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"In this volume Dr Hui has brought together a comprehensive overview of gestational trophoblastic disease that includes all the currently recognized entities: complete and partial hydatidiform moles, placental site trophoblastic tumor, epithelioid trophoblastic tumor, gestational choriocarcinoma, persistent gestational trophoblastic neoplasia, placental site nodule and exaggerated placental site reaction. Each entity is reviewed in detail, with emphasis on genetic background, clinical presentation, pathologic findings and ancillary studies, differential diagnosis and clinicopathological correlations.Descriptions of the pathology are supported by numerous excellent photomicrographs. Recent advances in our understanding of the genetics of gestational trophoblastic diseases are stressed. Introductory chapters cover the developmental biology of the placenta and the genetic basis of gestational trophoblastic disease, and one chapter is devoted to the molecular diagnosis of gestational trophoblastic disease. This chapter includes a review of the use of short tandem repeat (STR) genotyping which is of particular value in the diagnosis of hydatidiform moles. The final chapter covers clinical aspects of gestational trophoblastic disease, including treatment. The text throughout is current and thoroughly referenced. "

"Penelitian longitudinal prospektif analitik untuk menilai ketepatan prediksi timbulnya penyakit trofoblas ganas melalui sistem penilaian prognosis mola hidatidosa yang dikembangkan oleh NETDC (New England Trophoblast Disease Center) telah dilakukan. Di antara parameter faktor risiko yang dinilai; usia penderita, jenis mola hidatidosa, pembesaran uterus, kadar hCG serum, kista lutein, serta ada-tidaknya komplikasi merupakan factor risiko yang bermakna untuk timbulnya keganasan setelah mola hidatidosa dievakuasi (p=0,032). Penelitian dilakukan pada 50 penderita mola hidatidosa dengan pengamatan lanjutan selama 1 tahun (Januari 2001-Desember 2002) di Bagian Obstetri dan Ginekologi RS Mohammad Hoesin, Palembang. Hasilnya menunjukan prediksi keganasan skor NETDC 50% pada risiko tinggi dan 10% risiko rendah untuk berkembang menjadi ganas (p<0,05). Hasil ini lebih besar dibandingkan dengan nilai yang diajukan WHO yaitu 19-30%. Risiko untuk terjadinya keganasan pasca mola hidatidosa pada kelompok risiko tinggi ialah 9,0 kali lebih tinggi disbanding pada kelompok risiko rendah (CI: 1,769-45,786). (Med J Indones 2004; 13: 40-6)

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A prospective longitudinal analytic study assessing the efficacy of NETDC (New England Trophoblastic Disease Center) prognostic index score in predicting malignancy after hydatidiform mole had been performed. Of the parameter evaluated; age of patients, type of hydatidiform mole, uterine enlargement, serum hCG level, lutein cyst, and presence of complicating factors were significant risk factors for malignancy after hydatidiform mole were evacuated (p<0.032). The study were done on 50 women diagnosed with hydatidiform mole with 1 year observation (January 2001-December 2002) at the Department of Obstetrics and Gynecology, Mohammad Hoesin Hospital, Palembang. The results showed that the NETDC prognostic index score predicted malignancy in 50% of high risk group and 10% in low risk group (p<0.05). This showed a higher number than that found by the WHO (19%-30%). The risk for incidence of malignancy after hydatidiform mole in the high risk group is 9.0 times higher compared to that of the low risk group (CI: 1.769-45.786). (Med J Indones 2004; 13: 40-6)"

"Molecular pathology offers tools and techniques that can greatly enhance the drug discovery and development process, helping to make the promises of personalized medicine a reality. Molecular Pathology in Drug Discovery and Development provides an unmatched guide to this cutting-edge discipline and its applications to pharmaceutical science.With contributions from leading lights in drug discovery, drug development, and molecular pathology balanced by a consistent editorial approach, this reference offers both an overview of molecular pathology and a close look at the methods as they are applied to the process of drug discovery and development. Presented as steps in the drug development process, the coverage includes the use of molecular pathology to :

• Identify and validate new drug candidates
• Enhance transcriptional profiling to better find and validate biomarkers
• Assess toxicology
• Employ toxicogenomics to identify genes relevant to the safety of compounds
• Identify correct doses for different drugs
• Identify patients for treatment
• Develop molecular therapies
• Further the new techniques of Immunohistochemistry and Immunofluorescence

With many tests and treatments already working today, drug research and development using molecular pathology has shown itself an extremely fruitful area. Molecular pathology in drug Discovery and development gives practitioners an up-to-date resource on this highly active discipline and its role in furthering pharmaceutical research."

"ABSTRAKLatar Belakang: Sekitar 9-33% pasien penyakit trofoblas maligna (PTM) yang diobati dengan kemoterapi agen tunggal akan membutuhkan terapi multi agen karena adanya resistensi terhadap obat lini pertama, termasuk metotreksat (MTX), atau efek samping toksisitas. Hingga saat ini, resistensi terapi lini pertama masih menjadi masalah akibat tingkat identifikasi yang masih rendah. Sebelumnya, belum pernah dilakukan penelitian mengenai kadar Beta-HCG sebagai prediktor resistensi pada pasien PTM risiko rendah.Tujuan: Mengetahui nilai prediktif kadar Beta-HCG untuk risiko resistensi metotreksat pada PTM risiko rendah.Metode: Penelitian ini adalah studi analitik potong lintang menggunakan data rekam medis dari 58 subjek. Subjek adalah semua pasien yang terdiagnosis dengan PTM risiko rendah dan diberikan terapi MTX pada bulan Januari 2011 hingga Desember 2016 di RSUPN Dr. Cipto Mangunkusumo. Pengambilan subjek dilakukan secara konsekutif. Subjek dengan data yang tidak lengkap atau adanya riwayat PTM sebelumnya dieksklusi dari penelitian ini.Hasil: Prevalensi resistensi MTX yaitu 32,8%. Tidak ditemukan asosiasi bermakna antara karakteristik demografik (usia, paritas, pekerjaan, dan pendidikan) ataupun karakteristik klinis (riwayat kehamilan, interval antara kehamilan terakhir dan awal kemoterapi, ukuran tumor, riwayat gagal kemoterapi, lokasi dan jumlah metastasis) dengan resistensi MTX. Ditemukan perbedaan bermakna pada kadar Beta-HCG antara kelompok resistensi dan tidak resistensi pada siklus 4 (p<0,001), 6 (p<0,001), dan 8 (p<0,001). Perbedaan bermakna juga ditemukan pada perubahan kadar Beta-HCG dari awal hingga minggu kedua (p<0,001, AUC 0,8). Cut-off penurunan Beta-HCG sebesar 23% memiliki sensitivitas sebesar 78,9% dan spesifisitas sebesar 74,4% untuk memprediksi resistensi MTX.

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ABSTRACT

Background: Approximately 9-33% patients with gestational trophoblastic neoplasia (GTN) treated with single agent chemotherapy would need multi agent chemotherapy, whtether due to resistance to first-line therapy, including methotrexate (MTX), or toxic side effect. Currently, resistance to first-line therapy is still a problem due to low identification rate. To this date, there are no studies regarding Beta-HCG level as a MTX resistance predictor for low risk GTN.

Purpose: Identify the predictive value of Beta-HCG level for the risk of MTX resistance in low risk GTN.

Methods: This was an analytical cross-sectional study using medical records of 58 subjects. Subjects were all patients diagnosed with low risk GTN and given MTX therapy during the period of January 2011 to December 2016 at Cipto Mangunkusumo Hospital. Consecutive sampling was done. Subjects with incomplete data or history of previous GTN were excluded from this study.

Results: The prevalence of MTX resistance was 32,8%. No significant association was found between demographic characteristics (age, parity, job, and education) or clinical characteristics (gestational history, interval between last pregnancy and the start of chemotherapy, tumor size, history of chemotherapy failure, location and number of metastasis) and MTX resistance. A significant difference in the level of Beta-HCG between resistance and non-resistance groups were found on cycle 4 (p<0,001), 6 (p<0,001), and 8 (p<0,001). A significant difference was also found in the change of Beta-HCG from the start to the second week of therapy (p<0,001, AUC 0,8). Beta-HCG decrease cut-off of 23% had the sensitivity of 78,9% and specificity of 74,4% to predict MTX resistance.

Conclusions: The prevalence of MTX resistance was 32,8% in this study. The decrease in Beta-hCG level from the start to the second week of therapy could be used as a MTX resistance predictor in low risk GTN patients."

"Perawat sebagai bagian dari tenaga kesehatan memiliki peran untuk memberikan asuhan keperawatan yang komprehensif untuk memantau dan memonitor kondisi ibu. Salah satu peran perawat maternitas adalah memberikan asuhan keperawatan pada pasien dengan penyakit trofoblas dengan menerapkan teori keperawatan. Dari lima kasus kelolaan, dua kasus berumur 40 tahun. Semua kasus mengalami peradarahan. Dua kasus mengalami penyakit trofoblas ganas low risk. Dua kasus dikuretase, satu kasus histerektomi dan dua kasus kemoterapi. Semua kasus mengalami anemia baik anemia ringan sampai berat. Pasien mengalami masalah kekurangan volume cairan, kecemasan, defisit perawatan diri dan kesiapan peningkatan pengetahuan. Teori ini sesuai diterapkan pada pasien dengan penyakit trofoblas untuk memperoleh rasa nyaman selama proses tindakan dan dapat melewati proses kuretase dan kemoterapi dengan risiko minimal. Penanganan sedini mungkin akan meningkatkan peluang hidup ibu cukup besar dan peluang memiliki anak kembali cukup besar.

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Nurse as a part from health worker has role for giving comprhensive nursing care to see and observe the mother condition. One of the maternity nurse role is to give a nursing care to the patient with mola hidatidosa and applied the nursing concept. Five case management, the age of two cases are under 20 years old, one case is 27 years old, and two cases over the 40 years old. All of the cases have the bleeding. Two cases is low risk trofoblast gestational disease. Curettage is done for the two cases, hysterectomy is done for one case, and chemotherapy is done for the two cases. All of the cases get anemia, start from high until low anemia. Patients experience problems of fluid volume deficit, anxiety, self care deficit, and readness to increase knowledge. Both theory are able to be applied for the patient with Mola Hidatidosa to get the comfort feeling along the surgical prosess and can pass the curettage and chemotherapy process with the minimal risk. By early managing will increase the probability of the life and have the next child again."

"Molecular pathology of lung cancer bridges the gap between the molecular specialist and the clinical practitioner, including the surgical pathologist who now has a key role in decisions regarding molecular targeted therapy for lung cancer. Molecular pathology of lung cancer provides the latest information and current insights into the molecular basis for lung cancer, including precursor and preinvasive lesions, molecular diagnosis, molecular targeted therapy, molecular prognosis, molecular radiology and related fields for lung cancer generally and for the specific cell types. As many fundamental concepts about lung cancer have undergone revision in only the past few years, this book will likely be the first to comprehensively cover the new molecular pathology of lung cancer. It provides a foundation in this field for pathologists, medical oncologists, radiation oncologists, thoracic surgeons, thoracic radiologists and their trainees, physician assistants, and nursing staff."