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"ABSTRAKRuang Lingkup dan Cara Penelitian: Hubungan antara jenis kelainan histopatologik tertentu pada radang berulang tonsil dengan kelainan imunopatologik yang terjadi belum banyak diselidiki. Penelitian ini ditujukan untuk melihat hubungan antara kelainan histopatologik tertentu dengan kelainan imunopatologik yang timbul dengan jalan menghitung jumlah dan penyebaran set pengandung imunoglobulin (SPIg) pada tonsil serta mengukur kadar imunoglobulin serum pada penderita radang berulang tonsil. Diperiksa 125 pasang tonsil dan serum yang berasal dari 125 anak usia 4-14 tahun yang menjalani tonsilektomi. Dengan pewarnaan HE dilakukan penggolongan jenis kelainan histopatologik. Dengan cara imunoperoksidase (PAP) diperiksa jumLah SPIg (keLas G,M,A,E dan D) pada daerah sentrum germinativum (SG), kelim limfosit (KL), interfolikuler (IF) dan epitel retikuler kripta (ER). Dengan cara imunodifusi radial diperiksa kadar imunoglobulin (kelas G,M dan A) dalam serum penderita. Sebagai perbandingan diperiksa kadar Ig serum yang berasal dari 33 anak sehat dengan tonsil yang tidak menunjukkan tanda radang.HasiL dan Kesimpulan: Secara histopatologik ditemukan jenis kelainan yaitu: hiperplasia tonsil (HT), 60,5 %; tonsilitis kronik .(TK), 23,2% dan tonsilitis kronik eksaserbasi akut (IKEA), 16,0%. Jumlah SPIg di daerah KL pada kelompok TK Lebih banyak dan berbeda bermakna dibandingkan dengan kelompok TKEA dan HT. Di daerah ER, jumlah SPIg pada kelompok TK Lebih sedikit dan berbeda bermakna dibandingkan keLompok TKEA. Ditemukan peningkatan bermakna kadar Ig G dalam serum pada kelompok TK dan HT dibandingkan dengan keLompok kelola, dan peningkatan bermakna kadar Ig A dalam serum penderita TK dibandingkan dengan kelompok kelola. Perbedaan jumlah dan penyebaran SPIg pada tonsil yang mengatami radang berulang sesuai dengan jenis kelainan histopatoLogik, yang diikuti dengan peningkatan kadar Ig G dan Ig A dalam serum.

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ABSTRACT

Scope and Method of Study: The relationship between histo pathological and immunopathological changes caused by recurrent inflammation of the tonsil has not been studied extensively. The aim of this study was to see the relationship between particular histopathological changes by counting the immunoglobulin containing cells (Ig CC) and its distribution in tonsil and to measure immunoglobulin (Ig) Level in serum of patients with recurrent inflammation of the tonsil. One hundred and twenty five pairs of tonsils and 125 sera from children aged 4-14 years, who underwent tonsillectomy were examined. Histopathological diagnosis was based on routine H and E staining. Immunoperoxidase (PAP) staining was performed to count the amount and distribution of Ig CC (G,M,A,E and D classes) in germinal center (GC), Lymphocyte cuff (LC), interfoLlicular (IF) and reticular part of epithelium (RE) areas. Ig (G,M and A) serum Levels were measured by radial immunodiffusion technique. As a comparison, Ig serum levels of 33 healthy children without signs of inflammation of the tonsil was examined.

Findings and Conclusions: Three histopathological changes were found: hyper plastic tonsil (HT), 60.8%; chronic tonsillitis (CT), 23.2% and chronic tonsillitis with acute exacerbation (CTAE), 16.0%. Significantly higher proportion of Ig CC in LC area was found in CT group compared to CTAE and HT groups. In contrast, in RE area the proportion of Ig CC in CT group was significantly Lower than in CTAE group. There were significant elevations of Ig G serum level in CT and HT groups compared to the control group. Ig A serum Level in CT group was significantly higher than the control group. This study revealed that Ig G CC have different distribution in inflamed tonsil according to its histopathological changes, and those changes were accompanied by the increase of Ig G and Ig A serum Levels."

"Pendahuluan: Thalassemia adalah suatu kelainan genetik akibat kegagalan sintesis rantai globin, mengakibatkan terjadinya anemia berat akibat peningkatan aktivitas eritropoiesis yang inefektif dan hemolisis. Peningkatan aktivitas eritropoiesis akan memacu peningkatan absorpsi besi di usus sehingga terjadi kelebihan besi dalam tubuh. Transfusi darah dilakukan secara berkala untuk mengatasi anemia yang timbul pada pasien thalassemia mayor. Pemberian transfusi berulang akan mempercepat terjadi secondary iron overload, untuk mengatasinya diberikan terapi kelasi rutin. Tujuan : Mendapatkan perubahan nilai indeks transferin, saturasi transferin, dan feritin sebelum dan sesudah transfusi dan juga sebelum dan sesudah terapi kelasi pada pasien thalassemia mayor. Mendapatkan perbedaan indeks transferin dan saturasi transferin, dan feritin sebagai parameter untuk menilai perubahan status besi pada pasien thalassemia mayor pasca transfusi dan terapi kelasi. Metode: Desain penelitian kohort prospektif. Subjek penelitian terdiri dari 35 pasien thalassemia mayor usia 7-18 tahun yang mendapat transfusi berulang dan kelator besi rutin. Dilakukan pemeriksaan kadar besi serum, UIBC, TIBC, feritin, transferin, saturasi transferin dan indeks transferin pre transfusi, pasca transfusi dan pasca terapi kelasi. Hasil: Rerata indeks transferin pasca transfusi 124±22 % lebih rendah secara bermakna dari pre transfusi dengan nilai p=0,016, sedangkan pasca kelasi 123 ± 34.5 % (p=0,045). Saturasi transferin pasca transfusi 96 (51 – 100)% meningkat secara bermakna dibangdingkan pre transfusi 87(69-100)% dengan nilai p=0,026, namum tidak berbeda bermakna pada pasca kelasi 87 (39-100). Kadar feritin serum pasca transfusi 3737 (649 -17.094) mg/dL, meningkat secara bermakna dibandingkan pre transfusi 3315 (544,7-14.964) mg/dL (p=0,018). Perbedaan indeks transferin dan saturasi transferin pre transfusi 45(22-153)% lebih tinggi secara bermakna dibandingkan pasca transfusi 35(6-89)% dengan nilai p=0,000, sedangkan pasca kelasi adalah 41±25 dengan nilai p=0,036. Kesimpulan: pemeriksaan indeks transferin untuk pemantauan efektifitas terapi kelasi pada pasien thalasemia mayor dapat dipertimbangkan.

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Introduction: Thalassemia syndromes are a group of hereditary disorder characterized by genetic deficiency in the synthesis of β-globin chains. It is associated in severe anemia caused by an increase in ineffective erythropoiesis activity and hemolysis. Erythropoiesis activity will spur increased iron absorption in the intestine so there will be an excess of iron in the body. Blood transfusion is used routinely to treat anemia arising in patients with thalassemia major. Repeated transfusion will accelerate occur secondary iron overload, to solve given chelation therapy routine.

Objective: To know the index value changes transferrin, transferrin saturation, and ferritin before and after transfusion and also before and after chelation therapy in patients with thalassemia major. To know difference transferrin index and transferrin saturation, and ferritin as a parameter to assess changes iron status in patients thalassemia major post-transfusion and chelation therapy.

Methods: This was prosphective cohort, There were 35 patients with thalassemia major who receive repeated transfusions and iron kelator routine, with age 7-18 years. Examination of serum iron levels, UIBC, TIBC, ferritin, transferrin, transferrin saturation and transferrin index before transfusion, after transfusion, and after chelation therapy.

Results: Mean transferrin index post-transfusion 124±22% was significantly lower than pre transfusion (p=0.016), as well as post-chelation 123±34.5% with a value of p=0.045. Transferrin saturation post-transfusion 96 (51-100)% increased significantly with pre transfusion 87 (69-100)% with a value of p=0.026, However no significant difference were observed in post chelation therapy 87 (39-100). Post-transfusion serum ferritin level 3737 (649-17094) mg/dL, increased significantly compared to pre transfusion 3315 (544.7-14,964) mg/dL (p=0.018). Differences transferrin index and transferrin saturation pre transfusion was 45 (22-153)% significantly higher than the post-transfusion 35 (6-89)% with a value of p=0.000, while the post chelation thyrapy was 41±25% (p=0.036).

Conclusion: Transferrin index can be considered for monitoring the effectiveness of chelation therapy in patients with thalassemia major."

"Pasien sirosis hati perlu dievaluasi secara berkala untuk menentukan adanya varises esofagus (VE) dan ukurannya (besar atau kecil), karena VE besar membutuhkan penatalaksanaan yang lebih agresif. Evaluasi ini dilakukan dengan endoskopi yang tidak selalu ada, invasif, dan berbiaya tinggi. Penelitian ini bertujuan untuk mendapatkan pemeriksaan yang non invasif, lebih murah, dan lebih mudah diakses untuk menentukan besarnya VE. Parameter yang diteliti adalah hitung trombosit, prothrombin time (PT), kadar albumin, dan bilirubin. Desain penelitian adalah potong lintang dengan 64 subjek, terdiri atas 24 pasien sirosis hati dengan VE besar dan 40 tanpa VE besar. Pada penelitian ini didapatkan perbedaan bermakna pada hitung trombosit, PT, dan kadar albumin antara kedua kelompok, sedangkan kadar bilirubin tidak memberikan perbedaan yang bermakna. Untuk parameter hitung trombosit didapatkan besar area under the curve untuk memprediksi VE besar sebesar 80,9%, dengan cutoff 89,5 x 103/μL didapatkan sensitivitas 79,2% dan spesifisitas 75,0%; PT 68,4%, dengan cutoff 14,05 detik didapatkan sensitivitas 70,8% dan spesifisitas 67,5%; kadar albumin 76,6%, dengan cutoff 3,275 g/dL didapatkan sensitivitas 70,8% dan spesifisitas 75,0%. Model prediksi sirosis hati dengan VE besar adalah P = 1/(1 + Exp-Logit (y)) dengan Logit (y) = 11,989 ? 0,026 x hitung trombosit ? 2,243 x kadar albumin - 0,184 x PT.

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Patients with liver cirrhosis require periodic evaluation to determine the presence and size of esophageal varices (EV), because the large ones demand more aggressive management. Evaluation is done using endoscopy, which is not always available, invasive, and costly. This study aims to acquire tests that are noninvasive, cheaper, and more accessible to determine the size of EV. Studied parameters were platelet count, prothrombin time (PT), albumin, and bilirubin level. The study design was cross sectional with 64 subjects, consisted of 24 liver cirrhotic patients with large VE and 40 without.

This study found significant difference in platelet count, PT, and albumin level between both groups, while bilirubin level was not. The size of area under the curve for platelet count to predict large VE was 80.9%, cutoff 89.5 x 103/μL (sensitivity 79.2%, specificity 75.0%), PT 68.4%, cutoff 14.05 seconds (sensitivity 70.8%, specificity 67.5%), and albumin level 76.6%, cutoff 3.275 g/dL (sensitivity 70.8%, specificity 75.0%). Prediction model for liver cirrhosis with large VE was P = 1/(1 + Exp-Logit (y)) with Logit (y) = 11.989 ? 0.026 x platelet count ? 2.243 x albumin level - 0.184 x PT."