Rino Alvani Gani
Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta

Published : 58 Documents
Articles

Artificial Ascites in Radiofrequency Ablation for Liver Cancer Gani, Rino Alvani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 3 (2017): VOLUME 18, NUMBER 3, DECEMBER 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (359.311 KB) | DOI: 10.24871/1832017140-147

Abstract

Background: Radio Frequency Ablation (RFA) is one of the treatment modality for liver tumor either as primary tumor as well as secondary malignancy. Occasionally, a good ablation can’t be performed due to the tumor location. To assists the ablation in this particular case, some fluid can be deposited inside the abdomen which is called as artificial ascites. The aim of this study is to report and evaluate the method of artificial ascites in RFAMethod: This was a case series study consist of 19 consecutive patients that had been treated with ultrasound-guided RFA using artificial ascites from 2014 to 2017.Results: Artificial ascites was successfully performed in all 19 patients (100%) with total of 53 hepatocellular carcinoma (HCC) lesions in 34 RFA’s sessions and tumor size ranges from 10mm to 50mm. Most of the tumors were primary tumor (14/19). 9 patients had single tumor and 10 patients had multiple tumors and most of the tumor were located in segment 5 (14/53). Artificial ascites was performed using 5% dextrose in water (D/W) solution ranging from 500ml to 1500ml. No adverse effect occurred during and after the procedure.Conclusion: Percutaneous RFA using artificial ascites technique was safe and effective for treating HCC 
Hepatic Stellate Cells and Liver Disease Gani, Rino Alvani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 2 (2015): VOLUME 16, NUMBER 2, August 2015
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (379.342 KB) | DOI: 10.24871/162201565-66

Abstract

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Association between HBV DNA Level and Intrahepatic HBcAg Protein Expression of Hepatocytes in Patients with Chronic Hepatitis B Serevina, Devy; Krisnuhoni, Ening; Gani, Rino Alvani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 2, August 2010
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: Correlation between serum Hepatitis B viral deoxyribonucleic acid (HBV DNA) and hepatitis B core antigen (HBcAg) protein expression in the liver regarding hepatitis B e-antigen (HBeAg) status have not been well studied. This study was aimed to demonstrate association between serum HBV DNA and HBeAg levels with HBcAg expressions in the liver. Method: A total of 55 naive chronic hepatitis B (CHB) patients were enrolled. All samples were tested for HBeAg serum by serological test enzyme-linked immunosorbent assay (ELISA) and HBV DNA was determined by polymerase chain reaction (PCR) HBsAg and HBcAg were evaluated immunohistochemically in the liver tissue Results: Of 55 patients, 44 (80%) were HBeAg positive and 11 (20%) were HBeAg negative. There was a positive correlation between serum HBV DNA and HBcAg expression in the nuclei (r: 0.383; p = 0.004). There was association between HBcAg expression in the nucleus and qualitative HBeAg (p = 0.017). Conclusion: In the patient with chronic HBV, there is a very significant positive correlation between the level of viral replication and HBcAg expression in the nucleus of hepatocytes. Moreover, there is association between HBcAg expression in the hepatocytes nucleus and HBeAg serum level. These finding lead to the proposition that nucleus localization of HBcAg protein function to amplify the pool of cccDNA in the replication cycle of HBV.. Keywords: HBV DNA, Imunohistochemistry, HBcAg
CD4+ and CD8+ Counts in Liver and Their Correlation with Necroinflammatory and Fibrosis Grades in Chronic Hepatitis C Maurine, Chyntia Olivia; Gani, Rino Alvani; Krisnuhoni, Ening; Harimurti, Kuntjoro
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 3, Desember 2012
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

ABSTRACTBackground: Studies on the characteristics CD4+ and CD8+ in hepatitis C and their correlation with the severity of the disease have been rarely conducted. This study was aimed to obtain the mean difference between CD4+ and CD8+ count in liver to evaluate their correlation with fibrosis and necroinflammatory grades in chronic hepatitis C. Method: A cross-sectional study was conducted between March and July 2010 with 30 liver biopsies obtained from patients with non-B and non-HIV chronic hepatitis C who visited the Outpatient Clinic of Hepatology Unit at Cipto Mangunkusumo Hospital in January 2008–February 2010. Fibrosis and necroinflammatory grades were determined using METAVIR methods on liver biopsies. The mean values of CD4+ and CD8+ in portal tracts and hepatic lobules in liver biopsy specimens were evaluated. Statistical analysis was performed by using independent T-test and Spearman test. Results: There was a difference in mean CD4+ counts between portal tracts and the lobules (95% CI = 4.3-17.9; p = 0.002) and also differences in mean CD8+ counts in portal tracts and hepatic lobules (95% CI = 15.4-35.6; p < 0.001). There was no correlation between CD4+ and CD8+ counts, either in portal tracts or the lobules, and inflammatory grades as well as the liver fibrosis. Conclusion: CD4+ and CD8+ counts are greater in portal area compared to the hepatic lobules, with greater CD8+ counts than CD4+. However, both CD4+ and CD8+ counts are not correlated to the severity of liver damage.  Keywords: CD4+, CD8+, intrahepatic, chronic hepatitis C, METAVIR
Problems in Diagnosis Approach for Carcinoma of Pancreatic Head Kusumayanti, Ratu Ratih; Simadibrata, Marcellus; Abdullah, Murdani; Gani, Rino Alvani; Luthariana, Lies
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 9, ISSUE 2, August 2008
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Incidences of pancreatic cancer worldwide have been known to be increased. It is the fifth leading cause of death in United State of America. Seventy percent occurs in the head of the pancreas. Major risk factors are related to age, black race, smokers, high-fat diet, chronic pancreatitis, diabetes mellitus and alcohol consumption. Some clinical symptoms such as jaundice, abdominal pain, unexplained weight loss or ascites can occur early or even late in the course of disease. Diagnosing pancreatic cancer sometimes can be difficult, regarding to discrepancy between clinical symptoms and radiological findings. It is important to take good history of the patient, thorough examination, and combine several modalities in diagnosing tumor of pancreatic head. In this case report, a 54 year-old female, came to the hospital with abdominal swelling and jaundice. Physical examination revealed liver and spleen enlargement and edema on both lower extremities. The laboratory result showed increment in Carcinoembryonic Antigen (CEA) and carbohydrate antigen 19-9 (CA19–9) level, without marked increase in bilirubin level. Dilatation of the pancreatic duct was found in this patient, without any sign of bile stone. Endoscopic Retrograde Cholangiopancreatography (ERCP) in this patient was failed to have significant result. Keywords: carcinoma of pancreatic head, papilla vater carcinoma, diagnosis, ERCP, jaundiceHF
Nutrition Management on Acute Pancreatitis Gunarsa, Ralph Girson; Gani, Rino Alvani; Syam, Ari Fahrial
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8, ISSUE 1, April 2007
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Pancreatitis is an inflammatory process in pancreas. Clinical manifestation of acute pancreatitis can be mild to severe. Mortality rate is high in severe acute pancreatitis. Etiology of acute pancreatitis generally remains obscured. Supportive management is important in acute pancreatitis. Nutrition is important part in acute pancreatitis. Patient should not be given enteral nutrition temporarily and meanwhile parenteral nutrition must provide sufficient amount of calories and nutritional requirements. Immune nutrition should also be considered. In mild acute pancreatitis, oral realimentation can be started in 3rd-7th day. In severe acute pancreatitis with prolonged fasting, gradual enteral nutrition via nasoenteral tube is recommended Keywords: nutrition, acute pancreatitis, enteral nutrition
Acalculous Cholecystitis Prevalence on Abdominal Ultrasonography Examination of HIV/HCV Co-infection Patients in Cipto Mangunkusumo Hospital Sutopo, Bambang; Budihusodo, Unggul; Hasan, Irsan; Gani, Rino Alvani; Yunihastuti, Evy
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 1, April 2010
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: Acalculous cholecystitis is commonly found in patients with human immunodeficiency virus (HIV) compared to general population. Surprisingly, the signs and symptoms are unremarkable. On the other hand, HIV/hepatitis C virus (HCV) co-infection is a common finding. The aim of this study was to evaluate whether HCV infection has any influence to HIV patients concerning acalculous cholecystitis prevalence. Method: A cross-sectional study was performed in HIV/HCV patients who visited AIDS study group clinic at Cipto Mangunkusumo hospital during September 2008 to February 2009. The patients who met the criteria were examined physically and underwent abdominal ultrasonography. Routine blood count, alanine aminotranferase, aspartate aminotransferase, cluster of differentiation 4 (CD4) and serum albumin were recorded. Results: Of 63 patients underwent ultrasonography examination, we found acalculous cholecystitis in 33 patients (52.3%), cholelithiasis and cholecystitis in 2 patients, and 28 patients were considered normal. Patients with CD4 less than 200 cells, tend to have acalculous cholecystitis more than those who had CD4 more than 200 cells. Conclusion: The prevalence of acalculous cholecystitis among HIV/HCV co-infection is higher compared to those with HIV infection alone. Keywords: acalculous cholecystitis, HIV/HCV co-infection, CD4
Efficacy and Safety of In-Asia-manufactured Interferon alpha-2b in Combination with Ribavirin for Therapy of Naïve Chronic Hepatitis C Patients: A Multicenter, Prospective, Open-Label Trial Akbar, Nurul; Sulaiman, Ali; Gani, Rino Alvani; Hasan, Irsan; Lesmana, Laurentius; Sanityoso, Andri; Noer, Sjaifoellah; Pridady, FX; Soemarno, Soemarno
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 1, April 2009
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: An open-label, multi center and non-comparative study was conducted to evaluate the efficacy and safety of a more affordable in-Asia-manufactured interferon á-2b product in combination with ribavirin to treat naïve chronic hepatitis C patients. Method: Thirty chronic naïve hepatitis C patients were treated with in-Asia-manufactured interferon   a-2b subcutaneously 3 MIU thrice weekly and ribavirin 800-1,200 mg daily for 48 weeks. Follow-up was done until 24 weeks after the end of treatment. Efficacy was assessed by examining serologic and biochemical parameters at pre and post-treatment. Safety was assessed by evaluating clinical symptoms and laboratory parameters. Results: The virological response and sustained virological response rates of all Hepatitis C Virus (HCV) genotypes were 83.3% and 76.7% respectively. Post-treatment, 80% patients had significant alanine transaminase (ALT) decreased into normal level and remained normal in 76.7% patients at 24th week follow up period. At that time, the ALT level and sustained virological response were lower in HCV genotypes 1 and 4 than in non-1 and non-4 genotypes. The most frequent adverse event was flu-like syndrome. Conclusion: The efficacy and safety study on combination therapy of in-Asia-manufactured interferon a-2b and ribavirin has shown a good result based on the current standard of interferon alpha and ribavirin combination therapy. Keywords: interferons, combination drug therapy, chronic hepatitis C, treatment efficacy, safety
The Role of Specific Cellular Immune System in Chronic Hepatitis C Husna, Ihsanil; Akbar, Nurul; Gani, Rino Alvani; Budihusodo, Unggul; Sukmana, Nanang
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 5, ISSUE 1, April 2004
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Hepatitis C virus is a RNA virus with very high speed replication. The clinical course of chronic hepatitis C is frequently asymptomatic like other hepatitis viruses. Infection of hepatitis virus will activate the immune system specifically as well as non-specifically. Mechanism of the immune system regulation is controlled by tissues consisting of antibodies cells and cytokines. In the process, all of the immune systems integrate and coordinate with the main agent-lymphocytes. Lymphocytes recognize antigens through the specific-surface antigen receptors. Following exposure to viral chronic hepatitis virus, viremia takes place within 1-2 weeks. In immuno-competent hosts, viremia will be preceded with the increase in transaminase enzyme and delayed seroconversion of antibodies will occur. Unlike other immunologic processes, these established antibodies are not protective in nature but serve only as the sign that someone has been infected by hepatitis C. In most cases of hepatitis C virus infection, this virus cannot be eradicated in the acute phase. Approximately 80-90% of acute infection progresses to be chronic infection and in 50% of the cases, there is an increase in transaminase enzyme that reveals that there is still liver cell damage. The degree of liver tissue damage in hepatitis depends on the number of virus infecting and the activity of cytotoxic T cells. Keywords: hepatitis C virus, humoral immune response,cellular immune response
Non-Invasive Assessment and Evaluation of Portal Hypertension in Patients with Liver Cirrhosis Marki, Indra; Gani, Rino Alvani; Simadibrata, Marcellus; Manan, Chudahman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 2, NUMBER 2, August 2001
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Ultrasonography examination is an one of examination that can be used to see the abnormality of portal vein system. The technology of ultrasonography examination has further developed especially after using of Doppler ultrasonography which could portray haemodynamic changes from portal vein in liver cirrhosis patient. From this examination we also could predict bleeding.    Keywords: liver cirrhosis, portal hypertension, doppler ultrasonography