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"Edition after edition, Williams Hematology has guided generations of clinicians, biomedical researchers, and trainees in many disciplines through the origins, pathophysiological mechanisms, and management of benign and malignant disorders of blood cells and coagulation proteins. It is acknowledged worldwide as the leading hematology resource, with editors who are internationally regarded for their research and clinical achievements and authors who are luminaries in their fields. The Ninth Edition of Williams Hematology is extensively revised to reflect the latest advancements in basic science, translational pathophysiology, and clinical practice. In addition to completely new chapters, it features a full-color presentation that includes 700 photographs, 300 of which are new to this edition, and 475 illustrations. Recognizing that blood and marrow cell morphology is at the heart of diagnostic hematology, informative color images of the relevant disease topics are conveniently integrated into each chapter, allowing easy access to illustrations of cell morphology important to diagnosis. Comprehensive in its depth and breath, this go-to textbook begins with the evaluation of the patient and progresses to the molecular and cellular underpinnings of normal and pathological hematology. Subsequent sections present disorders of the erythrocyte, granulocytes and monocytes, lymphocytes and plasma cells, malignant myeloid and lymphoid diseases, hemostasis and thrombosis, and transfusion medicine. "

"To provide the most current concepts of the genetic basis, pathophysiology, diagnosis and treatment of hematological diseases"

"Pendahuluan: Trombosis Vena Dalam pada pasien tumor ganas tungkai bawah sering kali terjadi tanpa terdeteksi. Banyak faktor seperti usia, jenis kelamin, indeks massa tubuh, jenis tumor, metastasis, fraktur patologis, differential count, kadar fibrinogen, kadar D-dimer, rasio PT, rasio APTT, Neutrophil-Lymphocyte Rasio (NLR), Platelet-Lymphocyte Rasio (PLR) dan Khorana risk score yang dapat mempengaruhi kejadian TVD.

 

Metode: Penelitian ini menggunakan desain potong lintang di RSUPN Cipto Mangunkusumo dengan total sampling. Pasien dengan tumor ganas tungkai bawah selama periode September 2020 hingga September 2021 dilihat usia, jenis kelamin, indeks massa tubuh, jenis tumor, metastasis, fraktur patologis, differential count, kadar fibrinogen, kadar D-dimer, rasio PT, rasio APTT, NLR, PLR dan Khorana risk score.

 

Hasil: Dari 45 subjek penelitian dengan tumor ganas tungkai bawah, 4 positif TVD. Dari pengujian bivariat dengan uji statistik yang sesuai, tidak didapatkan hubungan yang bermakna antara data dasar pasien seperti jenis kelamin (p= 0.608), IMT (p=0.651), tipe tumor (p=0.754), fraktur patologis (p=0.754), metastasis (p=0.679), operasi (p=1.000), lokasi tumor (0.840), venektasi (p=0.561), dan kemoterapi (p=0.617). Pada penelitian ini ditemukan hubungan signifikan antara rasio prothrombin time (PT) dengan kejadian TVD (P = 0.012). Variabel yang berkorelasi signifikan secara statistic antara lain tipe tumor (p=0.023) dan kondisi fraktur patologis (p=0.026). Terdapat hubungan yang bermakna antara variable venektasi dengan kadar D-dimer (p=0.002). Didapatkan korelasi signifikan antara kadar D-dimer dengan skor faktor risiko Khorana (p= 0.039). Didapatkan hubungan yang bermakna secara signifikan antara variabel fraktur patologis dengan kadar Rasio Platelet-Limfosit (p=0.023). Terdapat 4 variabel yang secara statistic berhubungan signifikan dengan Khorana risk score yaitu Hb (p=0.011), leukosit (p=0.005), hematokrit (p=0.047) dan D-dimer (p=0.035).

 

Kesimpulan: Angka kejadian TVD pada tumor ganas tungkai bawah cukup rendah yaitu 8.89%, di mana tidak terdapat hubungan yang bermakna secara statistic antara variabel karakterisitik maupun laboratorium darah dengan kejadian TVD

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Introduction: Deep Vein Trombosis in patients with malignant tumors of the lower limbs often goes undetected. Many factors such as age, sex, body mass index, tumor type, metastasis, pathological fracture, differential count, fibrinogen level, D-dimer level, PT rasio, APTT rasio, NLR, PLR and Khorana risk score may affect the incidence of DVT

Methods: This study used a prospective cohort design at Cipto Mangunkusumo General Hospital with total sampling. Patients with malignant tumors of the lower limbs during the period September 2020 to September 2021 were assessed for age, sex, body mass index, tumor type, metastases, pathological fractures, diff count, fibrinogen levels, D-dimer levels, PT rasio, APTT rasio, NLR, PLR and Khorana risk score

Results: Of the 45 study subjects with malignant tumors of the lower limbs, 4 were positive for TVD. From bivariate testing with appropriate statistical tests, there was no significant relationship between patient baseline data such as gender (p= 0.608), BMI (p=0.651), tumor type (p=0.754), pathological fracture (p=0.622), metastases (p=0.679), surgery (p=1,000), tumor location (0.840), venectation (p=0.561), chemotherapy (p=0.617), and Khorana risk score (p=0,552). This study found a significant relationship between the prothrombin time (PT) rasio and the incidence of DVT (P = 0.012). Variables with statistically significant correlation were tumor type (p=0.023) and pathological fracture condition (p=0.026). There was a significant relationship between the venectation variable and the level of D-dimer (p=0.002). There was a significant correlation between D-dimer levels and the Khorana risk factor score (p= 0.035). A significant relationship was found between the pathological fracture variables and the levels of the Platelet-Lymphocyte Rasio (p=0.023). There are 4 variables that are statistically significantly related to the Khorana risk score, namely Hb (p = 0.011), leukocytes (p = 0.005), hematocrit (p = 0.047) and D-dimer (p = 0.035).

Conclusion: The incidence of DVT in malignant tumors of the lower limbs is quite low, namely 8.89%, where there is no statistically significant relationship between characteristic and blood laboratory variables with the incidence of DVT.

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"Latar Belakang : Melanoma malignum (MM) merupakan tumor ganas yang berasaldari proliferasi sel melanosit dan dapat ditemukan pada kulit, mukosa dan okular. Angka mortalitas MM cukup tinggi, terutama pada stadium lanjut yang ditandai dengan metastasis. Metastasis MM dipengaruhi berbagai faktor risiko yang dapat berbeda pada MM kulit, mukosa dan okular, salah satunya yaitu proses imunologi tumor yang dapat dinilai dari Tumor Infiltrating Lymphocyte (TIL). Komponen TIL yang berperan dalam proses penghindaran sistem imun pada MM adalah sel T regulator dengan penanda yang paling spesifik sampai saat ini adalah Foxp3. Hubungan Foxp3 dengan stadium MM masih kontroversial dan sampai saat ini belum ada penelitian mengenai hubungan Foxp3 pada TIL dengan stadium MM di Indonesia. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan karakteristik klinikopatologik dan ekspresi Foxp3 pada TIL dengan stadium MM. Metode: Penelitian analitik pada sediaan MM di Departemen Patologi Anatomik FKUI/RSCM selama periode Januari 2010 hingga Desember 2021. Pengambilan sampel penelitian dilakukan secara total sampling dari kasus yang memenuhi kriteria inklusi sesuai perhitungan besar sampel untuk masing-masing kelompok. Pemeriksaan imunohistokimia menggunakan antibodi primer monoklonal Foxp3. Data imunoekspresi dianalisis untuk mengetahui hubungannya dengan stadium MM. Hasil: Didapatkan 54 kasus MM, 19 kasus diantaranya merupakan MM kulit, 29 kasus MM okular, dan 6 kasus MM mukosa. Mayoritas kasus (63%) merupakan stadium lanjut.Tebal tumor dan mitosis berhubungan dengan stadium klinis MM kulit dan keseluruhan.Jenis kelamin perempuan, tebal tumor >2 mm, mitosis >16/10 LPB, adanya invasi limfovaskular dan invasi perineural umumnya mempunyai ekspresi Foxp3 yang rendah.Pada MM kulit dan MM keseluruhan, ekspresi Foxp3 yang rendah ditemukan padastadium klinis lanjut meskipun tidak didapatkan hubungan yang signifikan.Kesimpulan: Tebal tumor dan mitosis berhubungan dengan stadium klinis MM kulit dan keseluruhan. Karakteristik klinikopatologik tidak berhubungan signifikan dengan ekspresi Foxp3

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Background: Malignant melanoma (MM) is a malignant tumor originating from

proliferation of melanocyte cells and can be found in skin, mucosa and ocular. The

mortality rate for malignant melanoma is quite high, especially at advanced stage

characterized by metastases. Various risk factors can predispose MM into metastases,

which can be different in cutaneous, mucosal and ocular MM, one of which is the

immunological process of the tumor which can be assessed from Tumor Infiltrating

Lymphocyte (TIL). TIL components that play a role in the process of avoiding the immune

system in malignant melanoma are regulatory T cells, whose the most specific marker so

far is Foxp3. The association of Foxp3 with clinical stage of malignant melanoma is still

controversial and until now there has been no research on the association of Foxp3 in

TIL with clinical stage of MM in Indonesia.

Aims: This study aims to determine the association between clinicopathological

characteristics and Foxp3 expression in TIL with MM clinical stage.

Methods: Analytic study on malignant melanoma diagnosed at Anatomical Pathology

Department FKUI/RSCM during January 2010 until December 2021. Sampling was

carried out by total sampling from cases that met the inclusion criteria according to the

calculation of the sample size for each group. Immunohistochemical examination using

Foxp3 monoclonal primary antibody. Immunoexpression data were analyzed to

determine its relationship with clinical stage of malignant melanoma.

Result: There were 54 cases of MM: 19 cases were skin MM, 29 cases of ocular MM, and

6 cases of mucosal MM. Majority of cases (63%) were in advanced stages. Tumor

thickness and mitosis associated with clinical stage of cutaneous and overall MM. Female

gender, tumor thickness >2 mm, mitoses >16/10 HPF, presence of lymphovascular

invasion and perineural invasion generally had low Foxp3 expression. In cutaneous MM

and overall MM, low Foxp3 expression was found at advanced clinical stage although

no significant association was found.

Conclusion: Tumor thickness and mitosis associated with clinical stage of cutaneous and

overall MM. Clinicopathological characteristic was not statistically significant with

Foxp3 expression. Low Foxp3 expression was associated with advanced clinical stage

although no statistically significant association was found."