Bram Pradipta
Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia Dr. Cipto Mangunkusumo General Hospital

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Glioblastoma in Pregnancy: A Case Report Bram Pradipta; Cut M. Yeni; Rajuddin Rajuddin
eJournal Kedokteran Indonesia Vol 1, No 3 (2013): Desember
Publisher : Faculty of Medicine Universitas Indonesia

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A 33- year-old, Indonesian woman presented with pregnancy and glioblastoma. Chief complaintwas headache that worsened since 1 month ago. Other complaints included vomitting, seizure andweakness of the left part of her body when she was 12 weeks pregnant. CT scan result midline shiftto the left of falx cerebri with obliterated right ventricle and hypodens mass on right region Craniotomywas performed but the patient refuse to terminate the pregnancy. Patient was supposed to undergoseries of radiotherapy but decided not to since it may complicate her pregnancy. After 5 month, patienthad recurring complaint and CT scan showed area of hypo and hyperdens in fronto-parietal dextraand sinistra with brain edema. Joint operation of cesarean section continued with craniotomy wasperformed when her condition worsened. The patient treated in the intensive care unit and dischargedhome in good condition. Every brain tumours in pregnancy bring dilemmas with no standard treatmentin medicine. The treatment intention is to minimise mortality and morbidity for both maternal and fetal.The management have to be individualised from a multi-disciplinary team and the consideration of amultitude of factors, including location of the tumour, associated signs and symptoms, fetal gestationand the patient’s wishes.Keywords: glioblastoma, pregnancy, cancer
The Usage of Oral Anti Hyperglycemic Agent in Gestational Diabetes: Pros and Cons Bram Pradipta; M. Andalas
eJournal Kedokteran Indonesia Vol. 2, No. 1 (2014): April
Publisher : Faculty of Medicine Universitas Indonesia

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The prevalence of gestational diabetes mellitus (GDM) is increasing as the pregnant population becomes older and more obese. Fifteen percent of GDM patients require medical intervention. Insulin is still the drug of choice because it has not been implicated as a teratogen in human pregnancies.Insulin has its disadvantages such as the need for injections, the risk of hypoglycaemia, excessive weight gain and the costs. The use of oral anti hyperglicemic agent (OAHA), traditionally contraindicated, now can be considered as an alternative for insulin which can be beneficial in developing countries. From four groups of OAHA, sulfonylurea and biguanides can be used during pregnancy. Studies and randomized controlled trial (RCT) have been done and most summarized that it does not increase any maternal and perinatal morbidity. Most data also show that thereare also no differences in glycemic control or pregnancy outcomes compared with insulin. There are conflicting data shows metformin increase prevalence of preeclampsia patient and perinatal morbidity. OAHA usage, although not yet recommended internationally, can be considered in GDMpatients with uncontrolled blood sugar levels that require medical intervention but can not use insulin. Wellconducted, prospective, controlled studies regarding itsfeasibility in pregnant women with diabetes are still needed.Keywords:oral antihyperglycemic agent, gestational, diabetes
Diabetes Insipidus in Young Women with Cervical Cancer Bram Pradipta; Laila Nuranna
eJournal Kedokteran Indonesia Vol. 2, No. 2 (2014): Agustus
Publisher : Faculty of Medicine Universitas Indonesia

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AbstractA 25 year old, unmarried, Indonesian woman came to the emergency department Cipto Mangunkusumo Hospital with shock condition. Initially assessed as septic condition, the patient was then diagnosed as diabetes insipidus (DI). It was concurrently found that the patient also had several sexual intercourse before and not until later that the patient diagnosed with stage IB cervical cancer. Cervical cancer (CC) is the third most common cancer in women worldwide and primarily affects young adult women, with consequences not only individually but also socially. DI is a rare disease that causes frequent urination that is not freqently related with CC. Concurrent incidence of DI with CC can only be seen in several case reports. It has not yet been established whether these two conditions are concurrent or having a cause-effect relationship. DI is not a common case, hence knowing its clinical sign and syptoms are very important. In fund limited setting in third world countries, the laboratory examination can be simplified by examining the osmolality of the serum and urine condition. These low level of serum can be very helpful in diagnosing DIwith treatment can be as simple as fluid restriction. Regarding the CC, radical trachelectomy can be done with surveilance must be done every 3-6 month for 2 years and every 6-12 month for 3-5 years with cytology.Keywords: CC, diabetes insipidusAbstrakSeorang perempuan Indonesia, 25 tahun, belum menikah datang ke IGD RSCM dengan keadaan syok. Awalnya dinilai sebagai keadaan sepsis namun akhirnya didiagnosis sebagai diabetes insipidus (DI). Didapatkan riwayat berhubungan seksual sebelumnya dan kemudian diketahui menderita kanker serviks stadium IB. Kanker serviks merupakan kanker ketiga tersering pada perempuan di seluruh dunia dan terutama menyerang dewasa muda, dengan konsekuensi individual dan sosial. DI merupakan penyakit yang menyebabkan seringberkemih dan jarang berhubungan dengan kanker serviks. Kejadian bersamaan antara DI dan kanker serviks hanya ditemukan pada beberapa laporan kasus. Belum dipastikan bahwa kedua kondisi tersebut terjadi bersamaan atau memiliki hubungan sebab-akibat. DI bukan kasus yang sering sehingga mengetahui tanda dan gejala klinis menjadi penting. Di wilayah dunia ketiga dengan keterbatasan dana, pemeriksaan laboratorium dapat disederhanakan dengan memeriksa osmolalitas serum dan urin. Apabila didapatkan kadar yang rendah makadiagnosis DI dapat ditegakkan dengan tatalaksana sederhana seperti pembatasan cairan. Mengenai kanker serviks, trakhelektomi radikal dapat dilakukan dengan pengawasan tiap 3-6 bulan untuk 2 tahun dan tiap 6-12 bulan untuk 3-5 tahun dengan sitologi.Kata Kunci: kanker serviks, diabetes insipidus
Ovarian Cryopreservation and Transplantation: A Preserving Fertility Procedure Bram Pradipta; Rajuddin Rajuddin; M. Andalas
eJournal Kedokteran Indonesia Vol 2, No 3 (2014): Desember
Publisher : Faculty of Medicine Universitas Indonesia

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AbstractDevelopments in cancer treatment modalities and the ability to detect it in the early stages have increased survival rate, yet raise fertility problems for those who have to endure gonadotoxic therapy. Cryopreservation of either ovary, oocytes or embryo can be an option, surely with its own advantages or disadvantages. Cryopreservation procedures are not without risks. As an example, there is a risk of reimplanting an occult tumour within the frozen–thawed ovarian pieces. Therefore, a thorough discussion between the practitioner and patient regarding all available options should be performed prior to its implementation, and there should be a clear understanding that most fertility preservation options are currently experimental.Keywords: cryopreservation, fertility, cancerAbstrakPerkembangan modalitas tata laksana kanker dan kemampuan untuk mendeteksinya pada stadium awal dapat meningkatkan angka kelangsungan hidup, tetapi dapat meningkatkan masalah fertilitas pasien yang memerlukan terapi gonadotoksik. Kriopreservasi baik ovarium, oosit atau embrio dapat menjadi pilihan dengan keuntungan dan kerugian masing-masing. Prosedurkriopreservasi bukannya tanpa risiko. Sebagai contoh, terdapat risiko implantasi tumor di bagian ovarium yang dibekukan. Oleh karena itu, penggunaannya harus didiskusikan antara pasien dan dokter mengenai pilihan yang tersedia dan penjelasan bahwa pilihan preservasi kesuburan saat ini masih bersifat eksperimental.Kata kunci: kriopreservasi, kesuburan, kanker