Radical cystectomy with urinary diversion is definitive treatment for non metastatic bladder cancer . The present study assessed the clinical, pathological profile and early complications after radical cystectomy and urinary diversion for bladder cancer.  Between January 2013 and April 2015, 59 patients diagnosed with bladder cancer. A total of 13 radical cystectomies (22%)  were performed, with ileal conduit type of urinary diversion. Patient’s demographic, clinical, pathological, operative and post operative factors including early complications were collected. Among the 13 patients who underwent radical cystectomy, 11 patients was male (84.6%), mean age was 57 y.o ( 35–77 y.o). Three patients were excluded from this study because lack of data. All patients complained hematuria, 4 patients (30.8%) with local comorbidities like bladder stone. Three patients (23.1%) with organ confined tumour (T2). Of these tumours, 8 patients with urothelial bladder carcinoma (61.5%), and 1 had synchronous tumor of bladder and prostate. Two patients (15.4%) had neoadjuvant chemotherapy and 7 patients (53.8%) underwent adjuvant chemotherapy. Wound dehiscence found to be the most early complications after surgery and there were no significant complications in 3 month after surgery. Radical cystectomy with ileal conduit type of urinary diversion still become the most preferrable surgical techniques in our institution for bladder cancer with good outcome.

 

 

Humans seek to inhibit the effects of free radicals in the body so that the effect can be inhibited. One natural way to inhibit free radicals in the body is by eating foods that contain antioxidants, such as eating juwet fruits (Syzygium cumini). This study aimed to determine the effect of ethanol extract of the juwet fruit skin (Syzygium cumini) against viability of lymphocyte cells in Peripheral Blood Mononuclear Cell (PBMC) cultures exposed to H₂O₂ 3%. This study is a pure experiment with pattern Post Test Only Control Group Design. The samples used were lymphocytes in PBMC cultures as much as 766 x 10² cells/ml. The independent variable in this study is the concentration of the ethanol extract of the juwet fruit skin (Syzygium cumini) and as the dependent variable lymphocyte cells. Data were analyzed by One Way Anova followed by Post Hoc test. The concentration of 0.00002 g/ml (P4) after observation for 30 minutes, obtained the highest viability value of 88.74%. One Way Anova obtain results p value = 0.003 (p <0.05). That means, there is a statistically significant difference in lymphocyte cell viability of each group was studied. Based on the results of Post Hoc analysis obtained statistically significant differences in the highest at P4 and P1 (p =0.002). Ethanol extract of the juwet fruit skin is effective in improving the viability of lymphocytes compared with the positive control. The concentration of 0.00002 g/ml is more effective. Further research is needed with the same number of samples as well as the concentration of each group much more varied.

Politrauma is not only damage the affected organ but also has systemic effect to the distance organ because of the inflammatory process. Pain and stress  due to polytrauma result in neuroendocrine, neuroimmunology and metabolic change. Neuroendocrine change marked by release of countraregulatory hormones which increase glucose serum level. While neuroimmunology marked by released of proinflammatory cytokines, one of the most reliable and spesific cytokine is IL-6. Several study of glucose and Il-6 have been performed on polytrauma but research to find the correlation between both of them never done. This is a longitudinal cross sectional study  to find the correlation between glucose level and IL-6 at the first, third, and fifth day in patients with long bone fracture and polytrauma. Glucose level is measured by spectrophotometry and IL-6 level is measured by ELISA. Twenty two patients with long bone fracture and politrauma, age range 14-55(mean 34 year), no history of diabetes mellitus with normal HbA1C level (mean 5.08 %) which admitted to emergency room RSUP Sanglah. Both glucose level and IL-6 is measured at first, third, and fifth day. There was strong and significant correlation between glucose and IL-6 at first and fifth day (5.07 dan 5.20, p:0.016, p:0.013 ; p: 0.05). There is no significant correlation at third day although the highest mean were found at third day. From the results of the statistic analysis it can be concluded that blood glucose level can be a surrogate marker of the Il-6 at the first and fifth day in patient polytrauma with long bone fracture.

 

Surgery is the primary treatment for colorectal carcinoma. But of all surgical cases found most patients experience postoperative hypoalbuminemia. This study aimed to explore the risk factors that contribute causing postoperative hypoalbuminemia in patient with colorectal carcinoma. This study was an observational study with a cohort study design. The research sample was 102 patients with colorectal carcinoma who underwent surgery in Sanglah Hospital starting in September 2015 until February 2016. Then performed univariate analysis, bivariate (chi square) and multivariate (Poisson regression) based on the value of the significance level of p <0.05. The present study sample consisted of 102 51 (50.0%) men and 51 (50.0%) women. In bivariate analysis, the factors that influence the occurrence of postoperative hypoalbuminemia in patients with colorectal carcinoma, such as age ≥ 60 years RR of 2.63 (95% CI 1.34 to 5.16; p = 0.003), type of resection RR 2, 88 (95% CI 0.94 to 8.79; p = 0.035) and the operating time ≥ 3 hours with a RR of 5.32 (95% CI 1.98 to 14.28; p = 0.0001). Of these three factors after multivariate analysis, significant risk factors occurrence of postoperative hypoalbuminemia were age ≥ 60 years, RR 2.66 (95% CI 1.20 to 5.87; p = 0.016 and the operating time ≥ 3 hours with RR of 8.33 (95% CI 1.05 to 65.78; p = 0.044). Age ≥ 60 years allows experienced postoperative hypoalbuminemia by 2.66 times compared with < 60 tahun. The operating time ≥ 3 jam are likely to experience postoperative hypoalbuminemia by 5.32 times compared to the operating time < 3 hours.

 

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The Balinese traditional healing is a cultural heritage. It’ sources are in the form of usada which written on palm leaves. One of them is named usada mala. This article reports the total number of medicinal plants prescribed, the parts of plants used, the ways of giving the drugs and the dosage. There are 29 medicinal plants used in the all prescription written for mala diseases.  It has been prescribed of two kinds of prescription, consisted of single material medicae and plural forms of prescription making use of medicinal plants, minerals, solvent, and animal products. Dosage is not clearly written in every prescription. How long it will be used, is not written. The use of the herbals might be in forms of external uses in 5 methods, which are: drop in form of ear-, nose-, and eye drops, and internally as drinking and swallowing. The information on usada mala, is more limited if its compared with other usada, such as the kind of medicinal plants. Event though, all the medicinal plants which are written  on the usada must be known, so it can be preserved and conserved through the times for it’s conservation and preservation for further study of its’ active components. 

Aorta stenosis also known as idiopatic diseases because of degenerative and calcification of aortic valve. The presence of Severe AS has potentially important implications especially for prognosis of the patient that contribute 15-20% because of its potential for sudden death and inadequate systemic perfusion when performing a cardiopulmonary resuscitation. In this case report we present a patients with significant severe Aorta Stenosis and undergoing Transurethral Resection of the Prostate (TUR-P) are increased risk for cardiac complications. The presence of Severe AS form an absolute contraindication for regional anaesthesia subarachnoid block. We perform an general anesthesia target controlled infusion (TCI) mode marsh with Laryngeal Mask Airway (LMA) and controlled hemodynamic with closed monitoring anaesthesia to minimize cardiac complications.

 

Amyloidosis is a rare disease. The purpose of this case to report a case of amyloidosis in a male aged 49 years. Diagnosis is based on clinical data, radiological and histopathological of operating materials, which is supported by histochemical examination. These cases occurred in men aged 49 years, with complaints of enlargement in the neck region coli in the left and right are growing for 3 years. On examination ct-scan obtained solid mass with heterogeneous density in the nasopharynx right and left (dominant right). There does not appear to erosion and bone destruction calvaria. On microscopic examination of tissue obtained in the form of homogeneous eosinophilic material. Patients diagnosed as nasopharyngeal amyloidosis with involvement of systemic amyloidosis. Histochemical examination congo red, giving a positive result amyloid material pink visible under a microscope positive polarization yellowish green (apple-green birefringence). Amyloid is a protein substance pathological and deposited between various connective tissue and organ in the body. In this case, primary or secondary Amyloidosis can not be enforced.

 

 

 

Congenital pulmonary airway malformation (CPAM)is one of four major congenital cystic lesion found inlungs. The incidence is relatively rare, characterized by dense multicystic areas of abnormal lung tissue. There are five types of CPAM described by Stocker (2002), classified according to the location of the development site of malformation. Type 4 isa rare type, thelesion contains large cysts, lined with flat alveolar cells, some of  which contains surfactant. The case, a 2 monthold boy washospitalized with chief complaint shortness of breath. Physical examination showedtachipnea and from the auscultation of the lung was hyper-resonance on the right side. Chest X-ray revealed suspected congenital emphysema on the right lung and multi slice CT scan revealed suspected CPAM type 1. Thoracotomy and bullectomy surgery was successfully performed and chest X-ray evaluation post-surgery showed no residual cystic lesion. Result from pathologic study showed it is CPAM type 4.

 

 

Papillary Thyroid Carcinoma is the most common type of thyroid malignancy that frequently occurs in women age 25-50 years old which one of the risk factors is Hashimoto thyroiditis. A 43 year old woman came with chief complaints of shortness of breath, dizziness, and sometimes numb feeling hand with history had twice surgeries thyroid tumor. There are increase levels of TSH and FT4. Ultrasound examination of thyroid showed the residive mass of right and left thyroid. On macroscopic examination, there was white mass at right and left lobes, and isthmus with diameter of 3.8 cm, 5.2 cm, and 0.8 cm. On microscopic examination, the sample of thyroid with tumour mass formed follicle structures with description of intranuclear groove, ground glasss appearance, and partly with large eosinophylic cytoplasma (Hurthle cell). There was a solid aggregation surround of lymphoid cells forming germinal center. Patient was diagnosed as papillary thyroid carcinoma oncocytic variant with Hashimoto thyroiditis based on clinical, laboratory, radiologic and histopathologic findings.