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KORELASI ANTARA DERAJAT PENYAKIT SIROSIS HATI BERDASARKAN KLASIFIKASI CHILD-TURCOTTE-PUGH DENGAN KONSENTRASI TROMBOPOIETIN SERUM Juliana, I Made; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Thrombocytopenia is one of the most frequent haematological abnormalities in patients with livercirrhosis. It is generally considered to be due to pooling and destruction of the platelets in enlarged spleenwhich was defined as hypersplenism. Portal decompression procedures, either by surgical shunts ortransjugular intrahepatic portosystemic shunt (TIPS) have not led to a consistent rise in thrombocytes count.With the discovery of the lineage specific cytokine thrombopoietin (TPO) in 1994, the missing link betweenhepatocelular function and thrombopoiesis was found. TPO is predominantly produced by the liver andconstitutively expressed by the hepatocytes. In liver cirrhosis, the damaged of liver cells reduced TPOproduction. This leads to reduce thrombopoiesis in the bone marrow and consquently causesthrombocytopenia. However, these two pathogeneses were still remained controversial results in previousstudy abroad.The aim of this study was to determine the correlation between disease severity of liver cirrhosisbased on Child-Turcotte-Pugh classification and serum thrombopoietin concentration. An analytic crosssectional study had been conducted among liver cirrhotic patients in Sanglah Hospital Denpasar. The subjectwere adult liver cirrhotic patients that were not on upper or lower gastro-intestinal tract bleeding, septiccodition/septic shock, without history of taking antithrombocytic drugs or received platelets transfusion inlast two weeks, and no history of thrombocytopenia due to primary haematologic disorders. Statisticalanalysis was done by Spearman’s test and multivariate linier regression model, with significant level p <0,05.The number of subjects were 39 liver cirrhotic patients consist of 28 (71.8%) men and 11 (28.2%)women. The median of age was 53 (25 – 68) years. We found subjetcs with Child-Turcotte-Pugh class A 3(7.7%), B 18 (46.2%) and C 18 (46.2%) respectively with the median of Child-Turcotte-Pugh score was 9 (6– 14). The range of serum TPO concentration was 1.10 – 224.60 pg/ml, median of serum TPO was 40.60pg/ml. The median of thrombocyte was 103 x 103/L with range of 30 – 729 x 103/L. Liver cirrhoticpatients with thrombocytopenia were 29 (74.4%), 41.0% of them with moderate thromboytopenia. We foundnegative correlation between Child-Turcotte-Pugh score and serum TPO concentration ( r = - 0.319; p = 0.048) but there was no correlation between Child-Turcotte-Pugh class and TPO concentration. (r = -0.303;p = 0.061). We found significant positif correlation between thrombocyte count and serum TPOconcentration also (r = 0.354; p = 0.027). Based on multivariate linier regression model, we did not findsignificant association between TPO concentration and Child-Turcotte-Pugh score (p = 0.153) orthrombocyte count (p = 0.208), respectively. Conclusion: there was no correlation between disease severityof liver cirrhosis based on Child-Turcotte-Pugh classification and serum thrombopoietin concentration.
KOMPLIKASI PASKA TRANSPLANTASI GINJAL Juliana, I Made; Sidharta Loekman, Jodi
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

Renal transplantation is the take over of kidney from healthy person and then be transplanted to the other person who hassevere and permanent kidney function disorder. Renal transplantation is the most effective treatment for terminal stage of chronickidney disease. The survival of patients who underwent renal transplantation depend on some factors including screening ofpatients, pretransplantation management, surgery technic and management of patients after renal transplantation. Complicationsafter renal transplantation devide to surgery complications and non surgery (medical) complications. Surgery complications aremayor complication such as bleeding and anaestesion drug effect and the other complications due to transplantation process.Medical complications are rejection (hyperacute, acute and chronic rejection), infection, cardiovascular disease, anemia,hypertension, diabetes mellitus, dislipidemia, hyperhomocysteinemia, malignancy, lymphoproliferative disease and psychologicaleffect. Rejection is the most important complication. If hyperacute rejection ocured, kidney transplant must be take over to avoidmore severe systemic inflammation respon. New generation of humanized IL-2 receptor antibody, daclizumab (zenapax) candecrease the incident of hyperacute rejection. Acute rejection can be treated with steroid, polyclonal antilymphocyte globulin,monoclonal antibody OKT3 and plasma exchange. Chronic rejection was difficult to treat. Immunosupresion agen have no muchrole because destroyed were occured. Prevention just to manage risk factors and then wait the other transplantation. For the othercomplications, the management based on etiology and the type of complication.