ARAS

Coronary Artery Bypass Grafting (CABG) is an operation that restores oxygen to your heart. CABG is a surgical procedure that reroutes blood flow around your blocked coronary artery. In the procedure, a transplanted piece of vessel, called a graft, allows blood to "bypass" the blockage in your artery. The much-needed blood simply follows a detour on its way to the heart.

Grafts are created using healthy blood vessels taken from other parts of your body. Depending on your condition, your physician will use a vessel from your chest (internal mammary artery) or remove a section from your leg (saphenous vein). Your internal mammary arteries are close to your heart. In a CABG procedure using mammary arteries, one end of the vessel remains attached to the blood source while the other end is rerouted and connected beyond the blockage in your coronary artery.

In a procedure using saphenous vein, a part of the vessel is removed from your leg. The resulting graft is like a small section of hose. One end of the graft is connected to your aorta, the large artery that feeds your coronary arteries, and the other end is connected to a point on your coronary artery just beyond the blockage. This creates a detour for oxygen-rich blood to reach you heart.

The vessels used for grafts are redundant. This means your body can compensate for their loss. If you are suffering from CAD, vessels taken from other parts of your body are more valuable to you when they're used as grafts. Your leg will still function without a section of saphenous vein and your chest will receive blood without an internal mammary artery. However, if your physician recommends CABG, your heart can't function properly without a coronary artery bypass graft.

CABG requires general anaesthesia. This means you will be asleep for the procedure. After you are anaesthetized or put to sleep, you'll receive a breathing tube through your mouth. This tube is attached to a ventilator. This machine will help you breathe during and right after the operation. Depending on the type of procedure, a heart-lung machine may also be used to continue the function of your heart and lungs while you are asleep during the operation. The number of bypasses performed during the surgery will depend on your condition and the number of blocked arteries. Three to five bypasses are common during a procedure. Nonetheless, some surgeries require as many as nine bypasses. CABG can take six to twelve hours followed by a few days of recovery in intensive hospital care.

Etiology

Some investigators suggest that this distribution arises as a consequence of abnormal migration of germ cells during embryogenesis. Others hypothesize a widespread distribution of germ cells to multiple sites during normal embryogenesis, with these cells conveying genetic information or providing regulatory functions at somatic sites.

Extragonadal germ cell tumors were thought initially to be isolated metastases from an undetected primary tumor in a gonad, but it is now known that many germ cell tumors are congenital and originate outside the gonads. The most notable of these is sacrococcygeal teratoma, the single most common tumor diagnosed in babies at birth.

Classification

Germ cell tumors are classified by their histology, regardless of location in the body.

Germ cell tumors are broadly divided in two classes:

• The germinomatous or seminomatous germ cell tumors (GGCT, SGCT) include only germinoma and its synonyms dysgerminoma and sominoma.
• The nongerminomatous or nonseminomatous germ cell tumors (NGGCT, NSGCT) include all other germ cell tumors, pure and mixed.

The two classes reflect an important clinical difference. Compared to germinomatous tumors, nongerminomatous tumors tend to grow faster, have an earlier mean age at time of diagnosis (~25 years versus ~35 years, in the case of testicular cancers), and have a lower 5 year survival rate. The survival rate for germinomatous tumors is higher in part because these tumors are exquisitely sensitive to radiation, and they also respond well to chemotherapy. The prognosis for nongerminomatous has improved dramatically, however, due to the use of platinum-based chemotherapy regimens.

Location

Despite their name, germ cell tumors occur both within and outside the ovary and testis.

• head
• inside the cranium - pineal and suprasellar locations are most commonly reported

• inside the mouth — a fairly common location for teratoma
• neck
• 1% to 5% in the mediastinum (mediastinal germ cell tumor)
• pelvis, particularly sacrococcygeal teratoma
• ovary
  Main article: Ovarian cancer
• testis
  Main article: Testicular cancer

In females, germ cell tumors account for 30% of ovarian tumors, but only 1 to 3% of ovarian cancers in North America. In younger women germ cell tumors are more common, thus in patients under the age of 21, 60% of ovarian tumors are of the germ cell type, and up to one-third are malignant. In males, germ cell tumors of the testis occur typically after puberty and are malignant (testicular cancer). In neonates, infants and children younger than 4 years, the majority of germ cell tumors are sacrococcygeal teratomas.

Males with Klinefelter's syndrome have a 50 times greater risk of germ cell tumors (GSTs). In these persons, GSTs usually contain nonseminomatous elements, present at an earlier age, and seldom are gonadal in location.

Prognosis

The 1997 International Germ Cell Consensus Classification is a tool for estimating the risk of relapse after treatment of malignant germ cell tumor.

A small study of ovarian tumors in girls reports a correlation between cystic and benign tumors and, conversely, solid and malignant tumors. Because the cystic extent of a tumor can be estimated by ultrasound, MRI, or CT scan before surgery, this permits selection of the most appropriate surgical plan to minimize risk of spillage of a malignant tumor.

Access to appropriate treatment has a large effect on outcome. A 1993 study of outcomes in Scotland found that for 454 men with non-seminomatous (non-germinomatous) germ cell tumors diagnosed between 1975 and 1989, 5-year survival increased over time and with earlier diagnosis. Adjusting for these and other factors, survival was 60% higher for men treated in a cancer unit that treated the majority of these men, even though the unit treated more men with the worst prognosis.

Dr Lee believes his method will be less traumatic for patients, saying:'It's minimally invasive, with very small holes, not a big cut, so there will be less pain and where there is less pain, patients also recover faster'

Active people in their 40s are no longer puting up with the pain and immobility caused be damaged cartilage in their knees. They are instead checking into hospitals to get their problem surgical fixed. The operation, an autologous cartilage transplant, involves harvesting a small amount of their cartilage or connective tissue, growing this in a laboratory til there are millions of cells, and then implanting this is their bad knees.

The National University Hospital (NUH) Singapore has done more than 100 such transplants since 2000. Demand for this treatment is growing, with twoor three operations done every month here.

The surgery is like having an infusion of fresh cartilage to patch up 'potholes' in the tissue, which could have come from contact sports or other injuries. The patient's pain from this problem comes from the holes leaving nerve ends in the bone exposed. Patients are always given painkiller as the first line of treatment. But if these do not work, and the person wishes to continue playing sports, an aoutologues transplant cartilage is now a viable option. Since the cartilage is harvested from the patient himself, the risk of rejection is zero. However, this is not a treatment surgeons offer older people, who mostly given total knee replacements.

Source: National University Hospital - Singapore, September 2009

An experimental procedure to repair knee cartilage using Stem Cells has brought relief to 35 people here in last three years.

Now, Dr Kevin Lee from the division of adult reconstructive surgery at the National University Hospital, hopes to test into 100 patients over the next two years to see if it is better than current methods. His method marries two techniques used in other parts of the world, but with some modifications.

Dr Lee's method, a day-surgery procedure that lasts about 1 1/2 hours, involves making holes with a tiny pick, through keyhole surgery, in the bone of a patient's knee which has been worn out by overuse. This release a type of stem cell from bone marrow, which later grows into cartilage cells. At the same time, he extracts bone marrow from an area near the hip. This is done to obtain stem cells. a type of master cell which can be grown into bone, fat or cartilage.

Three weeks later, the few hundred stem cells would have grown into over 10 million adult stem cells. These are injected into the patient's knee, together with a fluid which protects the cartilage cells from damage. The stem cells are able to home in on the area where there is missing cartilage. These cells then either become cartilage cells themselves or stimulate surrounding cells to become cartilage cells. It takes few weeks for the stem cells to become cartilage cells and at least six months before the cells become mature cartilage.

Civil servant Wahida Mansor, 44, could climb the 12 storeys to her Jurong West flat several months after the procedure. The mother of three said:'In the past, after walking for few hours, my knees would swell and it would be very uncomfortable. I was unable to sleep. Now I still can't jog, but at least I can sleep and do housework because it's not painful and doesn't swell.

About 150 to 200 cartilage operations are done in Singapore a year. They are done by extracting cartilage cells, growing them in the lab and opening up the knee to transplant them.
An Orthopaedic surgeon ar Mount Elizabeth Medical Centre, Dr Yegappan Muthukaruppan, does about 10 such operation a year. Commenting on Dr Lee's method, he said: 'This is experimental currently, but I do believe this will be the way to go as it is minimally invasive'

Bulan Juni 2009 saya membawa anak saya (Sami) ke singapura (NUH, National University Hospital) karena diduga sakit leukemia. Leukositnya 43.000.

Saya ke dokter Allan bag cancer leukemia, menurut analisannya Sami tidak kena leukemia.

Saya puas atas analisanya, dokter dan susternya pun ramah2.

Trims ya

Banyak faktor yang mempengaruhi kadar kolesterol dalam darah. Sebagian faktor tidak bisa dirubah, tapi banyak yang bisa kita kontrol.

Faktor yang tidak bisa dirubah:

• Keturunan

Jumlah LDL yang dibentuk tubuh dan sebarapa cepat LDL dibuang sangat ditentukan oleh gen seseorang.
Sebagian orang memiliki LDL tinggi hanya disebabkan karena faktor keturunan, bukan oleh faktor resiko lainnya.

• Umur dan Jenis Kelamin

Kolesterol darah mulai meningkat pada usia 20 dan terus meningkat sampai usia 60 - 65.
Sebelum usia 50, total kolesterol pada pria lebih tinggi dibanding wanita pada usia yang sama, tetapi kondisi ini berbalik setelah usia 50. Karena wanita mengalami menopause, LDL seringkali meningkat.

Faktor yang bisa dikontrol:

• Diet / Pengaturan makan

Ada 3 jenis makanan yang meningkatkan kadar LDL
1. Lemak jenuh (Saturated fat), ditemukan pada makanan yang diproses dengan lemak yang berasal dari binatang
2. Lemak trans (trans fat), ditemukan pada makanan yang diproses dengan minyak hidrogenasi seperti margarine, crackers dan kentang goreng
3. Kolesterol, berasal dari produk binatang

Lemak jenuh meningkatkan kadar LDL lebih dari makanan yang lain.

• Overweight / kegemukan

Kelebihan berat badan meningkatkan kadar LDL, meningkatkan trigliserida dan menurunkan kadar HDL (kolesterol 'baik')

• Kurang Gerak

Kurang bergerak akan berdampak pada kegemukan, meningkatkan LDL dan menurunkan HDL.
Olahraga teratur dapat meningkatkan HDL dan menurunkan kadar Trigliserida.


KADAR KOLESTEROL IDEAL
Total Kolesterol
Kurang dari 200 mg/dL diharapkan
200 - 239 mg/dL batas atas
giLebih dari 240 mg/dL tinggi

Kolesterol LDL
Kurang dari 100 mg/dL optimal
100 - 129 mg/dL diatas optimal
130 - 159 mg/dL batas atas
160 - 189 mg/dL tinggi
Lebih dari 190 mg/dL sangat tinggi

Kolesterol HDL
Kurang dari 40 mg/dL sangat beresiko terkena serangan jantung
Lebih dari 60 mg/dL memberikan perlindungan terhadap serangan jantung

Siapa yang beresiko terkena Penyakit Jantung?

Mereka yang

1. Merokok
2. Memiliki penyakit darah tinggi (lebih dari 140/90 mmHg atau sedang dalam pengobatan darah tingginya)
3. Kadar HDL Kolestrol yang rendah (kurang dari 40mg/dL)
4. Riwayat keluarga ada yang memiliki penyakit jantung ( Ayah atau saudara laki laki didiagnosa berpenyakit jantung sebelum usia 55, Ibu atau saudara perempuan sebelum usia 65)
5. Usia (45 keatas bagi pria; 55 keatas bagi wanita)

catatan:
Obesitas (kegemukan) dan kurang gerak tidak tercantum dalam daftar diatas, tapi harus dikoreksi untuk menjaga jantung tetap sehat.
Kencing Manis bila tidak dikontrol dengan baik akan menyerang pembuluh darah termasuk pembuluh darah di jantung sehingga mengakibatkan penyakit jantung

Bagaimana pengobatan Kolestrol Tinggi?
akan dibahas di posting berikutnya...

Apakah itu Kolesterol?
Kolesterol adalah zat yang ditemukan dalam produk makanan hewani seperti daging merah, unggas, telur, produk olahan susu.
Kita memerlukan Kolesterol untuk membantu pembentukan dinding sel, pembentukan hormon steroid seperti terstosteron, progesteron dan estrogen. Kolesterol dalam tubuh juga membentuk Vitamin D dengan bantuan sinar matahari. Jadi Kolesterol sebenarnya sangat berguna untuk tubuh kita.
Kolesterol hanya mudah larut didalam lemak dan memerlukan 'kurir' untuk mengantarkannya ke dalam darah yang dasarnya air. Kurir ini disebut LIPOPROTEIN. Melalui Lipoprotein ini kita bisa menentukan kadar kolesterol seseorang.

Kolesterol HDL (Kolesterol baik)
HDL (high density Lipoprotein) bekerja dengan membawa 1/3 - 1/4 Kolesterol dari arteri seluruh tubuh kembali ke hati dimana HDL akan dibuang dari tubuh.
HDL membawa Kolesterol dari dinding arteri yang berpotensi membentuk plak atau sumbatan.
Bila plak atau sumbatan terletak di arteri jantung dapat menimbulkan Penyakit Jantung Koroner dan Serangan Jantung.
Jadi bisa dibutkan bahwa HDL adalah Kolesterol 'baik' karena membawa Kolesterol yang ada di pembukuh darah ke hati untuk kemudian dikeluarkan dari tubuh.
Semakin tinggi HDL, semakin rendah risiko penyakit jantung.

Kolesterol LDL (Kolesterol Jahat)
LDL (low density Lipoprotein) adalah kurir utama Kolesterol dalam darah. Bila terlalu banyak LDL bersirkulasi dalam darah secara perlahan dapat terbentuk plak dalam arteri dan menjadi berbahaya bila plak terjadi di arteri yang menyupali daran ke jantung dan otak.
akibatnya bisa menyebabkan Penyakit Jantung Koroner atau Stroke.

Berapa NILAI NORMAL Kolesterol?
Kolesterol HDL
Normal: Diatas 40

Kolesterol LDL
Normal: Kurang dari 100
Hampir Optimal: 100 - 129
Garis Batas Tinggi: 130 - 159
Tinggi: 160 - 189
Sangat Tinggi: Diatas 190

Kolesterol Total
Normal: Dibawah 200
Garis batas: 200 - 239
Tinggi: Diatas 240

Rasio Kolesterol
Untuk menentukan apakah seseorang beresiko terkena Penyakit Jantung Koroner dapat menggunakan Rasio Kolesterol, dengan membagi angka Kolesterol Total dengan angka HDL.
Rasio Ideal yang harus dicapai adalah 3.5 - 1. Semakin tinggi angka rasio, semakin besar resiko terjadinya Penyakit Jantung Koroner.

1. Penyakit jantung hanya terjadi pada orang gemuk saja
2. Penyakit jantung tidak bisa terjadi pada anak dan orang muda
3. Wanita terbebas dari penyakit jantung
4. Penyakit jantung hanya satu macam
5. Jantungnya sehat, tidak mungkin bisa sakit jantung
6. Tidak ada hubungannya dengan serangan Stroke
7. Penyakit jantung merupakan penyakit keturunan
8. Penyakit jantung tidak bisa dicegah
9. Penyakit jantung diakibatkan sering dikagetkan
10. Penyakit jantung disebabkan sering makan jantung pisang
    

Berobat ke Singapura atau Malaysia sekarang tidaklah sulit. Teman teman tinggal menghubungi kami: ARAS One Stop Medical Services. Sebagai perwakilan resmi Rumah Sakit Singapura dan Malaysia, kami akan membantu memberikan informasi, konsultasi, pengaturan penjadwalan berobat jalan, pengaturan rawat inap, penjadwalan operasi, gambaran estimasi biaya, gambaran lamanya waktu yang diperlukan untuk berobat ke Singapura atau Malaysia, evakuasi pasien ke Rumah Sakit di Singapura atau Malaysia.

Silakan hubungi kami:
ARAS One Stop Medical Services
Jl. Cikapayang 18
Bandung 40132
email: nhg-bdg@bdg.centrin.net.id
mobile: 0811236482

1. Minta rujukan dari dokter yang selama ini merawat kesehatan Anda. Mintalah surat keterangan yang merincikan :

• Keterangan rinci tentang kondisi kesehatan Anda yang perlu diperhatikan
• Riwayat kesehatan Anda
• Jenis obat yang Anda pakai
• Catatan kesehatan yang terkait

Jika bisa, mintalah referensi / rujukan langsung dari dokter anda untuk dokter di Singapura atau Malaysia yang ahli dalam menangani kasus / penyakit yang sedang anda derita saat ini. Seperti kita ketahui dokter di Singapura atau Malaysia memiliki bidang keahlian khusus, misalnya dokter internis bagian pencernaan atau dokter bedah dada dan jantung, dan lain lain.

3. Jika tidak ada referensi dari dokter anda dan belum tahu dokter yang ingin dikunjungi, anda bisa menghubungi representative resmi Rumah Sakit Singapura atau Malaysia

4. Setelah mendapatkan kepastian jadwal konsultasi, barulah disiapkan transportasi dan akomodasi di Singapura atau Malaysia

Untuk mempermudah proses berobat anda di Singapura atau Malaysia, kami siap membantu anda mulai dari: informasi, konsultasi, pengaturan jadwal konsultasi dengan dokter, pengurusan rawat inap, penjadwalan operasi, evakuasi pasien termasuk pengurusan transportasinya.

Penyakit Jantung merupakan penyebab kematian nomor satu pada orang dewasa di Amerika.
Setiap tahunnya:

• 1.500.000 orang mengalami serangan jantung
• 478.000 orang meninggal karena penyakit jantung koroner
• 407.000 orang mengalami operasi bypass
• 300.000 orang menjalani angiplasti, pemasangan ring

Faktor-faktor pemicu Serangan Jantung ialah:

• Merokok
• Mengkonsumsi Makanan Berkolesterol Tinggi
• Kurang gerak
• Malas berolahraga
• Stres
• Kurang Istirahat

Gejala Serangan Jantung:
Bisa berbeda pada setiap orang. Mungkin dimulai dengan rasa sakit yang tidak jelas, rasa tidak nyaman, sesak di bagian dada.
Kadang saking ringannya, sering disalahartikan sebagai gangguan pencernaan.
Untuk mendeteksinya harus dilakukan pemeriksaan EKG (Elektro Kardio Grafi).
Pada orang lain mungkin mengalami hal yang paling buruk yang pernah dialami: rasa sesak luar biasa, rasa ditekan benda berat pada bagian dada, rasa sakit yang menjalar ke leher dan tangan kiri, keluar keringat dingin, perasaan takut yang sangat.

Mengingat serangan jantung bisa berakibat fatal berupa kematian mendadak, sangat dianjurkan bila ada yang mengalami gejala gejala seperti diatas dapat segera berobat ke dokter keluarga atau Rumah Sakit terdekat.