Jurnal Respirasi adalah jurnal yang dikelola oleh Departemen Pulmonologi dan Ilmu Kedokteran Respirasi Fakultas Kedokteran Universitas Airlangga. Jurnal ini telah terbit berkala sejak 2015 dengan 3 kali penerbitan tiap tahun (Januari, Mei dan September). Phone: +6281249340825 Address: Sekretariat: SMF Paru Lt. 3 RSUD Dr.Soetomo Jl.Prof.Dr.Moestopo 6-8 Surabaya e-Mail : respirasi@journal.unair.ac.id Website: https://e-journal.unair.ac.id/JR
Diffusion capacity is useful for measuring ability of pulmonary microcirculation to transfer oxyg... more Diffusion capacity is useful for measuring ability of pulmonary microcirculation to transfer oxygen and carbon dioxide from alveoli to capillaries. Physiological examination of diffusion is a continuation of physiological examination of ventilation. Diffusion capacity is measured by DLCO (Diffusing capacity for Carbon Monoxide). Measurement of oxygen diffusion capacity directly is very difficult so that indirect methods are used using carbonmonoxide (DLCO). Diffusion capacity of oxygen is equivalent to DLCO multiplied by 1.23. Normal value of DLCO is 20-30 ml/minute mmHg. Some factors that affect DLCO are Hb levels, COHb in smokers, and alveolar volume. Some techniques for measuring DLCO include Steady-state, Three-equation Single-breath, Nitrogen Washout, and Intra-breath DLCO. This test is indicated in pulmonary parenchymal disease (pulmonary fibrosis, asbestosis, sarcoidosis, interstitial lung disease), cystic fibrosis, pulmonary hypertension, and pulmonary bleeding. DLCO is incr...
Background: Pleural effusion is the most common complication of pulmonary tuberculosis (TB). Some... more Background: Pleural effusion is the most common complication of pulmonary tuberculosis (TB). Some coexist with secondary infection could worsen clinical presentation as empyema. The incidence of pleural effusion in the early stage of empyema due to TB infection is about 31%. Somehow, untreated empyema increased in-hospital mortality. Case: A woman with unregulated diabetes mellitus was referred with organized empyema. The etiology of empyema is based on a specific process of TB infection with the ADA value of empyema fluid was 128 mg/dl. We decided to perform decortication with the result loculated empyema and bronchopleural fistula 2 cm in the inferior lobe of the right lung. The patient did not recover well. Unfortunately, fluidopneumothorax was found on a chest CT scan with contrast. Thoracotomy was performed and another bronchopleural fistula was found which length was about 1 cm in superior lobe of the right lung. Discussion: The worsening condition of the patient was caused by...
Background: Aspergilloma is a fungus ball (misetoma) that occurs because there is a cavity in the... more Background: Aspergilloma is a fungus ball (misetoma) that occurs because there is a cavity in the parenchyma due to previous lung disease. This fungus ball can move inside the cavity but does not invate the cavity wall. The presence of fungus ball causes recurrent hemoptysis. Case: We present a 45-year-old female patient with left lung Aspergilloma. Diagnosis of Aspergilloma was based on histopathology from FNAB CT guiding of left pulmonary which showed Aspergillus. Patient was treated with left superior lobe lobectomy at the hospital. The examination result of anatomical patology obtained from lung tissue was aspergillosis, from GeneXpert examination lung tissue showed positive MTB with rifampisin sensitive. Post-operative condition of the patient was stable, surgical wound improved, took off drain patient. There were clinical improvements after the surgery. Discussion: Diagnosis of Aspergilloma was based on clinical, radiology, and microbiology. Aspergilloma with severe symptoms (...
Metastasis is the ability of cells to escape from the primary tumor, then enter the circulation t... more Metastasis is the ability of cells to escape from the primary tumor, then enter the circulation to the distant tissue and form a secondary tumor. There are hemodynamic hypothesis (anatomical) and seed and soil hypothesis (molecular recognition). Tumor cells spread through several ways: percontinuitatum, lymphogen, hematogenous, transluminal, transcelomic, and iatrogenic. The stages of the metastasis process include: detachement, invasion, intravasation, circulation, extravasation, and angiogenesis. Predilection of lung cancer metastasis often happens in the brain, bones, liver, and adrenal glands. The spread of lung cancer metastasis to the brain, bone, and liver occurs hematogenously. Adrenal glands metastasis ipsilateral occurs lymphatically, while contralateral occurs hematogenously. Lung cancer is often diagnosed at an advanced stage, because in the early stage it is often asymptomatic. Metastasis of lung cancer to distant organs is the most cause of lung cancer deaths.
Background: Aspiration of a tracheobronchial foreign body is a serious and fatal event. Progress ... more Background: Aspiration of a tracheobronchial foreign body is a serious and fatal event. Progress in terms of prevention, first aid, and endoscopic technology, caused a decline of almost 20% of deaths from foreign body aspiration that occurred in the United States. Statistically, the percentage of foreign body aspirations based on their respective location is: 5% hypopharynx, 12% larynx-trachea, and 83% bronchus. Most cases of foreign body aspiration occur in children aged <15 years old; about 75% of foreign body aspirations occur in children aged 1-3 years. The female-to-male ratio is 1.4:1. Case: A 11-year-old boy swallowed needles while playing flashlight about 2 hours before coming to Pulmonary Emergency Room of Dr. Soetomo General Hospital. Discussion: Chest X-ray examination found a shadow of metal density projected in the right lung. Fiber optic bronchoscopy (FOB) was performed for diagnostic and therapeutic indication to see the presence of a foreign body in the airway and...
Background: Silicosis is a fibrosis in the lung caused by inhalation, retention, and reaction to ... more Background: Silicosis is a fibrosis in the lung caused by inhalation, retention, and reaction to crystalline silica. The prevalence rate is potentially increasing throughout the world. Cases of bilateral spontaneous pneumothorax and transaminitis due to complications of silicosis are very rare. In this case, the patient was presented with bilateral secondary spontaneous pneumothorax as well as in the development of the diagnosis of silicosis, liver dysfunction, and pneumonia. Case: A 36-year-old male was admited to hospital with shortness of breath, the patient was once stone artisans for 7 years, rarely using PPE. Bilateral pneumothorax was established based on the results of clinical and radiological examinations. HRCT showed that it supported silicosis, left fluidopneumothorax, and right pneumothorax. Bronchoscopy was not possible due to the incompatible conditions and subsequently the patient was examined for silica levels from both plueral fluid with significant pleural silica....
Background: Asthma is a heterogenous disease composed of various phenotype. Chronic airway inflam... more Background: Asthma is a heterogenous disease composed of various phenotype. Chronic airway inflammation are fundamental features of asthma. The main treatment of asthma is corticosteroid. The administration of inhaled corticosteroids will reduce the inflammatory process in asthma. Even with adequate inhaled corticosteroid treatment, there are still patients who develop symptoms with lower asthma control test score. Periostin is an extracellular matrix protein as the best single systemic biomarker for assessing tissue eosinophilia, airway remodeling in uncontrolled asthma. The objective of this study was to examine whether serum periostin is correlated with ACT in asthmatic patients. Methods: This research was an observational analytical with cross sectional design conducted in outpatient clinic Dr. Soetomo General Hospital Surabaya for 3 months. In total, we found 40 asthmatic patients who were qualified to the inclusion and exclusion criteria as the research samples. The questionn...
Background: Multidrug-resistant pulmonary tuberculosis (MDR-TB) is a major health problem worldwi... more Background: Multidrug-resistant pulmonary tuberculosis (MDR-TB) is a major health problem worldwide. Prompt diagnosis is necessary for insuring appropriate therapy to lower morbidity and mortality, as well as to prevent disease transmission. Determination of drug-resistance patterns through microbiological examination is sometimes challenging, especially when the sputum acid-fast bacilli smear is negative. Therefore, it is worthwhile to investigate whether there may be radiographic patterns suggesting MDR-TB infection. The objective of this study was to evaluate the radiographic features of MDR-TB. Methods: From September 2015 to March 2018, 167 patients with microbiologically proven MDR-TB were enrolled in the study. All radiographs were obtained before the patients received MDR-TB chemotherapy regimen. Posterior-anterior chest radiography was performed using digital radiography system (Hitachi Radnext50 500mAs) and retrospectively reviewed as digital raw data. Results: Based on se...
Background; Tuberculosis (TB) is a contagious disease caused by Mycobacterium tuberculosis (Acid-... more Background; Tuberculosis (TB) is a contagious disease caused by Mycobacterium tuberculosis (Acid-Fast Bacilli/AFB) that still be a world burden. Extra Pulmonary TB occurred when there were infection and development of Mycobacterium tuberculosis outside lungs, which about 10% cases was Milliary TB. There will be reported case with Lung TB New Case coexistence with Multiple Extra Pulmonary TB. Case; A female, 39 y.o., came to the Soetomo General Teaching Hospital with chief complaint body weakness since 12 months ago following with cough, decrease of appetite, decrease of body weight, low grade fever, and night sweating. The cough was on and off, not productive, and didn`t improve with usual therapy. Her other complaint were painless mass at the left supraclavicular area, swollen and pain at the right knee, and pain at the backbones. Patient had subsequently given Anti Tuberculosis Drugs (ATD) with Streptomycin injection based on clinical judgement. Discussion; In several cases, Prim...
Lung cancer is the leading cause of cancer death in Asia. In Indonesia, it contributes the highes... more Lung cancer is the leading cause of cancer death in Asia. In Indonesia, it contributes the highest number to cancer incidence in male and is ranked fifth in female cancer incidence. Determinated attempts have been delivered to eliminate cancer with chemotherapy being the most important management strategy for advance stage lung cancer. As most medicines come with side effects, so does chemotherapy. Beside killing the target cells, the cytotoxic compound of cancer drug may also seriously alter normal cells. Therefore, formidable toxic effect of chemotherapy to normal tissue becomes the main problem, which clinicians should consider. Myelotoxicity is one of the most common chemotherapy-induced adverse events. It takes place in bone marrow-producing regions causing netropenia, thrombocytopenia and anemia. Each of those cytopenias requires separate intervention. This article will review the physiology of hematopoiesis, pathophysiology of cytopenias, and current guidelines and recommend...
Background. Barium aspiration is one of rare major complication of esophagography. Aspiration pne... more Background. Barium aspiration is one of rare major complication of esophagography. Aspiration pneumonia occurs about 40% without clinical symptom and can cause 30% of dead. Case. A female 62 years old choked a mount of barium when swallowing barium liquid in esophagography procedure. There was ronkhi on lower left haemithorax and granuler pattern on left paracardial impressed the rest of barium in chest x-ray photo. Patient suffered symptom of infection in eight days evaluation with infiltrate and rest of barium from chest x-ray photo. Microbiology examination of bronchus lavage founded pathogen microbe Burcholderia Gladioli and Pseudomonas and containing 1,22 mg/L of barium. Discussion. Barium aspiration can occur in esophagography procedure in extreme age. Chest x-ray and Computed Tomography can be used as primer tool to diagnose and evaluate barium aspiration which imaging hiperdens pattern due to barium with high atomic number (56). Prognosis of aspiration barium can be affected...
Background: Malignant tumors arising from peripheral nerves or displaying differentiation along t... more Background: Malignant tumors arising from peripheral nerves or displaying differentiation along the lines of the various elements of the nerve sheath are referred to Malignant peripheral nerve sheath tumors (MPNST) and also called malignant schwannomas or neurofibrosarcomas. The common sites of involvement are head, neck, extremities and thorax. This case was discussed due to its rare incidence, namely less than 5% of soft tissue malignant tumor. The overall five year survival rate is approximately 50% in patients with resectable tumor. Case: We report a case of MPNST arising from mediastinum, the patient was a male, 41-years-old, with chief complaint are chest pain and mass in the back. Contrast enhanced chest CT Scan showed a solid mass (10.02 × 6.97 × 10.53 cm) in the right side of the posterior mediastinum. On microscopic examination with hematoxylin eosin imunostaining, of the mass on mediastinum showed typical features of MPNST, which were positive for S-100 imunostaining. Bas...
Pulmonary function is an examination to measure lung volume function using spirometry. Tests with... more Pulmonary function is an examination to measure lung volume function using spirometry. Tests with spirometry to detect abnormalities associated with respiratory distress. Spirometry examination is not only to determine the diagnosis but also to assess the severity of obstruction, restriction, and the effects of treatment. Spirometry examination is a test to measure the volume of a person’s static and dynamic lungs with a spirometer tool. Dynamic lung spirometry consists of Forced vital capacity (FVC), Forced expiratory volume (FEVT), Forced expiratory flow200-1200 / FEF 200-1200, Forced expiratory flow25% -75% / FEF 25% -75%, Peak expiratory flow rate / PEFR, Maximum voluntary ventilation / MVV / MBC, FEV1 / FVC Ratio. Ventilation disorders consist of: restriction and obstruction disorders. Restriction is a disorder of lung development by any cause. In obstruction disorder, it shows a decrease in velocity of expiratory flow and normal vital capacity. FEV values, which are widely use...
Background; Liquid silicone is a synthetic polymer incorporating oxygen and the semimetallic elem... more Background; Liquid silicone is a synthetic polymer incorporating oxygen and the semimetallic element silicon. It is widely used in plastic and reconstructive surgery as it displays little change in physical characteristicswith temperature and age, is poorly immunogenic, and is not carcinogenic. Case; We report a case of a 27-year-old woman presented to the hospital with the chief complain progressive shortness of breath, pleuritic chest pain, productive cough, hemoptysis and fever after liquid silicone injections to the mammae for cosmetic augmentation. Physical examination: tachycardia, tachypneu, hypertermia and diffuse rhonchi throughout the lungs. Abnormalities laboratory tests gave leuchositosis, granulositosis, increasing trassaminase serum, D-dimer elevation, Arterial blood gas analysis results respiratory disstres tipe 1. Chest radiograph showed difus bilateral infiltrates, CT angiography was negative for an acute embolus but demonstrated infiltrates in superior lobus...
Background: Prevalence of multi-drug resistant tuberculosis (MDR-TB) is increased by the time. In... more Background: Prevalence of multi-drug resistant tuberculosis (MDR-TB) is increased by the time. In Indonesia, there were an estimated 1.9% of new cases and 12% of previously treated cases. Protection against Mycobacterium tuberculosis is dependent on Th1 cell CD4+ that produced pro-inflammatory cytokines such as IFN-γ and TNF-α. T cell regulators (Tregs) produced IL-10 as anti- inflammatory cytokine is against the function of those pro-inflammatory cytokines. It is believed that immune suppression is responsible for MDR-TB. The previous study showed impaired Th1 responses and enhanced regulatory T-cell levels in circulatory blood of MDR- TB patients. The study of IL-10 represented anti-inflammation cytokine as immune suppression never been conducted in Indonesia. Objective: To analyze relationship between level of interleukin-10 and Multi-drug resistant tuberculosis. Methods: The study was conducted at the outpatient department of MDR-TB and DOTS of Dr. Soetomo hospital in Surab...
Background: Tuberculosis (TB) is a disease which has long been known and is still a cause of deat... more Background: Tuberculosis (TB) is a disease which has long been known and is still a cause of death in the world. The emergece of the drug resistance in TB treatment, particularly Multi drug-Resistance Tuberculosis (MDR TB) become a significant public health problem in many countries. The diagnosis of MDR TB based on culture results. In some cases radiographic feature with severe abnormalities consideres as MDR TB. From this phenomenon, there is no research that connects the resistance pattern of first line ATD with chest x-ray feature in patients with MDR TB. Methods: The research design are analytical observational with cross-sectional study conducted in outpatient clinic of MDR TB in Dr. Soetomo hospital. Subjects were patients who are following a theraphy program in outpatient clinic of MDR TB in Dr. Soetomo hospital from 2012 to 2014 who meet the inclusion and exclusion criteria. A total of 65 patients. Result: the result of this study showed that of all patterns of resistance, ...
Background: Indonesia is the third highest country of Tuberculosis (TB) prevalence world wide. Be... more Background: Indonesia is the third highest country of Tuberculosis (TB) prevalence world wide. Beside resistances, factor that being a burden for control TB is comorbidities, such as Diabetes Mellitus Type 2 (DMT2). This research aimed to determine the Nutritional Status of Multi Drug Resistance Tuberculosis (MDR-TB) with DMT2 Patients. Methods: This is a descriptive retrospective study observing Nutritional Status of MDR-TB with DMT2 patients based on gender, age, weight, height, and Fasting Blood Glucose (FBG) registered since January,1st –December, 31th 2016 in RSUD Dr. Soetomo Surabaya. Results: Out of 42 Samples, there are 20 mens and 22 womens suffer MDR-TB with DMT2. The Nutritional Status of Women is Normal (28.57 %) and Man is Underweight (16.6 %). Based on the age of patients, 51-60 years is the highest frequency. The mean of Body Mass Index (BMI) from all age categories are Normal, except 31-40 years. The mean of height is 159.95 cm and weight is 52.88 kg. In FBG’s catego...
Background: Primary mediastinal yolk sac tumor is an extremely rare and highly malignant tumors o... more Background: Primary mediastinal yolk sac tumor is an extremely rare and highly malignant tumors occuring in children and young adult. They are more common in men. The most common symptoms on ptesentation were dyspnea, chest pain, cought, fever, night sweat, or weight loss. Primary mediastinal tumor are considered to have poor prognosis. Case: A 18- year-old man who presented with shorthness of breath, chest pain, fever, night sweat, and generalized weakness. He had no significant surgical, familiy or social history. The chest X-Ray and computed tomographic scan of the chest showed a large anterior mediasti nal mass. The serum level of alpha- fetoprotein and β-HCG was elevated. The histological examination revealed the finding of yolk sac tumor. This supported the diagnosis of yolk sac tumor. The patient received a combination chemotherapy consisting of cisplatin, etoposide and bleomycin every 3 weeks for total of 4 cycles. Conclusions: Primary mediastinal yolk sac tumor is a rare tu...
Background: Primary resistance is the resistance that occurs in patients who have never received ... more Background: Primary resistance is the resistance that occurs in patients who have never received treatment OAT or had ever received treatment OAT is less than 1 month. The incidence of primary MDR in Central Java in 2006 2.07%. Extrapulmonary TB about 15-20% of all cases of TB, and TB lymphadenitis is the highest form (35% of all extrapulmonary TB). Patients with decreased immune systems (SLE) can increase the incidence of TB. Research in Spain get 6x higher TB incidence in patients with SLE. Case: We present the case of 19 year old woman SLE who received treatment for 11 months whose came with shortness of breath and chronic cough since 2 month prior to admission. In physical examination we found right and left submandibula lymphonodi enlargement as solid, slightly mobile nodule with diameter 3 cm. Chest X ray showed lung inflammation which suspicion of specific process and minimal left pleural effusion, and concluded as pulmonary TB. FNAB confirmed lymphadenitis TB with gra...
Background: Pleural effusion is a frequent complication of advanced stage are obtained in patient... more Background: Pleural effusion is a frequent complication of advanced stage are obtained in patients with malignancy. Shortness of breath at rest and decreased exercise tolerance are major functional limitations for patients with cancer who develop extensive pleural effusion. Pleural fluid drainage followed by a pleurodesis can reduce the symptoms of shortness of breath and prevent pleural fluid reaccumulation. Unfortunately, pleurodesis attempts fail in 10 to 40% of patients with recurrent pleural fluid and shortness of breath. Low pleural fluid pH can be used as a marker for increased metabolic activity of tumors in intrapleura, and is associated with increasing tumor, and can predict the failure of pleurodesis. The purpose of this study was to prove association between low pleural fluid pH value with failure pleurodesis in patients pleural effusion malignancy. Method: This is an observational study with cross sectional design that is the analysis conducted at Hospital Dr Soetomo in...
Diffusion capacity is useful for measuring ability of pulmonary microcirculation to transfer oxyg... more Diffusion capacity is useful for measuring ability of pulmonary microcirculation to transfer oxygen and carbon dioxide from alveoli to capillaries. Physiological examination of diffusion is a continuation of physiological examination of ventilation. Diffusion capacity is measured by DLCO (Diffusing capacity for Carbon Monoxide). Measurement of oxygen diffusion capacity directly is very difficult so that indirect methods are used using carbonmonoxide (DLCO). Diffusion capacity of oxygen is equivalent to DLCO multiplied by 1.23. Normal value of DLCO is 20-30 ml/minute mmHg. Some factors that affect DLCO are Hb levels, COHb in smokers, and alveolar volume. Some techniques for measuring DLCO include Steady-state, Three-equation Single-breath, Nitrogen Washout, and Intra-breath DLCO. This test is indicated in pulmonary parenchymal disease (pulmonary fibrosis, asbestosis, sarcoidosis, interstitial lung disease), cystic fibrosis, pulmonary hypertension, and pulmonary bleeding. DLCO is incr...
Background: Pleural effusion is the most common complication of pulmonary tuberculosis (TB). Some... more Background: Pleural effusion is the most common complication of pulmonary tuberculosis (TB). Some coexist with secondary infection could worsen clinical presentation as empyema. The incidence of pleural effusion in the early stage of empyema due to TB infection is about 31%. Somehow, untreated empyema increased in-hospital mortality. Case: A woman with unregulated diabetes mellitus was referred with organized empyema. The etiology of empyema is based on a specific process of TB infection with the ADA value of empyema fluid was 128 mg/dl. We decided to perform decortication with the result loculated empyema and bronchopleural fistula 2 cm in the inferior lobe of the right lung. The patient did not recover well. Unfortunately, fluidopneumothorax was found on a chest CT scan with contrast. Thoracotomy was performed and another bronchopleural fistula was found which length was about 1 cm in superior lobe of the right lung. Discussion: The worsening condition of the patient was caused by...
Background: Aspergilloma is a fungus ball (misetoma) that occurs because there is a cavity in the... more Background: Aspergilloma is a fungus ball (misetoma) that occurs because there is a cavity in the parenchyma due to previous lung disease. This fungus ball can move inside the cavity but does not invate the cavity wall. The presence of fungus ball causes recurrent hemoptysis. Case: We present a 45-year-old female patient with left lung Aspergilloma. Diagnosis of Aspergilloma was based on histopathology from FNAB CT guiding of left pulmonary which showed Aspergillus. Patient was treated with left superior lobe lobectomy at the hospital. The examination result of anatomical patology obtained from lung tissue was aspergillosis, from GeneXpert examination lung tissue showed positive MTB with rifampisin sensitive. Post-operative condition of the patient was stable, surgical wound improved, took off drain patient. There were clinical improvements after the surgery. Discussion: Diagnosis of Aspergilloma was based on clinical, radiology, and microbiology. Aspergilloma with severe symptoms (...
Metastasis is the ability of cells to escape from the primary tumor, then enter the circulation t... more Metastasis is the ability of cells to escape from the primary tumor, then enter the circulation to the distant tissue and form a secondary tumor. There are hemodynamic hypothesis (anatomical) and seed and soil hypothesis (molecular recognition). Tumor cells spread through several ways: percontinuitatum, lymphogen, hematogenous, transluminal, transcelomic, and iatrogenic. The stages of the metastasis process include: detachement, invasion, intravasation, circulation, extravasation, and angiogenesis. Predilection of lung cancer metastasis often happens in the brain, bones, liver, and adrenal glands. The spread of lung cancer metastasis to the brain, bone, and liver occurs hematogenously. Adrenal glands metastasis ipsilateral occurs lymphatically, while contralateral occurs hematogenously. Lung cancer is often diagnosed at an advanced stage, because in the early stage it is often asymptomatic. Metastasis of lung cancer to distant organs is the most cause of lung cancer deaths.
Background: Aspiration of a tracheobronchial foreign body is a serious and fatal event. Progress ... more Background: Aspiration of a tracheobronchial foreign body is a serious and fatal event. Progress in terms of prevention, first aid, and endoscopic technology, caused a decline of almost 20% of deaths from foreign body aspiration that occurred in the United States. Statistically, the percentage of foreign body aspirations based on their respective location is: 5% hypopharynx, 12% larynx-trachea, and 83% bronchus. Most cases of foreign body aspiration occur in children aged <15 years old; about 75% of foreign body aspirations occur in children aged 1-3 years. The female-to-male ratio is 1.4:1. Case: A 11-year-old boy swallowed needles while playing flashlight about 2 hours before coming to Pulmonary Emergency Room of Dr. Soetomo General Hospital. Discussion: Chest X-ray examination found a shadow of metal density projected in the right lung. Fiber optic bronchoscopy (FOB) was performed for diagnostic and therapeutic indication to see the presence of a foreign body in the airway and...
Background: Silicosis is a fibrosis in the lung caused by inhalation, retention, and reaction to ... more Background: Silicosis is a fibrosis in the lung caused by inhalation, retention, and reaction to crystalline silica. The prevalence rate is potentially increasing throughout the world. Cases of bilateral spontaneous pneumothorax and transaminitis due to complications of silicosis are very rare. In this case, the patient was presented with bilateral secondary spontaneous pneumothorax as well as in the development of the diagnosis of silicosis, liver dysfunction, and pneumonia. Case: A 36-year-old male was admited to hospital with shortness of breath, the patient was once stone artisans for 7 years, rarely using PPE. Bilateral pneumothorax was established based on the results of clinical and radiological examinations. HRCT showed that it supported silicosis, left fluidopneumothorax, and right pneumothorax. Bronchoscopy was not possible due to the incompatible conditions and subsequently the patient was examined for silica levels from both plueral fluid with significant pleural silica....
Background: Asthma is a heterogenous disease composed of various phenotype. Chronic airway inflam... more Background: Asthma is a heterogenous disease composed of various phenotype. Chronic airway inflammation are fundamental features of asthma. The main treatment of asthma is corticosteroid. The administration of inhaled corticosteroids will reduce the inflammatory process in asthma. Even with adequate inhaled corticosteroid treatment, there are still patients who develop symptoms with lower asthma control test score. Periostin is an extracellular matrix protein as the best single systemic biomarker for assessing tissue eosinophilia, airway remodeling in uncontrolled asthma. The objective of this study was to examine whether serum periostin is correlated with ACT in asthmatic patients. Methods: This research was an observational analytical with cross sectional design conducted in outpatient clinic Dr. Soetomo General Hospital Surabaya for 3 months. In total, we found 40 asthmatic patients who were qualified to the inclusion and exclusion criteria as the research samples. The questionn...
Background: Multidrug-resistant pulmonary tuberculosis (MDR-TB) is a major health problem worldwi... more Background: Multidrug-resistant pulmonary tuberculosis (MDR-TB) is a major health problem worldwide. Prompt diagnosis is necessary for insuring appropriate therapy to lower morbidity and mortality, as well as to prevent disease transmission. Determination of drug-resistance patterns through microbiological examination is sometimes challenging, especially when the sputum acid-fast bacilli smear is negative. Therefore, it is worthwhile to investigate whether there may be radiographic patterns suggesting MDR-TB infection. The objective of this study was to evaluate the radiographic features of MDR-TB. Methods: From September 2015 to March 2018, 167 patients with microbiologically proven MDR-TB were enrolled in the study. All radiographs were obtained before the patients received MDR-TB chemotherapy regimen. Posterior-anterior chest radiography was performed using digital radiography system (Hitachi Radnext50 500mAs) and retrospectively reviewed as digital raw data. Results: Based on se...
Background; Tuberculosis (TB) is a contagious disease caused by Mycobacterium tuberculosis (Acid-... more Background; Tuberculosis (TB) is a contagious disease caused by Mycobacterium tuberculosis (Acid-Fast Bacilli/AFB) that still be a world burden. Extra Pulmonary TB occurred when there were infection and development of Mycobacterium tuberculosis outside lungs, which about 10% cases was Milliary TB. There will be reported case with Lung TB New Case coexistence with Multiple Extra Pulmonary TB. Case; A female, 39 y.o., came to the Soetomo General Teaching Hospital with chief complaint body weakness since 12 months ago following with cough, decrease of appetite, decrease of body weight, low grade fever, and night sweating. The cough was on and off, not productive, and didn`t improve with usual therapy. Her other complaint were painless mass at the left supraclavicular area, swollen and pain at the right knee, and pain at the backbones. Patient had subsequently given Anti Tuberculosis Drugs (ATD) with Streptomycin injection based on clinical judgement. Discussion; In several cases, Prim...
Lung cancer is the leading cause of cancer death in Asia. In Indonesia, it contributes the highes... more Lung cancer is the leading cause of cancer death in Asia. In Indonesia, it contributes the highest number to cancer incidence in male and is ranked fifth in female cancer incidence. Determinated attempts have been delivered to eliminate cancer with chemotherapy being the most important management strategy for advance stage lung cancer. As most medicines come with side effects, so does chemotherapy. Beside killing the target cells, the cytotoxic compound of cancer drug may also seriously alter normal cells. Therefore, formidable toxic effect of chemotherapy to normal tissue becomes the main problem, which clinicians should consider. Myelotoxicity is one of the most common chemotherapy-induced adverse events. It takes place in bone marrow-producing regions causing netropenia, thrombocytopenia and anemia. Each of those cytopenias requires separate intervention. This article will review the physiology of hematopoiesis, pathophysiology of cytopenias, and current guidelines and recommend...
Background. Barium aspiration is one of rare major complication of esophagography. Aspiration pne... more Background. Barium aspiration is one of rare major complication of esophagography. Aspiration pneumonia occurs about 40% without clinical symptom and can cause 30% of dead. Case. A female 62 years old choked a mount of barium when swallowing barium liquid in esophagography procedure. There was ronkhi on lower left haemithorax and granuler pattern on left paracardial impressed the rest of barium in chest x-ray photo. Patient suffered symptom of infection in eight days evaluation with infiltrate and rest of barium from chest x-ray photo. Microbiology examination of bronchus lavage founded pathogen microbe Burcholderia Gladioli and Pseudomonas and containing 1,22 mg/L of barium. Discussion. Barium aspiration can occur in esophagography procedure in extreme age. Chest x-ray and Computed Tomography can be used as primer tool to diagnose and evaluate barium aspiration which imaging hiperdens pattern due to barium with high atomic number (56). Prognosis of aspiration barium can be affected...
Background: Malignant tumors arising from peripheral nerves or displaying differentiation along t... more Background: Malignant tumors arising from peripheral nerves or displaying differentiation along the lines of the various elements of the nerve sheath are referred to Malignant peripheral nerve sheath tumors (MPNST) and also called malignant schwannomas or neurofibrosarcomas. The common sites of involvement are head, neck, extremities and thorax. This case was discussed due to its rare incidence, namely less than 5% of soft tissue malignant tumor. The overall five year survival rate is approximately 50% in patients with resectable tumor. Case: We report a case of MPNST arising from mediastinum, the patient was a male, 41-years-old, with chief complaint are chest pain and mass in the back. Contrast enhanced chest CT Scan showed a solid mass (10.02 × 6.97 × 10.53 cm) in the right side of the posterior mediastinum. On microscopic examination with hematoxylin eosin imunostaining, of the mass on mediastinum showed typical features of MPNST, which were positive for S-100 imunostaining. Bas...
Pulmonary function is an examination to measure lung volume function using spirometry. Tests with... more Pulmonary function is an examination to measure lung volume function using spirometry. Tests with spirometry to detect abnormalities associated with respiratory distress. Spirometry examination is not only to determine the diagnosis but also to assess the severity of obstruction, restriction, and the effects of treatment. Spirometry examination is a test to measure the volume of a person’s static and dynamic lungs with a spirometer tool. Dynamic lung spirometry consists of Forced vital capacity (FVC), Forced expiratory volume (FEVT), Forced expiratory flow200-1200 / FEF 200-1200, Forced expiratory flow25% -75% / FEF 25% -75%, Peak expiratory flow rate / PEFR, Maximum voluntary ventilation / MVV / MBC, FEV1 / FVC Ratio. Ventilation disorders consist of: restriction and obstruction disorders. Restriction is a disorder of lung development by any cause. In obstruction disorder, it shows a decrease in velocity of expiratory flow and normal vital capacity. FEV values, which are widely use...
Background; Liquid silicone is a synthetic polymer incorporating oxygen and the semimetallic elem... more Background; Liquid silicone is a synthetic polymer incorporating oxygen and the semimetallic element silicon. It is widely used in plastic and reconstructive surgery as it displays little change in physical characteristicswith temperature and age, is poorly immunogenic, and is not carcinogenic. Case; We report a case of a 27-year-old woman presented to the hospital with the chief complain progressive shortness of breath, pleuritic chest pain, productive cough, hemoptysis and fever after liquid silicone injections to the mammae for cosmetic augmentation. Physical examination: tachycardia, tachypneu, hypertermia and diffuse rhonchi throughout the lungs. Abnormalities laboratory tests gave leuchositosis, granulositosis, increasing trassaminase serum, D-dimer elevation, Arterial blood gas analysis results respiratory disstres tipe 1. Chest radiograph showed difus bilateral infiltrates, CT angiography was negative for an acute embolus but demonstrated infiltrates in superior lobus...
Background: Prevalence of multi-drug resistant tuberculosis (MDR-TB) is increased by the time. In... more Background: Prevalence of multi-drug resistant tuberculosis (MDR-TB) is increased by the time. In Indonesia, there were an estimated 1.9% of new cases and 12% of previously treated cases. Protection against Mycobacterium tuberculosis is dependent on Th1 cell CD4+ that produced pro-inflammatory cytokines such as IFN-γ and TNF-α. T cell regulators (Tregs) produced IL-10 as anti- inflammatory cytokine is against the function of those pro-inflammatory cytokines. It is believed that immune suppression is responsible for MDR-TB. The previous study showed impaired Th1 responses and enhanced regulatory T-cell levels in circulatory blood of MDR- TB patients. The study of IL-10 represented anti-inflammation cytokine as immune suppression never been conducted in Indonesia. Objective: To analyze relationship between level of interleukin-10 and Multi-drug resistant tuberculosis. Methods: The study was conducted at the outpatient department of MDR-TB and DOTS of Dr. Soetomo hospital in Surab...
Background: Tuberculosis (TB) is a disease which has long been known and is still a cause of deat... more Background: Tuberculosis (TB) is a disease which has long been known and is still a cause of death in the world. The emergece of the drug resistance in TB treatment, particularly Multi drug-Resistance Tuberculosis (MDR TB) become a significant public health problem in many countries. The diagnosis of MDR TB based on culture results. In some cases radiographic feature with severe abnormalities consideres as MDR TB. From this phenomenon, there is no research that connects the resistance pattern of first line ATD with chest x-ray feature in patients with MDR TB. Methods: The research design are analytical observational with cross-sectional study conducted in outpatient clinic of MDR TB in Dr. Soetomo hospital. Subjects were patients who are following a theraphy program in outpatient clinic of MDR TB in Dr. Soetomo hospital from 2012 to 2014 who meet the inclusion and exclusion criteria. A total of 65 patients. Result: the result of this study showed that of all patterns of resistance, ...
Background: Indonesia is the third highest country of Tuberculosis (TB) prevalence world wide. Be... more Background: Indonesia is the third highest country of Tuberculosis (TB) prevalence world wide. Beside resistances, factor that being a burden for control TB is comorbidities, such as Diabetes Mellitus Type 2 (DMT2). This research aimed to determine the Nutritional Status of Multi Drug Resistance Tuberculosis (MDR-TB) with DMT2 Patients. Methods: This is a descriptive retrospective study observing Nutritional Status of MDR-TB with DMT2 patients based on gender, age, weight, height, and Fasting Blood Glucose (FBG) registered since January,1st –December, 31th 2016 in RSUD Dr. Soetomo Surabaya. Results: Out of 42 Samples, there are 20 mens and 22 womens suffer MDR-TB with DMT2. The Nutritional Status of Women is Normal (28.57 %) and Man is Underweight (16.6 %). Based on the age of patients, 51-60 years is the highest frequency. The mean of Body Mass Index (BMI) from all age categories are Normal, except 31-40 years. The mean of height is 159.95 cm and weight is 52.88 kg. In FBG’s catego...
Background: Primary mediastinal yolk sac tumor is an extremely rare and highly malignant tumors o... more Background: Primary mediastinal yolk sac tumor is an extremely rare and highly malignant tumors occuring in children and young adult. They are more common in men. The most common symptoms on ptesentation were dyspnea, chest pain, cought, fever, night sweat, or weight loss. Primary mediastinal tumor are considered to have poor prognosis. Case: A 18- year-old man who presented with shorthness of breath, chest pain, fever, night sweat, and generalized weakness. He had no significant surgical, familiy or social history. The chest X-Ray and computed tomographic scan of the chest showed a large anterior mediasti nal mass. The serum level of alpha- fetoprotein and β-HCG was elevated. The histological examination revealed the finding of yolk sac tumor. This supported the diagnosis of yolk sac tumor. The patient received a combination chemotherapy consisting of cisplatin, etoposide and bleomycin every 3 weeks for total of 4 cycles. Conclusions: Primary mediastinal yolk sac tumor is a rare tu...
Background: Primary resistance is the resistance that occurs in patients who have never received ... more Background: Primary resistance is the resistance that occurs in patients who have never received treatment OAT or had ever received treatment OAT is less than 1 month. The incidence of primary MDR in Central Java in 2006 2.07%. Extrapulmonary TB about 15-20% of all cases of TB, and TB lymphadenitis is the highest form (35% of all extrapulmonary TB). Patients with decreased immune systems (SLE) can increase the incidence of TB. Research in Spain get 6x higher TB incidence in patients with SLE. Case: We present the case of 19 year old woman SLE who received treatment for 11 months whose came with shortness of breath and chronic cough since 2 month prior to admission. In physical examination we found right and left submandibula lymphonodi enlargement as solid, slightly mobile nodule with diameter 3 cm. Chest X ray showed lung inflammation which suspicion of specific process and minimal left pleural effusion, and concluded as pulmonary TB. FNAB confirmed lymphadenitis TB with gra...
Background: Pleural effusion is a frequent complication of advanced stage are obtained in patient... more Background: Pleural effusion is a frequent complication of advanced stage are obtained in patients with malignancy. Shortness of breath at rest and decreased exercise tolerance are major functional limitations for patients with cancer who develop extensive pleural effusion. Pleural fluid drainage followed by a pleurodesis can reduce the symptoms of shortness of breath and prevent pleural fluid reaccumulation. Unfortunately, pleurodesis attempts fail in 10 to 40% of patients with recurrent pleural fluid and shortness of breath. Low pleural fluid pH can be used as a marker for increased metabolic activity of tumors in intrapleura, and is associated with increasing tumor, and can predict the failure of pleurodesis. The purpose of this study was to prove association between low pleural fluid pH value with failure pleurodesis in patients pleural effusion malignancy. Method: This is an observational study with cross sectional design that is the analysis conducted at Hospital Dr Soetomo in...
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