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Malang Respiratory Journal Department of Pulmonology Respiratory Medicine Universitas Brawijaya mrj@ub.ac.id
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Malang Respiratory Journal
Published by Universitas Brawijaya
ISSN : 27457842     EISSN : 27226492     DOI : https://doi.org/10.21776/ub.mrj
Malang Respiratory Journal is the official open-access journal of Department of Pulmonology Respiratory Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia. It publishes articles two times per year. It is a peer reviewed publication of Indonesian Pulmonology and Respiratory journals and accepting articles for publication from around the world. MRJ only publishes articles in the English version. The objective of this journal is publishing the selected clinical and basic research relevant to Pulmonology and Respiratory. It covers the following topics such as infection, thoracic oncology, asthma and COPD, interventional pulmonology and respiratory emergency, occupational and environmental pulmonology, and clinical immunology. It is an international journal dedicated to provide new information that could give a new insight for alternative solutions, diagnosis, therapy and prevention for researchers and practitioners in Pulmonology Respiratory Medicine.
Articles 22 Documents
Meningitis Tuberculous with Miliary Tuberculosis and Thoracic Vertebrae Level 11-12 Tumor showing Neurofibroma Patterns: A Case Report Wijayanto, Andi; Muktiati, Nunuk Sri; Bal’afif, Farhad; Rianawati, Sri Budhi
Malang Respiratory Journal Vol 1, No 1 (2019): The Many Faces of Respiratory Disease
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1183.161 KB) | DOI: 10.21776/ub.mrj.2019.001.01.2

Abstract

Background: Tuberculosis is an infectious disease that develop from systemic infection caused by bacterium Mycobacterium tuberculosis complex. Generally, M.tuberculosis spread from one person to another through nuclear droplet air transmission. Although TB has a lower transmission rate compared to another infectious disease, TB still become a global health problem. It is estimated that approximately one third of the world’s population is infected by tuberculosis. Every year it is estimated that there are nine million new cases and close to two million death cases caused by tuberculosis.Case: A 24-year-old female was admitted to the hospital complaining of could not move both of her legs and could not urinate. One month before admission, she was diagnosed with meningitis TB; miliary TB; and meningioma at thoracic vertebrae T11-12 based on physical examination, laboratory examination, Chest X-Ray, Head CT Scan without contrast, and thoracolumbal MRI. When admitted to the hospital, the patient already treated with Fixed Dose Combination of antituberculosis Drugs first category for one and a half month from Turen Primary Healthcare. Then the patient underwent bronchoscopy examination. The result of the anatomical pathology examination showed class two. Then the patient underwent a laminectomy surgery and tumor excision at thoracic vertebrae T11-12. The result of postoperative Anatomical Pathology examination showed a neurofibroma pattern. After surgery, the Physical Medicine and Rehabilitation Department placed thoracic lumbosacral orthoses (TLSO) to the patient. Postoperative evaluation up to three months showed that the patient’s general condition was quite good but still cannot move both of her legs and cannot urinate.
Provision of Gefitinib as Targeted Therapy in Lung Adenocarcinoma with EGFR Mutation and Brain Metastatic Widiasari, Komang Sri Rahayu
Malang Respiratory Journal Vol 1, No 1 (2019): The Many Faces of Respiratory Disease
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (684.418 KB) | DOI: 10.21776/ub.mrj.2019.001.01.3

Abstract

Adenocarcinoma is a malignant epithelial tumor with glandular differentiation or mucin production. Adenocarcinoma covers 30% of lung cancers in Europe and America. This report described a case of an unusual chronic headache since 3 years ago without any complementing symptom except for nausea. The primary tumor was detected with Thorax CT scan and confirmed by histopathology examination. Patient treated with gefitinib (1 x 250 mg) and showed a satisfying result. Gefitinib, as first-line therapy for patients with epidermal growth factor receptor ( EGFR) mutation, was effective and well-tolerated in this patient.
Tuberculosis Management in Renal Transplant Recipient Tantular, Rezki
Malang Respiratory Journal Vol 1, No 1 (2019): The Many Faces of Respiratory Disease
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2019.001.01.4

Abstract

Background: Tuberculosis (TB) is a major global health problem and South-East Asia was the leading contributor of TB cases globally. Treatment regimen of TB for an individual patient depends on multiple factors, and one of them was patient’s comorbidities. Comorbidities such as renal failure or concurrent use of immunosuppressant drugs post renal transplantation will influence pharmacological aspect of anti-tuberculosis drugs.Case: A 38-year-old male with a history of chronic renal failure who had undergone routine hemodialysis was diagnosed with pulmonary tuberculosis and was scheduled for a renal transplantation procedure. During the administration of anti-tuberculosis drugs in this patient, the physician mustconsider the kidney function, and possible drug interactions between anti-tuberculosis drugs especially rifampicin with immunosuppressant drugs used after renal transplantation. The initialregimen used in this patient was RHE which was followed by RH, but after using immunosuppressant drugs, rifampicin was replaced with moxifloxacin to avoid suboptimal effect of immunosuppressant drugs to prevent donor rejection, which is the biggest contributor ofmortality in transplant recipients in the first year post-transplantation.
Multilocular Thymic Cyst with Superior Cava Vein Syndrome Complication Widodo, Rahadi
Malang Respiratory Journal Vol 1, No 1 (2019): The Many Faces of Respiratory Disease
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (661.867 KB) | DOI: 10.21776/ub.mrj.2019.001.01.5

Abstract

Background: Thymic cysts are uncommon, only comprising 1-3% of all mediastinal masses and 5-28% of the mediastinal cysts. Usually benign entities representing remnants of persistent thymopharyngeal duct or cystic degeneration of Hassall corpuscles. Unilocular thymic cysts are probably of congenital origin (derived from embryologic thymic tissue) and without inflammation, while multilocular thymic cysts are predominantly acquired, resulting from inflammation or neoplasm, have thick walls and contain dark-brown fluid.Case: A 51-year-old male with complaint of pain on his neck, shoulder, and right chest, accompanied with swelling of right arm and vena ecstasis on his neck and chest wall. The patient was diagnosed as anterior mediastinal tumor with complication vena cava superior syndrome. He underwent surgical treatment with approach median sternotomy and wide excision of tumor. Histopathologic examinaton of the tumor reveals a multilocular thymic cyst. Pneumonia occured after surgery and could be overcome by aggresive combination antibiotic treatment. There was right pleural effusion and right phrenic nerve paralysis after surgery. In this patient, also there is a mass in right posterior pleural cavity which has not been removed by surgical treatment.
Myastehenia Gravis is Caused by the Thymoma in Anterosuperior Mediastinum Sinistra and Posteroinferior Sinistra Irfan, Ferdy Syah; Djajalaksana, Susanthy
Malang Respiratory Journal Vol 1, No 1 (2019): The Many Faces of Respiratory Disease
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (933.802 KB) | DOI: 10.21776/ub.mrj.2019.001.01.6

Abstract

Background: Thymoma is the most common thymus tumor; it covers 30% of the anterior mediastinum mass in adult. Almost half of thymoma does not present with any symptom and is found by accident. In 40% of patients have symptom of myasthenia gravis; other symptoms include chest pain, symptoms of bleeding and compression to other mediastinum’s structures. Ninety percent of thymoma is located in anterior mediastinum.Case: A 42-year-old woman came to Saiful Anwar Hospital with a complaint of difficulty in swallowing since three months before admission. We performed physical examination and chest X-ray AP’ and the result was within normal limit. In USG examination, there was no abnormality. From the laboratory examination, we found leucocytosis and from the CT-scan imaging, we found pocketed pleural effusion sinistra at the postero-inferior part.Based on these findings, we diagnosed (pre-operation diagnosis) this patient as anterosuperior mediastinum tumor: suspect thymoma. The pulmonologist consulted to Surgical Department for surgery. The surgeon performed sternotomy-tumor excision. The result from the vries coup and histopathogical examination was thymoma. FOB after the surgery showed an edema at the right vocal cord (post-extubation). Post-operative chest X-ray showed no mass in antero-superior mediastinum.
2018-2019 Antimicrobial Resistance Pattern in Bacterial Pneumonia at Dr. Soedarsono Hospital Pasuruan Susanto, Felicia; Purnamawati, Catur Elvi; Riasari, Devvi
Malang Respiratory Journal Vol 2, No 01 (2020): Shape the Curves
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (904.451 KB) | DOI: 10.21776/ub.mrj.2020.001.01.2

Abstract

Pneumonia is the ninth most common disease in dr. Soedarsono Pasuruan Region General Hospital. The resistance of Klebsiella pneumoniae to third-generation Cephalosporins and Streptococcus pneumonia to Penicillin were the topics discussed on World Health Organization’s (WHO) global report for antimicrobial resistance. This study purpose is to analyze the microbial pattern and antimicrobial resistance of bacterial pneumonia from sputum culture. This is a descriptive retrospective study with a total of 59 requests for sputum culture which included a clinical diagnosis of pneumonia. There are 37 male (63%) and 22 female (37%) with the most age group was adult (18-59 years) 39 people (66%) included in this study. Gram-negative bacteria are more common as the cause of pneumonia than gram-positive. Gram-negative bacteria that caused pneumonia in this study are Klebsiella pneumoniae (25.4%), Acinetobacter baumannii (15.3%), dan Enterobacter cloacae complex (15.3%). Gram-positive are Staphylococcus haemolyticus (11.9%), Staphylococcus aureus (8.5%), and Staphylococcus epidermidis (8.5%). The most antimicrobial resistance in gram-negative bacteria is Ampicillin (94.3%) and gram-positive bacteria are Benzylpenicillin (94.1%). The number resistance of Penicillin in gram-negative and gram-positive was high; therefore empirical therapy for pneumonia still uses broad-spectrum antimicrobial like beta-lactam.
The Role of Surgical Resection as A Salvage Therapy and Immunohistochemical Stain to Confirm Mediastinal Yolk Sac Tumor Eka Agustina, Dwi Rosa; Pratiwi, Suryanti Dwi; Retnani, Diah Prabawati; Isharanto, Artono; Erawati, Rachma Dini
Malang Respiratory Journal Vol 2, No 01 (2020): Shape the Curves
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (800.64 KB) | DOI: 10.21776/ub.mrj.2020.002.01.3

Abstract

Background: Mediastinal germ cell tumors are uncommon, representing less than 1% of all malignancies. They mostly occur in young men after puberty and have a poor prognosis with over all long term survival rate 42%. Case Report: We reported a case report in Saiful Anwar Malang Hospital, Indonesia, a young man, 26 years old with an anterior mediastinum tumor and VCSS The CT scan of the chest showed an anterosuperior mediastinal mass which compress the superior vena cava. The result from transthoracic FNAB with USG guidance showed an extragonadal germ cell tumor which resemble an Embryonal Carcinoma from mediastinum. The AFP serum level was elevated. Patient underwent a radiotherapy and a surgical debulking. The biopsy showed an Endodermal Sinus Tumor (Yolk Sac). Immunohistochemical stain for cytokeratin was positive in the tumor cells while stain for CD30 was negative. These were confirming the diagnosis of primary mediastinal yolk sac tumor. Patient received a combination chemotherapy for a total 6 cycles.Conclusion: Some procedures like biopsy, tumor marker, immunohistochemical stain, could differentiate the subtype of mediastinal germ cell tumor. The multimodality treatment by combining chemotherapy with surgical therapy or radiotherapy could increase the survival outcome of patients.
Well Differentiated B3 Thymoma complicated with Vena Cava Superior Syndrome undergo Debulking and Chemotherapy Semara Putra, Wayan Wahyu; Noor Chozin, Iin; Wantry, Kenty; Isharanto, Artono; Erawati, Rachma Dini
Malang Respiratory Journal Vol 2, No 01 (2020): Shape the Curves
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2020.002.01.4

Abstract

Background: Thymoma is a rare neoplasm. This incident is comparable to 390 new cases reported per year. Genetic factors are believed to be one of the factors of B3 thymoma and thymus carcinoma. Multimodality of thymoma therapy (surgery, radiation and chemotherapy) gives better results.Case Report: Mr A, 29 years old, with initial diagnosis of stage IV thymoma (according to Masaoka) with SVKS then undergo debulking, followed by chemotherapy with a regimen of Cisplatin + Vincristin, Cyclophospamid, Doxorubicin, Prednison every 21 days as much as 6 times. Subjective responses indicated by reduced complaints of chest pain and loss of swelling of the right arm. Semisubjective response indicated by increase of body weight. Objective response is progressive, so can be continued with second line chemotherapy or radiotherapy.Conclusion: The prognosis of patient with well differentiated thymic carcinoma stadium iv (thymoma b3) complicated with vena cava superior syndrome was poor because of the objective response of the chemotherapy was progressive, and the relapse case was higher.
Successful Therapy on Patients with Yolksac and Embrional Carcinoma by Surgery and Chemotherapy Prasetya, Fahmi Adhi; Djajalaksana, Susanthy; Retnani, Diah Prabawati; Isharanto, Artono; Normahayu, Indrastuti; Okta, Shinta
Malang Respiratory Journal Vol 2, No 01 (2020): Shape the Curves
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2020.002.01.5

Abstract

Background: Malignant mixed germ cell tumors account for 13-25% of all non seminoma germ cell tumors, almost all cases were found in males (85%), increased in the third decade, and had an average survival rate of 40-45%. With modern management the average 5-year survival rate can be over 80%.Case Report: We reported a case report in Saiful Anwar Malang Hospital, Indonesia, a young man, 26 years old with an malignant epithelial tumor derived from mediastinal or lung. The CT scan of the chest showed an lobulated solid mass of iso-hipodens on the anterior superior mediastinum, mass encompassing the aortic arch, left pulmonalis artery, subclavian artery. The result from transthoracic FNAB with USG guidance showed an malignant epithelial tumor derived from mediastinal or lung, impression of an adeno squamous carcinoma. The AFP, LDH, and NSE serum level was elevated. Patient underwent a surgical sternotomy and tumor debulking. The biopsy showed an malignant mixed germ cell tumor (yolksac and embrional carcinoma). These were confirming the diagnosis of malignant mixed germ cell mediastinal tumor (yolksac and embrinonal carcinoma). Patient received a combination bleomycin, etoposid, cisplatin 3 series chemoteraphy  and evaluated.Conclusion: Some procedures like biopsy, tumor marker, could differentiate the subtype of mediastinal germ cell tumor. The multimodality treatment by combining surgical therapy (surgical sternotomy and tumor debulking) with chemotherapy could increase the survival rate of patients.
Immunocytochemistry as a Diagnostic Procedure of Pleural Mesothelioma Trimurtini, Asih; Astuti, Triwahju; Yudhanto, Hendy Setyo; Erawati, Dini Rachma
Malang Respiratory Journal Vol 2, No 02 (2020)
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (795.153 KB) | DOI: 10.21776/ub.mrj.2020.002.02.2

Abstract

Background: Mesothelioma is a primary malignant tumor arising from the mesothelial surface of the pleura, peritoneal, tunica vaginalis, and pericardium. Most cases of mesothelioma originate from the pleura. Most patients have a history of asbestos exposure. A common diagnostic problem is distinguishing mesothelioma from adenocarcinoma since both tumors invade the pleura. Immunocytochemistry of calretinin and TTF-1 can be used to establish the diagnosis of mesothelioma.Case: Male, 56 years old presented with chest pain, shortness of breath, cough, and weight loss since 5 months before hospitalization. The patient had a history of occupational exposure to asbestos for 30 years. The movement and breath sounds were decreased as well as dull upon percussion at the right chest. A chest X-ray revealed a right lung tumor with pleural effusion. Thorax CT scan suggested pleural mass in right hemithorax, infiltration to intercostal muscles, and destruction of the 7th right rib, right perihilar lymphadenopathy, right pleural effusion, and liver nodules according to mesothelioma T4N1M1 Stage IV. Infiltrative stenting of the right and inferior lobe of the right lung, infiltrative and obstructive stenting of the medius lobe suggestive of a chronic malignancy and inflammation were found on FOB. Cytologic examination of pleural fluid, sputum, and Washing-and-brushing of FOB were a class II (no malignant cells). USG-guided transthoracic FNAB revealed adenocarcinoma with differential diagnosis of mesothelioma. Immunocytochemistry with calretinin showed positive results and TTF-1 showed a negative result. These confirmed the diagnosis of pleural mesothelioma T4N1M1 Stage IV. The patient showed a stable response from carboplatin/gemcitabine treatment.Keyword : Mesothelioma, Immunocytochemistry, TTF-1, Calrenitin

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