Laurentius Lesmana
Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta.

Published : 13 Documents
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The role of splanchnic vasoconstrictor in decreasing peripheral vasodilatation to reduce ascites formation of liver cirrhosis

Medical Journal of Indonesia Vol 6, No 4 (1997): October-December
Publisher : Faculty of Medicine Universitas Indonesia

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Abstract

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Efficacy and Safety of In-Asia-manufactured Interferon alpha-2b in Combination with Ribavirin for Therapy of Naïve Chronic Hepatitis C Patients: A Multicenter, Prospective, Open-Label Trial

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 1, April 2009
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: An open-label, multi center and non-comparative study was conducted to evaluate the efficacy and safety of a more affordable in-Asia-manufactured interferon á-2b product in combination with ribavirin to treat naïve chronic hepatitis C patients. Method: Thirty chronic naïve hepatitis C patients were treated with in-Asia-manufactured interferon   a-2b subcutaneously 3 MIU thrice weekly and ribavirin 800-1,200 mg daily for 48 weeks. Follow-up was done until 24 weeks after the end of treatment. Efficacy was assessed by examining serologic and biochemical parameters at pre and post-treatment. Safety was assessed by evaluating clinical symptoms and laboratory parameters. Results: The virological response and sustained virological response rates of all Hepatitis C Virus (HCV) genotypes were 83.3% and 76.7% respectively. Post-treatment, 80% patients had significant alanine transaminase (ALT) decreased into normal level and remained normal in 76.7% patients at 24th week follow up period. At that time, the ALT level and sustained virological response were lower in HCV genotypes 1 and 4 than in non-1 and non-4 genotypes. The most frequent adverse event was flu-like syndrome. Conclusion: The efficacy and safety study on combination therapy of in-Asia-manufactured interferon a-2b and ribavirin has shown a good result based on the current standard of interferon alpha and ribavirin combination therapy. Keywords: interferons, combination drug therapy, chronic hepatitis C, treatment efficacy, safety

Obstructive Jaundice Due to Bile Duct Tumor

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 5, ISSUE 1, April 2004
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

We reported here a rare case of a 62 year old male patient with obstructive jaundice due to bile duct tumor. The main clinical features were yellowish eye and skin, followed by pruritus and clay-colored stool. Ultrasonography showed common bile duct dilatation and without evidence of stones. Computed Tomography Scan of upper abdomen showed a mass which were thought of head of pancreas origin. Endoscopic Retrograde Cholangio Pancreatograph revealed tight narrowing of the distal bile duct to a malignant tumor. A stent was inserted to allow biliary drainage. A surgical plan for billio digestive anastomosis was rejected by the patient and family. Keywords: bile duct tumor, CT scan abdomen, ERCP

Prevalence and Distribution of Anemia Risk Factor in Patient with Chronic Hepatitis C who Has Combination therapy of Interferon Alpha and Ribavirin

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: Interferon alfa and ribavirin combination therapy is one of effective standard therapy for chronic hepatitis C (CHC.) However, anemia is a common side effect of this therapy that patients have to reduce or discontinue ribavirin therapy. But ribavirin dose reduction or discontinuation can reduce the effectivity of the therapy. Hence, it is important to know the prevalence of anemia and to determine the factors associated with anemia. Objective: To know the prevalence of anemia and some risk factors associated with anemia caused by the combination therapy in chronic hepatitis C. Method: Sixty one of CHC patients who received combination therapy were included in this study. The study used cross sectional design and data were obtained by measured complete blood count on 8th week of therapy. Result: Subjects 47 (77%) were males, 14 (23%) were females with mean age 38.9 years. Subjects had genotype 1 and 4 were 23 (71.9%) and 44 (72.1%) subjects received 1,000 mg ribavirin. Prevalence of anemia was found to be 52.5%. On multivariate analysis, only pretreatment hemoglobin concentration < 14 g/dl was found to be the risk factor of anemia. Conclusion: Prevalence of anemia was 52.5%. Pretreatment hemoglobin concentration < 14 g/dl was only found to be the risk factors of anemia. Although age > 50 years or female were not found to be the risk factor of anemia but patient with these risk factors should be carefully monitored. Intervention to prevent anemia should be considered to these patients. Eight subjects from 32 anemia patients had ribavirin dose reduction, and no patient had discontinuation treatment on 8th week of therapy.   Keywords: chronic hepatitis C, IFN-alfa- RIB combination therapy, risk factors of anemia

Prolonged QTc-Interval in Liver Cirrhotic Patient: Prevalence and Its Relationship with Severity of Liver Dysfunction

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 5, ISSUE 1, April 2004
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: The aim of the study was to determine the prevalence of prolonged QTc -interval and it’s relationship with the severity of liver dysfunction in liver cirrhotic patient in the outpatient clinic of Hepatology, Dr. Cipto Mangunkusumo General National Hospital Methods: cross sectional study. Eighty one subjects was recruited and being followed as a consecutive non random sampling. The patient was divided according to the modified Child-Pugh classification and undergo to the ECG examination (with minimal 2 leads have measured QT-interval; one of these is II, aVL, V2 or V3 lead). Result: The prolonged QTc-interval prevalence in liver cirrhotic patient was found in 55 subjects (67,9%) with the mean 448.6 msec (SD = 28,9; 95% CI = 442.2 - 454.8). Using the Forward Stepwise Method in multivariate analysis to the independent variables (p < 0.05) was found only the modified Child-Pugh classification had strongly correlation with the prolonged QTc-interval (OR = 11.2; 95% CI = 3.57-35.47; p = 0.000) Conclusion: The prolonged QTc-interval prevalence in liver cirrhotic patient is 67.9%. The prolonged QTc-interval were strongly associated with the severity of liver dysfunction. Keywords: The prolonged QTc-interval, liver dysfunction, liver cirrhosis

Normal Histological Appearances of the Duodenum Jejunum and Terminal Ileum in Indonesian People

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8, ISSUE 3, December 2007
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: There is no literature specifically on the normal appearance of small bowel mucosa amongst Indonesians. Diseases of the small bowel can cause chronic diarrhea. Chronic diarrhea is common in Indonesia. Methods: Thirty seven patients with normal stomach and small bowel on endoscopic and histopathologic examination were included in this study. Biopsies were taken from the duodenal bulb, descending part of duodenum, jejunum and terminal ileum. The scoring Method for the inflammatory cells (lymphocytes, plasma cells and eosinophil cells) was carried out using the symbols 0 (negative), +, ++, and +++. Results: The mean height of the villi of the duodenal bulb was 265.00 ± 81.89 mm, the mean height of the crypts of the duodenal bulb was 196.67 ± 56.01 mm, the mean width of the villi were 59.14 ± 74.14 mm. The mean height of the villi of the duodenum pars descendens was 317.27 ± 99.66 mm and the mean height of the crypts was 218.79 ± 84.66 mm. The mean height of the villi of the jejunum was 341.76 ± 76.06 mm and the mean height of the crypts was 189.41 ± 58.15 mm. The mean height of the villi of the terminal ileum was 235.41 ± 73.32 mm, and the mean height of the crypts was 186.22 ± 64.09 mm. Conclusion: Histologically, the mean height of the villi of the normal small bowel was between 235.41 ± 73.32 to 341.76 ± 76.06 mm and the mean height of the crypts of the normal small bowel was between 186.22 ± 64.09 to 218.79 ± 84.66 mm. Keywords: normal, duodenum, jejunum, terminal ileum, histological appearances, villous height, villous width, crypt height

Portal Hypertensive Enteropathy in Liver Cirrhosis

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 3, December 2006
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background/Aim: Some studies found that portal hypertension cause complication such as portal hypertensive gastroenterocolopathy. This study was done to find any abnormalities in the small intestinal mucosa and villi of the portal hypertensive patients. Method: Thirty patients with liver cirrhosis, portal hypertension and esophageal varices between 2000 - 2001 were included in this study. A duodenoscopic examination was performed to determine any abnormalities. Biopsy specimens were taken from the descending part of duodenum and the duodenal bulb for histopathological examination. The findings were compared to 37 functional dyspepsia patients. Result: In the duodenal bulb and descending part of duodenum: the width of the villous of the portal hypertensive group was larger than the control (p < 0.001), the diameter of the mucosal villous vessel was larger than in the control (p < 0.001) and the thickness of the mucosal villous vessel wall was thicker than in the control (p < 0.001). Conclusion: There were abnormalities of the mucosa in portal hypertensive enteropathy patients including the mucosal vessel diameter, wall thickness, number of goblet cells. Keywords: portal hypertensive enteropathy, liver cirrhosis

Normal Histological Appearances of the Duodenum Jejunum and Terminal Ileum in Indonesian People

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8, ISSUE 3, December 2007
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Original Source | Check in Google Scholar

Abstract

Background: There is no literature specifically on the normal appearance of small bowel mucosa amongst Indonesians. Diseases of the small bowel can cause chronic diarrhea. Chronic diarrhea is common in Indonesia. Methods: Thirty seven patients with normal stomach and small bowel on endoscopic and histopathologic examination were included in this study. Biopsies were taken from the duodenal bulb, descending part of duodenum, jejunum and terminal ileum. The scoring Method for the inflammatory cells (lymphocytes, plasma cells and eosinophil cells) was carried out using the symbols 0 (negative), +, ++, and +++. Results: The mean height of the villi of the duodenal bulb was 265.00 ± 81.89 mm, the mean height of the crypts of the duodenal bulb was 196.67 ± 56.01 mm, the mean width of the villi were 59.14 ± 74.14 mm. The mean height of the villi of the duodenum pars descendens was 317.27 ± 99.66 mm and the mean height of the crypts was 218.79 ± 84.66 mm. The mean height of the villi of the jejunum was 341.76 ± 76.06 mm and the mean height of the crypts was 189.41 ± 58.15 mm. The mean height of the villi of the terminal ileum was 235.41 ± 73.32 mm, and the mean height of the crypts was 186.22 ± 64.09 mm. Conclusion: Histologically, the mean height of the villi of the normal small bowel was between 235.41 ± 73.32 to 341.76 ± 76.06 mm and the mean height of the crypts of the normal small bowel was between 186.22 ± 64.09 to 218.79 ± 84.66 mm. Keywords: normal, duodenum, jejunum, terminal ileum, histological appearances, villous height, villous width, crypt height

Portal Hypertensive Enteropathy in Liver Cirrhosis

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 3, December 2006
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Original Source | Check in Google Scholar

Abstract

Background/Aim: Some studies found that portal hypertension cause complication such as portal hypertensive gastroenterocolopathy. This study was done to find any abnormalities in the small intestinal mucosa and villi of the portal hypertensive patients. Method: Thirty patients with liver cirrhosis, portal hypertension and esophageal varices between 2000 - 2001 were included in this study. A duodenoscopic examination was performed to determine any abnormalities. Biopsy specimens were taken from the descending part of duodenum and the duodenal bulb for histopathological examination. The findings were compared to 37 functional dyspepsia patients. Result: In the duodenal bulb and descending part of duodenum: the width of the villous of the portal hypertensive group was larger than the control (p < 0.001), the diameter of the mucosal villous vessel was larger than in the control (p < 0.001) and the thickness of the mucosal villous vessel wall was thicker than in the control (p < 0.001). Conclusion: There were abnormalities of the mucosa in portal hypertensive enteropathy patients including the mucosal vessel diameter, wall thickness, number of goblet cells. Keywords: portal hypertensive enteropathy, liver cirrhosis

Efficacy and Safety of In-Asia-manufactured Interferon alpha-2b in Combination with Ribavirin for Therapy of Naïve Chronic Hepatitis C Patients: A Multicenter, Prospective, Open-Label Trial

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 1, April 2009
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Original Source | Check in Google Scholar

Abstract

Background: An open-label, multi center and non-comparative study was conducted to evaluate the efficacy and safety of a more affordable in-Asia-manufactured interferon á-2b product in combination with ribavirin to treat naïve chronic hepatitis C patients. Method: Thirty chronic naïve hepatitis C patients were treated with in-Asia-manufactured interferon   a-2b subcutaneously 3 MIU thrice weekly and ribavirin 800-1,200 mg daily for 48 weeks. Follow-up was done until 24 weeks after the end of treatment. Efficacy was assessed by examining serologic and biochemical parameters at pre and post-treatment. Safety was assessed by evaluating clinical symptoms and laboratory parameters. Results: The virological response and sustained virological response rates of all Hepatitis C Virus (HCV) genotypes were 83.3% and 76.7% respectively. Post-treatment, 80% patients had significant alanine transaminase (ALT) decreased into normal level and remained normal in 76.7% patients at 24th week follow up period. At that time, the ALT level and sustained virological response were lower in HCV genotypes 1 and 4 than in non-1 and non-4 genotypes. The most frequent adverse event was flu-like syndrome. Conclusion: The efficacy and safety study on combination therapy of in-Asia-manufactured interferon a-2b and ribavirin has shown a good result based on the current standard of interferon alpha and ribavirin combination therapy. Keywords: interferons, combination drug therapy, chronic hepatitis C, treatment efficacy, safety