Fistual Ureterovaginalis. Suatu Komplokasi Cidera Ureter Bagian Distal

In the female complication of the distal portion of the ureter injury is the ureterovaginal fistula, seen most often after the Wertheim hysterectomy. The true incidence of the disease is difficult to ascertain in the literature. Incontinence is the first symptom of the ureterowaginal fistula patient. An IVP, RPG, cystography, crystoscopy and double dye test investigations are to be advocated for diagnosis of the disease. Ureterovaginal fistula is repaired by standard ureteroneocystostomy, incorporating an anti-refluxing submucosal tunnel. Key words: Wertheim hysterectomy-ureterovagina fistula-incontinence-ureteroneocystostomy-ureter injury. Prawito Singodimedjo, Sungsang Rochadi dan H. Moh Baried Ishom; Lab. Ilmu Bedah Fak. Kedokteran UGM.

Ekstrak Daun Jambu Biji Berpotensi Sembuhkan Demam Berdarah

DAUN jambu biji tua ternyata mengandung berbagai macam komponen yang berkhasiat untuk mengatasi penyakit demam berdarah dengue (DBD). Kelompok senyawa tanin dan flavonoid yang dinyatakan sebagai quersetin dalam ekstrak daun jambu biji dapat menghambat aktivitas enzim reverse trancriptase yang berarti menghambat pertumbuhan virus berinti RNA. Demikian hasil penelitian yang dilakukan oleh Badan Pengawas Obat dan Makanan (POM) bekerja sama dengan Fakultas Kedokteran dan Fakultas Farmasi Universitas Airlangga (Unair) Surabaya, yang sejak 2003 meneliti ekstrak daun jambu biji untuk pengobatan DBD. Pada tahap awal penelitian dimulai dengan pengujian preklinik. Hasil penelitian dipaparkan oleh Kepala Badan POM Drs Sampurno MBA di Jakarta, Rabu (10/3). Ide penelitian berasal dari Badan POM dan mereka menunjuk Dr Drs Suprapto Ma’at MS. apoteker dari Patologi FK Unair untuk meneliti daun jambu biji. Seperti diketahui, DBD merupakan penyakit yang disebabkan oleh virus dengue dengan angka kematian dan kesakitan yang cukup tinggi. Sampai saat ini pengobatan DBD masih bersifat suportif, yaitu mengatasi kehilangan cairan plasma akibat peningkatan permeabilitas pembuluh darah kapiler. Pada tahap awal dilakukan penelitian preklinik di FK Unair yang menggunakan hewan model mencit dengan pemberian oral ekstrak daun jambu biji terbukti dapat menurunkan permeabilitas pembuluh darah. Pada penelitian tersebut dilaporkan juga bahwa ekstrak daun jambu biji terbukti dapat meningkatkan jumlah sel hemopoetik terutama megakriosit pada preparat dan kultur sumsum tulang mencit. Pada uji keamanan (toksisitas) ekstrak daun jambu biji termasuk zat yang praktis tidak toksik. Hambat virus dengue Daun jambu biji memang mengandung berbagai macam komponen. Berkaitan dengan itu telah dilakukan uji invitro ekstrak daun jambu biji di mana ekstrak tersebut terbukti dapat menghambat pertumbuhan virus dengue. Kelak setelah dilakukan penelitian lebih lanjut diharapkan ekstrak daun jambu biji dapat digunakan sebagai obat anti virus dengue. Juga telah dilakukan uji awal berupa penelitian open label di beberapa rumah sakit di Jawa Timur (RS Jombang dan RS Petrokimia Gresik) pada penderita DBD dewasa dan anak-anak. “Hasil penelitian dibagi-bagikan ke RS Jombang dalam bentuk 30 kapsul dan 30 sirup, lalu RS Petrokimia Gresik 20 kapsul dan 20 sirup. Ada yang sukarela mau mencoba,” kata Suprapto. Hasil penelitian tersebut menunjukkan bahwa pemberian ekstrak daun jambu biji dapat mempercepat peningkatan jumlah trombosit tanpa disertai efek samping yang berarti, misalnya sembelit. Penelitian open label ini masih perlu dilanjutkan dengan uji klinik untuk membuktikan khasiat dengan evidence based yang lebih kuat. Pengamatan lain yang sedang dikerjakan dalam penelitian ini adalah pengaruh pemberian ekstrak daun jambu biji terhadap sekresi GM-CSF dan IL-11 untuk mengetahui mekanisme kerjanya pada trombopoiesis. Juga terhadap aktivitas sistem komplemen dan sekresi TNF-Alfa olehmonosit dalam hubungannya dengan mekanisme penurunan permeabilitas pembuluh darah. Pada tahun 2004 akan dilakukan uji klinik di RSUD Dr Soetomo Surabaya/FK Unair, yang akan dipimpin oleh Prof Dr dr Sugeng Sugijanto DSA yang dibantu dr M Nasirudin dengan Dr Ugrasena untuk pasien DBD anak dan Prof dr Edy Soewandojo SpPD untuk pasien DBD dewasa. Badan POM dalam waktu dekat juga akan melakukan kajian-kajian intensif dengan para pakar untuk mendukung tata laksana yang sekarang ini ada. Sampurno optimis karena daun jambu biji bahan bakunya sangat mudah diperoleh dan proses teknologinya sederhana. (LOK)

Polyester Sling Scrotal Cover Induces Oligozoospermia in Normal Indonesia Men

The objective of this study is to ascertain the effects of polyesther sling scrotal cover on sperm production in healthy volunteers used polyester sling scrotal cover all day and night for 24 weeks. Semen was analyzed at a 3-week interval, and clinical chemistry and hematology were monitored at a 12-week interval. The results showed that within 24 weeks sperm concentration, percentage of normal sperm morphology, and sperm velocity decreased to below normal range in all subjects. We concluded that polyester sling scrotal cover can suppress sperm production to aligospermia in Indonesia men. Not a single subject achieved azoospermia, as compared with in Egypt study that showed 100% azoospermia in 14 men. Keywords: Fertility, male contraception, spermatogenesis, electrostatic field, thermoregulation, polyester sling. Nukman Moeloek; Departmen of Biology, Faculty of Medicine University of Indonesia

Survival Patterns of Children with Rheumatic Heart Disease

We examined the survival curves of patients with estabished rheumatic heart disease treated at the Division of Cardiologi, Department of Child Health Faculty of Medicine University of Indonesia Cipto Mangunkusumo Hospital, Jakarta during the period of January 1983 until December 1992. There were 359 patients available for analysis. At the end of the 120-month observation, 69.1% patients were still alive. Comparisons of several curves based on certain characteristics showed that age at the time of diagnosis and the number of valves involved were associated with survival, while sex, parental education, or nutritional status were not. Closer examination of 177 patients who had completed 5 years of follow-up, both using univariate and multivariate analyses (logistic regression analysis) confirmed the results of survival analyses. We conclude that age at the time of diagnosis and the number of valvar involvement are strong determinants for the prognosis of children with rheumatic heart disease. Keywords: survival analysis, rheumatic heart disease, risk factors, prognosis. Sudigdo S, Bambang M, Ismet N Oesman, Sukman Tulus P, Najib A.; Departemen of Child Health Medical School University of Indonesia

Studies on Male Fertility Regulation in Indonesia

Male contraception has not received mush attention, compared with the extensive numbers of investigations dealing with female contraception. The condom and coitus interruptus were among the first methods of male contraception. These methods are usually started on the initiative of the couple, without any medical advice, as they are not ordinarily recommended in the family planning clinic. The development of safe, effective and reversible contraceptive methods for for men is an important step in increasing the options available for couples who wish to regulate their family size. This paper reviews the results of studies on male fertility regulation conducted in Indonesia, such as a combination of androgen-progestagenm androgen only, simetidine, ketoconazole, nonscalpel vasectomy and vas occlusion using medical grade silicone. Some of those studies showed good results and prospectives in developing safe and effective contraceptive methods for men. Keywords: hormonal, non-hormonal, male fertility regulation.K.M. Arsyad; Division of Andrology Departmen of Medical Biology, Faculty of Medicine, Sriwijaya University

The Mechanisms of Autoimmune Response: Insights into an Enigmatic Repertoire

Several possible mechanisms of autoimmune response leading to the development of autoimmune diseases are discussed briefly herein. Failure of both B and T sell tolerance, lack of suppressor T cell functions, an apoptosis defect, increased expression of superantigens, adverse effects of cytokines and possible microbial infections have all been proposed as the mechanisms of autoimmune response. Yet, none of the proposed mechanisms seems to explain satisfactorily and exclusively the development of a single autoimmune disease, suggesting that the diseases may involve complex mechanisms rather than due to a single pathway. Whether findings based upon the animal models can be extrapolated in humans remains also to be investigated further, since it would provide a direction for future bimodal therapy. Keywords: Immunoregulation, autoimmunity, autoimmune diseases. Wihaskoro Sosroseno, Endang Herminajeng, Department Dental Public Health

Treadmill Test in Patients with Rheumatic Mitral Regurgitation

Treadmill tests were performed in 48 patients with rheumatic mitral regurgitation ranging in age from 9 to 18 years, consisted of 17 boys and 31 girls. The method used was Bruce protocol. Patients with heart failure or other valvular defects were excluded from this study. Thirty-eight (79.2%) patients, 15 boys and 23 girls, could reach stage 4 or more. Shorter endurance time was associated with increasing age and larger body suface area, both in boys and girls. In the group of patients with cardiomegaly in their x-ray photos, 83.3% of the boys and 70.0% of the girls could reach stage 4 or more in, while in those without cardiomegaly 100% of the boys and 76.1% of the girls could achieve stage 4 or more. Patients with LVH on their ECGs could reach stage 4 or more in 87.5% of the boys and 85.7% of the girls, while patients without LVH could reach stage 4 or more in 88.8% of the boys and 70.0% of the girls. We conclude that: (1) treadmil test is quite safe for children with mild and moderate rheumatic mitral regurgitation; (2) older age and larger body surface area are assosiated with lower endurance, (3) cardiomegaly on chest X-ray can be used as guide for exercise restriction in that group, but this is not true with ECG-LVH. Keywords: Treadmill test, rheumatic mitral regurgitation, cardiomegaly, left ventricular hypertrophy. Bambang Madiyono, Sabiqun Rusdi, Ismet N. Oesman, Sudigdo Sastroasmoro, Sukman T. Putra, Najib Advani