Eka Kusmawan, A Bowolaksono, Raka Widiana

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Objectives: To explore clinical characteristics, treatment modalities and outcomes after the follow-up of penile cancer patients.

 Method: We reviewed penile cancer patients during 8 years, started from April 1993 to March 2001. The data collected through medical record consisted of patient identities, history takings, physical and pathological findings, treatment modalities and their follow-up after 3±4 years

 Results:  During eight years of study there were 46 patients aged 58+3 years. Out of 46 patients, 33 patients (72%) have history of urogenital infection and 40 patients (87%) with phymosis. With regard to physical examination, 24 patients (52%) presented as stage III (Jackson classification). Pathological findings showed that 100% patients were keratinizing squamous cell carcinoma. Partial penectomy alone was carried out in 21 patients (46%), total penectomy alone was done in 17 patients (37%), and total penectomy with lymph node dissection was done in 8 patients (17%). During the follow-up, majority of the patients (42) showed no complications or recurrence; only 2 patients showed recurrent tumor and the rest 2 were lost to follow-up.

 Conclusions: During eight years at Sanglah General Hospital there were 46 penile cancer patients, mean of age was 58±3 years. Predispositioning factors were urogenital infection and phymosis. All of them were keratinizing squamous cell carcinoma. Total or partial penectomy with or without lymph node dissection was carried out with good results.

Kristianto Yuli Yarso, I Wayan Sudarsa, I Bagus Tjakra Wibawa-Manuaba

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Objectives: Triple Negative, Luminal, HER-2 subtypes of breast cancer are markers to predict behavior, aggressiveness, and response to chemotherapy. The aim of this study is to understand character and response to standard neoadjuvant chemotherapy in different subtypes of breast cancer.

 Method: This is a descriptive study of breast cancer subtypes. From 687 patients (2003-2010) 351 patients have IHC data which divided into 3 groups, Triple negative, Luminal, and HER-2. We used 10% as a cut off point for ER, PR, while 30% & positive 3 for HER-2. We determined initial clinical response after 3 cycles of neoadjuvant chemotherapy although only 77 got standard neoadjuvant chemotherapy and had clinical response data. We used 50% diameters depreciation & no metastasis as cut off point for respond group.

 Results: There were 116 (33%) Triple Negative, 60 (17%) HER-2, and 175 (50%) Luminal Subtypes. The mean of age for 351 patients are 48.32 (23-82) years. In this study, it was obtained that no significant difference of means of age (p=0.24) in these 3 groups. Triple negative group significantly more advance in grade if compared with the other two groups (p=0.02). HER-2 group had highest response with standard neoadjuvant chemotherapy (50%), Luminal group had (49%), and Triple negative group had only (15%) response. One pCR in HER-2 group. There were no difference ages in subtypes.  Triple negative has more advances in grade. HER-2 group has highest response to standard neoadjuvant chemotherapy and Triple negative has lowest response to standard neoadjuvant chemotherapy.

R Laode, A Djoko, A Mansyur, B Burhanuddin

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Objectives: Traumatic brain injury (TBI) is accompanied by regional alterations of brain metabolism, reduction in metabolic rates and possible energy crisis. This metabolic disturbance reflected by increase and accumulation of the brain lactate levels. Objective of this study was to determine the correlation between abnormalities in lactate metabolism for predicting neurologic outcome after moderate or severe traumatic brain injury.

Methods: An observational prospective study in 60 patients with isolated TBI. Blood sample taken from vein of the limbs after underwent initial resuscitation. Serial assessment of the blood lactate level was measured in 1^st, 2^nd and 7^th day with Lact2 Roche Cobas® C-System. Neurologic outcome assessed on 7^th days using Modified GCS.

Results: On initial assessment, 38.3% of patients with normal lactate (≤ 2 mMol/L), 61.7% of patients was hyperlactatemia ( > 2 mMol/L). In this study, it was obtained that the lower of GCS level, the higher of blood lactate level, and vice versa (p = 0.033). In both treatment, there was a significant lactate clearance 24-hour as 37.96% ± 32.76 (p = 0.001) and 13.49% ± 40.32 (p = 0.011), respectively. No significant changes between blood lactate level on the 2^nd and 7^th day, both operative (p = 0.938; p > 0.05) neither conservative (p = 0.280; p > 0.05) patient. While, there was no correlation between neurologic outcome with 24-hour lactate clearance (p = 0.349). The higher of the initial blood lactate level, the patient’s outcome was worsen (p = 0.029).

Conclusion: There is a significant correlation between blood lactate level and severity TBI according to GCS level. The lower GCS level, the higher blood lactate level and vice versa. This study also demonstrates that 24-hour lactate clearance did not affect patient’s outcome, but more influence by initial blood lactate level. Therefore, initial blood lactate level can used as an outcome predictor in TBI patients.

 

I Sudarsa, I Semadi, N Riasa

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Objectives: Diabetic ulcer, one of chronic complications of diabetes mellitus (DM), showed a high morbidity and mortality rate. The main treatment modality for diabetic ulcer was debridement, followed by wound treatment as local control to promote wound healing. This study aims to compare efficacy of hyaluronic acid (HA) and 0.9% sodium chloride (NaCl) in severe diabetic ulcus two after debridement. Method: This study was a randomized clinical study to compare the efficacy of HA and NaCl 0.9% in severe diabetic ulcer two weeks post debridement. Thirty six severe diabetic ulcer (Wagner ≥3) samples were collected using consecutive sampling method and divided into 2 treatment groups: standard wound treatment using NaCl 0.9% and using hyaluronic acid. T-independent test was applied for statistical analysis data and p<0.05 was consider a statistically significant. Results: The two treatment groups showed insignificant difference in characteristics and laboratory findings. The mean tissue epithelialization width after two weeks of wound treatment using NaCl 0.9% was 17,22 ± 3,25 and using HA was 27,33 ± 2,43. Statistical analysis using t-independent test showed t = 10.59, p = 0.001 for both treatment groups. Conclusions: HA improves wound healing rate in severe diabetic ulcer 2 weeks post debridement compared to 0.9% NaCl.

Sri Maliawan, Tjok Mahadewa

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This study aims to present a review of the basic assessment of spine and spinal cord injury. This is a review of published articles between 1978 and 2005 on the neck spine and spinal cord injury. We present a summary about the basic principles according to the literatures.