgery under general and epidural anesthesia. Perioperative nutrition therapy provides carbohydrate loading, postoperative early enteral nutrition, as well as gradual nutrition based on clinical conditions. The monitoring given included clinical complaints, anthropometric measurement, physical examination, laboratory test results, and intake analysis.

Result Two patients had postoperative paralytic ileus with one patient requires total parenteral nutrition, and resolved within 7 days after surgery. One patient had reactive hyperglycemia and treated with insulin therapy, resolved in 7 days postoperative. One patient experienced impaired wound healing and had the longest postoperative care period. Patients with paralytic ileus may take more days to achieve 80 calorie target, yet all patients have been able to achieve the target in 7 days postoperative. The length of hospital stay after surgery was varied between 10 to 27 days.

Conclusion Perioperative nutrition therapy given to four patients in this case series leads to the clinical and nutritional status improvement, supports the recovery process, decreases the risk of postoperative complications, and shortens the hospital stays."

"Latar Belakang: Adenokarsinoma duktal pankreas dan adenokarsinoma ampula vateri, tanpa melihat gambaran episentrum tumor, sulit dibedakan secara histopatologi. Gejala klinis tidak spesifik sehingga kasus yang ditemukan seringkali tidak memenuhi kriteria resectable. Gambaran radiologi juga tidak spesifik, padahal terapi dan prognosis keduanya berbeda. Adenokarsinoma duktal pankreas memiliki angka kesintasan rendah dibanding adenokarsinoma ampula vateri. Penentuan asal tumor, berasal dari duktal pankreas atau ampula vateri, sangat penting. SMAD4 diduga dapat menjadi salah satu panel diagnostik imunohistokimia. Penelitian ini dilakukan dengan melihat perbandingan ekspresi SMAD4 di adenokarsinoma ampula vateri dan adenokarsinoma duktal pankreas.Tujuan: Mengetahui perbandingan ekspresi SMAD4 pada adenokarsinoma duktal pankreas dan adenokarsinoma ampula vateri.Metode: Penelitian analitik observasional, desain potong lintang pada sediaan reseksi adenokarsinoma duktal pankreas dan adenokarsinoma ampula vateri, periode Januari 2013 hingga September 2021. Pengambilan sampel dilakukan secara total sampling. Adenokasinoma ampula vateri dengan subtipe pankreatobiliar dieksklusi. Pemeriksaan imunohistokimia menggunakan antibodi primer SMAD4. Data imunohistokimia dianalisis untuk melihat adakah perbedaan ekspresi SMAD4 pada adenokarsinoma di ampula vateri dan adenokarsinoma duktal pankreas.Hasil: Loss of SMAD4 didapatkan pada 12 kasus (60 %) adenokarsinoma duktal pankreas dan 8 kasus (44,4 %) adenokarsinoma ampula vateri. Tidak didapatkan hubungan loss of SMAD4 pada adenokarsinoma duktal pankreas dan adenokarsinoma ampula vateri (p=0,338).Kesimpulan: Tidak terdapat hubungan bermakna loss of SMAD4 pada adenokarsinoma duktal pankreas dan adenokarsinoma ampula vateri. Namun terdapat trend loss of SMAD4 lebih tinggi pada adenokarsinoma duktal pankreas dibanding adenokarsinoma ampula vateri subtipe intestinal dan mixed type dominansi intestinal.

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ackground: Differentiating pancreatic ductal adenocarcinoma and ampullary adenocarcinoma without knowing the epicenter of the tumor is difficult. The clinical symptoms are non-specific. The cases found usually do not meet the operable criteria. Radiological examination is also non-specific, although the treatment and prognosis are different. Pancreatic ductal adenocarcinoma has lower survival rate than ampullary adenocarcinoma. It is very important to determine the origin of the tumor from pancreatic ductal or ampulla of Vater. SMAD4 is expected to be one of immunohistochemical diagnostic panel for the pancreatic ductal adenocarcinoma. This study compares the SMAD4 expression in pancreatic ductal adenocarcinoma and ampullary adenocarcinoma.

Objective: Knowing the comparison of SMAD4 expression in pancreatic ductal adenocarcinoma and ampullary adenocarcinoma.

Methods: Observational analytical study with cross sectional design, total sampling was performed on the resection specimens of pancreatic ductal adenocarcinoma and ampullary adenocarcinoma, period January 2013 to December 2021. Ampullary adenocarcinoma with pancreatobilliary subtype was excluded. Immunohistochemical examination using SMAD4 primary antibody. Immunohistochemical data will be analyzed to see SMAD4 expression difference between pancreatic ductal adenocarcinoma and ampullary adenocarcinoma.

Results: Loss of SMAD4 was found in 12 cases (66,7 %) of pancreatic ductal adenocarcinoma and 6 cases (44,4 %) of ampullary adenocarcinoma. There was no significant relationship between loss of SMAD4 in pancreatic ductal adenocarcinoma and ampullary adenocarcinoma (p=0,338).

Conclusions: There was no significant relationship between loss of SMAD4 in pancreatic ductal adenocarcinoma and adenocarcinoma of the ampulla of vater. However, there was a trend of higher SMAD4 loss in pancreatic ductal adenocarcinoma than ampullary vater adenocarcinoma of intestinal subtype and mixed type with intestinal dominance."

"Perawat residensi spesialis medikal bedah kekhususan respirasi yang melakukan praktik di RSUP Persahabatan Jakarta diharapkan dapat menerapkan proses asuhan keperawatan profesional dalam mengatasi masalah pernapasan yang dialami pasien untuk meningkatkan kualitas layanan kesehatan. Kompetensiyang harus dimiliki perawat spesialis diantaranya melakukan asuhan keperawatan profesional dan advokasi, berperan sebagai konsultan keperawatan Clinical Care Manajer (CCM ) bagi staf keperawatan dan pemberi terapi keperawatan kepada pasien. menjadi peneliti dan menerapkan evidence-based nursing practice (EBN), memimpin perubahan (inovator), Kompetensi tersebut sejalan dengan kompetensi yang telah dicapai pada praktik residensi ini. Peran pertama yaitu memberikan asuhan keperawatanprofesional pada pasien utama kanker paru dan 30 kasus resume menggunakan pendekatan teori Self Care Dorothea Orem. bertujuan untuk membantu individu kegiatan memenuhi kebutuhan dalam mempertahankan kehidupan, kesehatan dan kesejahteraan individu baik dalam keadaan sehat maupun sakit yang dilakukan oleh individu itu sendiri. Pasien dengan diagnosa kanker paru, untuk mengetahui stadium nodul kanker parunya. Maka dokter akan melakukan prosedur bronkoskopi. Pasien yang akan menjalani prosedur bronkoskopi, 57.2% pasien merasa takut/cemas. Pada penerapan Evidence Base Nursing (EBN), residen melakukan penerapan pemberian terapi musik binaural beat untuk mengurangi kecemasan pada pasien yang menjalani prosedur bronkoskopi. Hasil penerapan EBN menunjukan bahwa penerapan pemberian terapi musik binaural beat signifikan dalam menurunkan skor kecemasan pasien yang menjalani prosedur bronkoskopi. Implementasi proyek inovasi booklet bundle tracheostomy. Tujuan dari inovasi ini untuk meningkatkan kemampuan dan pengetahuan perawat dalam melakukan perawatan trakeostomi. serta perawat dapat memberikan edukasi terhadap pasien dalam melakukan perawatan trakeostomi secara mandiri.

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Competencies that are required with specialized nurse is to be able do professional nursing care plan, to advocate, to act as nursing consultant in Clinical Care Manager (CCM) for other nursing staff, to give therapy for patients, to be a a researcher and implement evidence-based nursing (EBN) practice, and to be an innovator. These competencies is in line with the competencies that was achieved during this residency practical. The first role is to give professional care plan for patients with primarily lung cancer and 30 case-resumes with the Dorothea Orem Self Care Theory approach, aiming to help individuals with life-sustaining needs, health care needs, and welfare needs during health condition or during illness of the individual. To know the stage of the lung cancer nodules for lung cancer diagnostics, the doctor is required to do bronchoscopy procedure. 57.2% of patients that will undergo bronchoscopy procedure felt scared or worried. In this implementation of Evidence-Based Nursing (EBN), binaural beat music therapy was given for the patients that will be having bronchoscopy procedure to help to reduce the patient's anxiety. The results of the EBN showed that giving binaural beat musical therapy significantly reduced the anxiety score for lung cancer patients that is undergoing bronchoscopy procedure. To implement the innovation project of Tracheostomy Bundle Booklet. The aim for this innovation is to increase the knowledge and ability for nurses to be able to do tracheostomy care. In addition, nurses will be able to educate patients and their families to do tracheostomy care independently if needed for home care."

"Pancreatic carcinoma commonly occur in patients over 60 years. It is usually manifested as abdominal pain, jaundice, and pancreatic mass. In this report, a pancreatic carcinoma occured in young woman is presented. A surgical drainage was done and followed by Whipple resection. However the patient passed away three month after the diagnosis.

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Karsinoma pankreas umumnya terjadi pada pasien berusia di atas 60 tahun. Biasanya bermanifestasi sebagai perut nyeri, penyakit kuning, dan massa pankreas. Dalam laporan ini, karsinoma pankreas yang terjadi pada wanita muda adalah disajikan. Drainase bedah dilakukan dan diikuti dengan reseksi Whipple. Namun pasien tersebut meninggal hilang tiga bulan setelah diagnosis."

"Latar belakang : Efek potensial EGFR-TKI terhadap fungsi paru belum diinvestigasi secara mendalam. Penelitian ini bertujuan untuk menilai efek pemberian EGFR TKI terhadap fungsi paru terutama nilai DLCO.Metode : Penelitian berlangsung secara prospektif dari September 2018 hingga Juni 2019 di Rumah Sakit Persahabatan Jakarta. Terdapat 20 subjek adenokarsinoma paru dengan mutasi tunggal di exon 19/21 yang dapat menyelesaikan pemeriksaan DLCO baik sebelum mendapat EGFR TKI dan setelah tiga bulan terapi.Hasil : Penelitian ini mendapatkan peningkatan bermakna nilai rerata KVP prediksi dari 60,6% menjadi 68,25% (p=0,03), nilai rerata VEP1 Prediksi dari 59,7% menjadi 67,05% (p=0,036), nilai rerata DLCO dari 11,55 ml/menit/mmHg menjadi 13,72 ml/menit/mmHg (p=0,004) dan DLCO prediksi dari 53,4% menjadi 63,85% (p=0,03). Peningkatan nilai rerata DLCO prediksi paling besar pada kelompok dengan hasil RECIST partial response yaitu sebesar 16,43% (p=0,056).Kesimpulan : Terapi EGFR TKI selama tiga bulan pada subyek adenokarsinoma paru dengan mutasi tunggal exon19/21 dapat meningkatkan fungsi paru secara bermakna baik nilai KVP prediksi, VEP1 prediksi, DLCO, dan DLCO prediksi.

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Background : The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are drugs of choice in non-small cell lung cancer possessing EGFR mutation. Its effect on the lung function is not well understood. This study aims to assess lung function using the lung diffusion capacity (DLCO) test in lung cancer patients treated with EGFR-TKIs. mingMethod :This prospective study included lung cancer patients treated with EGFR-TKIs at Persahabatan Hospital Jakarta, Indonesia, between September 2018 andGrowt June 2019. The study recruited 20 lung adenocarcinoma patients presented with a single mutation at exon 19 or 21 as subjects in the process. Their DLCO was examined before and three months after receiving EGFR-TKI. Subjects were grouped according to the Response Evaluation Criteria in Solid Tumors (RECIST) assessment.Results: There was an increase in predicted FVC from 60.60% to 68.25% (p=0.03), predicted FEV1 from 59.7% to 67.05% (p=0.036%), DLCO from 11.5 mL/minute/mmHg to 13.72 mL/minute/mmHg (p=0.004), and predicted DLCO from 53.4% to 63.85% (p=0.03) during the therapy. The largest increase of predicted DLCO was shown in RECIST group of partial response (16.43%, p=0.056) Conclusion: This study found an improvement in lung function (predicted FVC, predicted FEV1, DLCO, and predicted DLCO) among lung adenocarcinoma subjects exhibiting single mutation at exon 19 or 21 after three months of EGFR-TKIs treatment."