Vera Yuwono

Oxygen Hyperbaric Therapy in Patients with Radiation Proctitis

Background: Cervical cancer is the most common female malignancy in developing countries, including Indonesia. It usually occurs at the age of 20 years, reaches the peak incidence at the age of 35-55 years, and afterwards, the incidence declines. Radiotherapy is the most important treatment method in cervical cancer, especially for local advanced stage or stage IIb-IVa. It is also effective for the early stage. Oxygen hyperbaric therapy (OHBT) is defined as 100% oxygen (O2) administration of 2-3 ATA (Absolute Atmospheres) pressures in a high-pressure room. OHBT accelerates wound healing by improving oxygen perfusion around the wound and by increasing angiogenesis through Nitric Oxide Synthetase (NOS). Methods: The study was conducted at Cipto Mangunkusumo hospital, while OHBT was provided at Dr. Mintoharjo Navy Hospital. Block randomization was performed, Resulting 32 patients in OHBT group and 33 patients in control group; both groups were at normal distribution. The prevalence of radiation proctitis in OHBT and control group was determined using chi-square test. Results: By comparing the prevalence of radiation proctitis between OHBT and the control group, show that OHBT could decrease proctitis prevalence by p = 0.03. Conclusions: This study indicates that OHBT may reduce the prevalence of radiation proctitis. The OHBT is save and secure to the patients. Keywords: OHBT, cervical cancer, radiotherapy, radiation proctitis

Diseases in Chronic Non-infective Diarrhea

Background : Chronic diarrhea is common in Indonesia. The chronic non-infective diarrhea cases seem to be increasing recently. The aim of this study is to reveal the pattern of diseases that can cause chronic non-infective diarrhea. Methods : We examined all patients suffering from chronic non-infective diarrhea over a six years period. The patients underwent physical examination and performed laboratory tests, colon enema X-ray, colonoscopy, ileoscopy, upper gastrointestnal endoscopy and small bowel X-ray. Result : Chronic non-infective diarrhea was observed in 107 (51.7%) cases from 207 chronic diarrhea cases respectively. The frequently found abnormalities that had caused chronic non-infective diarrhea were carbohydrate maldigestion (62.61%), colorectal cancer (14.01%), Crohn’s disease (11.21%), ulcerative colitis (9.34%), irritable bowel syndrome (8.41%), colorectal polyp (8.41%) etc. Conclusion : The most frequent abnormality found in chronic non-infective diarrhea was maldigestion. Keywords : Chronic diarrhea, non-infective

Hepatocellular Carcinoma in an Infant due to HBV Vertical Transmission

Hepatocellular carcinoma (HCC) is one of the common tumors in the world. The incidence of HCC generally increases with age in all population but there is a tendency of decreasing incidence in the elderly and it is very rare in children. This is a case report of HCC in a 9-month-old boy, who was admitted to the hospital with palpable abdominal mass in the right upper quadrant. Imaging modality by ultrasonography could not adequately demonstrate definite findings demonstrating that the tumor was derived from liver, and the diagnosis was neuroblastoma. Intra-operatively, the tumor mass appeared to be derived from the surface of the posterior edge of the liver, so it was a pedunculated tumor. The histopathological examination revealed a pedunculatedhepatocellular carcinoma grade 3. The Victorian blue staining and immunohistochemical staining were done afterward, which showed HBsAg positive result as found in non-tumor lesion as well as inneoplastic lesion of liver tissue. Keywords : hepatocellular carcinoma, pedunculated HCC, infant HCC, occult hepatitis B virus infection

Normal Histological Appearances of the Duodenum Jejunum and Terminal Ileum in Indonesian People

Background : There is no literature specifically on the normal appearance of small bowel mucosa amongst Indonesians. Diseases of the small bowel can cause chronic diarrhea. Chronic diarrhea is common in Indonesia. Methods : Thirty seven patients with normal stomach and small bowel on endoscopic and histopathologic examination were included in this study. Biopsies were taken from the duodenal bulb, descending part of duodenum, jejunum and terminal ileum. The scoring Method for the inflammatory cells (lymphocytes, plasma cells and eosinophil cells) was carried out using the symbols 0 (negative), +, ++, and +++. Results : The mean height of the villi of the duodenal bulb was 265.00 ± 81.89 mm, the mean height of the crypts of the duodenal bulb was 196.67 ± 56.01 mm, the mean width of the villi were 59.14 ± 74.14 mm. The mean height of the villi of the duodenum pars descendens was 317.27 ± 99.66 mm and the mean height of the crypts was 218.79 ± 84.66 mm. The mean height of the villi of the jejunum was 341.76 ± 76.06 mm and the mean height of the crypts was 189.41 ± 58.15 mm. The mean height of the villi of the terminal ileum was 235.41 ± 73.32 mm, and the mean height of the crypts was 186.22 ± 64.09 mm. Conclusion : Histologically, the mean height of the villi of the normal small bowel was between 235.41 ± 73.32 to 341.76 ± 76.06 mm and the mean height of the crypts of the normal small bowel was between 186.22 ± 64.09 to 218.79 ± 84.66 mm. Keywords : normal, duodenum, jejunum, terminal ileum, histological appearances, villous height, villous width, crypt height

Portal Hypertensive Enteropathy in Liver Cirrhosis

Background/Aim : Some studies found that portal hypertension cause complication such as portal hypertensive gastroenterocolopathy. This study was done to find any abnormalities in the small intestinal mucosa and villi of the portal hypertensive patients. Method : Thirty patients with liver cirrhosis, portal hypertension and esophageal varices between 2000 - 2001 were included in this study. A duodenoscopic examination was performed to determine any abnormalities. Biopsy specimens were taken from the descending part of duodenum and the duodenal bulb for histopathological examination. The findings were compared to 37 functional dyspepsia patients. Result : In the duodenal bulb and descending part of duodenum: the width of the villous of the portal hypertensive group was larger than the control (p < 0.001), the diameter of the mucosal villous vessel was larger than in the control (p < 0.001) and the thickness of the mucosal villous vessel wall was thicker than in the control (p < 0.001). Conclusion : There were abnormalities of the mucosa in portal hypertensive enteropathy patients including the mucosal vessel diameter, wall thickness, number of goblet cells. Keywords : portal hypertensive enteropathy, liver cirrhosis

Intestinal Amebiasis: Diagnosis and Management

Intestinal amebiasis is an infection due to Entamoeba Histolytica and has the highest prevalence in tropical countries, including Indonesia. Amebiasis is responsible for approximately 70,000 deaths annually every year. High prevalence is found especially in endemic area which had poor hygiene and sanitation or crowded population. Human is the main reservoir, while the disease can be transmited by mechanical vector such as cokckroach and flies. Making diagnosis of intestinal amebiasis sometimes can be a problem. Clinical presentation and disease severity may be varied. Complication due to late management of the disease can be fatal. Lifestyle education, early diagnosis and proper management of amebiasis are very important measures to promote by health workers. Keywords : intestinal amebiasis, diagnosis, management

Hematochezia in Patient with Colorectal Polyps

More than 95% colorectal cancers arise from neoplastic adenomatous polyps (adenomas). The malignant potential of polyps depends on size, amounts, histological type and degree of dysplasia. The prevalence of adenoma increases with age. Patient whose age more than 40 years old with rectal bleeding as presenting symptom should never be ascribed solely to coexisting haemorrhoids without a through evaluation of the colon and rectum. We reported a case of hematochezia due to colorectal polyps with coexisting hemorrhoids as suspected bleeding source. Colonoscopy examination demonstrated colorectal adenomatous polyps in rectum and sigmoid. Polypectomy was done and tissue biopsy Result was tubular adenoma with mild dysplasia. Keywords : Adenomatous polyp, hematoschezia

Gastric Mucosa Mucous Layer Thickness in Liver Cirrhosis with Portal Hypertensive Gastropathy Compare to Functional Dyspepsia

Background : This study aimed to investigate gastric mucosa mucous layer thickness in portal hypertensive gastropathy (PHG) compare to normal mucosa in functional dyspepsia and its correlation with several variables such as child class, severity of esophageal varices and gastropathy. Methods : Biopsy specimens were taken from the antrum and corpus from both group of patients with PHG and functional dyspepsia. The specimen was given cryometric for frozen section. Tissue were sliced by sagital section 11 µm, placed in object glass, fixed and stained to evaluate mucous thickness and giemsa stained to observe Helicobacter pylori. Measurement of mucous thickness was done upward muscularis mucosa started from upper epithelial layer from foveale tip until outer mucous layer on 15 points which were marked randomly and calculate the mean value by micrometer (µm). Results : Mean value of antral mucous thickness in PHG was 13.30 ± 6.5 µm, while in the functional dyspepsia it was 25.59 ± 5.66 µm. Statistical analysis for both kinds of mucous thickness was p<0.001. Mean corpus mucous thickness in PHG was 10.6 ± 6.81 µm, while mucous thickness in dyspepsia was 32.54 ± 6.51 µm. Statistical analysis revealed p<0.001. This result showed significant difference of mucous thickness of antrum and corpus statistically between PHG and dyspepsia as control group. Conclusion : The study had proven the presence of decreased gastric mucosa mucous layer thickness in corpus and antrum in PHG. Thus, therapeutic approach to increase mucous thickness must be considered in patients with PHG. Keywords: Gastric mucosa, PHG, liver cirrhosisemistry

Advanced Gastric Cancer in a Young Patient

Gastric cancer remains the second most common cancer in the world, and is usually found in men, especially those over 50 years of age. The diagnosis is made by endoscopic biopsy. The high frequency of late diagnosis or advanced stages accounts for the overall poor prognosis for this tumor. Surgery is the most frequently employed modality for both cure and palliation. However, most patients present with advanced disease that is incurable. We reported a rare case of young female patient aged 23 years old with advanced gastric carcinoma. The main clinical features were epigastric discomfort, vomiting, and weight loss. An abdominal mass was palpable on physical examination. Endoscopy showed a giant tumor mass causing gastric outlet obstruction, nodular lesion, ulcerative and hemorrhagic. The histopathologic examination revealed mucinous gastric carcinoma. Palliative resection could not be performed because the tumor tightly adhered to adjacent structures. Jejunostomy was performed to allow enteral nutrition. Best supportive care is very important to improve the quality of life. Keywords : Gastric cancer, young patient

Abnormalities of the Small Bowel in Chronic Non-Infective Diarrhea: A Histopathological Study

Background : The incidence of chronic non-infectious diarrhea cases is increasing in line with the developments of medical technology and science. The objective of this study was to uncover the histopathologic abnormalities of the small bowel in cases of chronic non-infectious diarrhea. Methods : All chronic non-infectious diarrhea patients in Cipto Mangunkusumo Hospital from 1996 until 2000 were included in this study. For the control group, we used 37 endoscopically-normal patients with functional dyspepia with the same characteristics (sex and age). All of the patients underwent gastroduodeno-jejunoscopic and ileocolonoscopic examinations. Patients with infection were excluded from this study. Biopsies were taken from the duodenal bulb, descending duodenum, jejunum near the Treitz ligament, terminal ileum, and colon. Histopathological tests were performed on all of the biopsies. Result: Histopathological examination was carried out on 31 patients and 37 control patients. In the duodenal bulb, the width of villi, lymphocyte infiltration, eosinophil infiltration, stage of inflammation, and polymorphonuclear cells infiltration were all lower in the chronic non-infectious diarrhea group than in the control group (p < 0.01). In the descending part of duodenum and jejunum, lymphocyte infiltration, the stage of inflammation, and polymorphonuclear cell infiltration were found to be higher in the chronic non-infectious diarrhea group than in the control group (p< 0.01). Within the terminal ileum, lymphocyte infiltration, the stage of inflammation and lymphoid follicle hyperplasia were found to be higher in the chronic non-infectious diarrhea group than in the control group (p< 0.01). Conclusion : Histopathologically, increased lymphocyte infiltration, inflammation and lymphoid follicle hyperplasia were discovered in specified areas of small intestine in chronic non-infectious diarrhea patients. Keywords : Histopathological examination, chronic non-infectious diarrhea, lymphocyte infiltration, mucosal inflammation, lymphoid follicle hyperplasia