9 research outputs found
Hubungan Aiag Score dengan Besar Varises Esofagus Secara Endoskopi pada Penderita Sirosis Hati
No full textBackground: The majority of patients with liver cirrhosis will develop esophageal varices in the course of their illness. Endoscopic screening of esophageal varices is recommended to prevent variceal bleeding. This endoscopic screening is generally require relatively high cost. Some of non-invasive examination to predict liver fibrosis has been investigated by several researchers. The AIAG Score is a simple marker which could predict the presence of liver fibrosis with a good degree of accuracy and have been demonstrated in several studies. Liver fibrosis will lead to portal hypertension which eventually lead to the occurence of esophageal varices. Based on this concept, a non-invasive examination of liver fibrosis can be used as predictor of esophageal varices. Objective: To assess the association of a non-invasive marker AIAG Score with the size of esophageal varices endoscopically in liver cirrhosis patients. Methods: A cross sectional study had been conducted among 80 liver cirrhosis patients (60 males and 20 females) that were admitted to H. Adam Malik hospital from June 2014 to June 2015. Diagnosis of liver chirrosis was made based on clinical, biochemical and ultrasound, and esophageal varices by endoscopy. AIAG Score was calculated for all patients, with statistical analysis using Mann Whitney test. Results: Among 80 patients with esophageal varices, 50% caused by HBV infection. The majority of patients were Child Pugh C, while only 16% being Child Pugh A. Majority of the population had F1 esophageal varices (50%), followed by F2 (36.3%), and F3 (13.8%). AIAG Score in patients with a large varices was significantly higher than that in patients with small varices (0.99±0.005 vs 0.9±0.16; p0.944025 was highly predictive in diagnosed large esophageal varices with a sensitivity of 82.5%, specificity of 72.5%, positive predictive value of 75%, negative predictive value 80.6%. Conclusion: AIAG Score was significantly associated with the size of esophageal varices. AIAG Score is a good non-invasive marker of large esophageal varices in liver cirrhosis patients.Latar Belakang : Sebagian besar penderita sirosis hati akan mengalami varises esofagus dalam perjalanan penyakitnya. Skrining endoskopi varises esofagus pada penderita sirosis hati dianjurkan untuk mencegah terjadinya perdarahan varises. Skrining endoskopi ini umumnya membutuhkan biaya yang relatif mahal. Beberapa pemeriksaan non-invasive yang memprediksi adanya fibrosis hati pada penderita sirosis hati telah dikemukakan oleh beberapa peneliti. AIAG Score merupakan suatu marker sederhana yang dapat memprediksi fibrosis hati dengan tingkat akurasi yang baik dan telah dibuktikan pada beberapa penelitian. Fibrosis hati akan menyebabkan timbulnya hipertensi portal yang akhirnya akan menyebabkan terjadinya varises esofagus. Berdasarkan konsep ini maka pemeriksaan non-invasive untuk fibrosis hati dapat digunakan sebagai prediktor varises esofagus. Tujuan penelitian: Untuk menentukan hubungan AIAG Score sebagai noninvasive marker dengan besar varises esofagus secara endoskopi pada penderita sirosis hati. Metode penelitian: Dilakukan penelitian cross-sectional pada 80 penderita sirosis hati (60 pria dan 20 wanita) yang berobat ke RS Adam Malik dari bulan Juni 2014 sampai Juni 2015. Diagnosis sirosis hati berdasarkan klinis, biokimia dan USG, dan varises esofagus dengan endoskopi. AIAG Score dikalkulasikan pada seluruh penderita, dengan analisis statistik menggunakan uji Mann Whitney. Hasil: Di antara 80 penderita sirosis hati dengan varises esofagus, 50% disebabkan oleh infeksi virus Hepatitis B (HBV). Sebagian besar populasi penelitian memiliki klasifikasi Child-Pugh C dan hanya 16% memiliki Child Pugh A. Mayoritas populasi penelitian memiliki varises esofagus F1 (50%), F2 (36,3%), dan F3 (16%). Didapatkan hubungan bermakna AIAG Score dengan besar varises esofagus. AIAG Score pada varises besar secara signifikan lebih tinggi dibandingkan pada varises kecil (0.99±0.005 vs 0.9±0.16; p=0.000). Nilai cut-off AIAG Score >0,944025 dalam memprediksi adanya varises esofagus ukuran besar memiliki sensitivitas 82,5%, spesifisitas 72,5%, nilai prediksi positif 75%, nilai prediksi negatif 80,6%. Kesimpulan: AIAG Score berhubungan secara signifikan dengan besar varises esofagus. AIAG Score merupakan non-invasive marker yang baik untuk varises esofagus besar pada penderita sirosis hati.119 HalamanTesis Magiste
Cancer Stem Cells and Molecular Biology Test in Colorectal Cancer: Therapeutic Implications
No full textColorectal cancer (CRC) is the third most frequent cancer in males, the second in females, and is the second leading cause of cancer related death worldwide. Within Indonesia’s 250 million population, the incidence rates for CRC per 100,000 population were 15.2 for males and 10.2 for females, and estimated 63,500 cases per year. More than 50% of colorectal cancer patients will develop metastasis. CRC is still the main cause of tumor-related death, and although most CRC patients are treated with surgery to remove the tumor tissue, some of the CRC patients recurred. Chemotherapy used as adjuvant or neoadjuvant therapy also has several problems, in which these treatments are useless in tumor cells with chemo-resistance. Molecular testing of CRC from tumor tissues has important implications for the selection of treatment. Biomarkers can be used as prognostic value, molecular predictive factors, and targeted therapy. Recent research reported that, cancer stem cells (CSCs) are considered as the origin of tumorigenesis, development, metastasis and recurrence. At present, it has been shown that CSCs existed in many tumors including CRC. This review aims to summarize the issue on CSCs, and the future development of drugs that target colorectal cancer stem cells
Cancer Stem Cells and Signaling Pathways in Colorectal Cancer
No full textColorectal cancer (CRC) is the third most common cancer in males, the second in females and is the second leading cause of cancer related death worldwide. Despite recent advances in chemotherapy, and targeted therapy for CRC, the prognosis for patients with advanced cancer has remained poor, due to drug resistance, metastasis and recurrence. A small fraction of cells possess tumor propagation abilities. These are termed “cancer stem cells (CSCs). A subset of colorectal cancer stem cells, may hold a key to controlling cancer. The cancer stem cell (CSC) model suggests that tumors are hierarchically organized, only CSCs possess cancer-promoting potential. The killing of CSCs is thought to be a critical component of effective antitumor therapies. A number of signaling pathways, most notably the Wingless related (Wnt), transforming growth factor-beta (TGF-β), Notch and Hedgehog signaling and other mechanisms have been found to be associated with CSCs in CRC. They play important roles in maintaining the growth and functional integrity of CSC. Many new molecules are now being studied to block theses pathways. Some of the molecules block the self-renewal and induction of apoptosis in CSCs. The design of CSC-targeted interventions is a rational target, and reduce local recurrence and metastasis. This review aims to summarize the issue on CSCs and signaling pathway relevant for CRC, which may lead to more effective therapeutic strategies for CRC
Colonoscopy, Biomarkers, and Targeted Therapy in Colorectal Cancer
No full textThis review highlights the most versatile diagnostic test of colonoscopy for CRC. It remains the gold standard diagnostic tools for CRC, and to prevent CRC by screening and removing the polyp or premalignant lesions. This work also provides the most promising biomarkers, which highlights the application of the novel biomarkers in conjunction with clinical and pathologic features have allowed for more individualized approaches and targeted therapy to patients with CRC.CRC is the third most common cancer diagnosed, and the second leading cause of cancer-related deaths worldwide. With a population totaling 273,523,621 people, Indonesia has an estimated of 396,914 new cases of all cancers and 234,511 cancer-related deaths. Among those cancer cases, an estimated of 34,189 new CRC cases and 17,786 CRC deaths occurred in 2020. Most of CRC cases were located in the rectum compared to those in the distal colon or proximal colon. Clinical signs, symptoms and therapeutic approaches vary, depending on the stage and the location of CRC. Those cancer locations are different in terms of their associated molecular alterations.Biomarker tests of tumor tissue from colonoscopy biopsy can help doctors to select a specific CRC treatment, and the tests can be used to determine prognostic value, predictive factors and the targeted therapy. Targeted therapies are recommended for advanced or mCRC patients with KRAS/NRAS/BRAF mutated or wild-type tumors, HER2-amplified tumors, and NTRK gene fusion-positive, while immunotherapy is only offered for tumor with MSI-High (dMMR) status. The biomarkers and targeting approaches against colorectal CSCs are being developed and will be quite challenging
Molecular Diagnostics in Colorectal Cancer
No full textColorectal cancer (CRC) presents in one of three patterns: sporadic colorectal cancer in those without a family history (65-85%); those with a family history (familial CRC) 10-25% of cases; inherited CRC accounting for less of 10% cases and presents as well-characterized cancer predisposition syndromes including Lynch syndrome (hereditary non-polyposis colorectal cancer/HNPCC) which comprises about 1-5% of all colorectal cancer, and multiple polyps CRC, which includes familial adenomatous polyposis (FAP,1%), rare CRC syndrome < 0.1 %). Many efforts have been made to discover the genetic and molecular features of CRC, and there is more evidence that these features determine the prognosis and response to treatment. Colorectal cancer (CRC) is a heterogeneous disease, with three known major molecular groups. The most common is the chromosomal instability group, characterized by an accumulation of mutations in specific oncogens and tumor suppressor genes. The second is the microsatellite instability group, caused by the dysfunction of deoxyribonucleic acid (DNA) mismatch repair genes leading to genetic hypermutability. The CpG island methylation phenotype (CIMP) is the third group, distinguished by hypermethylation. In this review we would like to provide an up-to-date overview of molecular genetic aspects of CRC that are currently important and should guide clinical practice in colorectal cancer in the diagnosis and selection of therapy
Molecular Diagnostics in Colorectal Cancer
No full textColorectal cancer (CRC) presents in one of three patterns: sporadic colorectal cancer in those without a family history (65-85%); those with a family history (familial CRC) 10-25% of cases; inherited CRC accounting for less of 10% cases and presents as well-characterized cancer predisposition syndromes including Lynch syndrome (hereditary non-polyposis colorectal cancer/HNPCC) which comprises about 1-5% of all colorectal cancer, and multiple polyps CRC, which includes familial adenomatous polyposis (FAP,1%), rare CRC syndrome 0.1 %). Many efforts have been made to discover the genetic and molecular features of CRC, and there is more evidence that these features determine the prognosis and response to treatment. Colorectal cancer (CRC) is a heterogeneous disease, with three known major molecular groups. The most common is the chromosomal instability group, characterized by an accumulation of mutations in specific oncogens and tumor suppressor genes. The second is the microsatellite instability group, caused by the dysfunction of deoxyribonucleic acid (DNA) mismatch repair genes leading to genetic hypermutability. The CpG island methylation phenotype (CIMP) is the third group, distinguished by hypermethylation. In this review we would like to provide an up-to-date overview of molecular genetic aspects of CRC that are currently important and should guide clinical practice in colorectal cancer in the diagnosis and selection of therapy.</jats:p
Palliative Surgery for Biliary Drainage in an Unresectable Pancreatic Cancer
No full textPancreatic cancer, known for its rapid progression and poor prognosis, usually presents with obstructive jaundice. Biliary drainage can be achieved by various techniques and approaches, with endoscopic drainage as the preferred method. However, open drainage of the biliary tree is indicated when unresectable tumor is found during resection surgery. This is a case of biliary drainage with a double bypass biliodigestive construction, which could be performed in patients with unresectable cancer in the head of the pancreas presenting with obstructive jaundice and gastric outlet obstruction
