Pemeriksaan sitologik cairan pleura untuk diagnosis mesotelioma Ganas dan adenokarsinoma

Suatu diagnosis banding, Reccurent pleural effusions are frequently the first manifestation of a diffuse malignant pleural mesothelioma. Pleural effusion of the malignant mesothelioma is frequently industinguishable from the pleural effusion due to adenocarcinoma. The prognosis of this tumor is poor, but immediate and accurate therapy will render prolonged remission. For these reasons, microscopic examination of thoracocenthesis fluid is necessary, because it may provide an immediate diagnosis. Unfortunately the reliability of cytologic diagnosis is still disputable. Based on microscopic examination, there is no single pathognomonic feature. The cytologic diagnosis of a malignant pleural examination is based on the constellation of findings. The histiry of the course of the disease, optimal sample preparation and special stains are important requirements to provide definitive diagnosis. Keywords: mesothelioma-adenocarcinoma-thoracocenthesis fluid-air-drie May Grunwald-Giemsa-monoclonal antibody B72.3. Ahmad Ghozali; Lab. Patologi Anatomik UGM.

Amega Global

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Easing the Seizures, and Stigma, of Epilepsy

By ALIYAH BARUCHIN; The first thing you notice about 13-year-old Nora Leitner is the dark circles under her eyes. They stand in stark contrast to the rest of her appearance. At a glance she might be any petite, pretty tween girl, with her blond ponytail, elfin frame and thousand-watt smile, but the circles tell a different story. Nora looks as if she hasn’t slept in a month. In a sense, she hasn’t. Nora has epilepsy, and as with 30 percent of those with the disorder, her seizures are not controlled by existing treatments. She often has more than one a day, mostly at night. Her seizures, called tonic-clonic (what used to be known as grand mal), cause her to lose consciousness for a full minute while her body convulses. While some people feel an “aura” of symptoms before a seizure, Nora’s seizures happen entirely without warning. When she seized at the top of a staircase in her home in Yardley, Pa., it was plain luck that her parents were at the bottom and caught her as she fell. Though she is on the brink of she is rarely, if ever, left alone. Epilepsy affects 50 million people worldwide and more than 2.7 million people in the United States; half of all patients are children. Especially in its intractable form, also called refractory epilepsy, the disorder — and the side effects of epilepsy medications — can cause problems in learning, and behavior, and indelibly alter development. Epilepsy can also consume families, monopolizing their time, money and energy. Despite the number of people with epilepsy — the disorder affects more Americans than do combined — it still carries a stigma that dates to ancient civilizations. Many patients, doctors and families say the stigma hampers care, public recognition and the ability to raise money for research. “There is an ongoing, significant embarrassment level about it,” said Dr. Orrin Devinsky, director of the Epilepsy Center at New York University The feeling, for a lot of people, is that it does carry a lot worse stigma than a even. At some level, it’s society that needs to wake up and realize it’s just another neurologic disorder.”Warren Lammert, who runs a financial firm in Boston and whose daughter has epilepsy, founded an organization in 2002 with Dr. Devinsky and two others to support research into new treatments. “It’s better today,” he said about public perceptions of the disorder. “But even among well-educated people, people don’t like to talk about epilepsy.” While many public figures with cancer (or cancer in the family) are forthcoming about the illness, Mr. Lammert said, the same does not go for epilepsy. And though his organization, the Epilepsy Therapy Development Project, has two strong public representatives — the Olympic women’s hockey goaltender Chanda Gunn and the hip-hop artist D J Hapa — the disorder has never found an icon like Michael J. Fox, whose openness about Parkinson’s disease helps raise tens of millions of dollars a year for research. Meanwhile, despite advances that have helped people with treatable epilepsy, the 30 percent rate for the intractable form has changed little in 40 years. “Refractory epilepsy remains an enormous problem, Dr. Devinsky said. Epilepsy results from an electrical disturbance in the brain, though at various stages in history it has been thought of as evidence of a connection to the divine, a sign of demonic possession or the mark of a witch. The types of seizures vary from staring episodes or eye blinks to sudden falls or All can be debilitating, depending on factors like frequency and the age when they start. Comprehensive Epilepsy Centers, medical practices that specialize in treating the disorder at 50 around the nation, represent the gold standard in therapy. Treatments include anticonvulsant medications, which can have profound effects on memory, behavior and cognitive ability; the ketogenic a restrictive plan that has had remarkable success in controlling seizures; an implanted stimulator that sends regular pulses of electricity to the brain; and surgery to remove an affected area of the brain. In the last two decades, surgery has changed the landscape of epilepsy for many patients, including children. Yet Nora Leitner, like many others, is not a candidate for surgery because her seizures involve all of her brain, rather than a localized area. For Nora, her parents, Lee and Kina Leitner, and her brother, Ethan, 7, epilepsy has become the center of the universe, governing decisions about everything from where to live to whether to go out to dinner. The level of frustration and the level of stress is just phenomenal, said Ms. Leitner, 60, a resilient and energetic college professor. Mr. Leitner, 49, also a professor, hates seeing Nora’s youth overwhelmed by the illness. Her childhood is defined by this, he said, and it’s really sad.”The Leitners experience is typical, Dr. Devinsky said, adding, It involves everybody to an incredible degree.”Looking back, the Leitners think Nora had her first seizure in utero two weeks before she was born. Her first recognized seizure happened when she was 4 ½ months old; a month later, she had five seizures in three days. The formal diagnosis came after her first birthday. Dr. Christina Bergqvist, Nora’s neurologist at Children’s Hospital of Philadelphia, said Nora’s shows visible abnormalities in her brain. The critical struggle in Nora’s care, as for many children with epilepsy, has been to safeguard her cognitive life. Children with intractable epilepsy display a wide range of abilities, from normal functioning to profound retardation. Nora falls somewhere in the mid-high range. Her speech is extremely slow and soft; she often frowns before answering a question, as if struggling to formulate her response. While her answers are usually accurate, her response time is slow, and she sometimes is not aware that she has been asked a question at all. Yet beneath the layers of difficulty is a sharp mind, an avid reader in a home filled with books, a child whose favorite subject is science and who can discuss ancient Egyptian culture and identify common vertebrates and invertebrates. Despite her halting speech, she tells a reporter that her chore in the house is looking after the recyclable cans and bottles. Nora’s responsible for taking those out, Ms. Leitner said. Her daughter added dryly, Yeah, without asking. That child, and those submerged abilities, were what Ms. Leitner first saw clearly in 2000, when Nora went off a medication called Depakote. The side effects of anticonvulsant medications are often as disabling as seizures themselves, and Nora’s life on medication had begun at 6 months, when her doctor prescribed phenobarbital, a drug that causes cognitive and language delays. We were beside ourselves, said Ms. Leitner, who teaches at University of Maryland University College and who suddenly found herself putting her expertise to work for her own child. One of my biggest concerns was, do we medicate her? I knew that the drugs they used to treat epilepsy were all cognitive depressants. It is the Solomon’s choice faced by parents of children with intractable epilepsy: risk the damage wrought by seizures, or the side effects of medication? Over the next five years Nora tried eight or nine medications, and in 2000, at age 6, she entered first grade taking two anticonvulsants, Depakote and every day. Then she caught a break. The Depakote made her so sleepy that Ms. Leitner rescheduled the lunchtime dose so she would be alert at school. After a few months, they dropped the midday dose entirely. Suddenly, a new Nora surfaced. “It was a phenomenal change,” Ms. Leitner said. “She was awake, alert. We took away another dose; then that summer, we took the last one away and she started seizing again. But she had started talking, reading, everything she hadn’t done before; she never talked in full sentences until she was 6 years old. I wasn’t willing to go back.” In October 2002, Nora went on the ketogenic diet. It is like the Atkins diet in overdrive: it mandates vast quantities of fats, like oil, which Nora drank from a small bottle, and almost no Every morsel is weighed, and no deviations are allowed. Within weeks, Ms. Leitner said, there were pronounced changes in Nora’s abilities and attention span. Over the next 21 months, she had only two seizures. But in the summer and fall of 2004, there were three more, and that October, while swimming at school, Nora had a seizure and nearly drowned. Within a year, she had begun to have a seizure or two a month as she entered puberty. In March 2006 she had a vagus nerve stimulator implanted, but her seizures became so frequent that the Leitners had the device turned off two months later. Since then, she has often had more than one seizure a day. Families of children with intractable epilepsy often have a hard time getting the constellation of services they need. “Throughout the years, we’ve had to find things out for ourselves,” Ms. Leitner said. “Nobody ever said to us, Nora needs speech therapy, or Nora should see a developmental pediatrician.’ Even finding the right school was a trial. The Leitners now drive Nora 30 miles each way to the Orchard Friends School in Moorestown, N.J., and they will begin home-schooling her in the fall. Social isolation is a persistent issue. Schools may not want to include students with epilepsy on field trips; peers may not invite them for sleepovers. A lot of it just seems to be awareness issues,” Mr. Leitner said. “Most people have never seen somebody have a seizure.” Dr. Bergqvist agreed. “It is frightening to see a child seize, she said. “And then based on that fright, people decide, ‘I can’t deal with that child.’ People still think it’s contagious.”In late November 2006, the Leitners agreed to give the vagus nerve stimulator another try, but it made no difference in Nora’s seizure control. In fact, in the first half of 2007, her condition deteriorated to the point at which, on two separate days that summer, she had 19 full-blown seizures each day. A few months earlier, in March 2007, Dr. Bergqvist had been surprised to discover that a genetic test on Nora came back positive for a mutation called SCN1A, which is linked to a variety of severe seizure disorders. In August, Nora began taking stiripentol, a high-priced medication that has been approved in Europe, but not the United States, to treat patients with SCN1A mutations. (It is not covered by insurance plans in the United States.) In combination with two other medications, it brought her seizures completely under control at first. They have come and gone since, as Dr. Bergqvist and Ms. Leitner try to pin down the right combination of doses. Nora typically feels best in the brief period immediately after a change in treatment, but the improvement is always fleeting. When we make a change to the VNS settings, she is fabulous for about two to four hours — really alert and awake and bright and on target, all there, Ms. Leitner said. And when we introduce a new drug, or when we change the dosing on a drug, she’ll go seizure-free for about two weeks. And then it’s like the brain finds a way of getting around the drug.”So far, the new trio of medications has offered Nora a better level of control than almost any other treatment that the Leitners have tried over the years. In addition, last fall Nora went off the ketogenic diet and onto a less restrictive low-glycemic-index diet, freeing the Leitners to go to restaurants and travel as a family. In the midst of all of this, Nora is having as typical a 13-year-old life as she can. She loves to swim and has taken gymnastics, piano lessons, tae kwon do, and hip-hop dance classes. Her bedroom brims with books, dolls and stuffed animals, and she eagerly shows off her huge repertoire of knock-knock jokes. She dotes on the family dog, Franklin, and the cat, Lily. Dr. Bergqvist says Nora could experience a remission after she goes through puberty. Until then, the choices continue. But Ms. Leitner acknowledged that their approach may have to change. At a certain point, I’m going to have to stop worrying about her ability to think and go for the seizure control,” she said. But she knows that it will not be easy. “If she had always been the way she was before the diet, I probably wouldn’t be as dramatic about this as I am,” she said. “But I’ve seen what she can do.
Dr. Devinsky says that families like the Leitners, torn as they may be over the correct path to take, are on the right track. “If there’s a message, it’s not to give up, he said. They should do everything possible to maximize the quality of life of their child, but at the same time, never, ever give up. Because there will be other things coming down the pike.”Updated from an article that originally appeared in The Times

O.K., Avatar, Work With Me

Women, parents, even nursing-home residents have been drawn to the Wii’s simple evocations of games such as tennis and bowling. The Wii has become the best-selling game machine of the current generation, selling more than 25 million worldwide, and remains scarce on store shelves across the nation. Now Nintendo’s latest brainchild, Wii Fit, could send similar ripples through the home-fitness market. Scheduled to be released in North America next week, Wii Fit is not meant to replace a gym. But in a world of $3,000 elliptical machines and $150-an-hour personal trainers, it has at least a chance of becoming a global, affordable, mass-market interactive home-fitness system. (On its overseas debut last month, it became one of the fastest-selling games ever in Britain.) Exercising with Wii Fit is like having a Bob Harper or a Denise Austin who talks back — gently cajoling you through exercises, praising, nudging, even reminding you to eat a banana once in a while. It also lets you see how you stack up against friends or family members; each user creates a cartoony avatar called a Mii. The system costs $90, plus $250 for the basic Wii console. It uses a television and a sensitive “balance board” placed on the floor to present a few dozen activities, from push-ups to yoga, to more entertaining challenges like balance games and aerobic contests. Nintendo is not aiming Wii Fit at people with a serious exercise regimen. Rather, it is meant to appeal to the person busy with work and family who just wants to have fun getting a little toned at home. Believe me, I could use some help. As a video game journalist, I live in a world where Buffalo wings, potato chips and jalapeño poppers are considered food groups. The closest I get to serious exercise is flopping around at concerts like a lumpy, overeducated flounder. Then again, most Americans aren’t really in great shape either. So I felt I could reasonably reflect the broad mass market (if you will) in testing whether a silicon coach has the potential to rescue millions of Americans from decrepitude. To help me evaluate the system, Thursday Styles recruited two fitness professionals, an avid exerciser and one work-at-home parent to try Wii Fit at the Chelsea Piers sports complex in Manhattan. Here is what we thought:
THE MULTITASKER Shira Weiss, a 33-year-old mother of two who works out of her home in Teaneck, N.J., as a publicist for small businesses, wants Wii Fit because it fits both her lifestyle and her doorway. Before having the kids, I used to work out every day — I belonged to a gym — but now it really only when I have a chance,she said. Let me put it this way: I clean with vigor. I like aerobic exercise and would like a treadmill. But we tried to get one, and the door of our house was too narrow. It just wouldn’t fit, and my husband was like, ‘Forget the treadmill.
She eyed the 12 by 20” Wii Fit board. “But this could work,” she said. Wii Fits almost 50 exercises are divided among four categories: strength training, aerobics, balance games and yoga. Each user creates a personal profile, including a potential weight loss (or gain) goal. The system tracks a user’s weight and body-mass index as well as their performance on individual exercises. To help prevent novices from overextending or frustrating themselves, only a few exercises are initially available in each category; more advanced activities are unlocked only after completing simpler options. Ms. Weiss found her groove in Wii Fit’s aerobics section. She proved a quick study with the hula hoop game (gyrating in circles), before finding her long-sought treadmill replicated in the running game. In Wii Fit, running does not use the board. Rather, the user puts the TV-remote-size Wii controller in her pocket or hand and runs in place while the motion-sensitive controller serves as a pedometer. On screen, the user runs through a bucolic park while a pacesetter beckons the player onward. For longer runs, users can watch television while the Wii tracks their progress.

Low-Fat Diet

May Cut Prostate Cancer Risk. Cutting back on fried foods and baked goods may lower a man’s risk for prostate cancer, a new animal study suggests. Scientists at Jonsson Cancer Center at the University of California, Los Angeles, focused on fat from corn oil, which is made up primarily of omega-6 fatty acids. That’s the type of polyunsaturated fat typically used in high levels in processed baked goods and fried foods. The healthiest fats are omega-3 fatty acids, like those found in fish, or monounsaturated fat, the kind found in foods like almonds, pecans, cashew nuts, peanuts, avocados and olive and canola oil. Using a mouse model that closely mimics human prostate cancer, researchers fed one group of mice a diet with about 40 percent of calories coming from fat, similar to the amount found in a typical Western diet. The other group received 12 percent of their calories from fat. The study, published this month in the journal Cancer Research, found a 27 percent lower incidence of prostate cancer in the low-fat diet group. Precancerous cells, which can go on to become cancer, also grew at a much slower rate in the mice eating a low-fat diet, compared to those in the high-fat group, the study showed. Although the data come from mice, researchers say it’s reasonable to think the finding will translate to people. Further animal studies and human clinical trials are under way to study the issue. The theory is that lowering dietary fat results in an increase in levels of a protein that slows prostate cancer development by cutting off the growth factor that allows prostate cancer to thrive. Although the verdict is still out on the link between fat and prostate cancer, researchers say there are already known benefits to lowering or eliminating processed baked goods and fried foods from the diet. “A low-fat, high-fiber diet combined with weight loss and exercise is well known to be healthy in terms of heart disease and is known to reduce the risk of heart attacks and strokes, so that would be a healthy choice to make, said Dr. William Aronson, a Jonsson Cancer Center researcher and the study’s senior author. Whether or not it will prevent prostate cancer in humans remains to be seen.

Doctors Say ‘I’m Sorry’ Before ‘See You in Court

Once an X-ray provided proof in black and white, Dr. Das Gupta, the 74-year-old chairman of surgical oncology at the University of Illinois Medical Center at Chicago, did something that normally would make hospital lawyers cringe: he acknowledged his mistake to his patient’s face, and told her he was deeply sorry. “After all these years, I cannot give you any excuse whatsoever,” Dr. Das Gupta, now 76, said he told the woman and her husband. “It is just one of those things that occurred. I have to some extent harmed you.” For decades, malpractice lawyers and insurers have counseled doctors and hospitals to “deny and defend.” Many still warn clients that any admission of fault, or even expression of regret, is likely to invite litigation and imperil careers. But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach. By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits. Malpractice lawyers say that what often transforms a reasonable patient into an indignant plaintiff is less an error than its concealment, and the victim’s concern that it will happen again. Despite some projections that disclosure would prompt a flood of lawsuits, hospitals are reporting decreases in their caseloads and savings in legal costs. Malpractice premiums have declined in some instances, though market forces may be partly responsible. At the University of Michigan Health System, one of the first to experiment with full disclosure, existing claims and lawsuits dropped to 83 in August 2007 from 262 in August 2001, said Richard C. Boothman, the medical center’s chief risk officer. “Improving patient safety and patient communication is more likely to cure the malpractice crisis than defensiveness and denial,” Mr. Boothman said. Mr. Boothman emphasized that he could not know whether the decline was due to disclosure or safer medicine, or both. But the hospital’s legal defense costs and the money it must set aside to pay claims have each been cut by two-thirds, he said. The time taken to dispose of cases has been halved. The number of malpractice filings against the University of Illinois has dropped by half since it started its program just over two years ago, said Dr. Timothy B. McDonald, the hospital’s chief safety and risk officer. In the 37 cases where the hospital acknowledged a preventable error and apologized, only one patient has filed suit. Only six settlements have exceeded the hospital’s medical and related expenses. In Dr. Das Gupta’s case in 2006, the patient retained a lawyer but decided not to sue, and, after a brief negotiation, accepted $74,000 from the hospital, said her lawyer, David J. Pritchard. “She told me that the doctor was completely candid, completely honest, and so frank that she and her husband — usually the husband wants to pound the guy — that all the anger was gone,” Mr. Pritchard said. “His apology helped get the case settled for a lower amount of money.” The patient, a young nurse, declined to be interviewed. Mr. Pritchard said his client netted about $40,000 after paying medical bills and legal expenses. He said she had the rib removed at another hospital and learned it was not cancerous. “You have no idea what a relief that was,” Dr. Das Gupta said. Some advocates argue that the new disclosure policies may reduce legal claims but bring a greater measure of equity by offering reasonable compensation to every injured patient. Recent studies have found that one of every 100 hospital patients suffers negligent treatment, and that as many as 98,000 die each year as a result. But studies also show that as few as 30 percent of medical errors are disclosed to patients.

Memahami Efek Ketergantungan Narkoba

Ketergantungan Narkoba merupakan suatu penyakit kompleks yang ditandai oleh adanya keinginan kuat untuk selalu memakai obat (craving) meskipun disadari akan berbahaya dan dapat mengancam kehidupannya. Penyakit ini bersifat menahun dan sering kambuh walaupun ada periode abstinensia untuk waktu yang cukup lama. Namun demikian, disamping efek-efek jangka lama yang mungkin timbul perlahan-lahan, pengguna narkoba juga sangat mungkin mengalami keadaan darurat yang membutuhkan pertolongan segera, antara lain overdosis dan sakaw. Overdosis Obat-obatan yang sering dipakai untuk mabuk mempunyai efek pada kerja otak. Karena otak mengendalikan bagian lain dan fungsi dari tubuh - seperti paru-paru yang membuat oksigen tidak beredar ke darah, ginjal dan hati yang menetralkan racun dari tubuh, dan jantung yang memompa darah ke seluruh tubuh - menggunakan drugs dapat mempengaruhi satu atau lebih dari aktivitas fungsi tubuh yang penting ini, untuk membuat seseorang mabuk. Tubuh seseorang biasanya dapat menyesuaikan dengan perubahan ini, tetapi jumlah/kadar obat yang dipakai terlampau banyak, perubahannya bisa melebihi kemampuan tubuh dalam menyesuaikannya diri dan menimbulkan efek samping yang seringkali berbahaya. Beberapa efek samping yang terjadi dari pemakaian drugs yang berlebihan adalah serius, tetapi tidak dirasakan secara langsung. Hati dan ginjal dapat rusak karena pemakaian drugs ini membuat organ-organ akan bekerja lebih keras. Dan untuk menghilangkan efek dan kerusakan dari drugs tersebut membutuhkan waktu bertahun-tahun. Tetapi jika otak terlalu banyak memperoleh obat-obatan dalam waktu yang relatif singkat, efek samping yang muncul dapat sangat berbahaya seperti hilangnya kesadaran, berhentinya pernafasan, gagal jantung, serangan jantung- termasuk tentunya, kematian. Inilah yang disebut overdosis dari obat-obatan. Overdosis sangat serius tetapi tidak perlu berakhir fatal jika ditangani dengan cepat dan tepat. Siapa saja yang memakai drugs bisa overdosis, orang yang baru pertama kali menggunakan sampai orang yang telah bertahun-tahun menggunakan obat. Sakaw Ketergantungan fisik merupakan suatu fenomena alami bila seseorang menggunakan suatu obat (biasanya golongan opioid seperti morfin dll) dalam dosis yang cukup besar dan berjangka lama. Sel-sel tubuh yang terpajan obat akan beradaptasi sehingga terdapat suatu keseimbangan biologis yang baru. Penghentian penggunaan opioid secara tiba-tiba pada seseorang yang sudah bergantung pada opioid dalam jangka lama akan menimbulkan reaksi putus obat dengan gejala-gejala: Tingkat O: craving, ansietas. Tingkat I: menguap, lakrimasi, rinorea, berkeringat. Tingkat II: midriasis, piloereksi, anoreksia, tremor, panas dingin Tingkat III: peningkatan keluhan dan gejala, suhu meningkat, tekanan darah dan nadi meningkat, napas cepat dan dalam, ejakulasi/orgasme spontan. Gejala putus obat ini merupakan pengalaman yang sangat tidak mengenakkan walaupun tidak mematikan. Reaksi gejala putus obat berlangsung sekitar 5-10 hari. (klinikpria/*)