Kanker payudara adalah tumor ganas yang terbentuk dari sel-sel payudara yang tumbuh dan berkembang tanpa terkendali sehingga dapat menyebar ke jaringan atau organ yang berada dekat dengan payudara atau ke bagian tubuh lainnya. Annona muricata Linn atau Graviola telah digunakan sebagai obat tradisional untuk menangani berbagai jenis penyakit seperti demam, rematik, kanker dan juga sebagai sedatif, insektisida dan imunosupresif. Pada penelitian ini, cell line kanker payudara MCF-7 diberi ekstrak etanol A. muricata kemudian diinkubasi 24 jam. Setelah itu dilakukan uji sitotoksik menggunakan metode MTT assay. Parameter yang digunakan pada uji sitotoksik adalah IC50 yang menunjukkan konsentrasi inhibisi sel kanker sebanyak 50% dengan nilai IC50 sebesar 117,87 μg/ml. Ekstrak dapat dikatakan memiliki aktivitas sitotoksik jika nilai IC50 kurang dari 1000 μg/ml setelah 24 jam kontak dengan sel kanker. Dengan demikian, dapat disimpulkan bahwa ekstrak etanol daun A. muricata dapat digunakan sebagai pilihan terapi anti-kanker alami untuk kanker payudara.Kata Kunci:  Kanker payudara, Ekstrak etanol daun Annona muricata, MCF-7, MTT assay

Reperforation after gastric perforation repair is a complication which increases the rate of morbidity and mortality in gastric perforation. The lack of ability of the tissue to use oxygen in septic condition causes anaerobic cellular metabolism and furthermore it will cause failure in closing the perforation. The production of anaerobic metabolism is lactic acid which can be measured from the blood. The aim of this study is to determine the cut-off point of blood lactate level as a predictor of reperforation after repairing gastric perforation. Forty-six patients diagnosed as gastric perforation, who were repaired in Dr Soetomo Hospital from October 2014 to October 2015 were recruited as samples. Serum lactate was taken one hour before repairing the perforation. After being repaired, the patients were observed until the 14th day to evaluate whether any reperforation would occur or not . The design of this research was cross-sectional, analytic observational. The data was analyzed using independent t-test and ROC for obtaining the cut-off point as a predictor of the reperforation after the gastric perforation was repaired. There was a significant difference in the mean of lactate level in the group with reperforation compared with that of the non-reperforation group, that is as big as 3.74±0.59 mmol/L and 2.60±0.76 mmol/L. Using ROC curve analysis, there was the cut-off point of lactate level for reperforation 3.35 mmol/L, with sensitivity 92.9%, specificity 84.4%, positive predictive value 72% and negative predictive Value 96.4%, accuracy 87.0% and in the AUC value 0.902.

Generalized peritonitis caused by spontaneous gall bladder perforation is rare and difficult to diagnose preoperatively. The increased absorption of the spilling conjugated bile from the gall bladder by the inflamed peritoneum causes jaundice and direct hyperbilirubinemia. A 56-year-old male patient with septic generalized peritonitis and obstructive-type hyperbilirubinemia came to our hospital. The blood examination showed that total, direct, and indirect bilirubin were 6.20, 5.38, and 0.82 mg/dl. The gall bladder perforation was not detected on USG, CT scan, and MRCP. On laparotomy, we found a 0.5 cm perforation on the fundus of the gall bladder and 2500 cc of bilious fluid in the peritoneal cavity. Cholecystectomy was performed, and the patient completely recovered after the surgery. Preoperative diagnosis of spontaneous gall bladder perforation is difficult even by using ultrasonography, CT scan, and MRCP. The inflammatory reaction of the peritoneum in bile peritonitis increases the absorption of the spilled conjugated bile from the peritoneal cavity. The obstructive-type hyperbilirubinemia without dilatation of the bile duct on imaging examination was the sign of bile leakage into the peritoneal cavity. In septic condition, the preoperative diagnosis of the spontaneous gall bladder perforation is important to establish so that the surgeon can make only a minimal procedure in reducing the morbidity. Therefore, it could be concluded that the presently occurring obstructive-type jaundice without dilatation of the bile duct in the case of generalized peritonitis is a specific sign of spontaneous gall bladder perforation.

Surgical management in obstructive jaundice still contributes to significant morbidity and mortality. One of complications following surgery in obstructive jaundice is sepsis. This complication is caused by the toxic effects of bilirubin and bile salts, endotoxins, bacterial translocation, modulation of the immune-inflammatory cascade, decreased cellular immunity and/or nutritional status. Many studies have shown the elevated inflammatory response indicator, interleukin-1 (IL-1b), in patients with obstructive jaundice. However, only a few report described the association between the indicators of obstructive jaundice (alkaline phosphatase [ALP], g-glutamyl transpeptidase [GGT], and bilirubin) and the indicator of inflammatory response ). This study aimed to investigate the association between the indicator of obstructive jaundice (ALP, GGT, and bilirubin) and the level of interleukin-1b (IL-1b) in dogs as the animal model. We performed ligation on distal common bile ducts (CBD) to produce a model of obstructive jaundice. Every three days within a month, the blood samples from ten dogs were extracted to determine the ALP, GGT, direct and total bilirubin, and IL-1b levels. We found a significant correlation between the ALP and GGT with IL-1b level with p-value of 0.036 (r=0.626) and 0.003 (r=0.826). However, there was no association between the increased direct bilirubin with the IL-1b level (p=0.068; r=0.537). Moreover, the increased level of ALP and GGT had a strong correlation with the increased level of direct bilirubin with p-value of 0.004 (r=0.810) and p=0.011 (r=0.746). In conclusion, the increased level of GGT was the strongest indicator for inflammatory response in dogs with obstructive jaundice. Furthermore, the increased levels of GGT and ALP might imply the development of obstructive jaundice in dogs.

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Eviscerated ileum passing through a traumatic tear on the sigmoid wall is a rare case and all the cases reported previously showed that the eviscerated intestines were necrotic. However, in this case, although the huge size of eviscerated intestine had already exceeded the intestinal ischemic time, the small intestine outside the anus was not necrotic. Here we report the case of a 73-year-old female who presented with evisceration of the small intestine out of her anus as long as 200 cm 7 h before. The eviscerated small intestine (ileum) appeared still viable and there were no signs of pain, obstruction, or peritonitis. An intermittent rectal concomitant with uterovaginal prolapse had been experienced by the patient before. On surgery, the ileum was not necrotic and pulled back out of the sigmoid wall tear. The cardinal uterosacral ligament may have an important role in maintaining the uterovagina in place. When this ligament loses its ability to anchor the uterovagina to the sacrum, both the uterovagina and the rectum will lose their fixation to the sacrum and prolapse will occur. Hence, the rectum located posterior to the uterovagina also relieves its squeeze pressure so that it will not disrupt the blood supply of the ileum when the ileum enters through the rectal lumen. Rectal concomitant with

Background: Vitamin B1 (Thiamine) functions as a pyruvate dehydrogenase cofactor to produce acetyl Co-A and activate the Krebs cycle in cellular metabolism. The hypermetabolic state in septic condition requires excess thiamin to keep the Krebs cycle functioning well. The thiamin level in the blood decreases and causes mitochondrial dysfunction and vice versa results in an increase in lactate levels. This study aims to evaluate the correlation of blood thiamine concentrations with lactate acidosis in peritonitis patients with sepsisMethods: Prospective observational study in 65 adult septic patients who came to the hospital with peritonitis and underwent laparotomy. Thiamine concentration was assessed on days 1, 3, and 5 by liquid chromatography-mass spectrometry (LC-MS). The primary outcome was lactate levels. Data was analyzed using SPSS version 23 for Windows.Results: The incidence of thiamine deficiency (TD) was 61.5% of patients. Specifically, 29 cases (44.6%) had absolute thiamine deficiency (TD) on presentation, 4 patients (6.1%) developed it on day 3, and another 7 patients (10.8%) on day 5. Thiamine was negatively correlated with lactate levels (r=-0.600; p=0.020). The relationship appeared after multivariable regression analysis controlling for sex, septic shock, and malnutrition. Overall, for the TD group, there was a significant association with septic shock, malnourishment, and Mortality (p<0.05). Conclusion: Thiamine deficiency had significantly raised lactate levels, which might increase the risk of Mortality.

Background: Patients should be informed beforehand of the risk factors for exocrine pancreatic insufficiency (ExoPI) after pancreatic surgery; however, there are no clear identified risk factors for this condition. This study aimed to identify the preoperative, perioperative and postoperative risk factors for ExoPI after pancreatic surgery. Methods: We conducted a systematic search of PubMed, Scopus, SAGE, CINAHL Plus and Taylor & Francis from inception to Mar. 7, 2021, for full-text articles that included patients who had undergone pancreatic surgery. The primary outcome was the number of ExoPI events and any risk factors evaluated. We used the Newcastle–Ottawa Scale to assess study quality. Results: Twenty studies involving 4131 patients (2312 [52.3%] male, mean age 60.12 [standard deviation 14.07] yr) were included. Of the 4131 patients, 1651 (40.0%) had postoperative ExoPI. Among the 11 factors evaluated, the significant risk factors were preoperative main pancreatic duct (MPD) diameter greater than 3 mm (odds ratio [OR] 4.50, 95% confidence interval [CI] 1.06–19.05), pancreaticoduodenectomy (PD) as the surgical treatment procedure (OR 3.31, 95% CI 1.92–5.68), pancreaticogastrostomy (PG) as the anastomotic procedure (OR 3.13, 95% CI 1.83–5.35), hard pancreatic texture (OR 2.93, 95% CI 1.99–4.32) and adjuvant chemotherapy (OR 2.50, 95% CI 1.54–4.04). Gender, history of diabetes mellitus or endocrine pancreatic insufficiency (EndoPI), underlying diseases, de novo diabetes or EndoPI, pylorus-preserving PD and postoperative pancreatic fistula were not risk factors for ExoPI after pancreatic surgery. Conclusion: Preoperative MPD diameter greater than 3 mm, PD, PG reconstruction, hard pancreatic texture and adjuvant chemotherapy were risk factors for the development of ExoPI after pancreatic surgery. The findings should provide useful information for patients to reduce postoperative dissatisfaction and improve quality of life.