25 research outputs found
The Concept of Gynecologic Oncology Services in Jakarta Related to Academic Health System
No full textAn Academic Health System (AHS) is a system in partnership among universities and health care providers that focuses on education, training, service, and research. The final outcome of this partnership is to improve health status. Numerous countries have been using this system, since this system is proven to lead to better sustainable outcome.
The vision of Faculty of Medicine, University of Indonesia (FMUI) is "to create infinite experience for all through Academic Health System". The third mission of FMUI is to integrate the AHS to Dr. Cipto
Mangunkusumo Hospital and its other affiliated hospitals.
The division of Oncology Department of Obstetrics and Gynecology is a part of Academic Health System that is responsible to create the Gynecologic Oncology services in this system. We create the gynecologic
oncology services in preventive approach from primary to tertiary prevention.
The sister hospitals of FMUI’s including Dr. Cipto Manungunkusumo, Persahabatan, Fatmawati, Karawang, and Tangerang General Hospital. Ideally, we should have health provider partners from primary, District
Hospital (Rumah Sakit Umum Kecamatan/RSUK and Rumah Sakit Umum Daerah/RSUD). Another partner in collaborative project of AHS is Organization of Health Care Professions, such as Indonesian Medical Association, Indonesian Obstetrics and Gynecology Society, and Indonesian Gynecologic Oncology Society, and nongovernmental organization such as Female Cancer Program, Indonesian Cancer Foundation and others are part of partnership in AHS. When talking about public health status, it is also necessary to talk about the role of government as the policy maker and The Social Warranty Institution (Badan Penyelenggara Jaminan Sosial Kesehatan, BPJS) as the public health care insurance regulator. Primary health care should be included in the AHS’s partnership members because primary prevention strategy should be conducted in primary health care.
The example of this project is Cervical Cancer Surveilance as a pilot project. We would prepare the project in collaborative meeting with all partners to make proposal in gynecologic oncology services in primary,
secondary, and tertiary health care, and finally Dr. Cipto Mangunkusumo Hospital as the national referral Hospital. The proposal should talk about concepts of education, training, service, and research. Primary health care can promote cervical prevention and early detection via visual inspection using acetic acid and Pap test.
Cervical precancer lesion can be treated using cryotherapy in primary health care. In secondary health care setting, cervical precancer lesion until microinvasive cervical cancer (stage 1A1) can be treated. Invasive cervical cancer should be managed in tertiary health care. We are preparing concepts where all services should follow the Clinical Practice Guideline. All medical patient database should be recorded digitally as long term cohort data. By applying this system, we’ll have a large number of patients’ data from primary to tertiary health care.
This is crucial, considering that the process of education, training, and research of medical students, residents, and fellows is the backbone of AHS in improving health care status
Progressive Ovarian Cancer with Trocar Site Metastases Resulted from Inadequate Laparoscopy
Full text linkObjective: Discuss the complications of laparoscopic ovarian cystic neoplasms.
Method: Case report A-52 year old female with 2 parities, complained of a lump at anterior abdominal wall during chemothe rapy for clear cell ovarian adenocarcinoma after total hysterectomy and bilateral salphingooophorec tomy by lapa roscopy. The indication was suspected ovarian cancer from solid parts found during ultrasound and CA125 level 169. During previous laparoscopy, the cyst was ruptured, left in abdominal cavity with high C02 pressur e for five hour s and retrieved without a bag.The frozen section examination of the cyst wallwere diagnosed as endometriosis.The physician assured her that the lump was only scar and did not need further evaluation. CA125 level was 557 IV after chemotherapy. PET scan confirmed a 2 ern-diameter mass superior to periton eum and multiple implants intra abdominally.
Result: Adebulking laparotomy was done. Omental cake was found with one part adhered to the right previous trocar insertion site. It was connected to tumor implant size 3x4 em until fat tissue of abdomen wall.Another implant was also found at left para colical area .
Conclusion: Laparoscopy offers advantages such as less bleeding, better visualisation, and enhanced recovery. Some controversies exist in cases with suspicion of malignancy. Pneumoperitoneum might cause seeding of tumor cells. This could be prev ented by using low pressure, avoidance of exsuflation of gas through tro car opening, or by using bags to retrieve operative specimens. Preoperative evaluation of clinical findings, ultra sound, and tumor markers are important to prevent improper surgical management.
Keywords: complication, laparoscopy, metasta ses, ovarian cancer, trocar site
Effect of Nanocurcumin in Combination with Methotrexate on Telomerase Activity, NF-kb Expression, and Proliferation Index of Bewo Choriocarcinoma Cells: Pengaruh Kombinasi Nanokurkumin dengan Methotrexate terhadap Aktivitas Telomerase, Ekspresi NF-kb, dan Indeks Proliferasi Sel Koriokarsinoma Bewo
Full text linkTheurapeutic Response of Neoadjuvant Chemotherapy between Platinum and Ifosfamide Combination and Platinum, Vincristine and Bleomycin Combination in Cervical Carcinoma Stage IB2
Full text linkObjective: To evaluate the theurapeutic response and acute toxicity
of neoadjuvant chemotherapy between the combination of Platinum
and Ifosfamide, and the combination of Platinum, Vincristine and
Bleomycin in Cervical Carcinoma Stage IB2 and then continued with
radical hysterectomy and pelvic lymphadenectomy.
Method: Thirteen samples received neoadjuvant chemotherapy of
Platinum and Ifosfamide and 17 samples received neoadjuvant chemotherapy
of Platinum, Vincristine and Bleomycin, after receiving
the neoadjuvant chemotherapy, clinically complete response samples
underwent radical hysterectomy and pelvic lymphadenectomy
(PI VS PVB = 3 VS 1). Histopathology examination was performed to
evaluate the presence of malignant viable cells at the cervix, pelvic
lymph node metastasis and parametrium metastasis. Acute toxicity
evaluation was performed based on gastrointestinal, genitourinarius
and hematology sign and symptom.
Result: Theurapeutic response of PI is 1.12 higher than PVB
(p>0.05). Subanalysis of group response of PI is 1.962 higher than
PVB. PI and PVB have the same risk to have pelvic lymph node metastasis,
but not parametrial metastasis. There were no differences
in terms of the risk of gastrointestinal, genitourinarius and hematologic
toxicity between PI and PVB.
Conclusion: There was no statistical difference in clinical and
pathological response, and also in acute toxicity between the two
combination (p>0.05).
[Indones J Obstet Gynecol 2016; 1: 47-51]
Keywords: acute toxicity, cervical carcinoma stage IB2, neoadjuvant
chemotherapy, respons
Single vs Multiple Dose of Cefazolin Prophylaxis in Elective Cesarean Section
Full text linkIntroduction: Caesarean section (CS) is one of port d’ entrée from
infection in women and it is related to maternal morbidity during
puerpureal period. Until now, there is still lack of consensus
regarding prophylactic antibiotic protocol before CS procedure. This
study aims to determine the comparative efficacy between single
dose and multiple doses of cefazolin prior incision toward the
incidence of maternal infection.
Methods: This was a single-blind, randomized, clinical trial study
with two methods of intervention including 2-gram single dose
cefazolin at 30 minutes’ prior incision and 2-gram single dose
cefazolin at 30 minutes’ prior incision continued 1-gram cefazolin
after 8 hours of procedure. We recruited women undergone elective
CS at Fatmawati and Anna Hospital, Jakarta from January to March
2016. The primary outcomes were surgical site infection, urinary
tract infection, and endometritis based on clinical findings during 30
days of follow-up period.
Results: A total of 46 subjects were recruited which 23 of them were
in single dose cefazolin group and the other 23 subjects were in
multiple dose of cefazolin group. There were 9 subjects having
infection (19.6%). There was no statistical difference in the
incidence of infection between two groups (p=1.00; relative risk
0.80, 95% CI 0.25-2.61).
Conclusion: Single dose of cefazolin shows similar rates of infection
incidence to multiple dose. Therefore, single dose of cefazolin can be
a protocol in CS based on its efficacy and efficiency.
[Indones J Obstet Gynecol 2017; 5-1: 60-65]
Keywords: cefazolin, maternal infection, multipe dose, single dos
Fascin Expression as Prognostic Factor for Survival in Advanced Epithelial Ovarian Carcinoma
Full text linkObjective: To evaluate fascin expression as a prognostic factor and
its correlation with survival and clinicopathologic factors (degree of
differentiation and stage) in epithelial ovarian carcinoma.
Methods: This study is prognostic study with historical cohort design.
Fascin was analyzed in paraffin block sections of 33 advanced
stage ovarian carcinoma patients using immunohistochemistry. Fascin
expression was tested for its correlation with overall survival as
well as with grade and stage of the cancer.
Results: In this study, fascin expression has no correlation with survival.
In the period of 17-22 months, samples with high fascin expression
had a HR of 1.59 (95% CI=0.38-6.67, p=0.449), but in the
period of 17-23 months, both groups had comparable HR. In the period
of more than 23 months, samples with high expression of fascin
had a better HR of 0.40 (95% CI=0.04-4.38, p=0.449). No significant
correlation was found between fascin expression with grade
(OR=2.08, 95% CI=0.44-9.84, p=0.442) and stage (OR=2.70, 95%
CI=0.39-18.96, p=0.360).
Conclusion: In this study, there was no correlation between fascin
expression and survival, and also no correlation between fascin,
grade and stage. Further study with a larger, more homogenous
sample, analyzing confounding factors is needed.
[Indones J Obstet Gynecol 2015; 3-4: 222-229]
Keywords: advanced stage ovarian carcinoma, fascin, surviva
Recurrence-Free Survival Stage IB1-IIA2 Intermediate Risk Group (Based on Kartu Delgado) Cervical Carcinoma after Radical Surgery and Adjuvant Radiotherapy
Full text linkObjective: To evaluate the benefits of adjuvant radiotherapy (ART) based on Kartu Delgado (simple form of Gynecologic Oncology Group (GOG) scoring system) aimed at women with early stage cervical cancer after radical surgery.
Method: Fifty patients were enrolled for this study. Twenty one patients from 2011-2012 were given ART following surgery based on their Kartu Delgado score from as follows: score 120 were given ART. Their score and recurrence were compared with 29 patients who were treated in 2009-2010 (based on single prognostic factor).
Result: We observed eighteen recurrences for the duration this study. Thirteen patients from the period of 2009-2010 and five patients from the period of 2011-2012. Most recurrences occurred in patients from 2009-2010 with score > 120 but were not designated ART. Two-years recurrence-free survival (RFS) for subjects with score 120 with ART was 64.29%.
Conclusion: Adjuvant radiotherapy given based on Kartu Delgado reduced the number of recurrences in women with stage IB-IIA cervical cancer after treated by surgery.
Keywords: cervical carcinoma, intermediate risk, prognostic factor, radical hysterectom
Treatment Response of PlatinumBased Chemoradiation on Locally Advanced Cervical Cancer
Full text linkObjective: To evaluate the efficacy (treatment response), toxicity,
and overall survival of concomitant chemoradiation (CRT) with
three-weekly cisplatin-ifosfamide compared to CRT with weekly cisplatin
in advanced stage cervical cancers (stage IIB-IIIB).
Method: This is a historical cohort between 32 patients receiving
CRT with three-weekly cisplatin and ifosfamide and 29 patients receiving
weekly cisplatin in Gynecologic Oncology division outpatient
clinic and ward, Dr. Cipto Mangunkusumo Hospital.
Results: There was no significant difference in treatment response,
overall and disease-free survival. There was more gastrointestinal
toxicity in the cisplatin-ifosfamide arm compared to the other arm
(p=0.014), but other toxicity effects were not different.
Conclusion: Platinum based-chemoradiation has the same efficacy
in terms of treatment response for locally advanced cervical cancer.
[Indones J Obstet Gynecol 2015; 3-4: 212-221]
Keywords: cisplatin, concomitant chemoradiation, ifosfamide, locally
advance stage cervical cance
Uterine Perforation on Invasive Hydatidiform Mole during EMACO Treatment
Full text linkObjective: Improving skill and knowledge to recognize and manage a rare case of uterine perforation on invasive hydatidiform mole.
Method: Case report.
Result: A 42 years old Indonesian woman, Parity 2 Abortus 2 with history of 2 c-sections and 2 curettage, came with chief complaint of recurrent vaginal bleeding since 4 months before admission. Patient had a history of previous curettage with indication of hydatidiform mole and recurrent bleeding with no histopathology results. On examination we found a vesicular mass with infiltration, destroying the right-front uterine corpus, size 8x6 cm with an internal echo mass. Chest x-ray showed multiple nodules in the lung. The patient, considered as low risk Gestational Trophoblastic Neoplasia patient with FIGO Score of 6, underwent chemotherapy with 2 series of methotrexate . Due to the non-declining level of -hCG, the regimen was added with EMACO. In the process of chemotherapy, the pa-tient’s-hCG declined but then she complained of major abdominal pain. Exploratory laparotomy was performed and we found a mass sized 5x5x5 cm on the right side of the uterus at the broad ligament with a rupture at the posterior part of the mass sized 0.5x0.5 cm. Upon incision of the uterus, we found a mass from the right side protruding to the isthmus of the uterus. Histopathology showed necrosis, blood and chorionic villi in myometrium corresponding to invasive mole. Patient was then given another 5 series of EMACO and her condition was unremarkable during the remaining course of treatment.
Conclusion: Invasive mole treatment is determined based on the risk factors. Uterine perforation still occurred in this case regardless of the decreasing hCG level during EMACO treatment. It emphasizes the importance of clinical examination as chemotherapy responsiveness. Long-term treatment can have a good prognosis but good collaboration between the gynecologist and the patient is essential.
Keywords: EMACO, invasive mole, perforatio
