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Successful Management of Takayasu’s Arteritis with Pulmonary Hypertension in Pregnancy: A Rare Case

Open Journal of Obstetrics and Gynecology 2019年第8期9卷 1151-1160页

作者： wiryawan permadi Dani Setiawan Muhammad Alamsyah Aziz Yanuarman Anita D. Anwar Firman Fuad Wirakusumah Obstetrics and Gynecology Department Faculty of Medicine Padjadjaran University Hasan Sadikin Hospital Bandung Indonesia

Introduction: Takayasu’s arteritis (TA) is a rare systemic, chronic inflam-matory, progressive, idiopathic disease of aorta and its main branches. Taka-yasu’s arteritis causes narrowing, occlusion and aneurysm of arteries. The eti-ology of TA is still unknown. It may be autoimmune or genetic in origin or infective diseases. It is commonly found in Asia and oriental countries. Worldwide annual incidence is 1.2 - 2.6 cases/million. Women are affected in 80% - 90% of cases with age of onset below 40 years. TA does not worsen or improve with pregnancy but has adverse effect on pregnancy in the form of abortion, Intrauterine fetal death, superimposed preeclampsia, Intrauterine growth restriction, abruption and congestive heart failure. Because the disease is common in women of childbearing age, management of pregnancy in these patients becomes important;however optimal management for pregnant pa-tients with this disease has not yet been established. Due to the manifold car-diovascular complications that can occur in the course of the disease, man-agement of pregnancies in TA patients is a challenge for the clinician. An in-terdisciplinary collaboration of obstetrician, rheumatologist, cardiologist and anaesthetist is necessary to improve maternal and fetal prognosis. This was the first reported case of TA in pregnancy in Hasan Sadikin Hospital with superimposed preeclampsia and pulmonary hypertension. Materials and Methods: The patient, G1P0A0 was diagnosed as TA since one year ago, and when the patient was pregnant, the patient routinely came to obstetric and rheumatology clinics. Angiographic examination showed dilatation of aorta ascendant, narrowing of aorta descendent at 8 thoracal vertebrae, and arcus aorta, abdominal aorta and the branches were without abnormalities that lead to type IIb TA. On physical examination blood pressure was 200/100 mmHg on the right arm, and 140/100 mm Hg on the left arm, right hand pulse 120 x/m, left hand pulse 113 x/m, respiration rat

关键词： Takayasu’s Arthritis Pulmonary Hypertension Pregnancy

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Association between mRNA Expression of Aromatase, 17β-HSD2, Level of TGF-β1 and Stage of Endometriosis

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Open Journal of Obstetrics and Gynecology 2016年第7期6卷 411-418页

作者： Ruswana Anwar Firman F. Wirakusumah Duddy S. Nataprawira Ani M. Maskoen wiryawan permadi Tono Djuwantono Department of Obstetrics and Gynecology Faculty of Medicine University of Padjadjaran Dr. Hasan Sadikin Hospital Bandung Indonesia Medical Research Unit Faculty of Medicine University of Padjadjaran Bandung Indonesia

Aim: To identify the correlation between mRNA expression of aromatase, 17β-HSD2 level of TGF-β1 and stage of endometriosis. Methods: Case control study was done on 80 patients divided by 40 endometriosis patients and 40 patients as control. mRNA expression of aromatase, mRNA 17β-SD2, was checked using reverse-transcriptase polymerase chain reaction (RT-PCR) and TGF-β1 serum and peritoneal fluid was checked using ELISA. Result: Level of mRNA aromatase from ectopic and eutopic endometrium increased significantly compared to control group (p < 0.001). mRNA 17β-HSD2 expression is significantly lower compared to control (p TGF-β1 on endometriosis group was significantly higher compared to control group (p < 0.05). Level of peritoneal fluid TGF-β1 on endometriosis group was higher than control group (p < 0.001). There are no correlations between mRNA aromatase, type 2 17β-HSD, TGF-β1 serum level to endometriosis stage. There are significant correlations between peritoneal fluid TGF-β1 levels to endometriosis stage.

关键词： Aromatase 17βHSD2 TGFβ1 Stage Endometriosis

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Alobar Holoprosencephaly with Duodenal Atresia: A Case Report

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Open Journal of Obstetrics and Gynecology 2019年第8期9卷 1189-1196页

作者： wiryawan permadi D. Setiawan M. Alamsyah Aziz Yanuarman Anita D. Anwar F. F. Wirakusumah Obstetrics and Gynecology Department Faculty of Medicine Padjadjaran University Hasan Sadikin Hospital Bandung West Java Indonesia

Introduction: Holoprosencephaly (HPE) is the most frequent malformation of the prosencephalon. It represents the absence or incomplete division of the prosencephalon during the 4th and 8th week of gestation. Its incidence is estimated to be 1 in 16,000 live births and 1 in 250 spontaneous abortions. According to the degree of cerebral involvements, it is classified into 3 types: alobar, semilobar, and lobar. Alobar is the most severe type. Duodenal atresia occurs in approximately 1:10,000 live births. It can be fatal unless diagnosed and surgically treated promptly. It is a less common cause of polyhydramnion. The diagnosis of duodenal obstruction may be suspected prior to the child’s birth by prenatal ultrasonography. The outcome of congenital duodenal obstructions, in terms of mortality rate, has improved over the last decades, mainly attributable to the improvement in the quality of prenatal diagnosis and neonatal intensive care. Embryological basis for etiology of duodenal atresia is thought to be due to errors of recanalization. Duodenal atresia is associated with other congenital anomalies in spite with holoprosencephaly. This is the only case (HPE with duodenal atresia) which is reported in Hasan Sadikin Hospital in the last five years. Materials and Methods: A patient G2P1A0 who had vaginal birth 6 years ago, without complication on mother and fetus was referred to Hasan Sadikin Hospital with abdominal discomfort as main complaint on her 33 - 34 weeks of pregnancy. Prenatal care was during the first and second trimester by midwife and sonography in satellite hospital. She had polyhydramnion and head abnormality and referred to Hasan Sadikin Hospital. Sonography examination showed alobar holoprosencephaly, abnormal facial (cleft lip and palate, absent nasal bone, hypotelorism), duodenal atresia and polyhydramnios (Amniotic Fluid Index 50 cm);other examinations were normal. Amnioreduction and karyotyping examination were done. After 3 weeks the amniotic fluid

关键词： Holoprosencephaly Duodenal Atresia Ultrasound Examination

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