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"Kanker vulva merupakan kanker ginekologi yang kejadiannya relative sedikit. Pasien umumnya datang pada stadium lanjut, terapi radiasi pada stadium lanjut tidak memberi prognosis yang baik. Dua modalitas utama pengobatan kanker vulva yaitu terapi pembedahan dan terapi radiasi. Terapi radiasi dapat dilakukan pula pada stadium awal, tetapi terapi pembedahan dinilai mempunyai beberapa kelebihan, antara lain faktor efek samping pada ovarium/gangguan fungsi reproduksi, faktor higienis pasien dan kemudahan terapi bila terjadi residif. Berbagai variasi teknik pembedahan kanker vulva, antarannya adalah vulvektomi radikal dengan insisi kupu-kupu (VRIK), vulvektomi radikal dengan insisi terpisah (VRIP).Tujuan penelitian adalah melihat keuntungan pembedahan vulvektomi radikal dengan insisi terpisah dibandingkan dengan insisi kupu-kupu dalam hal lamanya pembedahan, penyembuhan luka, kejadian infeksi, lamanya perawatan. Penelitian ini merupakan uji klinik. Selama kurun waktu 1990-2000 terdapat 15 kasus kanker vulva yang dilakukan pembedahan, 14 kasus stadium II dan 14 kasus dengan histologi karsinoma sel skuamosa dan 1 kasus dengan adenokarsinoma. Lama pembedahan pada VRIP rata-rata 168 menit, lebih singkat dibandingkan VRIK yang mencapai rata-rata 275 menit. Kejadian infeksi pada kelompok VRIP 3 dari 11 kasus (27.27%) sedangkan pada kelompok VRIK seluruh kasus mengalami infeksi pada luka pembedahan. Kegagalan aproksimasi luka operasi 1 dari 12 kasus ( 9.99% ) sedangkan pada VRIK seluruh kasus mengalami kegagalan sehingga memerlukan pembedahan kosmetik. Lama perawatan pasca bedah kelompok VRIP 12.3 hari sedangkan VRIK 21.5 hari. Dengan demikian pembedahan VRIP lebih kecil komplikasinya dan lebih pendek lama pembedahan dan lebih pendek masa perawatan pasca bedah. (Med J Indones 2003; 12: 103-8)

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Vulvar cancer is a gynecological cancer whose incidence rate is relatively low. Patients generally were admitted at advanced stage, and radiation therapy at advanced stage does not provide favorable prognosis. Two main modalities in the treatment of vulvar cancer are surgery and radiation therapy. However, radiation can be performed in early stage vulvar cancer but surgery is thought to have more benefits, such as in side effect on the ovary/ reproductive function disorder, patient's hygiene factor, and the ease in performing therapy if recurrence occurs. There are various techniques of vulvar cancer surgery, such as radical vulvectomy with butterfly incision (RVBI) and radical vulvectomy with separated incision (RVSI).

The objective of this study was to identify the benefits of radical vulvectomy with separated incision in comparison with radical vulvectomy with butterfly incision in terms of the length of surgery, wound recovery, infection incidence, length of hospital stay. This study was a clinical trial performed during the period of 1990-2000. Fifteen cases of vulvar cancer were found and underwent surgery. Fourteen cases were at stage II and 14 cases were histologically defined as squamous-cell carcinoma and 1 case was adenocarcinoma. The average length of surgery in RVSI was 168 minutes, this was shorter than that in VRBI which reached an average of 275 minutes. The incidence of infection in RVSI group was 3 of 11 cases (27.27%), while in RVBI group all cases had infection in surgical wound. Failure of surgical wound approximation was 1 of 12 cases (9.99%), while in RVBI all cases experienced the failure such that cosmetic surgery was required. Length of postoperative care in RVSI group was 12.3 days, while in RVBI 21.5 days. Thus, complications in VRBI were lower, and length of surgery and length of postoperative care were shorter. (Med J Indones 2003; 12: 103-8)"

"Approximately 120 different surgical procedures are used to correct congenital heart diseases, and the burden that this places on the surgeon is compounded by the exceptional complexity of the techniques and the rarity of many of the lesions. Training is problematic, not least because of legal issues, and currently available texts, drawings, and images are no substitute for real ‘live’ surgery.Against this background, the authors have set out to create an interactive multimedia manual that covers many aspects of congenital heart surgery. Each heart defect is addressed in an individual chapter, elaborating specific surgical anatomy and indication for surgery of heart defect first, followed by video clips depicting the operative approach and technique. The clips are accompanied by a clear descriptive narrative, and patient history and diagnostic images are available to provide a clear backdrop to the operation. "

"Tujuan Pemeriksaan: Melakukan analisis nilai DNA EBV dalam serum penderita KNF Stadium Awal (I/II) dan Stadium Lanjut (III/IV). Material dan Metode: Sebanyak 83 serum darah penderita kanker nasofaring (ICNF) bClj8IliS undWerenzia1e¢ diambil sebelum pcmberian tempi. Sampel dibagi menjadi 2 group berdasarkan sistem TNM (UICC) dan didapatkan: 25 sampel berasal dari sennn pendcrita KNF stadium awal (I/ll) dan 58 dari penderita stadium Ianjut (III/IV). Mcnggtmakan real time pobwmerase chain reaction (PCR) dilakukan pengukuran kadar DNA EBV dengan LMP2 sebagai gen target. Perbedaan kadar DNA EBV ditentukan menggunakan analisa dcskriptif menggunakan test non parametrik antara penderita KNF stadium awal dan stadium lanjut dan terhadap status T,N dan M. Hasil: Pengukuran kadar senun DNA EBV pada penderita KNF stadium awa! (I/Il) sebelum memulai pengobatan, menunjukkan sebanyak I7 dari 25 sampei (66.7%) tidak terdeieksi adanya copy DNA EBV dan 8 sampe] (33.3%) terdeteksi. Pada penderita KNF stadium lanjut (Ill/IV), 37 dari 58 sampel (63.I5%) terdeteksi adanya copy DNA EBV dan 21 sampel (36.84%) tidak terdeteksi. Kadar DNA EBV pada penderim KNF stadium lanjut menunjukkan hasil yang lcbih tinggi dibandingkan dengan hasil penderita KNF stadium awal (median 24.8 copy/ml vs 0 copy/ml), dengan nilai cut off pada 7.15 copy/ml (sensitititas 60.3% dan spcsifisitas 72.0%). Kadar DNA EBV yang lcbih tinggi terdapai pula pada hasil pengukuran serum DNA EBV antara penderita KNF dengan status T3-T4, N2-N3 dan Ml dibandingkan dengan penderita KNF dengan status Tl-'I`2, N0-Nl dan M0. Kesimpulan: Pengukuran kadar serum DNA EBV merupakan cam yang potensial untuk membedakan antara pcnderita IONIF stadium awatl (l/ll) dan Qadium lanjut (III/IV) dengan perkiraaan nilai cut off pads 7.15 copy/ml. Termasuk pula untuk membedakan antara status T,N dan M. Pcngukumn kadar DNA EBV dapat menyempurnakan penggunaan sistem TNM pada tingkst molekuler.

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To analyze the difference of pretreatment serum EBV DNA concentration between early stage (l/II) and advance stage (Ill/IV) nasopharyngeal carcinoma (NPC) patient.

Methodes: Eighty-three (83) pretreatment serum of undifferentiated with all stages of NPC were studied and devided into two groups: 25 samples cattle from early stage (I/II) NPCand 58samplesB~omadvancestage(IIl/IV)NPCasbyUlCCTNM staging system. LMP2 was used as target gene and the concentration were quantified by real-time polymerase chain reactant assay. EBV DNA concentration of the two groups were measured and the difference were accessed, including the T,N,M status with non parametric test.

Result: Pretreatment EBV DNA serum concentration from early stage (I/ll) NPC patients showed: I7 of 25 sampels (66.7%) were undetectable for copy of EBV DNA, and 8 sampels (33.3%) were detectable. Pretreatment EBV DNA from advance stage NPC showed: 37 of 58 patiens (63.l5%) were detectable for copy of EBV DNA and 21 patients were not. Pretreatment EBV DNA serum consentration ti-om advance stage NPC showed higher senzm concentration than early stage (median 24.8 copylml vs 0 copy/ml), on cuz of point prediction at 7.15 copy/ml. Higher concentration as well, were found among those patients whose had T3-T4, N2-N3 and Ml stages compared with Tl-T2, N0-Ni and M0 stages NPC.

Conclusion: EBV DNA semm concentration was found potential to differentiate between early and advance stage NPC, on out ojfpoinr prediction at 7.l5 copy/ml, as well as to differentiate T,N and M stages. EBV DNA measurement was good to improve UICC TNM staging system in clinical practice based, on molecular level."

"This book, a distinguished panel of clinicians provides a thorough update of the significant improvements in knowledge surrounding the pathogenesis of diabetic foot problems, as well as the optimal healthcare treatment for this debilitating condition. The authors, many practicing at the famous Joslin-Beth Israel Deaconess Foot Center, again illuminate the successful new multidisciplinary approach now clearly required for the successful treatment of diabetic foot. Drawing on the experiences of diabetologists, podiatrists, vascular surgeons, infectious disease specialists, orthotists, plastic and orthopedic surgeons, this invaluable third edition, so timely given the continued rise of diabetes and its complications, clearly describes established techniques known to be effective. This updated edition blends new knowledge with the time-tested principles of diabetic foot management and will be of significant value to all physicians and researchers with an interest in a state-of-the-art understanding of diabetic foot."