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"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."

"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."

"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."

"Kanker kolorektal merupakan jenis kanker terbanyak ketiga di Indonesia. Hal ini disebabkan oleh pola hidup yang tidak sehat seperti merokok, pola makan yang mengadopsi makanan cepat saji, kegemukan, dan kurangnya aktivitas fisik. Penatalaksanaan medis utama pada kasus kolorektal yaitu pembedahan dengan cara mereseksi kanker, kemudian membuat stoma, dan penyambungan kembali usus yang disebut anastomosis. Salah satu masalah utama pada pasien postoperasi adalah nyeri akut. Penelitian ini bertujuan untuk menyajikan hasil analisis asuhan keperawatan pada pasien post operasi close colostomy dan dan laparatomi adhesiolisis. Metode yang digunakan adalah studi kasus. Adapun intervensi berbasis bukti yang diterapkan yaitu intervensi manajemen nyeri berupa teknik relaksasi napas dalam guna menurunkan intensitas nyeri pada pasien post operasi close colostomy dan laparatomi adhesiolisis. Penerapan teknik relaksasi napas dalam diharapkan dapat diaplikasikan oleh perawat bedah di ruangan khususnya untuk mengurangi nyeri akut post operasi close colostomy dan laparatomi adhesiolisis. Kata kunci : kanker kolorektal, close colostomy, laparatomi adhesiolisis, nyeri akut, relaksasi napas dalam.

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Colorectal cancer is the third most common type of cancer in Indonesia. This is caused by unhealthy lifestyles such as smoking, eating patterns that adopt fast food, obesity, and lack of physical activity. The main medical management in colorectal cases is surgery by resecting the cancer, then making a stoma, and reconnecting the intestine which is called anastomosis. One of the main problems in postoperative patients is acute pain. This study aims to present the results of the analysis of nursing care in postoperative patients with close colostomy and adhesiolysis and laparotomy. The method used is a case study. The evidence-based intervention applied is pain management intervention in the form of deep breathing relaxation techniques to reduce pain intensity in postoperative close colostomy and adhesionic laparotomy patients. It is hoped that the application of deep breathing relaxation techniques can be applied by surgical nurses in the room especially to reduce acute pain after close colostomy surgery and adhesiolysis laparotomy. Keywords : colorectal cancer, close colostomy, laparotomy adhesiolisis, acute pain, deep breat relaxation."

"[ABSTRAKLatar Belakang: Kanker kolorektal merupakan tumor ganas ketiga di dunia.Sembilan puluh lima persen kanker kolorektal merupakan adenokarsinoma yangberasal dari lesi prekursor adenoma. Dilaporkan 15%-20% kanker terkait denganinfeksi virus. Virus yang diduga berhubungan dengan kanker kolorektal adalahhuman papilloma virus (HPV) dan tipe tersering adalah 16 dan 18. Hubunganantara HPV dan kanker kolorektal masih menjadi perdebatan. Penelitian inibertujuan untuk mengetahui perbedaan prevalensi infeksi HPV pada adenoma danadenokarsinoma kolorektal di Departemen Patologi Anatomik FKUI/RSCMJakarta dengan menggunakan teknik polymerase chain reaction (PCR). Bahandan Metode: Pemeriksaaan DNA HPV pada 33 kasus adenoma dan 33 kasusadenokarsinoma kolorektal dengan teknik nested PCR MY/GP dan elektroforesis.Pada kasus dengan hasil HPV positif, dilanjutkan PCR menggunakan primerspesifik HPV 16 dan HPV 18. Subjek penelitian berasal dari Departemen PatologiAnatomik FKUI/RSCM. Hasil: Satu dari 33 kasus (3,0%) adenoma dan 3 dari 33kasus (9,1%) adenokarsinoma positif infeksi HPV. Satu kasus adenoma positifHPV bukan merupakan tipe 16 dan 18. Satu kasus adenokarsinoma denganpositif, HPV merupakan tipe 16, 2 kasus merupakan gabungan tipe 16 dan 18.Kesimpulan: Prevalensi infeksi HPV pada adenokarsinoma lebih tinggidibandingkan adenoma kolorektal. Tipe HPV pada kasus adenokarsinomakolorektal merupakan tipe 16 dan 18.

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ABSTRACTBackground : Colorectal cancer is the third malignant tumor in the world.Ninety-five percent of colorectal cancers are adenocarcinomas derived fromprecursor lesions adenoma. There are 15% -20% of cancers associated with viralinfections. Virus are suspected associated with colorectal cancer is the humanpapilloma virus (HPV) and the most common types are 16 and 18. Therelationship between HPV and colorectal cancer is still being debated. This studypurpose to determine the prevalence differences of HPV infection in colorectaladenomas and adenocarcinomas in the Department of Anatomic Pathology,FKUI/RSCM Jakarta by using the polymerase chain reaction (PCR). Materialsand Methods : HPV DNA examination on 33 cases of adenoma and 33 cases ofcolorectal adenocarcinoma by nested MY/GP PCR technique and electrophoresis.In the cases with positive HPV results, continue by specific primers HPV 16 andHPV 18 PCR. The subject of the study came from the Department of AnatomicPathology, FKUI/RSCM. Result : One (3.0%) adenomas and 3 (9.1%)adenocarcinoma from 33 cases adenoma and adenocarcinoma are HPV positive.One case of HPV positive adenomas are not types 16 and 18. HPV positiveadenocarcinoma, 1 case was type 16, two cases are combination of types 16 and18. Conclusion : The HPV prevalence in adenocarcinoma was higher thancolorectal adenoma. HPV types on positive colorectal adenocarcinoma cases aretypes 16 and 18., Background : Colorectal cancer is the third malignant tumor in the world.Ninety-five percent of colorectal cancers are adenocarcinomas derived fromprecursor lesions adenoma. There are 15% -20% of cancers associated with viralinfections. Virus are suspected associated with colorectal cancer is the humanpapilloma virus (HPV) and the most common types are 16 and 18. Therelationship between HPV and colorectal cancer is still being debated. This studypurpose to determine the prevalence differences of HPV infection in colorectaladenomas and adenocarcinomas in the Department of Anatomic Pathology,FKUI/RSCM Jakarta by using the polymerase chain reaction (PCR). Materialsand Methods : HPV DNA examination on 33 cases of adenoma and 33 cases ofcolorectal adenocarcinoma by nested MY/GP PCR technique and electrophoresis.In the cases with positive HPV results, continue by specific primers HPV 16 andHPV 18 PCR. The subject of the study came from the Department of AnatomicPathology, FKUI/RSCM. Result : One (3.0%) adenomas and 3 (9.1%)adenocarcinoma from 33 cases adenoma and adenocarcinoma are HPV positive.One case of HPV positive adenomas are not types 16 and 18. HPV positiveadenocarcinoma, 1 case was type 16, two cases are combination of types 16 and18. Conclusion : The HPV prevalence in adenocarcinoma was higher thancolorectal adenoma. HPV types on positive colorectal adenocarcinoma cases aretypes 16 and 18.]"

"Latar Belakang:Kanker prostat merupakan keganasan ketiga yang paling sering ditemukan di Indonesia. Sekitar 90-95% kanker prostat adalah adenokarsinoma asinar. Prognosis kanker prostat dan strategi tatalaksana didasarkan pada derajat keganasan. Tujuan penelitian ini untuk evaluasi rasio ADC dalam menentukan agresivitas kanker prostat. Metode:Sebanyak 32 sampel kanker prostat dari zona perifer yang terbukti dengan biopsi dan telah dilakukan pemeriksaan MRI 1,5T dengan body coil. Rasio ADC dihitung menggunakan nilai ADC tumor dengan urin di vesika urinaria, otot obturator, dan ramus pubis sebagai referensi. Analisis rasio ADC dengan hasil histopatologi grade group <2 dan >3 menggunakan student t. Kurva ROC digunakan untuk akurasi diagnostik rasio ADC dalam menentukan grade group. Hasil:Terdapat 12 dan 20 sampel grade group <2 dan >3. Rasio ADC tumor-urin 0,24, tumor-obturator internus 0,64, dan tumor-ramus pubis 0,85, lebih rendah dan bermakna pada pasien dengan grade group >3 (p <0,005). AUC dihitung menggunakan rasio ADC tumor-urin menunjukkan hasil tertinggi (0,988) di antara rasio ADC tumor-obturator internus (0,887) dan tumor-ramus pubis (0,783).Kesimpulan:Ketiga rasio ADC berbeda bermakna dalam membedakan grade group<2 dan grade group>3, serta merupakan prediktor signifikan dari kanker prostatgrade group >3.

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Background: Prostate cancer is the third most common malignancy in Indonesia. Approximately 90-95% of prostate cancers are adenocarcinoma acinar. Prostate cancer prognosis and treatment strategies are based on degree of malignancy. Objective of this study was to evaluate the ADC ratio in determining the aggressiveness of prostate cancer.

Method: Thirty two prostate cancer samples from peripheral zones were proven by biopsy and 1.5T MRI examination was performed with body coil. ADC ratio was calculated using ADC value of tumor with urine in bladder, obturator muscle, and pubic ramus as a reference. Analysis ADC ratio with grade group <2 and >3 using a student T-test. The ROC curve is used for the accuracy of ADC ratio in determining the grade group.

Results: Twelve and 20 samples of grade group <2 and >3. Three ADC ratio (0.24, 0.64, and 0.85, respecively) lower in grade group >3 (p <0.002). AUC was calculated, ratio ADC tumor-urine show the highest results (0.988) among tumor-internal obturator (0.887) and tumor-pubic ramus (0.783).

Conclusion: Three ADC ratio have differed significantly in distinguishing grade group <2 and >3, and were a significant predictor of grade group >3 prostate cancer."

"Latar Belakang: Kanker paru merupakan kanker terbanyak kedua yang terdiagnosis dan menjadi penyebab terbanyak kematian akibat kanker. Pemberian afatinb sebagai terapi target Epidermal Growth Factor Receptor (EGFR)-Tyrosine Kinase Inhibitor (TKI saat ini telah menjadi terapi standar untuk pasien adenokarsinoma paru dengan mutasi EGFR di Indonesia, termasuk di RSUP Persahabatan. Penelitian ini dilakukan untuk menganalisis pemberian terapi afatinib pada pasien adenokarsinoma paru dengan mutasi EGFR di RSUP Persahabatan.Metode: Desain penelitian ini adalah kohort retrospektif menggunakan data rekam medis fisik dan elektronik, dilakukan di Poli Onkologi RSUP Persahabatan, dengan teknik total sampling. Subjek penelitian adalah pasien adenokarsinoma paru dengan mutasi EGFR yang mendapatkan afatinib pada Januari 2018-Desember 2021 di Poli Onkologi RSUP Persahabatan yang memenuhi kriteria penelitian.Hasil: Didapatkan 116 subjek penelitian, pasien adenokarsinoma paru dengan mutasi EGFR yang mendapatkan afatinib di RSUP Persahabatan dengan karakteristik lebih banyak laki-laki (52,6%), kelompok usia <65 tahun (80,2%), suku Jawa (81,9%), tanpa faktor risiko keganasan di keluarga (82,8%). Saat terdiagnosis subjek penelitian lebih banyak dengan stage IVA (75%), metastasis pleura (59,5%), mutasi EGFR delesi ekson 19 (53,4%) status tampilan 0-1 (75,9%) dan metastasis otak didapatkan pada 19% subjek. Nilai median progression free survivival (PFS) subjek penelitian yang mendapat afatinib adalah 13 bulan (95%IK 10,5-15,5 bulan), dan nilai median overall survival (OS) adalah 17 bulan (95%IK 14,9-19,1 bulan). Angka tahan hidup satu tahun yang didapat 65,1% dan Objective Respons Rate (ORR) adalah 36,1%. Sebanyak 35,3% subjek mendapatkan penurunan dosis afatinib 20 mg atau 30 mg. Toksisitas nonhematologi tersering pada pada penelitian ini adalah diare (74,1%), diikuti oleh stomatitis (61,2%), ruam kulit (59,5%) dan paronikia (49,1%).Kesimpulan: Afatinib sebagai terapi lini pertama memberikan luaran yang cukup baik untuk pasien adenokarsinoma paru dengan mutasi EGFR di RSUP Persahabatan dengan efek samping samping nonhematologi yang dapat dikelola. Riwayat penurunan dosis afatinib tidak memengaruhi angka kesintasan.

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Background: Lung cancer is the second most diagnosed cancer and the most common cause of death from cancer. Afatinib as targeted therapy with Epidermal Growth Factor Receptor (EGFR)-Tyrosine Kinase Inhibitor (TKI) has now become standard therapy for lung adenocarcinoma patients with EGFR mutations in Indonesia, including at RSUP Persahabatan. This study was conducted to analyze the administration of afatinib therapy in lung adenocarcinoma patients with EGFR mutations at Persahabatan General Hospital.

Metode: Design of the study was retrospective cohort using secondary data, physical and electronic medical records at Oncology Clinic Persahabatan Hospital with total sampling technique. Subject of this study were medical records of lung adenocarcinoma patients with EGFR mutation and received afatinib therapy by January 2018- December 2021 which met the inclusion criteria.

Results: There were 116 subjects of lung adenocarcinoma with EGFR mutation and received afatinib at Persahabatan Hospital, with predominant of male (52,6%), age <65 years old (80,2%), Javanese (81,9%), without history of cancer in family (82,8%). Most of subjects are diagnosed as lung adenocarcinoma at stage IVA (75%), with most of them have pleural metastases (59,5%), EGFR mutation with exon 19 deletion (53,4%), performa status 0-1 (75,9%), and brain metastases were found in 19% of subject. The median progression free survival (PFS) of subjects was 13 months (95% CI 10.5-15.5 months), and the median overall survival (OS)was 17 months (95% CI 14.9- 19.1 months). The one-year survival rate was 65.1% and the Objective Response Rate (ORR) was 36,1%. As many as 35.3% of subjects had adjustment dose of afatinib to 20 mg or 30 mg The most common non-hematological toxicity found was diarrhea (74.1%), followed by stomatitis (61.2%), skin rash (59.5%) and paronychia (49.1%).

Conclusion: Afatinib as a first-line therapy provides a good outcome for lung adenocarcinoma patients with EGFR mutations at Persahabatan General Hospital with manageable non-hematological adverse events. History of adjustment dose of afatinib did not affect survival rate."

"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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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"

"ABSTRAKDiare persisten merupakan masalah kesehatan serius dan sering menyebabkan malnutrisi. Kerusakan mukosa pada diare diduga menyebabkan penurunan hormon sekretin dan kolesistokinin sehingga mengurangi stimulasi ke pankreas dan memperberat diare persisten dan malnutrisi.Penelitian ini bertujuan untuk mengetahui fungsi eksokrin pankreas pada anak diare persisten, anak malnutrisi, mendapatkan nilai referensi pemeriksaan fecal elastase-1 FE-1 anak Indonesia, dan mengetahui kehandalan analisis feses dan steatokrit dalam mendeteksi insufisiensi eksokrin pankreas.Penelitian potong lintang pada tahap pertama dilakukan untuk mendapatkan sebaran nilai FE-1 pada anak normal, membandingkan nilai FE-1 subjek diare persisten dan malnutrisi dengan anak normal, dan mengetahui sensitivitas, spesifisitas, dan kemampuan diskriminasi analisis feses dan steatokrit dalam mendeteksi insufisiensi eksokrin pankreas. Tahap kedua uji klinis dua kelompok paralel tersamar ganda dilakukan untuk menguji efek suplementasi enzim pankreas 8371 USP unit tiga kali sehari selama sebulan pada anak diare persisten. Penelitian dilakukan di 5 Rumah Sakit di Jakarta Januari 2015 minus;Juli 2016 pada anak berusia 6 ndash;60 bulan.Sebanyak 182 anak usia 6 ndash;60 bulan direkrut sebagai subjek yang terdiri dari 31 anak dengan diare persisten, 31 anak dengan malnutrisi, dan 120 anak normal. Nilai cut-off FE-1 yang didapatkan pada penelitian ini adalah 307 mcg/g feses. Terdapat perbedaan bermakna nilai FE-1 antara subjek diare persisten dan anak normal. Tidak ditemukan perbedaan bermakna nilai FE-1 antara subjek malnutrisi dan anak normal. Terdapat perbedaan bermakna lama diare sekitar 7 hari antara kedua kelompok. Kadar FE-1 dan prealbumin antara baseline dan endpoint pada kelompok plasebo dan perlakuan tidak berbeda bermakna. Uji kehandalan masing-masing komponen analisis feses dan steatokrit menunjukkan hasil sensitivitas dalam rentang 5 ndash;32 , spesifisitas 73 ndash;98 , nilai prediksi positif 1 ndash;43 , dan nilai prediksi negatif 87 ndash;89 . Nilai AUC analisis feses dan steatokrit masing-masing adalah 0,664 IK 95 0,539 ndash;0,788 dan 0,501 IK 95 0,372 ndash;0,629 sedangkan AUC gabungan sebesar 0,671.Kesimpulannya, pada penelitian ini didapatkan adanya insufisiensi eksokrin pankreas pada anak dengan diare persisten. Suplementasi enzim pankreas terbukti dapat memperpendek lama diare secara bermakna. Analisis feses dan/atau steatokrit memiliki sensitivitas yang rendah, spesifisitas yang tinggi, dan kemampuan diskriminasi kurang.Kata kunci: anak, diare persisten, fungsi eksokrin pankreas, malnutrisi, suplementasi enzim pankreas

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ABSTRACTPersistent diarrhea is a serious health problem and is closely related to malnutrition. Prolonged mucosal injury in diarrhea is thought to cause reduced secretin and cholecystokinin CCK secretion, which decreases stimulation to the pancreas and further aggravate persistent diarrhea and malnutrition.This research aims to study pancreatic exocrine function in children with persistent diarrhea and children with malnutrition, to obtain reference values of fecal elastase 1 FE 1 in Indonesian children, and to assess the ability of stool analysis and steatocrit in detecting exocrine pancreatic insufficiency.Cross sectional study was done to obtain FE 1 distribution in healthy children, to study FE 1 levels in children with persistent diarrhea and children with malnutrition, and to study the sensitivity, specificity, and discriminative capacity of stool analysis and steatocrit in detecting exocrine pancreatic insufficiency. A randomized, two double blind parallel group, placebo controlled clinical trial was conducted to evaluate the effects of 8371 USP units of pancreatic enzyme replacement therapy PERT 3 times daily for 1 month in children with persistent diarrhea. This study involved children age 6 ndash 60 months in 5 hospitals in Jakarta from January 2015 to July 2016.As much as 182 children 6 ndash 60 months of age consisting of 31 children with persistent diarrhea, 31 children with malnutrition, and 120 healthy children were recruited as subjects. Cut off point of FE 1 in this study was 307 mcg g faeces. Significant difference of FE 1 was found between children with persistent diarrhea and healthy children. The FE 1 difference between subjects with malnutrition and healthy children was not significant. Duration of diarrhea was 7 days significantly shorter in the PERT group. Changes of FE 1 and prealbumin values between baseline and endpoint in placebo and treatment group were found to be statistically insignificant. The diagnostic value of each stool analysis component and steatocrit test showed that the sensitivity was within range of 5 ndash 32 , specificity 73 ndash 98 , positive predictive value 1 ndash 43 and negative predictive value 87 ndash 89 . The AUC values of stool analysis and steatocrit were 0.664 95 CI 0.539 ndash 0.788 and 0.501 95 CI 0.372 ndash 0.629 , respectively, and the combined AUC 0,671.In conclusion, exocrine pancreatic insufficiency was observed in children with persistent diarrhea, and PERT has been proven to significantly shorten the duration of diarrhea by 1 week. Stool analysis and or steatocrit has low sensitivity, high specificity, and low discrimination capacity.Keywords children, exocrine pancreatic function, malnutrition, pancreatic enzyme supplementation, persistent diarrhea"