Harijono Achmad
Division of Gastroentero-Hepatology, Department of Internal Medicine University of Brawijaya/Dr. Saiful Anwar General Hospital, Malang

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Pengaruh Outer Membrane Protein Helicobacter Pylori terhadap Perubahan Histopatologi Mukosa Lambung dan S-IgA pada Mus musculus Outbred Balb/C

The Journal of Experimental Life Science Vol 1, No 1 (2011)
Publisher : Graduate School, University of Brawijaya

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Abstract

Helicobacter pylori (H. pylori) merupakan bakteri penyebab inflamasi mukosa lambung. Faktor virulensi bakteri berperan pada patogenesis penyakit infeksi oleh bakteri yang pada umumnya dapat merangsang sistem imun. Secara umum antigen yang merupakan faktor virulensi ini terdapat dalam Outer Membrane protein (OMP). Pemberian antigen secara per oral mampu menginduksi respon imun mukosal dengan cara membentuk Secretory IgA (S-IgA). Penelitian ini bertujuan untuk mengetahui pengaruh OMP H. pylori terhadap histopatologi mukosa lambung Mus musculus Outbred Balb/C dan peningkatan konsentrasi S-IgA pada Mus musculus Outbred Balb/C. Metode Penelitian yang digunakan adalah Post-test only kontrol group design. Bakteri H. pylori dikultur kemudian dilakukan isolasi OMP dengan menggunakan bahan n-Octyl-ß-D-Glucopyranoside (NOG) 0,5% melalui isolasi bertahap dan dilakukan SDS-PAGE. Setelah itu dilakukan coupling dengan CTB dan diberikan ke mencit secara intragastrik dengan dosis 100 μgml-1 setiap minggu. Pada akhir minggu ke-2, ke-4, ke-6 dan ke-8 dilakukan pemeriksaan histopatologis dan kadar S-IgA. Hasil penelitian menunjukkan terdapat perbedaan yang signifikan (p<0,05) pada perhitungan jumlah sel polimorfonuklear (PMN), jumlah sel Mononuklear (MN) dan kadar S-IgA antara kelompok kontrol dan perlakuan. Berdasarkan hasil penelitian dapat disimpulkan bahwa OMP H. pylori dapat menyebabkan kerusakan mukosa lambung menginduksi S-IgA Mus musculus Outbred Balb/C.Kata Kunci : Helicobacter pylori, n-Octyl-ß-D-Glucopyranoside, outer membrane protein (OMP)

A Dominant Alarm Symptom in Eldery Patient with Gastroduodenitis Erosive NSAID

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 3, December 2005
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Alarm symptoms for dyspepsia, such as anemia, evidence of gastrointestinal bleeding, weight loss, dysphagia, odynophagia and new onset at age > 50 years are associated with an increase risk of cancer. Most guidelines for the management of dyspepsia emphasize that patients with alarm symptoms should undergo aggressive evaluation including endoscopy. We reported a case of 65 years old female with several alarm symptoms that suggesting of malignancy, but endoscopy finding revealed gastroduodenitis erosive NSAID due to the pain killer herbal medicine use.   Keywords: melena, alarm symptoms, cancer, gastroduodenitis, NSAID

Comparing the Effects of Genistein, Silymarin, Lecithin on Improved Liver Necrosis Induced by Paracetamol Toxic Dose Administration in Rattus novergicus Wistar Strain

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

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Abstract

Background: Paracetamol, a widely used antipyretic and analgesic drug has been known for its side effect of liver toxicity resulting from free radical formation leading to necrotic hepatocytes. Oral genistein may reduce lipid peroxidation and increase total antioxidant capacity in liver. The present study was aimed to compare the effects of administering genistein, silymarin and lecithin on improved necrotic hepatocytes in Wistar rats fed with toxic dose of paracetamol. Method: An experimental study was conducted at the Laboratory of Physiology and Anatomical Pathology, University of Brawijaya between May and September 2011. About 48 male rats were categorized into 4 groups. The first group was treated with 600 mg/kgBW of oral paracetamol. The other groups were treated with 600 mg/kgBW paracetamol and additional 2 mg/kgBW genistein, 50 mg/kgBW silymarin or 100 mg/kgBW lecithin. ALT, AST, bile acid, malondialdehyde (MDA) and glutation (GSH) levels were measured and centrilobular necrosis observed by histopathological examination. Data were analyzed statistically by ANOVA. Results: AST and ALT level were significantly lower in genistein group (p = 0.004 and p = 0.001). The lowest bile acid level was found in the lecithin group (p = 0.025); while lowest MDA level was found in silymarin group (p = 0.009). The highest GSH level was found in lecithin group (p = 0.001). The lowest percentage of centrilobular necrosis was found in genistein group (p = 0.001). Conclusion: Genistein, silymarin and lecithin supplementation improve liver necrosis induced by toxic dose of paracetamol. Among them, genistein is the most significant agent. Keywords: genistein, silymarin, lecithin, paracetamol, hepatotoxicity

Cranial Metastasis as Initial Manifestation of Hepatocellular Carcinoma

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 1 (2014): VOLUME 15, NUMBER 1, April 2014
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Cranial metastasis from hepatocellular carcinoma (HCC) prior to diagnosis of the primary tumor withoutliver dysfunction is a very rare event. Cranial metastasis may be the sole initial presentation of HCC. Earlydiagnosis is essential in order to treat the primary disease. Cranial metastasis from HCC should be consideredin the differential diagnosis in patients with subcutaneous scalp mass and osteolytic defects on X-ray.A 55 year old female patient without known liver disease, presented with a palpable right occipital scalp mass. On head computed tomography (CT) scan, a tumor on right orbita wall, osteolytic skull and invasion to theright frontal lobe was observed. The histological diagnosis obtained from the biopsy was a poorly differentiatedcranial metastasis adenocarcinoma that was difficult to determine the origin. On positron emission tomography(PET) scan, there was a hypermetabolic mass around intra hepatal bile duct which suspicious primary cancer.The histological diagnosis obtained from the liver biopsy was appropriate with HCC grade II. The metastatictumor was removed via occipital craniectomy. She received a palliative course of external beam radiationtherapy to the right orbit. Then, she received symptomatic treatment and herbal medicine with cassava leavesfor the last three months. Evaluation of bone survey shows lytic lesion at calvaria and compression fractureat vertebrae thoracal 11-12 appropriate with metastasis process. According to Barcelona Clinic Liver Cancer(BCLC) criteria she suffered from HCC terminal stage D with average survival of about 4 months.Keywords: hepatocellular carcinoma, cranial metastasis, palliative treatment ABSTRAKMetastasis kranial dari karsinoma hepatoselular sebelum diagnosis tumor primer dengan hasil tanpa adanyagangguan fungsi hati adalah peristiwa sangat jarang ditemui. Metastasis pada tulang kranial dapat menjadi salah satu presentasi awal dari karsinoma hepatoseluler. Menegakkan diagnosis di awal sangat diperlukan untuk menentukan penatalaksanaan pada penyakit primer. Metastasis pada kranial dari karsinoma hepatoseluler harusdipertimbangkan pada kasus subkutan skalp tumor dan pada pasien dengan defek osteolitik pada gambaranradiologi.Seorang pasien perempuan usia 55 tahun, yang tidak didapatkan riwayat penyakit hati sebelumnya, datangdengan benjolan pada region oksipital kanan. Hasil computed tomography (CT) scan kepala didapatkantumor pada dinding orbita kanan. Dari pemeriksaan histologi menunjukkan metastasis dari adenokarsinomaberdiferensiasi buruk yang sulit ditentukan asalnya. Pada pemeriksaan positron emission tomography (PET)scan, terdapat massa hipermetabolik di sekitar duktus intrahepatik yang diduga sebagai tumor primer. Hasil biopsi menunjukkan karsinoma hepatoselular derajat 2. Dilakukan kraniektomi region oksipital pada penyebaran tumor dan dilanjutkan radioterapi paliatif pada region oksipital kanan. Selanjutnya pasien hanya mendapatkanterapi simtomatik dan daun singkong sebagai terapi herbal selama 3 bulan terakhir. Evaluasi survei tulangsetelah 3 bulan menunjukkan lesi litik pada kalvaria dan fraktur kompresi pada tulang vertebrae thorakal 11- 12. Menurut kriteria Barcelona Clinic Liver Cancer (BCLC) pasien tersebut masuk ke dalam stadium terminalD dengan rata-rata angka harapan hidup 4 bulan setelah terdiagnosis.Kata kunci: karsinoma hepatoseluler, metastasis kranial, terapi paliatif

Role of Phytopharmacy as Hepatoprotector in Chronic Hepatitis

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 3 (2014): VOLUME 15, NUMBER 3, December 2014
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: Hepatitis is one of the health problems in Indonesia that require special treatment, in line with the increase of morbidity and mortality rate of this disease. Complications of hepatitis include liver cirrhosis and hepatocellular carcinoma. Indonesia, as a tropical country, has many medicinal plants that act as hepatoprotector, a substance that can protect liver from toxic agent. Use of medicinal plants is still considered as controversial treatment because there is still lack of studies. Medicinal plants with mix composition of phytopharmacy, such as: Curcuma xanthorrhiza, Arcangelesia flava, Nigella sativa, and Kleinhovia hospita show potency as hepatoprotector. The objective of this study is to analyse the function of phytopharmacy as hepatoprotector in chronic hepatitis.Method: This study is a clinical trial performed in the Gastroenterology Department and Outpatient Clinic in Saiful Anwar Hospital in May-June 2013. Chronic hepatitis B or C patients who have received antiviral therapy with > 3 fold increase of the threshold value of transaminase level, were included in this study. In this study, patients consumed phytopharmacy tablet 3 times per day. After 7 days of treatment, patients’ serum transaminase levels (ALT and AST) were re-assessed. Statistical analysis of before and after treatment data was performed using Wilcoxon test and the result was significant with p < 0.05.Results: From 10 patients, the average age was 50.3 years old. Sixty percent (60%) of them were male, with 50% suffered from chronic hepatitis B and the other 50% suffered from chronic hepatitis C. From this study, decrement of alanine transaminase (ALT) and aspartate transaminase (AST) after seven days of treatment were 45.06%, with p = 0.007 and 48.63%, with p = 0.007, respectivelyConclusion: Phytopharmacy supplementation in chronic hepatitis can decrease serum transaminase, however further study is needed. Keywords: chronic hepatitis, phytopharmacy, ALT, AST, hepatoprotector 

Ensefalopati Hepatik pada Sirosis Hati: Faktor Presipitasi dan Luaran Perawatan di RSUD dr. Saiful Anwar Malang

Jurnal Kedokteran Brawijaya Vol 28, No 4 (2015)
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

Peran Th17 dalam patogenesis asma dan imunoterapi menjadi konsep dan paradigma terbaru. Imunoterapi merupakan salah satu manajemen di dalam asma dan memerlukan waktu yang lama sehingga sering mengakibatkan kegagalan terapi. Terapi adjuvant antara lain probiotik dan Nigella sativa diduga dapat meningkatkan efektifitas imunoterapi. Penelitian dilakukan untuk mengevaluasi efek pemberian imunoterapi, probiotik dan/atau Nigella sativa terhadap jumlah sel Th17, neutrofil dan skoring asma pada anak asma selama imunoterapi fase rumatan. Penelitian dilakukan pada 31 anak yang dikelompokkan secara acak yaitu imunoterapi plus plasebo atau imunoterapi plus Nigella sativa atau imunoterapi plus probiotik atau imunoterapi plus Nigella sativa plus probiotik selama 56 minggu. Pengukuran jumlah sel Th17 dan neutrofil dilakukan menggunakan flowcytometry setelah perlakuan. Asthma Control Test dilakukan untuk mengevaluasi gejala klinis. Data dianalisis menggunakan uji komparasi Anova One Way dan uji korelasi Pearson. Hasil menunjukkan tidak didapatkan perbedaan yang bermakna jumlah sel Th17 dan neutrophil antara kelompok perlakuan (p-value 0,199 dan 0,326). Asthma control test secara bermakna didapatkan perbedaan antara perlakuan imunoterapi plus probiotik dibandingkan imunoterapi saja. Skoring asma pada kelompok perlakuan imunoterapi plus probiotik adalah yang tertinggi (22,6). Jumlah sel Th17, neutrofil dan ACT menunjukkan hubungan yang lemah dan tidak bermakna secara statistik (r=-0,2) (p= 0,156). Jumlah sel Th17 dan neutrofil tidak didapatkan perbedaan yang bermakna. Skoring asma pada kelompok imunoterapi plus probiotik adalah yang tertinggi. Dapat disimpulkan tidak terdapat hubungan antara Th17, neutrofil dan skoring asma. Kata Kunci: Imunoterapi, neutrofil, Nigella sativa, probiotik, sel Th17, skoring asma

A Dominant Alarm Symptom in Eldery Patient with Gastroduodenitis Erosive NSAID

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 3, December 2005
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Original Source | Check in Google Scholar

Abstract

Alarm symptoms for dyspepsia, such as anemia, evidence of gastrointestinal bleeding, weight loss, dysphagia, odynophagia and new onset at age > 50 years are associated with an increase risk of cancer. Most guidelines for the management of dyspepsia emphasize that patients with alarm symptoms should undergo aggressive evaluation including endoscopy. We reported a case of 65 years old female with several alarm symptoms that suggesting of malignancy, but endoscopy finding revealed gastroduodenitis erosive NSAID due to the pain killer herbal medicine use.   Keywords: melena, alarm symptoms, cancer, gastroduodenitis, NSAID

Comparing the Effects of Genistein, Silymarin, Lecithin on Improved Liver Necrosis Induced by Paracetamol Toxic Dose Administration in Rattus novergicus Wistar Strain

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 | Original Source | Check in Google Scholar

Abstract

Background: Paracetamol, a widely used antipyretic and analgesic drug has been known for its side effect of liver toxicity resulting from free radical formation leading to necrotic hepatocytes. Oral genistein may reduce lipid peroxidation and increase total antioxidant capacity in liver. The present study was aimed to compare the effects of administering genistein, silymarin and lecithin on improved necrotic hepatocytes in Wistar rats fed with toxic dose of paracetamol. Method: An experimental study was conducted at the Laboratory of Physiology and Anatomical Pathology, University of Brawijaya between May and September 2011. About 48 male rats were categorized into 4 groups. The first group was treated with 600 mg/kgBW of oral paracetamol. The other groups were treated with 600 mg/kgBW paracetamol and additional 2 mg/kgBW genistein, 50 mg/kgBW silymarin or 100 mg/kgBW lecithin. ALT, AST, bile acid, malondialdehyde (MDA) and glutation (GSH) levels were measured and centrilobular necrosis observed by histopathological examination. Data were analyzed statistically by ANOVA. Results: AST and ALT level were significantly lower in genistein group (p = 0.004 and p = 0.001). The lowest bile acid level was found in the lecithin group (p = 0.025); while lowest MDA level was found in silymarin group (p = 0.009). The highest GSH level was found in lecithin group (p = 0.001). The lowest percentage of centrilobular necrosis was found in genistein group (p = 0.001). Conclusion: Genistein, silymarin and lecithin supplementation improve liver necrosis induced by toxic dose of paracetamol. Among them, genistein is the most significant agent. Keywords: genistein, silymarin, lecithin, paracetamol, hepatotoxicity

Cranial Metastasis as Initial Manifestation of Hepatocellular Carcinoma

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 1 (2014): VOLUME 15, NUMBER 1, April 2014
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Original Source | Check in Google Scholar

Abstract

Cranial metastasis from hepatocellular carcinoma (HCC) prior to diagnosis of the primary tumor withoutliver dysfunction is a very rare event. Cranial metastasis may be the sole initial presentation of HCC. Earlydiagnosis is essential in order to treat the primary disease. Cranial metastasis from HCC should be consideredin the differential diagnosis in patients with subcutaneous scalp mass and osteolytic defects on X-ray.A 55 year old female patient without known liver disease, presented with a palpable right occipital scalp mass. On head computed tomography (CT) scan, a tumor on right orbita wall, osteolytic skull and invasion to theright frontal lobe was observed. The histological diagnosis obtained from the biopsy was a poorly differentiatedcranial metastasis adenocarcinoma that was difficult to determine the origin. On positron emission tomography(PET) scan, there was a hypermetabolic mass around intra hepatal bile duct which suspicious primary cancer.The histological diagnosis obtained from the liver biopsy was appropriate with HCC grade II. The metastatictumor was removed via occipital craniectomy. She received a palliative course of external beam radiationtherapy to the right orbit. Then, she received symptomatic treatment and herbal medicine with cassava leavesfor the last three months. Evaluation of bone survey shows lytic lesion at calvaria and compression fractureat vertebrae thoracal 11-12 appropriate with metastasis process. According to Barcelona Clinic Liver Cancer(BCLC) criteria she suffered from HCC terminal stage D with average survival of about 4 months.Keywords: hepatocellular carcinoma, cranial metastasis, palliative treatment ABSTRAKMetastasis kranial dari karsinoma hepatoselular sebelum diagnosis tumor primer dengan hasil tanpa adanyagangguan fungsi hati adalah peristiwa sangat jarang ditemui. Metastasis pada tulang kranial dapat menjadi salah satu presentasi awal dari karsinoma hepatoseluler. Menegakkan diagnosis di awal sangat diperlukan untuk menentukan penatalaksanaan pada penyakit primer. Metastasis pada kranial dari karsinoma hepatoseluler harusdipertimbangkan pada kasus subkutan skalp tumor dan pada pasien dengan defek osteolitik pada gambaranradiologi.Seorang pasien perempuan usia 55 tahun, yang tidak didapatkan riwayat penyakit hati sebelumnya, datangdengan benjolan pada region oksipital kanan. Hasil computed tomography (CT) scan kepala didapatkantumor pada dinding orbita kanan. Dari pemeriksaan histologi menunjukkan metastasis dari adenokarsinomaberdiferensiasi buruk yang sulit ditentukan asalnya. Pada pemeriksaan positron emission tomography (PET)scan, terdapat massa hipermetabolik di sekitar duktus intrahepatik yang diduga sebagai tumor primer. Hasil biopsi menunjukkan karsinoma hepatoselular derajat 2. Dilakukan kraniektomi region oksipital pada penyebaran tumor dan dilanjutkan radioterapi paliatif pada region oksipital kanan. Selanjutnya pasien hanya mendapatkanterapi simtomatik dan daun singkong sebagai terapi herbal selama 3 bulan terakhir. Evaluasi survei tulangsetelah 3 bulan menunjukkan lesi litik pada kalvaria dan fraktur kompresi pada tulang vertebrae thorakal 11- 12. Menurut kriteria Barcelona Clinic Liver Cancer (BCLC) pasien tersebut masuk ke dalam stadium terminalD dengan rata-rata angka harapan hidup 4 bulan setelah terdiagnosis.Kata kunci: karsinoma hepatoseluler, metastasis kranial, terapi paliatif

Role of Phytopharmacy as Hepatoprotector in Chronic Hepatitis

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 3 (2014): VOLUME 15, NUMBER 3, December 2014
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Original Source | Check in Google Scholar

Abstract

Background: Hepatitis is one of the health problems in Indonesia that require special treatment, in line with the increase of morbidity and mortality rate of this disease. Complications of hepatitis include liver cirrhosis and hepatocellular carcinoma. Indonesia, as a tropical country, has many medicinal plants that act as hepatoprotector, a substance that can protect liver from toxic agent. Use of medicinal plants is still considered as controversial treatment because there is still lack of studies. Medicinal plants with mix composition of phytopharmacy, such as: Curcuma xanthorrhiza, Arcangelesia flava, Nigella sativa, and Kleinhovia hospita show potency as hepatoprotector. The objective of this study is to analyse the function of phytopharmacy as hepatoprotector in chronic hepatitis.Method: This study is a clinical trial performed in the Gastroenterology Department and Outpatient Clinic in Saiful Anwar Hospital in May-June 2013. Chronic hepatitis B or C patients who have received antiviral therapy with > 3 fold increase of the threshold value of transaminase level, were included in this study. In this study, patients consumed phytopharmacy tablet 3 times per day. After 7 days of treatment, patients’ serum transaminase levels (ALT and AST) were re-assessed. Statistical analysis of before and after treatment data was performed using Wilcoxon test and the result was significant with p < 0.05.Results: From 10 patients, the average age was 50.3 years old. Sixty percent (60%) of them were male, with 50% suffered from chronic hepatitis B and the other 50% suffered from chronic hepatitis C. From this study, decrement of alanine transaminase (ALT) and aspartate transaminase (AST) after seven days of treatment were 45.06%, with p = 0.007 and 48.63%, with p = 0.007, respectivelyConclusion: Phytopharmacy supplementation in chronic hepatitis can decrease serum transaminase, however further study is needed. Keywords: chronic hepatitis, phytopharmacy, ALT, AST, hepatoprotector