Purpose:Racial differences exist in the incidence of prostate cancer (PCa). Although many studies have looked at the performance of prostate-specific antigen (PSA) and PSA density (PSAD) in the detection of PCa, only a few have looked at it in relation to Indonesian men. The objective of this study is to find out better PSA and PSAD cutoff point in the detection of PCa in Indonesian men.Methods:A total of 404 consecutive Indonesian men underwent prostate biopsy for suspicion of PCa from 2008 to 2011. The biopsy criteria include one or more of the following: serum PSA more than 10 ng/mL, PSAD more than 0.15 if PSA 4–10 ng/mL, hypoechoic lesion during transrectal sonography and/or abnormal digital rectal examination.Results:Forty five out of 404 (11.1%) had positive biopsies. The mean age, prostate volume, PSA and PSAD were respectively 64.06 years, 43.03 mL, 45.59 ng/mL and 1.15. Of the 404, 131 cases (32.4%) were confirmed to be urinary retention. Positive urine culture found in 182 cases (45%). The cutoff point to detect PCa as estimated by the receiver operating characteristics was 6.95 ng/mL for PSA (sensitivity 97.8%, specificity 19.6%) and 0.7072 for PSAD (sensitivity 62.2%, specificity 78.7%). Positive predictive value for this PSA and PSAD cutoff point were 11.6% and 27.5% respectively (P=0.004 and P=0.000). There was a significant correlation between hypoechoic lesion and positive biopsy results (P =0.000). Urinary retention elevates PSA cutoff point to 14.55 (sensitivity 90.9%, specificity 50%), while positive urine culture alters almost no PSA cutoff elevation.Conclusions:PSA and PSAD cutoff point for Indonesian men in this series is relatively different from international consensus. Furthermore, these data show that PSA and PSAD cutoff point must be adjusted to racial variation to discriminate between malignant and benign disease. Urinary retention is a significant factor for PSA cutoff increase.
CUPPING AS PAIN ALTERNATIVE THERAPYABSTRACTPain is still a world’s problem. Current pain treatment is still unsatisfactory due to its chronicity and existing drugs’ side effects. Due to dissatisfaction with the existing treatment, many patients are choosing a traditional therapy for their pain treatment. Cupping therapy is one of the traditional therapies that is widely used to relieve pain. Cupping therapy has been used in many countries in the world. Some of these countries have used cupping therapy as a pain treatment in hospitals. Neurologists are handling pain cases in their daily practice. Nearly 80% of patients come to the doctor with one of their complaint related to pain directly. The knowledge of cupping therapy for pain is important for the development of new therapies in order to solve the pain problems that so far have not reached a satisfactory level.Keyword: Alternative therapy, cupping therapy, pain, pain problemsABSTRAKNyeri masih merupakan masalah dunia. Pengobatan nyeri saat ini masih belum sampai tahap yang memuaskan terkait kronisitas dan efek samping obat yang ada. Akibat ketidakpuasan dengan pengobatan yang ada, banyak pasien yang memilih terapi tradisional untuk pengobatan nyerinya. Terapi bekam merupakan salah satu terapi tradisional yang banyak dipakai untuk meredakan keluhan nyeri. Terapi bekam telah dipakai di banyak negara di dunia. Sebagian negara tersebut telah menggunakan bekam sebagai terapi nyeri di rumah sakit. Bekam menurunkan nyeri melalui efek antinosiseptifnya, dengan cara stimulasi sistem saraf perifer dan menurunkan stres oksidatif. Studi terbaru menunjukkan bahwa terapi bekam basah dapat meningkatkan ekspresi ß-endorphin dan HSP70 keratinosit pada lokasi bekam. Dalam praktek sehari-hari dokter spesialis saraf menangani kasus nyeri. Hampir 80% pasien datang ke dokter dengan disertai salah satu keluhan yang berkaitan dengan nyeri secara langsung. Pengetahuan tentang terapi bekam untuk nyeri penting diketahui untuk pengembangan terapi baru guna menyelesaikan permasalahan nyeri yang sampai saat ini belum sampai pada tahap yang memuaskan.Kata kunci: Masalah nyeri, nyeri, terapi alternatif, terapi bekam
In the case of advanced stage gynecological disorders, most patients have a disturbance in the upper urinary tract. Most patients with uterine cervical carcinoma are already in stage 3B and require urine diversion. The purpose of this study is to find and determine the profile of gynecological disorders that require urine diversion, the type of urine diversion, and urine diverted output in patients with cervical carcinoma. This descriptive analytical retrospective study was conducted at Dr. Soetomo Hospital, Surabaya, Indonesia, between 2012 and 2015. The samples of this study were all patients with gynecological disorders who underwent retrograde DJ stent procedures, underwent ureterocutaneostomy and nephrostomy at the Integrated Central Surgery Building, Dr. Soetomo Hospital, Surabaya, for three years between 2012 and 2015. Data was collected based on the medical record number of patients with gynecological disorders who underwent urine diversion procedures and were recorded in the book on the operation schedule. We find that the most common cause of gynecological abnormalities in kidney obstruction is cervical carcinoma. There are three types of urine diversions used, namely DJ stent, percutaneous nefropyelostomy, and ureterocutaneostomy, with DJ as the most commonly performed. Urine diversion can improve creatinine without being influenced by the type of diversity.
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