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"Latar Belakang: Pasien dengan keganasan gaster berisiko tinggi mengalami malnutrisi. Terapi kuratif utama pada pasien keganasan gaster adalah tindakan operasi, sehingga diperlukan dukungan terapi medik gizi perioperatif yang dapat menunjang perbaikan status gizi, kapasitas fungsional, dan kualitas hidup.Metode: Pasien pada serial kasus adalah dua laki-laki dan dua perempuan, berusia 34-64 tahun, dengan diagnosis tiga pasien dengan karsinoma gaster, dan satu pasien gastrointestinal stromal tumor gaster stadium lanjut. Terapi medik gizi praoperasi diberikan dalam bentuk oral dan parenteral. Pada enam jam sebelum tindakan operasi, dua pasien mendapatkan nutrisi parenteral, dan dua pasien mendapatkan nutrisi oral. Pasien pascaoperasi juga mendapatkan nutrisi enteral dini dalam 48 jam pertama.Hasil: Pasien pasca gastrektomi selama mendapatkan nutrisi perioperatif, tiga pasien mengalami proses penyembuhan luka yang baik, sedangkan satu pasien mengalami komplikasi pascaoperasi berupa fistula enterokutan yang kemudian mengalami pemulihan, dan satu pasien mengalami hiperglikemia dipengaruhi oleh tindakan pankreatektomi distal. Lama masa rawat inap pasien antara 21-31 hari. Semua pasien pascaoperasi mengalami peningkatan kapasitas fungsional.

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Background: Patients with gastric malignancy have high risk of malnutrition. The main curative therapy in patients with gastric malignancies is surgery, so it requires the support of perioperative nutritional therapy which could support the improvement of nutritional status, functional capacity, and quality of life.

Methods: Patients in this case series were two men and two women, aged 34-64 years, and the diagnosis of three patients are advanced gastric carcinoma, and one patient with advanced gastric gastrointestinal stromal tumor. Preoperative nutritional therapy was given in oral and parenteral route. At six hours before surgery, two patients received parenteral nutrition, and two patients received oral nutrition. All patients also got early enteral nutrition in the first 48 hours after surgery.

Results: Patients after gastrectomy during obtaining perioperative nutrition, three patients experienced a good wound healing process, while one patient experienced postoperative complications in the form of enterocutaneous fistula which later recovered, and one patient experienced hyperglycemia that affected by distal pancreatectomy. The length of stay for patients was between 21-31 days, after surgery all patients had increased functional capacity.

Conclusion: Perioperative nutritional therapy in gastric malignancies patients undergoing gastrectomy could help improve the nutritional status and functional capacity."

"Latar belakang: MRCP merupakan teknik pencitraan tidak invasif untuk mengevaluasi anatomi dan mendeteksi kelainan sistem bilier. Cairan di saluran bilier akan memperlihatkan sinyal yang tinggi pada MRCP. Salah satu keterbatasan pemeriksaan MRCP ialah cairan di saluran gastrointestinal juga memberikan sinyal tinggi yang dapat mengganggu evaluasi saluran bilier. Sari buah nanas dapat menjadi kontras oral negatif untuk menurunkan sinyal di gastrointestinal. Belum terdapat penelitian penggunaan sari buah nanas pada pemeriksaan MRCP di Indonesia dan belum terdapat penelitian yang menilai visualisasi cabang-cabang duktus intrahepatikus setelah pemberian sari buah nanas. Tujuan: Mengukur perbedaan SNR gaster dan duodenum serta perubahan tingkat visualisasi cabang-cabang duktus bilier intrahepatikus sesudah pemberian sari buah nanas pada pemeriksaan MRCP. Metode: Dilakukan pemeriksaan MRCP sebelum dan sesudah pemberian sari buah nanas pada subjek penelitian. Mengukur perbedaan rerata SNR gaster dan duodenum serta mengukur perubahan tingkat visualisasi cabang-cabang duktus bilier intrahepatikus sebelum dan sesudah pemberian sari buah nanas. Perbedaan rerata SNR gaster dan duodenum dianalisis menggunakan uji Wilcoxon dan perubahan tingkat visualisasi dianalisis dengan uji McNemar untuk menilai diskordans. Hasil: Didapatkan 25 subjek penelitian yang menjalani pemeriksaan MRCP sebelum dan sesudah pemberian sari buah nanas. Terdapat penurunan bermakna SNR gaster dan duodenum setelah pemberian sari buah nanas, 127,1 (18,7-1194,6) menjadi 42.2 (4,2-377,1) untuk gaster dan 64,1 (3,8-613.4) menjadi 44,6 (6,5-310,3) untuk duodenum (p < 0,05). Terdapat perubahan bermakna tingkat visualisasi duktus bilier intrahepatikus (p < 0,05, diskordans >50%) dengan peningkatan tingkat visualisasi duktus intrahepatikus kanan segmen anterior pada 66% pengamatan, duktus intrahepatikus kanan segmen posterior pada 58% pengamatan, dan 70% pengamatan untuk duktus intrahepatikus kiri. Simpulan: Pemberian sari buah nanas dapat menurunkan sinyal gaster dan duodenum pada pemeriksaan MRCP dan mempengaruhi tingkat visualisasi cabang-cabang duktus bilier intrahepatikus.

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Background: MRCP is a non-invasive imaging technique for evaluating anatomy and detecting abnormalities of the biliary system. Fluid in biliary tract will show high signal on MRCP. One of the limitations of MRCP is high signal in gastrointestinal fluid which can interfere biliary tract evaluation. Pineapple juice as negative oral contrast can reduce signal in gastrointestinal tract. There have been no studies on the use of pineapple juice for MRCP in Indonesia, and no studies assessed the visualization of intrahepatic ductal branches after administration of pineapple juice. Objective: Measuring difference in gastric and duodenal SNR and changes of visualization of intrahepatic biliary ductal branches after administration of pineapple juice on MRCP. Methods: MRCP before and after administration of pineapple juice were performed on subjects. Gastric and duodenal SNR mean difference were measured, and analysis were done with Wilcoxon test. Level of visualization of intrahepatic biliary ductal branches were also measured and analysed with McNemar test for discordances. Results: There were 25 subjects underwent MRCP. Gastric and duodenal SNR were statistically decreased after administration of pineapple juice, 127.1 (18.7-1194.6) vs 42.2 (4.2-377.1) and 64.1 (3.8-613.4) vs 44.6 (6.5-310.3) respectively (p <0.05). Statistically significant difference was observed in visualization of intrahepatic ductal branches (p<0,05), discordance >50%) with increase in visualization of right duct anterior segment in 66% observation, right duct posterior segment in 58% observation, and 70% observation in left intrahepatic bile duct. Conclusion: Use of pineapple juice as negative oral contrast significantly reduce gastric and duodenal signal in MRCP also affect visualization of the intrahepatic biliary duct branches."

"Purpose

The association between the preoperative absolute neutrophil count (NC), lymphocyte count (LC), and monocyte count (MC) in the peripheral blood and the prognosis of gastric cancer (GC) patients has not been investigated widely.

Methods

We enrolled 445 patients who underwent surgery for GC between January, 2005 and April, 2013 to analyze the correlations among NC, LC, and MC and their prognoses.

Results

Based on cut-off values calculated by ROC analysis, patients were sub grouped as having: NC ≥ 4477 (NCHigh), NC < 4477 (NCLow); and as LC ≥ 1447 (LCHigh), LC < 1447 (LCLow); and as MC ≥ 658,5 (MCHigh), MC < 658,5 (MCLow). Each group was assigned as follows; NCHigh group = 1, NCLow group = 0, LCHigh group = 0, LCLow group = 1, MCHigh group = 1, MCLow group = 0, and the sum of each score was defined as the lymphocyte-monocyte-neutrophil score (LMN score). The overall 5-year survival rates were 89%, 74%, 57,8%, and 53,3% for LMN scores of 0, 1, 2, and 3, respectively (P = 0,0004). Multivariate analysis indicated that the LMN score was an independent prognostic indicator.

Conclusions

The combination of preoperative NC, LC, and MC appears to be a useful indicator of GC prognosis."

"Penyakit lambung merupakan penyakit yang paling umum diderita di kalangan masyarakat Indonesia, terutama pada kalangan dewasa. GERD (Gastroephageal reflux disease) merupakan suatu kondisi isi lambung yang naik kembali ke esofagus atau kejadian refluks. Clinical pathway atau alur klinis merupakan suatu rencana terapi dan perawatan multidisiplin berdasarkan praktik klinis. Alur klinis ini dirancang sebagai bentuk usaha terbaik untuk sekelompok pasien dengan diagnosis tertentu, untuk meminimalkan keterlambatan perawatan, memaksimalkan kualitas perawatan serta hasil klinis pada pasien. Panduan praktik klinis di setiap rumah sakit perlu tersedia, khususnya penyakit lambung sebagai penyakit yang paling sering diderita masyarakat Indonesia. Pengerjaan dilakukan dengan studi literatur dan melakukan penelusuran pustaka terkait pengobatan penyakit lambung, terutama golongan obat PPI (proton pump inhibitor), yakni omeprazol, lansoprazol, esomeprazol, pantoprazol, dan rabeprazol. Secara farmakologis, lambung memproduksi asam lambung pada permukaan sel parietal dengan tiga neurotransmiter yang akan terikat ke reseptornya masing-masing. Ketiga neurotransmiter tersebut adalah gastrin dengan reseptor CCK2, asetilkolin dengan reseptor M3 (muskarinik 3), dan histamin dengan reseptor H2. Reseptor CCK2 dan M3 yang teraktivasi akan melepaskan ion K+ melalui jalur Ca2+ dependen. Sedangkan reseptor H2 akan melepaskan ion H+ melalui jalur sikloadenosinfosfat (cAMP) dependen. Kedua ion ini akan tertarik dan mengaktivasi enzim H+/K+-ATPase untuk menukar ion K+ dari lumen dengan H+ ke lumen dari sel parietal. Golongan PPI ini akan menghambat sistem enzim H+/K+-ATPase sehingga ion H+ tidak terproduksi. Oleh karena itu, golongan PPI dapat menghambat sekresi asam lambung.

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Gastric disease is the most common disease among Indonesian people, especially among adults. GERD (Gastroephageal reflux disease) is a condition where gastric contents rise back into the esophagus or reflux occurs. Clinical pathway or clinical flow is a multidisciplinary therapy and care plan based on clinical practice. This clinical pathway is designed as a best practice for a group of patients with a certain diagnosis, to minimize treatment delays, maximize quality of care and clinical outcomes for patients. Clinical practice guidelines in every hospital need to be available, especially gastric disease as the most common disease in Indonesian society. The work was carried out by studying the literature and conducting literature searches related to the treatment of gastric disease, especially the PPI (proton pump inhibitor) class of drugs, namely omeprazole, lansoprazole, esomeprazole, pantoprazole, and rabeprazole. Pharmacologically, the stomach produces gastric acid on the surface of parietal cells with three neurotransmitters that will bind to their respective receptors. The three neurotransmitters are gastrin with CCK2 receptors, acetylcholine with M3 receptors (muscarinic 3), and histamine with H2 receptors. Activated CCK2 and M3 receptors release K+ ions via a Ca2+ dependent pathway. Meanwhile, H2 receptors will release H+ ions via the cycloadenosinfophosphate (cAMP) dependent pathway. These two ions will be attracted and activate the H+/K+-ATPase enzyme to exchange K+ ions from the lumen with H+ into the lumen of the parietal cells. This PPI group will inhibit the H+/K+-ATPase enzyme system so that H+ ions are not produced. Therefore, PPI groups can inhibit gastric acid secretion."