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Abstrak :
Background: Tire methods of ERCP have been used for diagnostic and therapeutic purposes to pass bile fluid and extract stones from the bite duct in patients with obstructive extrahepatic jaundice. Method: A retrospective study was performed on patients with obstructive extrahepatic jaundice patients who underwent ERCP dttring a two-years time period from January 1999 to December 2000. ERCP was performed with a premedication of I0 mg midazolam, followed by a chollangiography contrast containing 1 mg/dl of Garamicin and 25 mg of Pethidine if sphincterotomy was performed. Results: From 126 patients with obstructive extrahepatic jaundice treated with ERCR the male to female ratio was 1.86:1. The majority of the (group) of patients were between 51-60 years of age (33.3 % ). The youngest patient (group) was 24 years and the oldest 97 years. The diagnostic study found the following cases: normal 3 cases (28%), bile duct stone 46 cases (43.4%) carcinoma of ampula voter 20 cases (18.9%), CBD tumor 7 crises (6.6%), carcinoma of head of pancreas 2 cases (1.9%), diverticle 4 cases (38%), duodenal tumor I case (0.9%), carcinoma of ampula vater and bite duct stone 1 case (0.9%), SOD 5 cases (4.7%), CBD stricture 1 case (0.9%) and failure I6 cases (15.1%). The patients received the following treatment: sphyncterotomy 36 cases (51 .4%), stent application 11 cases (15.7%), sphincterotomy with stent 18 cases (25.7%) and basket method 5 cases ( 7. 1%).

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ABSTRAK
Neonatal jaundice sering terjadi pada minggu pertama awal kehidupan bayi setelah lahir. Deteksi dini neonatal jaundice dapat mencegah terjadinya kernikterus sebagai komplikasi tingginya kadar bilirubin pada neonatus. Visual assessment merupakan salah satu pemeriksaan untuk menilai neonatal jaundice yang diperkenalkan oleh Kramer. Tujuan penelitian ini adalah mengetahui nilai sensitivitas, spesifitas dan akurasi visual assessment atau pemeriksaan Kramer pada neonatal jaundice. Penelitian ini menggunakan desain cross sectional pada 102 bayi dengan teknik pengambilan sampel consecutive sampling. Analisis data dilakukan dengan tabel uji diagnostik 2x2. Hasil penelitian ini menunjukkan bahwa visual assessment pada neonatal jaundice nilai sensitivitas 76,92 , spesifisitas 89,47 , dan nilai akurasi 86,27 . Penelitian ini dapat menjadi informasi untuk pengembangan pemeriksaan noninvasif lainnya dalam menilai neonatal jaundice untuk menurunkan angka mobiditas neonatus. Kata Kunci: akurasi, neonatal jaundice, sensitivitas, spesitifitas, visual assessment

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ABSTRACT
Neonatal jaundice often occurs in the first week after birth. Early detection of neonatal jaundice can prevent kernicterus as a complication of high levels of bilirubin in neonates. Visual assessment is one of the examinations to assess the neonatal jaundice introduced by Kramer. The purpose of this study was to determine the sensitivity, specificity and accuracy of visual assessment or Kramer examination in neonatal jaundice. This study used cross sectional design to examine 102 babies as the sample which was selected by convenience sampling method. 2x2 table diagnostic test was employed in this study to analyze the data. The results of this study showed that visual assessment in neonatal jaundice had sensitivity valued 76.92 , specificity valued 89.47 , and accuracy valued 86.27 . This research can be acknowledged for the development of other non invasive examinations in assessing neonatal jaundice for decreasing the number of neonatal morbidity. Keywords accuracy, neonatal jaundice, sensitivity, specificity, visual assessment

Abstrak :
Obstructive jaundice can be caused by malignant or benign origi. The treatment for these situations includes drainage by biliary stenting.The main of this study was to evaluate the success rate of endoscopic retrograde cholangiopancreatography (ERCP) in evaluating malignant obstructive jaundice and the success rate of plastic stent placement....

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Incidences of pancreatic cancer worldwide have been known to be increased. It is the fifth leading cause of death in United State of America.Seventy percent accourts in the head of the pancreas....

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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. ...... 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.

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Tujuan: mendapatkan kesintasan dan faktor-faktor yang berhubungan dengan mortalitas pada pasien ikterus obstruktif dengan etiologi maligna. Metode: penelitian kohort retrospektif dan prospektif dilakukan dengan data sekunder pasien ikterus obstruktif yang dirawat di RS. Cipto Mangunkusumo, Jakarta antara Januari 2010-Desember 2013. Faktor-faktor yang dinilai meliputi umur, jenis kelamin, sepsis, hipoalbumin, tingkat bilirubin serum, tingkat CA 19-9 serum, drainase bilier, keganasan non ca ampula Vater, dan komorbid dengan hasil keluaran berupa mortalitas pasien. Hasil: sebanyak 181 dari 402 pasien ikterus obstruktif dengan etiologi maligna memenuhi kriteria penelitian dengan proporsi laki-laki sebesar 58,6 % dengan pasien berumur ≥50 tahun sebesar 57,5%. Analisis multivariat menunjukkan bahwa sepsis, riwayat drainase bilier sebelumnya dan skor komorbid Charlson ≥4 merupakan prediktor independen terhadap mortalitas. Median kesintasan pasien dengan faktor prognosis bermakna adalah 14 hari sedangkan median kesintasan keseluruhan 26 hari. Ambang skor prognostik terbaik didapatkan pada skor ≥2 dengan sensitivitas 68% dan spesifisitas 75%. AUC pada kurva ROC 0.769. Kesimpulan: kesintasan pasien dengan faktor prognosis sepsis, drainase bilier tidak berhasil/tidak ada, dan skor indeks komorbid Charlson ≥4 lebih pendek dibandingkan kesintasan keseluruhan pasien. Skor prognostik ≥2 termasuk dalam risiko tinggi kematian dan kemampuan prediksi mortalitas dari faktor prognosis bermakna adalah 76.9%.

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Aim: to obtain survival rate and mortality-related factors of malignant obstructive jaundice patients. Methods: all medical records of obstructive jaundice inpatient at Cipto Mangunkusumo Hospital, Jakarta from January 2010 to December 2013 were reviewed retrospectively. The following factors were analyzed in terms of mortality: age, gender, sepsis, hypoalbumin, serum bilirubin level, serum CA 19-9 level, billiary drainage, non-ampulla Vateri carcinoma, and comorbid factors. Results: total 181 out of 402 patients were enrolled in this study with male proportion was 58.6%, and patients aged 50 years or above was 57.5%. Multivariate analysis showed that only sepsis, unsuccessful or no prior biliary drainage and Charlson comorbid score ≥4 were independent predictors of mortality. Patients with significant prognostic factors had median survival 14 days compared with overall median survival 26 days. Score ≥2 identified as the highest prognostic score threshold with sensitivity 68%, specificity 75%, and AUC on ROC curve 0.769. Conclusion: sepsis, unsuccessful or no prior bilirary drainage, and Charlson comorbid score ≥4 are factors significantly associated with shortened survival in malignant obstructive jaundice patients. Prognostic score ≥2 was determined to classify patients into high risk mortality group. Mortality of patients with those significant prognostic factors can be predicted in 76.9%.

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Tuberkulosis (TB) dan Human Immunodeficiency Virus (HIV) menjadi beban utama penyakit menular terutama di negara-negara berpenghasilan rendah. Pada pasien penderita Tuberkulosis dengan adanya infeksi penyerta seperti koinfeksi HIV, diestimasikan akan meningkatkan risiko terjadinya drug-induced liver injury (DILI) akibat OAT sebanyak 4 kali lipat. Dilakukan pemantauan terapi obat ini untuk menganalisis masalah terkait obat (MTO)/ Drug’s Related Problem (DRP) yang terjadi pada pengobatan pasien dan memberikan rekomendasi tindak lanjut menggunakan metode SOAP. Diperoleh hasil bahwa pasien memiliki diagnosis ikterus obstruktif, anemia normositik normokrom, hiponatremia hipoosmolar euvolemik, Dili et causa OAT, HIV on ARV, TB on OAT dan terdapat interaksi obat kategori antara sukralfat dengan dolutegravir yang menyebabkan Sukralfat menurunkan efek dari dolutegravir dengan pengikatan kation dlm saluran GI. Hasil analisis DRP disajikan dalam SOAP sebagai komunikasi tertulis untuk menyampaikan rekomendasi kepada dokter penanggung jawab (DPJP). ...... Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are the main burden of infectious diseases, especially in low-income countries. In patients suffering from Tuberculosis with accompanying infections such as HIV co-infection, it is estimated that the risk of drug-induced liver injury (DILI) due to OAT will increase by 4 times. This drug therapy monitoring is carried out to analyze drug-related problems (MTO)/Drug-Related Problems (DRP) that occur during patient treatment and provide follow-up recommendations using the SOAP method. The results showed that the patient had a diagnosis of obstructive jaundice, normochromic normocytic anemia, euvolemic hypoosmolar hyponatremia, Dili et causa OAT, HIV on ARV, TB on OAT and there was a major category of drug interaction between sucralfate and dolutegravir which caused Sucralfate to reduce the effect of dolutegravir by binding cations in GI tract. The results of the DRP analysis are presented in SOAP as written communication to convey recommendations to the doctor in charge (DPJP).

Abstrak :
Latar Belakang. Keganasan merupakan etiologi utama ikterus obstruktif selain batu. EUS memiliki nilai diagnostik yang lebih baik dibandingkan MRCP dalam mendeteksi batu saluran empedu. Di Indonesia, belum ada penelitian yang membandingkan EUS dan MRCP pada kasus keganasan saluran bilier dan pankreas. Nilai diagnostik ini penting untuk meningkatkan kecepatan dan ketepatan diagnostik sehingga dapat diambil tatalaksana yang paling sesuai. Tujuan. Mengetahui nilai sensitivitas dan spesifisitas EUS dibandingkan MRCP pada pasien ikterus obstruktif karena keganasan. Metode. Studi observasional analitik dengan mengumpulkan data rekam medik pasien usia > 18 tahun di RSCM yang terdiagnosis ikterus obstruktif diduga karena keganasan tahun 2014-2018 dan telah dilakukan pemeriksaan EUS dan atau MRCP sebelum dilakukan ERCP (baku emas). Dilakukan identifikasi hasil EUS, MRCP, dan ERCP, kemudian dilakukan analisis dengan IBM SPSS Statistic 20 untuk uji diagnostik. Hasil Utama. Terdapat 54 subyek yang memenuhi kriteria inklusi dan eksklusi, dimana 53,7% di antaranya adalah laki-laki dengan rerata usia 56,48 ± 11,37 tahun. Tumor kaput pankreas merupakan jenis keganasan yang paling banyak dijumpai (50%) berdasarkan pemeriksaan ERCP. Nilai sensitivitas, spesifistas, NDP, NDN, RKP, RKN, dan akurasi untuk EUS masing-masing adalah 96%, 60%, 96%, 60%, 2.40, 0.07, dan 93%. Untuk MRCP, nilai masing-masing adalah 90%, 40%, 94%, 29%, 1.50, 0.26, 85%. Sedangkan nilai AUC dari EUS adalah 78% (IK95% 51%-100%), p = 0,041. Untuk MRCP, nilai AUC yang diperoleh adalah 64,9% (IK95% 36,2%-93,6%), p = 0,276. Simpulan. EUS memiliki nilai sensitivitas dan spesifisitas yang lebih baik dibandingkan MRCP pada pasien ikterus obstuktif karena keganasan.

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Background Malignancy is the main etiology of obstructive jaundice besides stones. EUS has a better diagnostic value than MRCP in detecting bile duct stones. In Indonesia, there are no studies comparing EUS and MRCP in cases of biliary and pancreatic malignancies. This diagnostic value is important to improve the speed and accuracy of the diagnostic so that the most appropriate treatment can be taken. Methods Analytic observational study by collecting medical records of patients aged> 18 years in RSCM diagnosed with obstructive jaundice suspected due to malignancy in 2014-2018 and EUS and / or MRCP examination before the ERCP (gold standard) was performed. EUS, MRCP, and ERCP results were identified, then an analysis was performed with IBM SPSS Statistics 20 for diagnostic tests. Results There were 54 subjects who met the inclusion and exclusion criteria, of which 53.7% were men with an average age of 56.48 ± 11.37 years. Pancreatic head tumor is the most common type of malignancy (50%) based on ERCP examination. The sensitivity, specificity, PPV, NPV, LR+, LR-, and accuracy values for EUS are 96%, 60%, 96%, 60%, 2.40, 0.07, and 93%, respectively. For MRCP, the values are 90%, 40%, 94%, 29%, 1.50, 0.26, 85%, respectively. AUC value for EUS is 78% (CI95% 51%-100%), p = 0.041. Meanwhile, AUC value for MRCP is 64,9% (CI95% 36,2%-93,6%), p = 0.276. Conclusion: EUS has better sensitivity and specificity values than MRCP in obstructive jaundice patients due to malignancy.