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Abstrak :
Latar Belakang: Ikterus obstruktif merupakan salah satu komplikasi tersering keganasan sistem bilier. Keadaan ini akan memicu pelepasan sitokin proinflamasi. Terdapat kontroversi mengenai pengaruh drainase bilier terhadap perubahan kadar sitokin proinflamasi pada penderita kanker pankreatobilier. Tujuan: Untuk mengetahui kadar Tumor Necrosis Faktor alfa (TNF-alfa) dan Interleukin 6 (IL6) sebelum dan sesudah Endoscopic Retrograde Cholangio Pancreatography (ERCP) atau Percutaneus Transhepatic Biliary Drainage (PTBD) pada penderita ikterus obstruksi etiologi kanker pankreatobilier. Metode: Desain penelitian adalah one group before after study. Pemilihan sampel secara consecutive sampling. Sampel darah diambil sebelum dan lima hari sesudah ERCP atau PTBD. Pengukuran kadar TNF-alfa dan IL-6 dengan cara Enzyme Linked Immunosorbed Assay (ELISA). Hasil: Terdapat 40 orang responden yang diikutsertakan dalam penelitian ini, 22 laki laki dan 18 perempuan dengan usia rata rata 55,3 tahun. Berdasarkan imaging dan endoskopi, ditegakkan diagnosis kolangiokarsinoma sebanyak 22 orang, tumor ampula Vateri 10 orang, dan tumor pankreas 8 orang. Kadar rata-rata TNF- alfa sebelum tindakan 4,81 (2,91) pg/ml dan sesudah tindakan 8,05 (6,7) pg/ml, terdapat peningkatan yang bermakna setelah tindakan drainase bilier (p:0,02). Kadar rata-rata IL-6 sebelum tindakan 7,79 (1,57) pg/ml dan sesudah tindakan 7,75 (1,76) pg/ml, tidak terdapat perbedaan yang bermakna setelah tindakan drainase bilier (p:0.52). Kadar rata-rata bilirubin sebelum tindakan 15,5 mg% dan sesudah tindakan 11,3 mg%. Simpulan: Terjadi peningkatan kadar rata-rata TNF-alfa secara bermakna setelah drainase. Tidak ada penurunan yang bermakna kadar rata-rata IL-6.

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Background: Obstructive jaundice represents the most common complication of biliary tract malignancy. Obstructive jaundice causes releases of proinflammatory cytokine. There has been controversy about effect of biliary drainage on the change in proinflammatory cytokine level in pancreatobiliary cancer patients. Objective: The present study was designed to determine levels of Tumor Necrosis Factor Alpha (TNF-Alpha) and Interleukin 6 (IL-6) in preprocedure of either Endoscopic Retrograde Cholangio Pancreatography (ERCP) or Percutaneus Transhepatic Biliary Drainage (PTBD) and postprocedure of them in obstructive jaundice patient caused by pancreatobiliary cancer. Methods : The study method is before- and- after case study design with consecutive sampling. Blood was collected five days prior to either Endoscopic Retrograde Cholangio Pancreatography (ERCP) procedure or Percutaneus Transhepatic Biliary Drainage (PTBD) procedure and five days after either of them. Enzyme Linked Immunosorbed Assay (ELISA) was used to determine TNF-Alpha and IL-6. Results: Forty subjects were included in this study which consisted of 22 men and 18 women. The mean age was 55.3 years old. According to the results of imaging and endoscopy procedure, twenty two (22) people were diagnosed cholangi carcinoma, ten (10) people were diagnosed ampulla varteri and eigth (8) people were diagnosed pancreatic tumor. In preprocedure, the mean of TNF-Alpha concentration was 4.81 (2.91) pg/mL, the mean of IL-6 concentration was 7.79 (1.57) pg/mL and the mean of bilirubin concentration was 15.5 mg%. In postprocedure, the mean of TNF-Alpha concentration was 8.05 (6.7) pg/mL, there was significant increase in TNF-Alpha concentration (p:0.02). However, the mean of IL-6 concentration was 7.75 (1.76) pg/mL, there was not any significant chance in IL-6 concentration (p:0.52). The mean of bilirubin concentration was 11.3 mg%. Conclusions: On one hand, there was significant increase in mean concentration value of TNF-Alpha after biliary drainage procedure. On the other hand there was not any significant decrease in mean concentration value of IL-6 after biliary drainage procedure.

Abstrak :
Sepsis memiliki angka kematian yang cukup tinggi di seluruh dunia. Hal ini disebabkan sebagian besar oleh karena penegakan diagnostik, pemantauan, dan tatalaksana yang tidak adekuat. Mortalitas dan morbiditas sepsis masih dalam banyak penelitian di seluruh dunia. Penyebab terbanyak adalah keadaan imunoparalisis pada sepsis. Penelitian ini bertujuan untuk melihat kejadian, gambaran klinis imunoparalisis pada sepsis klinis anak.Penelitian ini dengan desain deskriptif, dimana subjek di IGD, PICU, dan ruang rawat anak RSCM usia 1 bulan ndash; 18 tahun dengan diagnosis sepsis klinis yang memilki 2/lebih dari 4 kriteria: 1 takikardia; 2 takipnu; 3 hipo/hipertermia; 4 leukositosis/leukopenia, dengan bukti infeksi berupa prokalstionin 0,5 ng/mL dan/atau dijumpai pertumbuhan kuman pada kultur. Setelah orangtua subjek mengisi informed consent, pasien dilakukan pemeriksaan darah rutin, analisa gas darah, prokalsitonin, kultur darah, dan darah diambil untuk pemeriksaan TNF alfa ex vivo. Pemeriksaan TNF alfa ex vivo dilakukan dengan menstimulasi darah segar dengan lipopolisakarida salmonella serotipe abortus equii 500 pg/mL yang kemudian akan dilakukan inkubasi pada suhu 370C selama 4 jam dan disentrifugasi 1000XG selama 5 menit, dilakukan pemeriksaan TNF alfa dengan metode ELISA. Subjek dikatakan imunoparalisis jika didapati hasil TNF alfa ex vivo < 200 pg/mL.Hasil penelitian menunjukkan angka kejadian imunoparalisis 12 17,1 dari 70 subjek terdiagnosa sepsis klinis. Proporsi laki:perempuan 1,4:1. Status gizi kurang n=8/66,7 lebih banyak didapati pada imunoparalisis sepsis klinis. Fokus infeksi tersering adalah infeksi pada sistem hematologi, nefrologi dan respirasi. Subjek demam 5 41,7 , takikardia 3 25 , takipnu 3 25 dari 12 subjek imunoparalisis pada sepsis klinis anak Untuk pemeriksaan laboratorium, prokalsitonin >2,0 ng/mL dan jumlah leukosit > 11.000/mm3 lebih sering dijumpai.Simpulan: angka kejadian imunoparalisis pada sepsis klinis anak di RSCM 17,1 . Gambaran pasien imnoparalisis pada sepsis klinis yang memiliki persentase besar adalah gizi kurang; pasien dengan fokus infeksi hematologi, nefrologi, dan respirasi; prokalsitonin ge; 2 ng/mL; dan leukosit ge; 11.000/mm3

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Mortality in sepsis is high worldwide. It is caused by the diagnostic, monitoring, and inadequate therapeutic. Mortality and morbidity in sepsis is still in research. Immunoparalysis is a leading cause of mortality and morbidity of sepsis. The objectives of this study were investigating incidence, clinical characteristics immunoparalysis in clinically sepsis.Design of study was descriptive. The subjets were children age 1 month-18 years from emergency room, PICU, and pediatric ward with clinically sepsis following ge; 2 of 4 criterias: 1 tachycardia; 2 tachypnea; 3 hypo/hyperthermia; 4 leucocytosis/leucopenia, with proven infection such as procalcitonin 0.5 ng/mL with/without positive culture. After informed consent was filled, subjects were examined blood sample, procalcitonin, blood culture, and TNF alpha ex vivo. Whole blood was stimulated with lipopolysaccharides salmonella serotype abotrtus equii, incubated in 37 0C for 4 hours, centrifugated 1000XG for 5 minutes, and examined for TNF alpha with ELISA. Subjects was defined imunoparalysis with TNF alpha ex vivo < 200 pg/mL.We found the incidence of immunoparalysis was 12 17.1 of 70 clinically sepsis subjects. Malnourished status n=8/66.7 was higher frequency. The large numbers for focus of infection were hematologic, nephrologic, and respiratory system. Subjects had fever 5 41,7 , tachycardia 3 25 , and tachypnea 3 25 from 12 imunoparalysis clinically sepsis subject. Laboratorium findings showed procalcitonin > 2.0 pg/mL 8 66,7 subjects and leucocyte > 11.000/mm3 6 50 subjects.Conclusion: The incidence of imunnoparalysed sepsis was 17.1 . Profile of pediatric clinically sepsis had a big number in malnourished status, focus infectious on hematology, nephrology, and respitarory with laboratorium findings showed procalcitonin > 2.0 ng/mL and leococyte > 11.000/mm3 had a high numbers in immunoparalysed clinically sepsis.