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Abstrak :
Latar Belakang: Pasien dengan keganasan gaster berisiko tinggi mengalami malnutrisi. Terapi kuratif utama pada pasien keganasan gaster adalah tindakan operasi, sehingga diperlukan dukungan terapi medik gizi perioperatif yang dapat menunjang perbaikan status gizi, kapasitas fungsional, dan kualitas hidup. Metode: Pasien pada serial kasus adalah dua laki-laki dan dua perempuan, berusia 34-64 tahun, dengan diagnosis tiga pasien dengan karsinoma gaster, dan satu pasien gastrointestinal stromal tumor gaster stadium lanjut. Terapi medik gizi praoperasi diberikan dalam bentuk oral dan parenteral. Pada enam jam sebelum tindakan operasi, dua pasien mendapatkan nutrisi parenteral, dan dua pasien mendapatkan nutrisi oral. Pasien pascaoperasi juga mendapatkan nutrisi enteral dini dalam 48 jam pertama. Hasil: Pasien pasca gastrektomi selama mendapatkan nutrisi perioperatif, tiga pasien mengalami proses penyembuhan luka yang baik, sedangkan satu pasien mengalami komplikasi pascaoperasi berupa fistula enterokutan yang kemudian mengalami pemulihan, dan satu pasien mengalami hiperglikemia dipengaruhi oleh tindakan pankreatektomi distal. Lama masa rawat inap pasien antara 21-31 hari. Semua pasien pascaoperasi mengalami peningkatan kapasitas fungsional. ......Background: Patients with gastric malignancy have high risk of malnutrition. The main curative therapy in patients with gastric malignancies is surgery, so it requires the support of perioperative nutritional therapy which could support the improvement of nutritional status, functional capacity, and quality of life. Methods: Patients in this case series were two men and two women, aged 34-64 years, and the diagnosis of three patients are advanced gastric carcinoma, and one patient with advanced gastric gastrointestinal stromal tumor. Preoperative nutritional therapy was given in oral and parenteral route. At six hours before surgery, two patients received parenteral nutrition, and two patients received oral nutrition. All patients also got early enteral nutrition in the first 48 hours after surgery. Results: Patients after gastrectomy during obtaining perioperative nutrition, three patients experienced a good wound healing process, while one patient experienced postoperative complications in the form of enterocutaneous fistula which later recovered, and one patient experienced hyperglycemia that affected by distal pancreatectomy. The length of stay for patients was between 21-31 days, after surgery all patients had increased functional capacity. Conclusion: Perioperative nutritional therapy in gastric malignancies patients undergoing gastrectomy could help improve the nutritional status and functional capacity.

Abstrak :
Latar belakang: MRCP merupakan teknik pencitraan tidak invasif untuk mengevaluasi anatomi dan mendeteksi kelainan sistem bilier. Cairan di saluran bilier akan memperlihatkan sinyal yang tinggi pada MRCP. Salah satu keterbatasan pemeriksaan MRCP ialah cairan di saluran gastrointestinal juga memberikan sinyal tinggi yang dapat mengganggu evaluasi saluran bilier. Sari buah nanas dapat menjadi kontras oral negatif untuk menurunkan sinyal di gastrointestinal. Belum terdapat penelitian penggunaan sari buah nanas pada pemeriksaan MRCP di Indonesia dan belum terdapat penelitian yang menilai visualisasi cabang-cabang duktus intrahepatikus setelah pemberian sari buah nanas. Tujuan: Mengukur perbedaan SNR gaster dan duodenum serta perubahan tingkat visualisasi cabang-cabang duktus bilier intrahepatikus sesudah pemberian sari buah nanas pada pemeriksaan MRCP. Metode: Dilakukan pemeriksaan MRCP sebelum dan sesudah pemberian sari buah nanas pada subjek penelitian. Mengukur perbedaan rerata SNR gaster dan duodenum serta mengukur perubahan tingkat visualisasi cabang-cabang duktus bilier intrahepatikus sebelum dan sesudah pemberian sari buah nanas. Perbedaan rerata SNR gaster dan duodenum dianalisis menggunakan uji Wilcoxon dan perubahan tingkat visualisasi dianalisis dengan uji McNemar untuk menilai diskordans. Hasil: Didapatkan 25 subjek penelitian yang menjalani pemeriksaan MRCP sebelum dan sesudah pemberian sari buah nanas. Terdapat penurunan bermakna SNR gaster dan duodenum setelah pemberian sari buah nanas, 127,1 (18,7-1194,6) menjadi 42.2 (4,2-377,1) untuk gaster dan 64,1 (3,8-613.4) menjadi 44,6 (6,5-310,3) untuk duodenum (p < 0,05). Terdapat perubahan bermakna tingkat visualisasi duktus bilier intrahepatikus (p < 0,05, diskordans >50%) dengan peningkatan tingkat visualisasi duktus intrahepatikus kanan segmen anterior pada 66% pengamatan, duktus intrahepatikus kanan segmen posterior pada 58% pengamatan, dan 70% pengamatan untuk duktus intrahepatikus kiri. Simpulan: Pemberian sari buah nanas dapat menurunkan sinyal gaster dan duodenum pada pemeriksaan MRCP dan mempengaruhi tingkat visualisasi cabang-cabang duktus bilier intrahepatikus. ......Background: MRCP is a non-invasive imaging technique for evaluating anatomy and detecting abnormalities of the biliary system. Fluid in biliary tract will show high signal on MRCP. One of the limitations of MRCP is high signal in gastrointestinal fluid which can interfere biliary tract evaluation. Pineapple juice as negative oral contrast can reduce signal in gastrointestinal tract. There have been no studies on the use of pineapple juice for MRCP in Indonesia, and no studies assessed the visualization of intrahepatic ductal branches after administration of pineapple juice. Objective: Measuring difference in gastric and duodenal SNR and changes of visualization of intrahepatic biliary ductal branches after administration of pineapple juice on MRCP. Methods: MRCP before and after administration of pineapple juice were performed on subjects. Gastric and duodenal SNR mean difference were measured, and analysis were done with Wilcoxon test. Level of visualization of intrahepatic biliary ductal branches were also measured and analysed with McNemar test for discordances. Results: There were 25 subjects underwent MRCP. Gastric and duodenal SNR were statistically decreased after administration of pineapple juice, 127.1 (18.7-1194.6) vs 42.2 (4.2-377.1) and 64.1 (3.8-613.4) vs 44.6 (6.5-310.3) respectively (p <0.05). Statistically significant difference was observed in visualization of intrahepatic ductal branches (p<0,05), discordance >50%) with increase in visualization of right duct anterior segment in 66% observation, right duct posterior segment in 58% observation, and 70% observation in left intrahepatic bile duct. Conclusion: Use of pineapple juice as negative oral contrast significantly reduce gastric and duodenal signal in MRCP also affect visualization of the intrahepatic biliary duct branches.

Abstrak :
Purpose The association between the preoperative absolute neutrophil count (NC), lymphocyte count (LC), and monocyte count (MC) in the peripheral blood and the prognosis of gastric cancer (GC) patients has not been investigated widely. Methods We enrolled 445 patients who underwent surgery for GC between January, 2005 and April, 2013 to analyze the correlations among NC, LC, and MC and their prognoses. Results Based on cut-off values calculated by ROC analysis, patients were sub grouped as having: NC ≥ 4477 (NCHigh), NC < 4477 (NCLow); and as LC ≥ 1447 (LCHigh), LC < 1447 (LCLow); and as MC ≥ 658,5 (MCHigh), MC < 658,5 (MCLow). Each group was assigned as follows; NCHigh group = 1, NCLow group = 0, LCHigh group = 0, LCLow group = 1, MCHigh group = 1, MCLow group = 0, and the sum of each score was defined as the lymphocyte-monocyte-neutrophil score (LMN score). The overall 5-year survival rates were 89%, 74%, 57,8%, and 53,3% for LMN scores of 0, 1, 2, and 3, respectively (P = 0,0004). Multivariate analysis indicated that the LMN score was an independent prognostic indicator. Conclusions The combination of preoperative NC, LC, and MC appears to be a useful indicator of GC prognosis.