Czeresna Heriawan Soejono
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Papilla Vaterƒs Tumor in Elderly: an Interdisciplinary Issue Tenda, Eric Daniel; Abdullah, Murdani; Harimurti, Kuntjoro; Wahyudi, Edy Rizal; Soejono, Czeresna Heriawan
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: 10.24871/1132010155-159

Abstract

Tumors of the papilla Vater are very rare. Papilla Vater’s tumors are benign or malignant tumors in the ampulla of Vater and periampullary region. Blockage of ampulla leads to the development of obstructive jaundice; intermittent cholangitis, epigastric discomfort and weight loss. Treatment possibilities include endoscopic ampulectomy, surgical transduodenal excision of tumors of the ampulla and pancreatoduodenectomy (PDE). Prognosis depends on histological typing of the tumor and their clinical stage. We report a case of papilla Vater’s tumor in elderly with comorbidities based on literature review. A 68-year-old female patient was referred for evaluation of intra and extra hepatic bile duct dilatation noted on abdominal ultrasonography. She complained of intermittent epigastric and right upper abdominal pain, with yellowish skin for two months. The laboratory findings showed leukocytosis, hyperbilirubinemia, abnormal liver function test, and high Ca 19-9. An endoscopic retrograde cholangiopancreatography (ERCP) revealed a distal obstruction caused by papilla Vater’s tumor. Abdominal computed tomography (CT) with contrast, revealed a dilated common bile duct and pancreatic duct. The histologic evaluation was highly suggestive for dysplasia. She is now on a schedule for a Whipple procedure. To make a true diagnosis and optimal treatment of papilla Vater’s tumor is multimodal. By doing a comprehensive geriatric assessment, with a careful modality selection, a Whipple procedure can be performed in elderly (65 years) safely. The post operative morbidity and mortality depends on their multi morbidity. Surgical, endoscopic, or radiologic biliary decompression; relief of gastric outlet obstruction; and adequate pain control may improve the quality of life but do not affect overall survival rate. By building a great interdisciplinary teamwork, the quality of life increased as follows.Keywords: papilla Vater tumor, elderly, Whipple procedure
Papilla Vaterƒs Tumor in Elderly: an Interdisciplinary Issue Eric Daniel Tenda; Murdani Abdullah; Kuntjoro Harimurti; Edy Rizal Wahyudi; Czeresna Heriawan Soejono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 3, December 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1132010155-159

Abstract

Tumors of the papilla Vater are very rare. Papilla Vater’s tumors are benign or malignant tumors in the ampulla of Vater and periampullary region. Blockage of ampulla leads to the development of obstructive jaundice; intermittent cholangitis, epigastric discomfort and weight loss. Treatment possibilities include endoscopic ampulectomy, surgical transduodenal excision of tumors of the ampulla and pancreatoduodenectomy (PDE). Prognosis depends on histological typing of the tumor and their clinical stage. We report a case of papilla Vater’s tumor in elderly with comorbidities based on literature review. A 68-year-old female patient was referred for evaluation of intra and extra hepatic bile duct dilatation noted on abdominal ultrasonography. She complained of intermittent epigastric and right upper abdominal pain, with yellowish skin for two months. The laboratory findings showed leukocytosis, hyperbilirubinemia, abnormal liver function test, and high Ca 19-9. An endoscopic retrograde cholangiopancreatography (ERCP) revealed a distal obstruction caused by papilla Vater’s tumor. Abdominal computed tomography (CT) with contrast, revealed a dilated common bile duct and pancreatic duct. The histologic evaluation was highly suggestive for dysplasia. She is now on a schedule for a Whipple procedure. To make a true diagnosis and optimal treatment of papilla Vater’s tumor is multimodal. By doing a comprehensive geriatric assessment, with a careful modality selection, a Whipple procedure can be performed in elderly (65 years) safely. The post operative morbidity and mortality depends on their multi morbidity. Surgical, endoscopic, or radiologic biliary decompression; relief of gastric outlet obstruction; and adequate pain control may improve the quality of life but do not affect overall survival rate. By building a great interdisciplinary teamwork, the quality of life increased as follows.Keywords: papilla Vater tumor, elderly, Whipple procedure
Length of Stay of Geriatric Patients with Gram-Negative Bacteremia: An Analytical Observation Soejono, Czeresna Heriawan
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 1
Publisher : UI Scholars Hub

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Abstract

Pengaruh Status Nutrisi terhadap Kesintasan 30 Hari Pasien Geriatri yang Dirawat di Rumah Sakit Lugito, Nata Pratama Hardjo; Soejono, Czeresna Heriawan; Wahyudi, Edy Rizal; Dewiasty, Esthika
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 3
Publisher : UI Scholars Hub

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Abstract

Pendahuluan: Dengan meningkatnya jumlah populasi usia lanjut, masalah kesehatan yang dialami juga semakin banyak, salah satunya malnutrisi. Studi di luar negeri menunjukkan malnutrisi pada pasien geriatri yang dirawat di rumah sakit menurunkan kesintasan. Pasien usia lanjut di Indonesia mempunyai karakteristik yang berbeda dengan pasien usia lanjut di luar negeri. Di Indonesia belum ada studi tentang status nutrisi pasien usia lanjut yang dirawat di rumah sakit dan pengaruhnya terhadap kesintasan. Penelitian ini bertujuan mengetahui pengaruh status nutrisi terhadap kesintasan 30 hari pasien usia lanjut yang dirawat di ruang rawat akut geriatri dan ruang rawat penyakit dalam rumah sakit. Metode: Penelitian kohort retrospektif, dengan pendekatan analisis kesintasan, dilakukan terhadap 177 pasien geriatri yang dirawat di ruang rawat akut geriatri dan ruang rawat penyakit dalam Rumah Sakit Cipto Mangunkusumo selama bulan April–September 2011. Data demografis, diagnosis medis, kadar albumin, indeks ADL Barthel, geriatric depression scale, status nutrisi dengan mini nutritional assessment (MNA) dikumpulkan, dan diamati selama 30 hari sejak mulai dirawat untuk melihat ada tidaknya mortalitas. Perbedaan kesintasan kelompok pasien dengan status nutrisi baik, berisiko malnutrisi dan malnutrisi ditampilkan dalam kurva Kaplan-Meier, diuji dengan uji Log-rank, serta analisis multivariat dengan Cox proportional hazard regression model untuk menghitung adjusted Hazard Ratio dan interval kepercayaan 95% terjadinya mortalitas 30 hari dengan memasukkan variabel-variabel perancu sebagai kovariat. Hasil: Kesintasan antara subyek yang status nutrisinya baik, berisiko malnutrisi dan malnutrisi ialah 94,7% dengan 89,0% dan 80,7%, namun perbedaan kesintasan 30 hari tak bermakna dengan uji Log-rank (p=0,106). Pada analisis multivariat didapatkan adjusted HR setelah penambahan variabel perancu sebesar 1,49 (IK 95% 0,29 – 7,77) untuk kelompok berisiko malnutrisi dan 2,65 (IK 95% 0,47 – 14,99) untuk kelompok malnutrisi dibandingkan dengan pasien nutrisi baik. Simpulan: Perbedaan kesintasan 30 hari pasien geriatri yang dirawat di rumah sakit yang menderita malnutrisi dan berisiko malnutrisi dibandingkan dengan status nutrisi baik pada awal perawatan belum dapat dibuktikan.