International Journal of Human Capital Management (IJHCM)
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Correlation between Thrombopoietin Serum Level and Liver Fibrosis in Chronic Hepatitis Patients
No full textBackground: Thrombopoetin (TPO) is a cytokine mainly produced in the liver and is the principal regulator in the humoral control mechanism of thrombopoesis. Presumably TPO production is not adequate in patients suffering from severe necroinflammation and advanced liver fibrosis in chronic hepatitis. The aim of this study was to identify the correlation between serum TPO levels and the degree of liver fibrosis. Method: With analytical cross-sectional design, this sudy analyzed the relationship between the serum TPO level and the degree of liver fibrosis in 62 chronic hepatitis patients from June 2006 to March 2008. The serum level of TPO was examined using the Quantikine human TPO immunoassay, and liver biopsy was performed in accordance to the Metavir scoring system. Results: There were 22 female and 33 male, with age range from 18 to 70 years old. We found that serum TPO levels were negatively correlated with the degree of liver fibrosis in a very significant fashion (r = -0.284, p < 0.05). At serum TPO level 16.01 pg/mL or lower, the sensitivity and specificity of serum TPO for diagnosing the severity of the fibrosis were the 64.1% and 70.3% respectively, when the disease process was at F3 or greater level (p = 0.003). There was a significant difference between the degree of liver fibrosis and platelet count (p < 0.0001), and significant negative correlation between the degrees of fibrosis with platelet level (r = - 0.783; p = 0.001). Conclusion: There was a significant negative correlation between serum TPO levels and the degree of liver fibrosis in chronic hepatitis patients and significant negative correlation between the degree of liver fibrosis and platelet count. Keywords: chronic hepatitis, liver fibrosis, thrombopoieti
The Cyclooxygenase-2 and Nuclear Factor-kappa B Expressions in Colorectal Polyps
No full textBackground: Cyclooxygenase-2 (COX-2) is the rate-limiting enzyme in prostaglandin synthesis, while nuclear factor kappa B (NF-kB) is a family of transcription factors. Both play an important role in tumorigenesis. In the present study, we examined NF-kB and COX-2 expressions pattern, and their association in neoplastic and non-neoplastic colorectal polyps (CP). Method: Formalin-fixed and paraffin embedded tissue blocks from 77 patients with CP were immunostained with anti-NF-kB (p 65) and anti-COX-2. Expressions of NF-kB, and COX-2 were detected immunohistochemically. The relationship between these expressions and the two types of CP, and other clinicopathological findings were evaluated Results: The expressions of NF-kB and COX-2 in patients with neoplastic and non-neoplastic CP were high. The results of this study indicated that generally in CP, NF-kB was associated with COX-2 and the association was also seen in neoplastic and non-neoplastic polyps. There was no significant difference of NF-kB and COX-2 expressions in terms of patient’s age, sex, histologic type, and location of the CP. Neoplastic CPs were more common in the distal colon, female patients and older patients (> 60 years) compared with non-neoplastic CPs. Neoplastic CP were located more at the distal colon, more in female, and more in older (> 60 years) patients as compared with the non-neoplastic CP. Further studies are needed to elaborate the role of inflammation in sporadic colorectal carcinogenesis. Conclusion: The expressions of NF-kB and COX-2 in patients with CP were high, and strong correlated each other. There were no significant differences between expression of NF-kB and COX-2 in neoplastic and non-neoplastic polyps. Keywords: colorectal polyps (CP), NF- B, COX-2, inflammatio
Mucus Thickness of the Gastric Mucosa and Helicobacter pylori Infection in Dyspeptic Patients with or without Diabetic Symptom
No full textBackground: Chronic Helicobacter pylori (H. pylori) infection affects the mechanisms of gastric mucosal protection. In patients with diabetes mellitus, data on the prevalence of H. pylori infection are scanty and contradictory. We have examined, using histological fixation technique, the thickness of the adherent mucus gel layer in the gastric mucosal and H. pylori infection in dyspeptic patients with or without diabetes. Method: A cross-sectional study was conducted in 86 dyspeptic patients consisted of 43 diabetics and 43 non-diabetics patients. In all cases, upper gastrointestinal endoscopy were performed, measurement of the gastric corpus and antral mucus thickness was carried out at the corpus and antral biopsy specimens were snap frozen and cryostat sections were stained using a hematoxyline eosin. One biopsy within 2 cm of the pylorus was examined for detection of H. pylori status by using polymerase chain reaction (PCR). Results: In all sections the mucus layer was continuous. At the gastric corpus and antrum, the mucus thickness of diabetic patients was thinner than non diabetic patients: 35.2 ± 2.2 µ m and 43.9 ± 3.8 µ vs 45.2 ± 2.5 µ m and 51.2 ± 2.2 µ m. The results were significantly different (p = 0.001). The difference of H. pylori prevalence between diabetics (52.5%) and nondiabetics patients (47.5%) was not significant (p = 0.67). Conclusion: This study shows a significant thinning of the adherent mucus gel layer both in diabetic patients and H. pylori-positive individuals. No difference has been found between patients with H. pylori infection and diabetes mellitus. Keywords: mucus thickness, Helicobacter pylori infection, diabetic patien
Complicated Benign Peptic Stricture of the Esophagus
No full textPeptic esophageal stricture secondary to gastroesophageal reflux is an important cause of esophageal stenosis and dysphagia. Symptoms of peptic strictures are usually insidious but progressive beginning with dysphagia to solids followed by dysphagia to liquids. It was estimated to occur in up to 20% of untreated patients, which has decreased significantly since the era of proton pump inhibitor therapy. The presence of esophageal reflux stricture is typically diagnosed by means of a barium esophagogram, although endoscopy may have both diagnostic and therapeutic value. Treatment usually involves dilation combined with acid- suppressive therapy. We reported a 43-year-old patient with complicated benign peptic stricture of the esophagus that finally underwent esophageal resection, a rarely therapeutic option. Keywords: gastroesophageal reflux disease, benign peptic esophageal stricture, dysphagia, esophageal dilatation, surgical treatmen
Alteration of Subcellular Beta Catenin Expression in Normal Mucosa Adenoma and Carcinoma in Relation to Colorectal Carcinogenesis
No full textBackground: Adenomatous polyposis coli (APC) gene mutation was found in up to 80% of cases of sporadic colorectal cancers and adenomas. Loss of APC protein function has been known as one of the early process in colorectal carcinogenesis. This event leads to the accumulation of beta catenin in the cytoplasm and nucleus and subsequently activates target genes that regulate cell proliferation and apoptosis. The aim of this study was to investigate the alteration of subcellular beta catenin expression in the progression of colorectal cancer. Method: This cross-sectional study was conducted with 30 paraffin-embedded tissue sections each of normal colorectal mucosa, adenomas and carcinomas. Alteration of beta catenin expression in membranous, cytoplasmic, and nuclear compartments were evaluated by immunohistochemical staining. Results: Beta catenin immunoreactivity was detected in all cases, of which 87 (96.7%) cases showed membranous expression, 78 (86.7%) cases had cytoplasmic and 51 cases (56.7%) had nuclear expression. Such results were statistically significant (p 0.05). Conclusion: Altered subcellular expression of beta catenin occurs as the oncogenic process develops from adenoma into carcinoma. Such finding reflects the importance of beta-catenin in colorectal carcinogenesis. Keywords: beta catenin, colorectal cancer, adenoma, colorectal cancer progressio
Primary Gastrointestinal Tract Lymphoma
No full textExtranodular lymphomacanbe found in almostallorgan. One third of the cases found in gastrointestinal(GI) tract, whichisthemost commonformofextranodular lymphoma.All thesubtypesof lymphomamayoccurasprimarylesionalongingastrointestinaltract,butthemostcommonformis B-celldiffuse largecelllymphoma.DiseasesthatlinkedwithGItractlymphomaareinflammatorybowel disease, celiac disease,Helicobacter pylori, virus infection,collagen diseaseandionicradiation.This reportdescribed a40yearsoldmanwith recurrentbloodystoolandcolon lymphomawasblamedas the sourceofbleeding withitsmanagementoflymphoma. Keywords:lymphoma, gastrointestinaltract,extranodular
Barrett's Esophagus
No full textBarrett’s esophagus (BE) is a predisposing factor of esophageal adenocarcinoma. Metaplasia on BE occurs due to imbalance between esophageal defensive and reluxate materials offensive factors. Nowadays, it is believed that gastroesophageal reflux disease (GERD) is one of major risk factors of BE. Patients with BE generally have lower esophageal sphincter (LES) pressure, shorter LES and intra- abdominal esophageal length, and longer acid exposure than patients with severe esophagitis. Acid exposure has pro-proliferation and anti-apoptosis effect which can facilitate BE occurrence. Currently BE management has gone through various advance, especially in its diagnostic section, from the development of sophisticated endoscopic modality to the finding of biomarker to predict cancer occurrence on BE. Therapeutic section has also been progressing, especially with its endoscopic and chemoprevention therapy. This review article addresses the latest update of BE management. Keywords: Barrett’s esophagus, GERD, managemen
Correlation between the Degree of Esophageal Varices and Liver Stiffness in Liver Cirrhosis Patients
No full textBackground: Bleeding due to rupture of esophageal varices is one of main cause of death in liver cirrhosis, that endoscopy screening is recommended. However endoscopy is invasive and frequently cannot be performed due to contraindication, high-cost or uncomfortable effect to the patients, particularly on patients have not had any bleeding before. Consequently, it is necessary to find other assessment which can predict the presence of esophageal varices. Recent studies found liver stiffness measurement by the liver transient-elastography is one of non invasive measurement to evaluate liver fibrosis.This study was designed to know the correlation between degree of the esophageal varices and the degree of liver stiffness. Method: This was cross sectional study. Liver cirrhosis patients were consecutively enrolled in this study. They underwent endoscopy to determine esophageal varices and subsequently the liver transient- elastography by Fibroscan technique to determine liver stiffness. Degree of the esophageal varices based on OMED criteria. Liver stiffness are expressed in kilopascal (kPa). Correlation analysis was done to assess this study. Result: There were 13 subjects. Most subjectswere male, age > 50 years and Child-Pugh A or B. The mean value of liver stiffness was 35.55 ± 23.60 kPa and mean OMED was 5.61 ± 2.14. The coefficient correlation between degree esophageal varices and degree liver stiffnes was 0.492, p = 0.087. Conclusion: There is moderate correlation but not statistically significant between the degree of liver stiffness and the degree of esophageal varices. Larger sample size is necessary to find the correlation between the degree of liver stiffness and esophageal varices. Keywords: liver cirrhosis, degree of esophageal varices, liver stiffnes
Early Experiences with Percutaneous Endoscopic Gastrostomy in Pondok Indah Hospital
No full textBackground: Percutaneous endoscopic gastrostomy (PEG) is only recently being introduced in Indonesia with limited clinical experience. Clinical study of patients underwent PEG is very limited. This study was aimed to evaluate clinical profile of patients underwent PEG in a private hospital in Jakarta. Method: A retrospective study was done to patients underwent PEG in Pondok Indah hospital, Jakarta using medical record. Clinical data collected were patients’ demographics, diagnosis of underlying disease, indication for PEG insertion, and follow-up visits. Results: Ten cases were found between 2000 and 2008, six among them were men. All but one cases aged more than 50 years. Ninety percents of the patients had cerebrovascular disorder as their primary diagnosis and 60% of the main indication was dysphagia. Conclusion: No procedure-related major complications and death has occurred. This procedure was safe and potentially be offered to more widely clinical settings. Keywords: dysphagia, percutanelus endoscopic gastrostomy, enteral feedin
Child Pugh C and Male Gender were Related to Nutritional Status of Liver Cirrhosis Patients in Koja Hospital Jakarta
No full textBackground: Malnutrition is found in 65-90% patients with liver cirrhosis. Malnourished patients with cirrhosis have a higher rate of complications. Aim of this study was to evaluate the prevalence and risk of malnutrition in liver cirrhosis patients at Koja hospital, Jakarta. Method: All liver cirrhosis patients visited Koja hospital during January - March 2009 was evaluated. An inclusion criterion was liver cirrhosis. An exclusion criterion was unable to speak Indonesia. The distributions of age, gender, body mass index (BMI), triceps skin-fold thickness (TSF), mid-upper arm circumference (MUAC), mid-arm muscle circumference (MAMC), Child Pugh classification were assessed. The criteria of malnutrition was done according to MAMC and BMI. Result: There were 38 liver cirrhosis patients fit the criteria. Twenty five (65.8%) cases were classified as malnutrition according to MAMC, 21 (55.3%) were classified as malnutrition according to BMI. Four patients (10.5%) were Child Pugh scores A, 15 Child Pugh B (39.5%) and the rest 19 patients (50.0%) were Child Pugh C. There was a trend correlation between malnutrition according to MAMC and Child Pugh criteria but not statistically significant. Conclusion: In our study we found 65.8% of liver cirrhosis patients were malnourished according to MAMC. Malnutrition was higher in male, as well as in Child Pugh score C. MAMC is more accurate than BMI in assessing nutritional status in liver cirrhosis. Keywords: liver cirrhosis, nutritional status, MAMC, BMI, Child Pugh scor