Rino Alvani Gani
Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta

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Hepatitis B Virus Double Mutations is There any Role in Pathogenesis of Hepatocellular Carcinoma in Young Patients Sulaiman, Andri Sanityoso; Gani, Rino Alvani; Hasan, Irsan; Utama, Andi; Tai, Susan; Christine, Griscalia
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, NUMBER 3, December 2009
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/103200996-98

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Background: The incidence of hepatocellular carcinoma (HCC) below age 40 years old in our institution were relatively high compared with other institutions in Asia. Hepatitis B virus (HBV) basal core promoter (BCP) double mutations correspond with increasing age. The aim of this study was to know if there was any role of HBV double mutations in young HCC patients. Method: A descriptive study was performed on HBV related HCC patients in Cipto Mangunkusumo Hospital in May 2006-November 2008. Patient were recruited consecutively and divided in to two groups, below 40 and above 40 years old. The genotypes were examined by polymerase chain reaction (PCR) method. The alpha feto protein (AFP) values were diagnosed based on ELISA method. The BCP A1762T/G1764A double mutations were examined by direct sequencing. Results: There were 49 HBV related HCC samples consist of 14 (28.5%) samples with age below 40 years old and 35 (71.5%) samples with age above 40 years old. We only found two genotype, genotype B was dominant in patients with HBV related HCC compare to genotype C, 43 (88%) and 6 (12%) respectively. The increasing of AFP level above 400 ng/mL was only found in about half of the samples, 7 (50%) < 40 years old, 19 (54%) > 40 years old. Double mutations of A1762T/G1764A in BCP occurred in 5 (36%) < 40 years old, 15 (43%) > 40 years old. Conclusion: The incidence of HBV related HCC in young patients were relatively high. The proportion of patients with AFP level < 400 ng/mL in patients below 40 years old were higher compared to patients above 40 years.   Keywords: hepatocellular carcinoma, BCP double mutation, HBV genotype
Acalculous Cholecystitis Prevalence on Abdominal Ultrasonography Examination of HIV/HCV Co-infection Patients in Cipto Mangunkusumo Hospital Sutopo, Bambang; Budihusodo, Unggul; Hasan, Irsan; Gani, Rino Alvani; Yunihastuti, Evy
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 1, April 2010
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/111201032-34

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Background: Acalculous cholecystitis is commonly found in patients with human immunodeficiency virus (HIV) compared to general population. Surprisingly, the signs and symptoms are unremarkable. On the other hand, HIV/hepatitis C virus (HCV) co-infection is a common finding. The aim of this study was to evaluate whether HCV infection has any influence to HIV patients concerning acalculous cholecystitis prevalence. Method: A cross-sectional study was performed in HIV/HCV patients who visited AIDS study group clinic at Cipto Mangunkusumo hospital during September 2008 to February 2009. The patients who met the criteria were examined physically and underwent abdominal ultrasonography. Routine blood count, alanine aminotranferase, aspartate aminotransferase, cluster of differentiation 4 (CD4) and serum albumin were recorded. Results: Of 63 patients underwent ultrasonography examination, we found acalculous cholecystitis in 33 patients (52.3%), cholelithiasis and cholecystitis in 2 patients, and 28 patients were considered normal. Patients with CD4 less than 200 cells, tend to have acalculous cholecystitis more than those who had CD4 more than 200 cells. Conclusion: The prevalence of acalculous cholecystitis among HIV/HCV co-infection is higher compared to those with HIV infection alone. Keywords: acalculous cholecystitis, HIV/HCV co-infection, CD4
Hepatocellular Carcinoma (HCC) Surveillance – Comprehensive Management in Liver Cirrhosis Patients Gani, Rino Alvani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 3 (2017): VOLUME 18, NUMBER 3, DECEMBER 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (287.531 KB) | DOI: 10.24871/1832017137-139

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The Difference Expressions of EBNA-1 in Epstein-Barr Virus Infection in Low and High Grade Colorectal Carcinoma Simatupang, Epistel Pangujian; Simadibrata, Marcellus; Gani, Rino Alvani; Budiani, Dyah Ratna
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 1, April 2012
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/13120122-7

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Background: Colorectal carcinoma is a common malignancy with the highest mortality rate. Epstein- Barr virus (EBV) as the virus that most commonly infect humans, also can infect the body in a latent and induce the occurrence of malignancy. This study aimed to prove an association between EBV virus infection with degree of colorectal carcinoma by examining the main EBV oncogene expression, namely Epstein-Barr nuclear antigen-1 (EBNA-1), in low grade and high grade colorectal carcinoma. Method: Cross-sectional study was performed in 14 colorectal cancer patients in Moewardi Hospital, Surakarta between July 2011 and January 2012. The biopsy specimens were stained for EBNA-1 expression using immunohistochemical technique. Statistical analysis was performed using T-test and Mann-Whitney by SPSS software version 19.0 for windows. Results: Of the 14 patients, there were 7 patients with low grade colorectal carcinoma and 7 patients with high grade colorectal carcinoma. EBNA-1 expression was found in epithelium of low grade and high grade colorectal carcinoma with p = 0.01; CI = -5.24-0.88. We also assessed the expression of EBNA-1 on lymphocytes B of low grade colorectal carcinoma and high grade colorectal carcinoma with p = 0.043. Conclusion: Significant differences in the expression of EBNA-1 was found in association with EBV infection either in low grade and high grade colorectal carcinoma. The role of EBNA-1 as tumor initiator needs to be elucidated further. Keywords: carcinoma colorectal, Epstein-Barr virus, EBNA-1
Mucus Thickness of the Gastric Mucosa and Helicobacter pylori Infection in Dyspeptic Patients with or without Diabetic Symptom Albertus, Jacobus; Rani, Abdul Aziz; Simadibrata, Marcellus; Abdullah, Murdani; Syam, Ari Fahrial; Gani, Rino Alvani; Subekti, Imam
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 3, December 2010
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/1132010112-120

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Background: Chronic Helicobacter pylori (H. pylori) infection affects the mechanisms of gastric mucosal protection. In patients with diabetes mellitus, data on the prevalence of H. pylori infection are scanty and contradictory. We have examined, using histological fixation technique, the thickness of the adherent mucus gel layer in the gastric mucosal and H. pylori infection in dyspeptic patients with or without diabetes. Method: A cross-sectional study was conducted in 86 dyspeptic patients consisted of 43 diabetics and 43 non-diabetics patients. In all cases, upper gastrointestinal endoscopy were performed, measurement of the gastric corpus and antral mucus thickness was carried out at the corpus and antral biopsy specimens were snap frozen and cryostat sections were stained using a hematoxyline eosin. One biopsy within 2 cm of the pylorus was examined for detection of H. pylori status by using polymerase chain reaction (PCR). Results: In all sections the mucus layer was continuous. At the gastric corpus and antrum, the mucus thickness of diabetic patients was thinner than non diabetic patients: 35.2 ± 2.2 µ m and 43.9 ± 3.8 µ vs 45.2 ± 2.5 µ m and 51.2 ± 2.2 µ m. The results were significantly different (p = 0.001). The difference of H. pylori prevalence between diabetics (52.5%) and nondiabetics patients (47.5%) was not significant (p = 0.67). Conclusion: This study shows a significant thinning of the adherent mucus gel layer both in diabetic patients and H. pylori-positive individuals. No difference has been found between patients with H. pylori infection and diabetes mellitus.   Keywords: mucus thickness, Helicobacter pylori infection, diabetic patient
Non-Invasive Assessment and Evaluation of Portal Hypertension in Patients with Liver Cirrhosis Marki, Indra; Gani, Rino Alvani; Simadibrata, Marcellus; Manan, Chudahman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 2, NUMBER 2, August 2001
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/22200121-28

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Ultrasonography examination is an one of examination that can be used to see the abnormality of portal vein system. The technology of ultrasonography examination has further developed especially after using of Doppler ultrasonography which could portray haemodynamic changes from portal vein in liver cirrhosis patient. From this examination we also could predict bleeding.    Keywords: liver cirrhosis, portal hypertension, doppler ultrasonography
Nutrition Management on Acute Pancreatitis Gunarsa, Ralph Girson; Gani, Rino Alvani; Syam, Ari Fahrial
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8, ISSUE 1, April 2007
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/81200716-19

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Pancreatitis is an inflammatory process in pancreas. Clinical manifestation of acute pancreatitis can be mild to severe. Mortality rate is high in severe acute pancreatitis. Etiology of acute pancreatitis generally remains obscured. Supportive management is important in acute pancreatitis. Nutrition is important part in acute pancreatitis. Patient should not be given enteral nutrition temporarily and meanwhile parenteral nutrition must provide sufficient amount of calories and nutritional requirements. Immune nutrition should also be considered. In mild acute pancreatitis, oral realimentation can be started in 3rd-7th day. In severe acute pancreatitis with prolonged fasting, gradual enteral nutrition via nasoenteral tube is recommended Keywords: nutrition, acute pancreatitis, enteral nutrition
Artificial Ascites in Radiofrequency Ablation for Liver Cancer Gani, Rino Alvani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 3 (2017): VOLUME 18, NUMBER 3, DECEMBER 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (359.311 KB) | DOI: 10.24871/1832017140-147

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Background: Radio Frequency Ablation (RFA) is one of the treatment modality for liver tumor either as primary tumor as well as secondary malignancy. Occasionally, a good ablation can’t be performed due to the tumor location. To assists the ablation in this particular case, some fluid can be deposited inside the abdomen which is called as artificial ascites. The aim of this study is to report and evaluate the method of artificial ascites in RFAMethod: This was a case series study consist of 19 consecutive patients that had been treated with ultrasound-guided RFA using artificial ascites from 2014 to 2017.Results: Artificial ascites was successfully performed in all 19 patients (100%) with total of 53 hepatocellular carcinoma (HCC) lesions in 34 RFA’s sessions and tumor size ranges from 10mm to 50mm. Most of the tumors were primary tumor (14/19). 9 patients had single tumor and 10 patients had multiple tumors and most of the tumor were located in segment 5 (14/53). Artificial ascites was performed using 5% dextrose in water (D/W) solution ranging from 500ml to 1500ml. No adverse effect occurred during and after the procedure.Conclusion: Percutaneous RFA using artificial ascites technique was safe and effective for treating HCC 
Hepatic Stellate Cells and Liver Disease Gani, Rino Alvani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 2 (2015): VOLUME 16, NUMBER 2, August 2015
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (379.342 KB) | DOI: 10.24871/162201565-66

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The Role of Specific Cellular Immune System in Chronic Hepatitis C Husna, Ihsanil; Akbar, Nurul; Gani, Rino Alvani; Budihusodo, Unggul; Sukmana, Nanang
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 5, ISSUE 1, April 2004
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/512004%p

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Hepatitis C virus is a RNA virus with very high speed replication. The clinical course of chronic hepatitis C is frequently asymptomatic like other hepatitis viruses. Infection of hepatitis virus will activate the immune system specifically as well as non-specifically. Mechanism of the immune system regulation is controlled by tissues consisting of antibodies cells and cytokines. In the process, all of the immune systems integrate and coordinate with the main agent-lymphocytes. Lymphocytes recognize antigens through the specific-surface antigen receptors. Following exposure to viral chronic hepatitis virus, viremia takes place within 1-2 weeks. In immuno-competent hosts, viremia will be preceded with the increase in transaminase enzyme and delayed seroconversion of antibodies will occur. Unlike other immunologic processes, these established antibodies are not protective in nature but serve only as the sign that someone has been infected by hepatitis C. In most cases of hepatitis C virus infection, this virus cannot be eradicated in the acute phase. Approximately 80-90% of acute infection progresses to be chronic infection and in 50% of the cases, there is an increase in transaminase enzyme that reveals that there is still liver cell damage. The degree of liver tissue damage in hepatitis depends on the number of virus infecting and the activity of cytotoxic T cells. Keywords: hepatitis C virus, humoral immune response,cellular immune response