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Abstrak :
Telah diketahui asap rokok menjadi penyebab utama emfisema akan tetapi mekanisme pajanan asap rokok sampai menimbulkan destruksi arsitektur paru seperti tampak pada emfisema masih kontroversial. Hipotesis protease anti protease telah dikembangkan sejak 30 tahun yang lalu. Menurut teori tradisional sel efektor yang berpengaruh pada perokok ialah netrofil, sedangkan protease yang panting ialah netrofil elastase. Akhir-akhir ini perhatian difokuskan pada matriks metaloproteinase (MMP) yang dilepas oleh paru dan sel inflamasi yang memegang peran utama pada patogenesis PPOK. Matriks metaloproteinase utama yang berkemampuan melisiskan serat eiastin ialah matrix metalloproteinase-9 (MMP-9). Asap rokok menyebabkan penarikan makrofag ke paru selanjutnya makrofag mensekresi sitokin yang dapat meningkatkan respons inflamasi Iebih lanjut, menyebabkan induksi dan pelepasan MMP-9 oleh makrofag dan netrofil. Tujuan utama penelitian ini ialah membuktikan terdapat korelasi antara jumlah makrofag dan kadar MMP-9, jumlah makrofag dan netrofil, serta jumlah netrofil dan kadar MMP-9 di dalam cairan kurasan bronkoalveolar perokok. Penelitian ini memakai metode cross sectional, dan pengambilan sample menggunakan cara quota sampling. Penelitian dilakukan pada 24 penderita tumor paru atau mediastinum yang memerlukan pemeriksaan bronkoskopi di RSUD Dr Moewardi Surakarta, terdiri dari 12 perokok dan 12 bukan perokok. Pemeriksaan hitung jumlah sel total (makrofag, netrofil, limfosit, eosinofil, basofil) memakai Cell Dyn 3700, hitung jenis sel kurasan bronkoalveolar memakai pewarnaan Giemsa dan pemeriksaan MMP-9 metode ELISA menggunakan reagen Quantikine HS kit. Hasil pemeriksaan cairan kurasan bronkoalveolar ditemukan kadar MMP-9, jumlah makrofag serta netrofil kelompok perokok lebih tinggi dan berbeda bermakna dibanding bukan perokok (p < 0,05), hal ini sesuai hipotesis_ Pada perokok ditemukan korelasi kuat antara jumlah makrofag dan kadar MMP-9 (r : 0,713 ; p :0,009), antara jumlah makrofag dan netrofil (r : 0,804 ; p :0,002), serta antara jumlah netrofil dan kadar MMP-9 (r : 0,741 : p : 0,006) sehingga hipotesis terbukti. Kesimpulan : Ditemukan korelasi kuat antara jumlah makrofag, netrofil dan kadar MMP-9 pada cairan kurasan bronkoalveolar perokok. Saran : Untuk lebih memahami proses infamasi pada perokok perlu dilakukan penefitian longitudinal dan dapat dilengkapi pemeriksaan Tissue Inhibitor of Metalloproteinase (TIMP)-1.

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Cigarette smoking is the main cause of emphysema; however, the mechanism is still controversial. According to the old theory, neutrophil is the effectors cell which influenced smokers. The current concept regarding the pathogenesis of emphysema would be focusing on MMP released by lung and inflammatory cells. MMP-9 is the main component of MMP which has the ability to lysis elastin fibers. The purposes of this study were to prove the correlation between macrophage counts and the level of MMP-9, macrophage counts and neutrophil, neutrophil counts and the level of MMP-9 in the smoker's bronchoalveolar lavage fluid. The study design was cross sectional and the sample was taken by quota sampling. A total of 24 patients were divided into 12 smokers and 12 nonsmokers. The level of MMP-9, macrophage counts and neutrophil had been detected to be higher in the smoker's bronchoalveolar lavage fluid than the non smoker's ; and the difference reached significant level (p , 0,05). There was strong correlation between macrophage counts and the level of MMP-9 (r : 0,713 ; p : 0,009), macrophage counts and the neutrophil (r: 0,804; p: 0,002) also neutrophil counts and the level of MMP-9 (r : 0,741 ; p : 0,006) in the smoker's bronchoalveolar lavage fluid. Conclusion : The result showed that there was correlation among macrophage counts, neutrophil , and the level of MMP-9 in the smoker's bronchoalveolar lavage fluid.

Abstrak :
ABSTRAK Non-alcoholic fatty liver disease (NAFLD) adalah penyakit hati kronik yang ditandai dengan akumulasi lemak berlebihan di hati. Elastografi Transien (ET) dan metode Controlled Attenuation Parameter (CAP) merupakan metode pemeriksaan non-invasif untuk menilai derajat fibrosis dan steatosis, namun tidak tersedia di seluruh rumah sakit di Indonesia. Rasio Neutrofil Limfosit (RNL) merupakan penanda peradangan sederhana yang berpotensi memprediksi luaran penyakit. Tujuan : Mengetahui nilai diagnostik RNL sebagai indikator derajat keparahan steatosis dan fibrosis NAFLD. Metode : Penelitian ini adalah studi potong lintang menggunakan data sekunder dari data rekam medis tahun 2016-2018. Analisis statistik deskriptif dan analitik berupa uji korelasi, Receiver Operating Curve (ROC) dan Area Under The Curve (AUC) dipakai untuk mengetahui luaran studi. Hasil : Dari 106 subjek penelitian, kebanyakan pasien adalah perempuan (62,3%) berusia rata-rata 57,29 tahun dan menderita sindrom metabolik (77,4%). Sebagian besar pasien memiliki derajat steatosis sedang-berat (66%) dengan rerata ET 6,14 (2,8-18,2). Terdapat korelasi antara nilai CAP (r=0,648; p<0,001) dan ET (r=0,621; p<0,001) dengan RNL. Penggunaan RNL untuk menilai derajat steatosis sedang-berat memiliki titik potong 1,775 dengan sensitivitas, spesifisitas, NDP dan NDN sebesar 81,5%, 80,6%, 89,1%, dan 69,1%; titik potong 2,150 untuk menilai fibrosis signifikan dengan sensitivitas, spesifisitas, NDP dan NDN berurutan sebesar 92,3 %; 87,5%; 70,6%; dan 97,2%. Simpulan : RNL memiliki korelasi positif dan signifikan terhadap derajat steatosis (CAP) dan fibrosis (ET) dengan sensitivitas dan spesifisitas yang cukup tinggi.

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ABSTRACT Non-alcoholic fatty liver disease (NAFLD) is a chronic inflammatory disease with excessive fat accumulation in the liver. Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) is a device and method to examine the degree of fibrosis and steatosis. However, this device is not widely available across Indonesia. Neutrophil and Lymphocyte Ratio (NLR) is a simple marker for inflammation which has a potency to predict disease outcome. This study aims to know the diagnostic value of NLR as the indicator of steatosis and fibrosis severity. Methods: This was a cross-sectional study with consecutive sample collection. We used secondary data from medical record, starting from 2016-2018. A descriptive and analytic statistic, including correlation test, multivariate linear regression, t test, Receiver Operating Curve (ROC) and Area Under the Curve (AUC) were done to know the outcome of the study. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) Version 20.0 (SPSS Inc, Chicago, Illinois). A P value <0.05 was considered as statistically significant. Results: Out of 106 subjects, 62.3% patients were women with the mean of age 57.29 years old and 77.4% had metabolic syndrome. Most patients had moderate to severe steatosis degree (66%) with the mean of ET mean 6.14 (2.8-18.2). There was a positive correlation between CAP and TE compared with NLR with r=0.647 (p<0.001) and r=0.621 (p<0.001) respectively. The use of RNL to assess moderate-severe steatosis has a cutoff point of 1.775 with sensitivity,  specificity, PPV and NPV respectively at 81,5%, 80,6%, 89,1%, and 69,1%; cutoff point 2,150 to assess significant fibrosis with sensitivity, specificity, PPV and NPV of 92.3 %, 87.5%, 70.6%, and 97.2% respectively. Conclusion: NLR has a positive and significant correlation with the degree of steatosis and fibrosis with high sensitivity and specificity in comparison with TE/CAP.

Abstrak :
Pada awalnya imunologi dianggap tidak memiliki peran dalam penyakit kanker, namun berbagai penelitian saat ini telah membuktikan bahwa sel imun tubuh dapat menghambat perkembangan sel kanker. Sel imun yang diketahui berperan dalam mematikan sel tumor adalah sel limfosit T sitotoksik CD4+ dan CD8+. Reseptor PD-1 atau programmed death 1 ligand (CD279) sebagai molekul yang bersifat mensupresi proses imunologi dihasilkan pada membran plasma sel T dan jika berikatan dengan PD-L1 akan menekan respon imun, ekspresi berlebihan dari PD-L1 akan menekan respons dari sel imun terutama sel limfosit T. Saat ini rasio neutrofil-limfosit (NLR) darah dikenal sebagai salah satu petanda untuk prognosis maupun prediktor dalam terapi kanker. Peningkatan jumlah neutrofil di darah perifer merupakan petanda dari inflamasi kronik yang menunjukkan gangguan dari imunitas seluler, sedangkan jumlah limfosit darah menunjukkan respons dari sel T sitotoksik yang baik. Penelitian ini menemukan bahwa terdapat hubungan signifikan antara NLR pra radiasi dengan PD-L1 ELISA pasca radiasi (p=0.010) sehingga NLR pra radiasi dapat digunakan sebagai prediktor untuk PD-L1 ELISA pasca radiasi. Tidak ditemukan hubungan signifikan antara PD-L1 intratumoral ELISA dengan sebukan limfosit stromal tumor, namun terdapat kecenderungan hubungan negatif antara PD-L1 intratumoral ELISA dengan sebukan limfosit stromal tumor pasca radiasi.

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Decades ago immunology was not considered to have role in cancer, but various studies have now proven that immune cells can inhibit the development of cancer cells. Immune cells that are known to play a role in killing tumor cells are CD4 + and CD8 + cytotoxic T cells. PD-1 receptor or programmed death 1 ligand (CD279) as a molecule that suppresses the immunological process produced on the T cell plasma membrane and it binds to PD-L1 will suppress the immune response, thus excessive expression of PD-L1 will suppress the response of immune cells especially T cell lymphocytes Recently the neutrophil-lymphocyte ratio (NLR) is known as one of the markers for the prognosis and predictor of cancer therapy. An increase in the number of neutrophils in peripheral blood is a sign of chronic inflammation which shows a disruption of cellular immunity, whereas the number of blood lymphocytes shows a response from normal cytotoxic T cells. This study showed that there was a significant correlation between pre-EBRT NLR and post EBRT PD-L1 ELISA (p = 0.010) so that pre-EBRT NLR could be used as a predictor for post EBRT PD-L1 ELISA. No significant relationship was found between intratumoral PD-L1 ELISA with a tumor stromal lymphocyte, but there was a trend of negative relationship between intratumoral PD-L1 ELISA with a post-radiation tumor stromal lymphocyte

Abstrak :

 

Latarbelakang: Demam neutropenia merupakan komplikasi tersering pada terapi anak dengan keganasan. Terapi antibiotik empiris diketahui dapat menurunkan angka morbiditas dan mortalitas. Namun demikian, dilaporkan peningkatan kejadian resistensi terhadap seftazidim.  Sefepim menurunkan demam lebih cepat dan mempersingkat lama perawatan dibandingkan seftazidim sehingga pada beberapa negara dilaporkan sebagai antibiotik monoterapi lini pertama. Penelitian ini bertujuan untuk membandingkan efektivitas pemberian seftazidim dan sefepim dalam hal lama penurunan demam dan kenaikan jumlah neutrofil absolut yang diamati selama 72 jam pertama setelah pemberian terapi empiris pada demam neutropenia anak dengan leukemia akut, serta bertujuan untuk mengetahui pola kuman dan sensitivitas antibiotik.

Metode: Uji acak terkontrol membandingkan efektivitas pemberian sefepim dan seftazidim. Pasien secara acak dibagi ke dalam dua kelompok intervensi, seftazidim dan sefepim, pada setiap kelompok terdiri atas 36 pasien. Dilakukan pemberian terapi dan hasil dicatat setelah pengamatan selama 72 jam.

Hasil: Penurunan demam didapatkan pada 28 anak (77.8%) dengan terapi seftazidim dan 33 anak (91.7%) dengan terapi sefepim. Tidak terdapat perbedaan bermakna antara kedua kelompok dalam hal lama penurunan demam (p=0.101). Pada kelompok seftazidim, median lama penurunan demam adalah 32 jam (8-171 jam), sedangkan pada kelompok sefepim adalah 24 jam (6-75 jam). Kenaikan jumlah neutrofil absolut didapatkan pada 1 anak (2.8%) dengan terapi seftazidim dan 10 anak (27.8%) dengan terapi sefepim dengan jumlah neutrofil absolut ≥ 1000 sel/mm³ setelah 72 jam pertama pemberian terapi. Terdapat perbedaan bermakna antara kedua kelompok (p=0.003). Median kenaikan jumlah neutrofil absolut pada 72 jam pertama kelompok seftazidim adalah 315 (0-1887) sel/mm³, sedangkan pada kelompok sefepim adalah 432 (0-4266) sel/mm³. Tidak terdapat perbedaan bermakna antara kedua kelompok (p=0.235). Pada hasil kultur darah didapatkan biakan terbanyak adalah bakteri Gram negatif, ditemukan pada 8 subyek (72%) dari kedua kelompok yaitu bakteri Escherichia coli, Klebsiella pneumoniae dan Salmonella sp. Hasil uji sensitivitas isolat bakteri Gram negatif dari biakan darah, antibiotik sefepim mempunyai persentase terbesar, yaitu 75% dari bakteri yang tumbuh pada biakan, sedangkan seftazidim 38%.

Kesimpulan: Sefepim lebih baik dibandingkan seftazidim dalam penurunan suhu dan kenaikan jumlah neutrofil absolut lebih pada 72 jam walaupun secara statistika tidak berbeda bermakna

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Introduction: Neutropenic fever is the most frequent complication during cancer therapy in children. Empirical antibiotic therapy has been known to reduce the mortality and morbidity rate. However, resistance against ceftazidime has been reported. Cefepime reduces fever and shorten the length of hospitalization better than ceftazidime that several countries have reported using it as the first-line antibiotic therapy. This study is aimed to compare the effectivity of ceftazidime and cefepime to reduce fever and to increase the absolute neutrophils count in the first 72 hours.

Method: A randomized controlled trial to compare cefepime and ceftazidime. Patients were randomly divided into two intervention groups, ceftazidime and cefepime, each group consist of 36 patients. Patients were treated, the results were noted after 72 hours.

Results: Fever was reduced in 28 children (77.8%) treated with ceftazidime and 33 children (91.7%) treated with cefepime. No significant difference was found between the two groups regarding the amount of time it took for the fever to drop (p=0.101). For ceftazidime, fever was reduced in 32 hours (8-171 hours) on average, while it took cefepime 24 hours (6-75 hours) on average to reduce the fever. The increase of absolute neutrophils in the first 72 hours was found in 1 child (2.8%) treated with ceftazidime, while there were 10 children (27.8%) treated with cefepime whose absolute neutrophils increased ≥ 1000 cells/mm³ in the first 72 hours. A significant difference was found between the two groups (p=0.003). On average, the increase of absolute neutrophils in the first 72 hours for ceftazidime was 315 (0-1887) cells/mm³, while the average number for cefepime was 432 (0-4266) cells/mm³. No significant difference was found between the two groups (p=0.235). Blood culture revealed that the most common pathogen are gram-negative bacterias. Found in 8 subjects (72%) in the two groups were Escherichia coli, Klebsiella pneumoniae, and Salmonella sp. Sensitivity test for isolated gram-negative bacteria from the blood culture revealed that cefepime had the greatest sensitivity of 75% while ceftazidime had only 38%.

Conclusion: It was found that cefepime yielded better results compared to ceftazidime regarding fever reduction and absolute neutrophil increase in the first 72 hours, even if the results were not statistically significant.

 

Abstrak :
Latar belakang. Kanker kolorektal merupakan penyebab kematian terbesar kedua di dunia dengan tingkat kematian yang tinggi. Penelitian ini bertujuan untuk meneliti nilai prediktif dari rasio neutrofil-limfosit (NLR) dan antigen carcinoembryonic (CEA) dalam memprediksi tingkat kelangsungan hidup pasien kanker kolorektal di Indonesia. Metode. Ini adalah penelitian kohort retrospektif. Populasi penelitian terdiri dari pasien dengan kanker kolorektal tahap I-IV yang diobati di Rumah Sakit Umum Cipto Mangunkusumo. Variabel independen adalah NLR dan CEA, sedangkan variabel dependen adalah kelangsungan hidup lima tahun pasien kanker kolorektal. Pengolahan dan analisis data dilakukan menggunakan SPSS versi 20. Hasil. Penelitian ini melibatkan 96 subjek yang memenuhi kriteria inklusi dan eksklusi. Analisis menunjukkan bahwa 6,25% subjek memiliki NLR tinggi dan 66,6% memiliki kadar CEA tinggi. Tingkat kelangsungan hidup lima tahun secara keseluruhan untuk semua subjek adalah 35,4%. Meskipun tidak signifikan secara statistik, proporsi subjek dengan NLR normal memiliki tingkat kelangsungan hidup lima tahun yang lebih tinggi dibandingkan dengan mereka yang memiliki NLR tinggi, dan pola yang sama juga teramati pada kadar CEA. Analisis subkelompok berdasarkan stadium kanker menunjukkan hubungan yang signifikan antara NLR tinggi dan peningkatan risiko kematian pada tahap TNM I-II, namun tidak terdapat perbedaan signifikan dalam kelangsungan hidup berdasarkan NLR pada tahap III-IV. Kesimpulan. Rasio NLR praoperasi dan CEA praoperasi tidak menunjukkan peran prediktif dalam kelangsungan hidup kanker kolorektal. Namun, ketika dibagi berdasarkan stadium kanker, terdapat perbedaan signifikan dalam kadar NLR praoperasi antara kelompok yang meninggal dan tidak meninggal pada pasien dengan kanker kolorektal stadium I-II. ......Background. Colorectal cancer is the second leading cause of death worldwide, with a high mortality rate. This study aims to investigate the predictive value of the neutrophil-lymphocyte ratio (NLR) and carcinoembryonic antigen (CEA) in predicting the survival rates of colorectal cancer patients in Indonesia. Method. This is a retrospective cohort study. The study population consisted of patients with colorectal cancer stage I-IV treated at Cipto Mangunkusumo General Hospital. The independent variables are NLR and CEA, while the dependent variable is the five-year survival of colorectal cancer. Data processing and analysis are conducted using SPSS version 20. Results. This study included 96 subjects who met the inclusion and exclusion criteria. Analysis revealed that 6.25% of the subjects had high NLR and 66.6% had high CEA levels. The overall five-year survival rate for all subjects was 35.4%. Although not statistically significant, the proportion of subjects with normal NLR had a higher five-year survival rate compared to those with high NLR, and the same pattern was observed for CEA levels. Subgroup analysis based on cancer stage showed a significant association between high NLR and increased risk of mortality in TNM stages I-II, but no significant difference in survival based on NLR was observed in stages III-IV. Conclusion. The preoperative NLR ratio and preoperative CEA did not show a predictive role in colorectal cancer survival. However, when stratifying by cancer stage, there was a significant difference in preoperative NLR levels between the deceased and non-deceased groups in patients with stage I-II colorectal cancer.

Abstrak :
Rasio neutrofil limfosit (RNL) adalah salah satu biomarker prognostik yang sudah banyak dipakai untuk memprediksi luaran klinis berbagai penyakit. Nilai RNL yang tinggi berhubungan dengan luaran klinis yang buruk pada pasien stroke iskemik. Asupan energi dan protein yang cukup selama rawatan di rumah sakit (RS) dapat membantu menurunkan kadar RNL yang tinggi saat admisi. Asupan nutrisi yang cukup selama rawatan membantu mempertahankan sistem imun, meningkatkan proliferasi limfosit dan produksi antibodi. Penelitian ini bertujuan untuk melihat hubungan kecukupan energi dan protein selama rawatan di RS terhadap perubahan nilai RNL pada pasien stroke iskemik di RSCM dan RSUI. Penelitian menggunakan desain kohort prospektif pada subjek berusia ≥18 tahun yang dirawat di RSCM dan RSUI. Diperoleh 52 subjek dengan kelompok cukup asupan energi dan protein sebanyak 26 subjek dan kelompok yang tidak cukup sebanyak 26 subjek. Rerata usia subjek 62,34 + 11,8, laki – laki 61,5%, subjek dengan status nutrisi obesitas derajat 1 berdasarkan indeks massa tubuh (IMT) 23,1%, dan faktor risiko hipertensi sebanyak 82,7%. Tidak terdapat hubungan bermakna antara kecukupan energi dan protein dengan penurunan nilai RNL selama rawatan. Namun, sebagian besar subjek yang mendapat asupan cukup energi dan protein mengalami penurunan nilai RNL. Penelitian lanjutan diperlukan dengan menggunakan subjek lebih banyak dan menganalisis faktor – faktor lain yang dapat memengaruhi penurunan nilai RNL dan asupan makan pada pasien stroke iskemik yang dirawat. ......Neutrophil-lymphocytes ratio (NLR) is one of the prognostic biomarkers that has been widely used to predict clinical outcomes of various diseases. High NLR values are associated with poor clinical outcomes in ischemic stroke patients. Adequate energy and protein intake during hospitalization can help reduce high NLR levels at admission. Adequate nutritional intake during treatment helps maintain the immune system, increase lymphocyte proliferation and antibody production. This study aims to look at the relationship between energy and protein adequacy during hospitalization and changes in NLR values in ischemic stroke patients at RSCM and RSUI. The study used a prospective cohort design on subjects aged ≥18 years who were hospitalized at RSCM and RSUI. Total 52 subjects and then divided into two groups, an adequate energy and protein groups 26 subjects and an insufficient groups 26 subjects. The mean age of the subjects was 62.34 + 11.8, male 61.5%, subjects with nutritional status of grade 1 obesity based on body mass index (BMI) 23.1%, and risk factors for hypertension were 82.7%. There was no significant relationship between energy and protein adequacy group and the decrease in NLR values during hospitalization. However, most subjects who received energy and protein adequate experienced a decrease in NLR. Further research is needed by using more subjects and analyzing other factors that can affect the decrease in NLR value and food intake in stroke patients during hospitalization.

Abstrak :
Purpose The association between the preoperative absolute neutrophil count (NC), lymphocyte count (LC), and monocyte count (MC) in the peripheral blood and the prognosis of gastric cancer (GC) patients has not been investigated widely. Methods We enrolled 445 patients who underwent surgery for GC between January, 2005 and April, 2013 to analyze the correlations among NC, LC, and MC and their prognoses. Results Based on cut-off values calculated by ROC analysis, patients were sub grouped as having: NC ≥ 4477 (NCHigh), NC < 4477 (NCLow); and as LC ≥ 1447 (LCHigh), LC < 1447 (LCLow); and as MC ≥ 658,5 (MCHigh), MC < 658,5 (MCLow). Each group was assigned as follows; NCHigh group = 1, NCLow group = 0, LCHigh group = 0, LCLow group = 1, MCHigh group = 1, MCLow group = 0, and the sum of each score was defined as the lymphocyte-monocyte-neutrophil score (LMN score). The overall 5-year survival rates were 89%, 74%, 57,8%, and 53,3% for LMN scores of 0, 1, 2, and 3, respectively (P = 0,0004). Multivariate analysis indicated that the LMN score was an independent prognostic indicator. Conclusions The combination of preoperative NC, LC, and MC appears to be a useful indicator of GC prognosis.

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ABSTRACT
A 59-year-old lady with underlying hypothyroidism presented with acute contact dermatitis progressed to cellulitis with superimposed bacterial infection and acute kidney injury. She responded to initial management with antibiotics, but a week later, she had cutaneous and systemic vasculitis. Her skin biopsy consistent with immune-mediated leuko-cytoclastic vasculitis and her blood test was positive for cytoplasmic-anti-neutrophil cytoplasmic antibody (c-ANCA). A diagnosis of ANCA-associated vasculitis was made and she was treated with immunosuppressant with plasmapheresis and hemodialysis support for her kidney failure. Despite aggressive measures, the patient succumbed to her illness. This case report demonstrates that soft tissue infection could trigger the development of ANCA-associated vasculitis whilst a background of hypothyroidism serves as a predisposing factor as both condition were reported separately in a couple of case studies before.

Abstrak :
Latar Belakang. Cedera Reperfusi-iskemik merupakan isu klinis yang penting dan umum. Hal tersebut dapat terjadi pada trombo-embolisme, penyakit vaskuler aterosklerotik, bedah kardiovaskuler, transplantasi organ, replantasi tungkai dll. Reperfusi jaringan yang iskemik bukan hanya menyebabkan reaksi iniamasi lokal tetapi juga mempengaruhi fungsi organ lain melalui respons inflamasi sistemik. Banyak studi menunjukkan sel polimorfonuklear terutama netrofil mempunyai peranan cedera yang panting dalam proses reperfusi-iskemik dengan menginfiltrasi jaringan iskemik dan juga kedalam organ yang jauh seperti hati, pare, ginjal dsb. Banyak obat yang sudah dicoba untuk untuk mengurangi efek cedera reperfusi dengan basil yang bervariasi. Salah satu obat yang menjanjikan dapat mengurangi cedera reperfusi melalui efek antiinflamasinya adalah Pentoksifilin (PTX). Pada studi eksperimental, kami mengamati efek pemberian PTX terhadap infiltrasi netrofil pada jaringan otot skeletal, hati dan pare hewan kelinci yang dibuat iskemik secara akut pada tungkai bawah dan diikuti dengan reperfusi. Metoda. Dua belas ekor kelinci jantan ras New Zealand White dibagi secara acak menjadi 3 grup (A,B dan C). Grup A diberikan PTX ( n=5); Group B diberikan NaCl 0.9% sebagai kontrol (n=5); Grup C adalah kontrol negatif (n=2). Grup A dan B mengalami total iskemia selama 3 jam pada tungkai bawah dengan Cara menjepit arteri iliaca komunis sinistra dengan klem. Dosis PTX adalah 40 mg/ kgBB bolus diikuti lmglkgBB sebagai dosis rumatan. PTX diberikan 30 menit sebelum reperfusi. Grup B diberikan NaCl 0.9 % dan pada grup C tidak dilakukan tindakan iskemia. Potongan jaringan histopatologi dari otot yang iakemik, hati dan pare diambil pada akhir percobaan (3jam setelah rep erfusi) sebelum dilakukan etanasia. Hasil. Jumlah rerata netrofil pada jaringan otot skeletal, hati dan pare berturut-turut adalah sebagai berikut : Pada grup C adalah 0.67 ± 0.75; 2.00 ± 1.41 dan 4.33 ± 1.49. GrupA adalah 3.53 ± 6.01; 7.20 ± 5.29 dan 13.87 t 7.84. Grup B adalah 13.80 ± 12.68; 12.33 ± 4.39 dan 34.13 ± 12.83. Tampak jumlah netrofil lebih rendah bermakna pada jaringan pare grup A dibandingkan grup B (p < 0.009). Ada kecenderungan jumlah netrofil lebih rendah dalam jaringan otot skeletal dan hati pada grup A dibandingkan grup B, walaupun secara statistik tidak bermakna (p < 0.075). Kesimpulan. Pentoksifilin dapat mempunyai efek mengurangi infiltrasi netrofil kedalam jaringan pada kelinci yang mengalami cedera reperfusi-iskemik tungkai akut.

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Background. Ischemic-reperfusion injury is a common and important clinical issues.lt occurs in many clinical setting such as thrombo-embolic phenonrenon,atherosclerotic vascular disease, cardiovascular surgery, organ transplantation, replantation of limb etc. Reperfusion of ischemic tissue not only causing local inflammatory reaction but also affect remote organ function by systemic-inflammatory responses. Many studies have showned that polymorphonuclear leukocyte especially neutrophil has an important damaging role in reperfusion injury. They exert their effect through infiltration into ischemic tissue and also into remote organ like liver,lung,kidney etc. So far a lot of agents have been tried to attenuate reperfusion injury with variable results. One promising drug for attenuating ischemic-reperfusion injury through its anti-inflammatory effect is Pentoxifylline (PTX). In this exploratory experimental study, we observed the effect of giving PTX on neutrophil infiltration to skeletal muscle, liver and lung tissue in rabbits with induced acute limb ischemia followed by reperfusion . Methods. Twelve male New Zealand White rabbits were randomly divided into 3 groups (A,B and C). Group A were given PTX(n =5); Group B using Na CI 0.9% as a control group (n= 5); Group C was negative control (n=2). Group A and B underwent 3 hours of total ischemia of the lower limb by clamping proximal left common iliac artery, follow by 3 hours of reperfusion. The dose of intravenous PTX was 40mg1kgB W bolus followed by 1 mg/kg BWlhour maintenance dose. PTX was given 30 minutes before reperfusion. Group B was given normal saline and in Group C, no intervention done. Histopathologic section of iskernic skeletal muscle, liver, and lung tissue were taken at the end of experiment before( 3 hours of reperfusion) euthanasia was done. Results. The mean numbers ofneutrophil in ischemic skeletal musle, liver and lung tissue consecutively were as follow ; In Group C were, 0.67 t 0.75; 2.00 f 1.41; and 4.33 ± 1.49. In group Awere,3.53 ±6.0]; 7.20±5.29; and 13.87±7,84, and in groupB (control)were 13.80 ± 12.68; 12.33 ± 4.39; and 34.13 ± 12.83. There was significantly lower number of netrophil in lung tissue of group A compare to group B (p< 0.009). Although not statistically significant (p= 0.075), there were a trend to have lower neutrophil counts in ischemic skeletal muscle and liver tissue in group A rabbits compared to group B. Conclusion. Pentoxifylline has attenuating effect on neutrophil infiltration in rabbits undergoing ischemic-reperfusion injury of lower limb.