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Abstrak :
The first laparoscopy-assisted gastrectomy for gastric cancer was performed in Japan in 1991. In the ensuing 20 years, at first through a process of trial and error, then through the sharing of master surgeons’ accumulated experience, the procedure has been honed and refined to its current high level. From the beginning, it soon became evident that this much less invasive form of gastrectomy, in comparison with traditional open surgery, led to improved quality of life for postsurgical patients, and use of the procedure spread rapidly among gastric surgeons. Early on, however, there were calls for the establishment of standard techniques and procedures to be followed, with a recognized need to improve the level of safety and the quality of lymph node dissection for local control in cancer treatment. Toward that end, the Laparoscopy-Assisted Gastrectomy Club was formed in 1999. In the following year, because both Japan and Korea experience a high rate of gastric cancer, specialists from those two nations came together to form the Japan–Korea Laparoscopic gastrectomy joint seminar, to facilitate and encourage the exchange of vital information. The result has been to achieve an evolving consensus among specialists in the field of endoscopic surgery in Japan and Korea with expertise that can be shared worldwide. A compilation of the current state-of-the-art is now presented in this volume, with accompanying DVD, which will be of great value to all endoscopic surgeons who perform laparoscopic gastrectomy.

Abstrak :
Pendahuluan: Revaskularisasi segera jaringan yang telah iskemia, tidak selalu membuahkan hasil yang diharapkan. Berbagai reaksi yang timbul dari pembentukan reactive oxygen species dan aktivasi sistem komplemen menyebabkan cedera iskemia reperfusi. Ischemia preconditioning PRC dan hipotermia diduga dapat mengurangi efek dari cedera iskemia reperfusi. Metode: Penelitian eksperimental ini adalah lanjutan dari penelitian sebelumnya, di mana dilakukan uji statistika terhadap kelompok kontrol dan tiga kelompok perlakuan, yaitu cedera reperfusi IRI, ischemia preconditioning PRC, dan hipotermia. Data kelompok kontrol dan IRI diambil dari penelitian sebelumnya. Kelompok PRC dan hipotermia masing-masing menggunakan enam hewan coba Oryctolagus cuniculus. Pada kelompok PRC dilakukan ligasi arteri femoralis komunis kanan selama dua menit, dilepaskan tiga menit sebanyak dua siklus. Pada kelompok hipotermia dilakukan pembungkusan ekstremitas bawah kanan dengan es. Kemudian kedua kelompok dilanjutkan dengan dilakukan pengikatan arteri femoralis komunis kanan selama empat jam, dan kemudian ikatan dilepaskan selama delapan jam. Kemudian dilakukan laparotomi, dan diambil organ gaster. Bagian antrum diambil untuk pemeriksaan histopatologi dan biokimia. Pemeriksaan biokimia dilakukan menggunakan malondialdehid MDA. Hasil: Uji hipotesis dari perbedaan histopatologi dan biokimia secara keseluruhan bermakna secara statistik. Derajat kerusakan secara histopatologi pada kelompok ischemia preconditioning lebih rendah dengan signifikan dibandingkan kelompok IRI; namun secara biokimiawi, lebih tinggi namun tidak signifikan. Derajat kerusakan secara histopatologi pada kelompok hipotermia lebih rendah namun tidak signifikan dibandingkan dengan kelompok IRI; namun secara biokimiawi, lebih tinggi dengan signifikan dibandingkan dengan kelompok IRI. Bila membandingkan PRC dan hipotermia, secara histopatologi, PRC lebih rendah dengan signifikan. Secara biokimia, rerata PRC lebih rendah namun tidak signifikan. Kesimpulan: Ischemia preconditioning memiliki efek protektif terhadap dampak destruktif yang yang dihasilkan oleh ischemia reperfusion injury terhadap organ jauh. terhadap organ jauh. Hipotermi juga memiliki efek protektif, namun tidak sebaik ischemia preconditioning. ...... Background: Immediate revascularization of ischemic tissue, does not always produce the expected results. Various reactions that arise from the formation of reactive oxygen species and the activation of the complement system cause ischemia reperfusion injury. Ischemia preconditioning PRC and hypothermia are thought to reduce the effects of ischemic reperfusion injury. Methods: This experimental study was performed on the control group and three treatment groups, namely reperfusion injury IRI, ischemia preconditioning PRC, and hypothermia. Two experimental animals were used in control group and six experimental animals were used in IRI, PRC and hypothermia groups. In IRI group, right common femoral artery was ligated for four hours, and released for eight hours. In the PRC group, ligation of right common femoral artery was performed for two minutes and released for three minutes in two cycles. In the hypothermia group, right lower extremity was wrapped with ice. Subsequently, in the two groups, the right common femoral artery was ligated and released like IRI group. Then, laparotomy was performed and the stomach was taken. The antrum part is acquired for histopathology and biochemistry assay. Biochemical examination was performed using malondialdehyde MDA. Results: The hypothesis test of histopathologic and biochemical differences in general was statistically significant. The degree of histopathological damage and MDA in IRI group was significantly higher than control group. The degree of histopathological damage in the PRC group was significantly lower than in the IRI group but biochemically, higher but not significant. The degree of histopathologic damage in the hypothermia group was lower, but not significant, compared to the IRI group but biochemically, significantly higher than the IRI group. When comparing PRC and hypothermia, histopathologically, PRC is significantly lower. Biochemically, the mean PRC is lower but not significant. Conclusion: Ischemia preconditioning has a protective effect on the destructive impact of ischemia reperfusion injury in distant organs. Hypothermia also has a protective effect, but is not as good as ischemia preconditioning.

Abstrak :
ABSTRACT
Purpose To classify the shape of the remnant stomach after Billroth-I (B-I) reconstruction and evaluate the relationship between the shape of the remnant stomach and the postoperative clinical outcomes. Methods One hundred and ninety-five consecutive patients with gastric cancer underwent distal gastrectomy with B-I reconstruction between May 2006 and October 2014. We retrospectively reviewed their medical records and radiological findings. Finally, the shapes of the remnant stomach of 150 patients were classified as either straight type (type A) or stagnant type (type B). The clinical outcomes were compared with respect to the types of remnant stomach. Results The incidence of anastomotic leakage was significantly higher in the type A group than in the type B group (9.4 vs. 1.5%, p = 0.044). The body weight change ratio after surgery was significantly lower in the type B group than in the type A group [p = 0.0068, two-way repeated measures analysis of variance (ANOVA)], while the serum albumin levels showed marginally significant improvement in the type B group compared with the type A group (p = 0.0542, two-way repeated measures ANOVA). Conclusion The shape of the remnant stomach after distal gastrectomy with B-I reconstruction might influence the degree of anastomotic leakage and long-term nutritional status.

Abstrak :
ABSTRAK
Penelitian ini bertujuan untuk mengisolasi dan memurnikan enzim bromelain dari bonggol nanas Ananas comosus L. Merr. disertai pengujian kestabilannya dalam cairan lambung artifisial. Tahap pemurnian dimulai dari isolasi, fraksionasi menggunakan garam ammonium sulfat dilanjutkan dengan proses dialisis. Tiap tahap pemurnian menghasilkan peningkatan aktivitas spesifik pada fraksi enzim, mulai dari ekstrak kasar berturut-turut sebesar 0,276 U/mg; 14,591 U/mg; dan 16,05 U/mg. Tingkat kemurnian yang paling tinggi diperoleh pada hasil dialisis fraksi 3 50-80 sebesar 58,15 kali ekstrak kasarnya. Hasil uji kestabilan bromelain dalam cairan lambung artifisial melalui metode milk clotting units fraksi bromelain memiliki aktivitas proteolitik dalam menggumpalkan substrat susu. Pemaparan fraksi bromelain pada cairan lambung artifisial yang memberikan aktivitas proteolitik bromelain bonggol paling tinggi diperoleh pada volume sekitar 0,4-0,5 mL. Pemaparan berdasarkan waktu reaksi dengan cairan lambung artifisial yang mengandung pepsin menunjukkan aktivitas proteolitik yang relatif stabil pada 4 jam pertama.

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ABSTRACT
This study aimed to isolate and purify the bromelain enzyme from pineapple stem Ananas comosus L. Merr followed with test of its stability in artificial stomach juice. Purification steps start with isolation, fractionation with ammonium sulfate salt and dialysis process. Each step of purification produced an increasing specific activity in enzyme fraction, starting with crude extract, respectively 0.276 U mg 14.591 U mg and 16.05 U mg. The highest level of purity was achieved from dialyzed 3rd fraction 50 80 in the amount of 58.15 fold in comparison with crude extract. The result of bromelain stability test in artificial stomach juice by milk clotting units assay bromelain fraction have proteolytic activity in clotting milk substrate. Exposing bromelain fraction in artificial stomach juice which gave the highest stem bromelain proteolytic activity was achieved at estimated volume of 0.4 0.5 mL. Exposure in a period of reaction time to artificial stomach juice that contained pepsin showed relatively stable proteolytic activity in the first 4 hours.

Abstrak :
Beberapa penelitian melaporkan bahwa ekstrak rimpang kunyit (Curcuma domestica Val.) dan ekstrak kulit batang mimba (Azadirachta indica A. Juss) masing-masing menunjukkan aktivitas gastroprotektif baik pada uji preklinik maupun klinik. Tujuan dari penelitian ini adalah untuk mengetahui efektivitas gastroprotektif kombinasi ekstrak rimpang kunyit dan kulit batang mimba pada tikus yang diinduksi dengan asetosal. Penelitian ini menggunakan tikus jantan galur Sprague Dawley dengan berat badan 100- 150 gram sebanyak 32 ekor yang dibagi menjadi 8 kelompok dengan metode Rancangan Acak Lengkap (RAL); kelompok I, II, III, IV, V, dan VI diberikan kombinasi ekstrak selama 7 hari sebelum diinduksi, kelompok VII sebagai kontrol negatif diberikan CMC 1% selama 7 hari sebelum dinduksi, kelompok VIII sebagai kontrol normal diberikan larutan CMC 1% dan tidak diinduksi dengan asetosal. Delapan jam setelah perlakuan, tikus dibedah dan dilakukan pengujian pada organ lambung meliputi perhitungan indeks ulkus, pemeriksaan keasaman lambung, determinasi mukus, dan pengamatan histologi. Hasil dari penelitian ini menyebutkan bahwa pemberian kombinasi ekstrak rimpang kunyit (50 mg/kg bb) dan ekstrak kulit batang mimba (250 mg/kg bb) dapat menurunkan indeks ulkus secara signifikan, pembentukan mukus yang tinggi, serta didukung dengan hasil pengamatan histologi, yakni tidak ditemukannya perubahan bentuk dan ukuran sel parietal yang bermakna jika dibandingkan dengan kontrol normal. ......Some studies reported that turmeric (Curcuma domestica Val.) rhizome and neem (Azadirachta indica A. Juss) bark extracts which each of them demonstrated strong gastroprotective activities on both preclinical and clinical studies. The objective of this study was to investigate the gastroprotective effect of turmeric rhizome and neem bark extracts on acetosal-induced gastric mucosal lesions in rats. Thirty two male Sprague Dawley rats 100-150 g bw used in the study were divided into 8 groups using Complete Randomized Design (CRD) method; group I, II, III, IV, V and VI received combination extracts orally in various doses for 7 days before acetosal, group VII served as negative control received orally 1% CMC for 7 days before acetosal, group VIII received orally 1% CMC solution and served as normal control. Eight hours after treatment, animals were sacrificed and the stomach were taken to measure ulcer index, gastric acid determination, mucus determination and histology examination. The result suggests that pretreatment with combination of turmeric rhizome (50 mg/kg bw) and neem bark extract (250 mg/kg bw) and was observed significantly reduced the ulcer index, demonstrated high mucus production, also suppported by histopatological examination with no significantly changing on parietal cells microscopic appearance compared with normal control.

Abstrak :
Penyakit lambung merupakan penyakit yang terjadi di lambung atau bersumber dari lambung. Terdapat beberapa macam penyakit lambung, seperti Gastroesophageal Reflux Disease (GERD), tukak lambung, dan dispepsia. Golongan obat Antagonis Reseptor Histamin H2 atau Antagonis H2, adalah golongan obat penekan asam lambung yang sering digunakan dalam berbagai kondisi penyakit lambung. Clinical pathway atau alur klinis merupakan suatu alat yang digunakan untuk memandu perawatan kesehatan untuk pasien. Pembuatan clinical pathway harus dikembangkan berdasarkan bukti yang tersedia, seperti pedoman praktik klinis yang memuat tatalaksana penyakit, tindakan, dan terapi yang akan diberikan kepada pasien. Peran farmasis dalam clinical pathway adalah dalam manajemen terapi obat, kebutuhan obat pasien, edukasi obat kepada pasien berserta keluarga pasien dan juga tenaga kesehatan, merevisi dan menetapkan protokol pengobatan, dan evaluasi hasil pengobatan. Oleh karena itu, clinical pathway terapi penyakit lambung perlu diketahui untuk memberikan informasi serta rekomendasi terkait pengobatan dan penanganan pasien kepada tenaga kesehatan demi tercapainya hasil pengobatan yang diharapkan dan sebagai manajemen terkait kualitas, biaya, kepuasan pasien dan efisiensi. Metode pelaksanaan tugas khusus ini adalah dengan cara studi literatur untuk pencarian clinical pathway penyakit lambung dengan obat golongan Antagonis H2 dengan mencari sumber atau referensi dan melakukan penelusuran pustaka terkait penatalaksaan atau algoritma penyakit lambung. Berdasarkan hasil studi literatur yang dilakukan, golongan obat Antagonis H2 dapat dijadikan sebagai pilihan terapi untuk GERD ringan, dapat menjadi pilihan untuk mengobati dispepsia tanpa alarm symptoms, baik untuk pasien yang sebelumnya mengonsumsi obat-obatan NSAID ataupun tidak, dan dapat menjadi terapi pilihan untuk penyakit lambung dengan dosis yang berbeda-beda sesuai dengan penyakitnya. ......Gastric disease is a disease that occurs in the stomach or originates from the stomach. There are several kinds of gastric diseases, such as Gastroesophageal Reflux Disease (GERD), peptic ulcers, and dyspepsia. The H2 Histamine Receptor Antagonist drug class or H2 antagonists, is a class of drugs that suppress stomach acid which is often used in various conditions of gastric disease. Clinical pathway is a tool used to guide health care for patients. Making a clinical pathway must be developed based on available evidence, such as clinical practice guidelines that contain disease management, actions, and therapies to be given to patients. The role of pharmacists in clinical pathways is in drug therapy management, patient drug needs, drug education for patients and their families as well as health workers, revising and establishing treatment protocols, and evaluating treatment results. Therefore, it is necessary to know the clinical pathway for gastric disease therapy to provide information and recommendations related to treatment and patient care to health workers in order to achieve the expected treatment results and as management related to quality, cost, patient satisfaction and efficiency. The method of carrying out this special assignment is by means of a literature study to search for clinical pathways for gastric disease with H2 antagonist class drugs by finding sources or references and conducting literature searches related to gastric disease management or algorithms. Based on the results of a literature study conducted, the H2 antagonist drug class can be used as a therapeutic option for mild GERD, can be an option for treating dyspepsia without alarm symptoms, both for patients who have previously taken NSAID drugs or not, and can be the therapy of choice for chronic kidney disease. stomach with different doses according to the disease.