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Objective: To evaluate the effectiveness of a nasopharyngeal carcinoma (NPC) awareness programme on the short-term and long-term improvement of knowledge and referral of patients with NPC by primary healthcare centres (PHCCs) staff in Indonesia. Design: The NPC awareness programme consisted of 12 symposia including a Train-The-Trainer component, containing lectures about early symptoms and risk factors of NPC, practical examination and the referral system for NPC suspects. Before and after training participants completed a questionnaire. The Indonesian Doctors Association accredited all activities. Participants: 1 representative general practitioner (GP) from each PHCC attended an NPC awareness symposium. On the basis of the Train-The-Trainer principle, GPs received training material and were obligated to train their colleagues in the PHCC. Results: 703 GPs attended the symposia and trained 1349 staff members: 314 other GPs, 685 nurses and 350 midwives. After the training, respondents’ average score regarding the knowledge of NPC symptoms increased from 47 points (of the 100) to 74 points (p

Undifferentiated nasopharyngeal carcinoma (NPC) is 100% associated with Epstein‐Barr virus (EBV) as oncogenic driver. NPC is often diagnosed late due to initial vague complaints and obscured location. Prior studies suggest that measurement of EBV DNA load and RNA transcripts in nasopharyngeal (NP) brushings is useful for minimally invasive NPC diagnosis. However, whether these EBV markers relate to local virus replication or reflect tumor origin remains to be demonstrated. To resolve this, we analysed EBV‐DNA characteristics and quantified latent and lytic viral RNA transcripts in NP brushings and matching frozen NP‐biopsy specimens from patients suspected of having NPC. We observed non‐fragmented and Cp‐promotor methylated EBV‐DNA in both NP brushings and biopsies suggestive of tumor origin. Using quantitative RT‐PCR we determined expression levels of 7 critical latent (EBER1, Qp‐EBNA1, EBNA2, BART, LMP1, LMP2, BARF1) and 5 lytic (Zta, Rta, TK, PK and VCA‐p18) RNA transcripts. Although latent and early lytic RNA transcripts were frequently detected in conjunction with high EBV viral load, in both brushings and biopsies the latent transcripts prevailed and reflected a typical NPC‐associated latency‐II transcription profile without EBNA2. Late lytic RNA transcripts were rare and detected at low levels mainly in NP brushings, suggestive of abortive viral reactivation rather than complete virus replication. EBV‐IgA serology (EBNA1, VCA, Zta) did not correlate to the level of viral reactivation in situ. Overall, viral RNA profiling, DNA fragmentation and methylation analysis in NP brushings and parallel biopsies indicate that NP brush sampling provides a true and robust indicator of NPC tumor presence., What's new? Nasopharyngeal carcinoma (NPC) often is diagnosed at late stages, in part because physical examination of the nasopharyngeal (NP) space is difficult. Moreover, despite a strong association with Epstein‐Barr virus (EBV) infection, optimal EBV‐based diagnostic modalities for NPC are lacking. Here, EBV DNA load, methylation status and EBV latent and lytic RNA profiles obtained from NP brush biopsy were found to be robustly indicative of tumor presence at the site of initiation. EBV (immediate) early mRNAs were frequently detected, suggesting local abortive viral reactivation. Using the described EBV markers, NP brushing may be a practical minimally invasive approach for NPC diagnosis.

Latar belakang: Lipoblastoma merupakan tumor mesenkim jinak pada bayi dan anak-anak. Gejalaklinik bervariasi tergantung lokasi dan gejala penekanan pada organ sekitarnya. Tujuan: Menentukantatalaksana bedah terbaik untuk kasus lipoblastoma kepala leher pada anak. Kasus: Dilaporkan seoranganak laki berusia 5 tahun dengan benjolan di pelipis kiri yang meluas ke pipi kiri sejak berusia 3 thn,makin membesar tidak disertai nyeri Metode: Pencarian literatur secara terstruktur dilakukan denganmenggunakan PubMed, EBSCO, dan Cochrane, sesuai dengan pertanyaan klinis. Pemilihan artikeldilakukan berdasarkan kriteria inklusi dan eksklusi. Satu artikel yang terpilih kemudian dinilai kualitasnyadengan kriteria telaah kritis dari Oxford. Hasil: Telaah studi menunjukan bahwa ekstirpasi tumor komplitmerupakan tata laksana terbanyak yang dipilih pada kasus lipoblastoma kepala leher anak. Pada pilihantatalaksana dengan eksisi parsial didapatkan adanya beberapa rekurensi tumor. Kesimpulan: Berdasarkanliteratur yang memiliki tingkat bukti yang paling tinggi, menunjukkan bahwa teknik ekstirpasi komplitmerupakan pilihan yang terbaik. Kata kunci: Lipoblastoma, kepala leher, teknik bedah ABSTRACT Background: Lipoblastoma is a rare benign mesenchymal tumor of infancy and early childhood.Symptoms vary depending on localization, and signs of compression of adjacent organs may be seen. Purpose: To determine the best surgical management of head and neck lipoblastoma in children. Case :A 5 years old boy with painless rapid growing mass in the left temple and cheek. Method: A structuredliterature search was performed using PubMed, EBSCO, and Cochrane, according to clinical questions.The selection of articles was based on inclusion and exclusion criteria. One selected article was assessedfor quality with criteria of critical appraisal from Oxford. Results: Most study showed that complete tumorextirpation was the most preferred procedure in cases of child head neck lipoblastoma. In managementwith partial excision, there were some recurrence of tumor. Conclusion: Based on the literature that hadthe highest level of evidence, complete extirpation techniques were the best choice. Keywords: Lipoblastoma, head of neck, surgical technique

BackgroundNasopharyngeal carcinoma (NPC) is endemic in Indonesia and 20% of the patients are diagnosed before the age of 31. This study evaluates presentation and treatment outcome of young patients in Jakarta, in a tertiary referral centre.MethodsForty-nine patients under the age of 31, diagnosed with NPC between July 2004 and January 2007, were evaluated. Baseline data included histological type, stage of disease and presenting symptoms. We intended to follow all patients after diagnosis to reveal treatment outcome and overall survival (OS).ResultsAll but two patients had advanced stage disease (94%), 7 (14%) had distant metastasis. The median interval between start of complaints and diagnosis was 9 months. Forty-two patients were planned for curative intent treatment. Eleven patients (26%) never started treatment, 2 patients did not complete treatment and 3 patients did not return after finishing treatment. Four patients died before radiation could start. Three patients died within 4 months after treatment. Nine patients (21%) had a complete response. Due to the high number of patients who were lost to follow-up (LFU), OS was analyzed as follows: a best-case (patients censored at last contact) and a worst-case scenario (assuming that patients who did not finish treatment or had disease at last contact would have died). The 2-year OS for patients without distant metastases was 39-71%.ConclusionTreatment outcome for young patients with NPC in this institute was poor. Improvement can be achieved when NPC is diagnosed at an earlier stage and when there is better treatment compliance.

Background: Acinic cell carcinoma is an uncommon type of parotid malignant tumour. One commonsymptom of this low grade malignancy is slowly growing parotid mass. Pain in parotid area and facialnerve paresis are important symptoms that indicate malignancy. From clinical manifestations, it is difficultto differentiate between this kind of malignancy with benign parotid tumour. Fine needle aspiration biopsyand CT scan are important in diagnosing acinic cell parotid carcinoma, and surgery is the main therapy. Purpose: We present this case to enlighten general practitioners and also otorhinolaryngologists aboutthis kind of parotid malignancy that has similar presentation with benign parotid tumour. Case: Onecase of acinic cell carcinoma of the parotis was reported. A 53 years old man was diagnosed as stage IVacinic cell carcinoma. Case management: The patient underwent radical parotidectomy. He was plannedfor chemotherapy and radiotherapy but untill now, he still refused further treatment. Conclusion: Aciniccell carcinoma is one of malignant tumour that has a good prognosis, especially if diagnosed early andadequately treated. Key words: malignant parotid tumour, acinic cell carcinoma, fine needle aspiration biopsy,parotidectomy. Abstrak : Latar belakang: Karsinoma sel asinus adalah salah satu tipe keganasan kelenjar liur yang jarang sekaliterjadi. Karsinoma ini bersifat low grade yang ditandai oleh benjolan pada daerah parotis yang tumbuhsecara lambat. Dari pemeriksaan klinis, keganasan ini sulit dibedakan dengan tumor jinak. Salah satugejala yang membedakan dari tumor jinak adalah rasa nyeri dan paresis nervus fasialis. Pemeriksaan biopsiaspirasi jarum halus dan tomografi komputer dapat menegakkan diagnosis karsinoma parotis jenis ini.Terapi utamanya adalah parotidektomi. Tujuan: Kasus ini diajukan agar para dokter umum dan dokterspesialis Telinga, Hidung, Tenggorok dapat mengenali adanya karsinoma parotis yang bermanifestasiklinis seperti tumor jinak ini. Kasus: Dilaporkan satu pasien, laki-laki berusia 53 tahun yang didiagnosiskarsinoma sel asinus kelenjar parotis stadium IV. Penatalaksanaan: Pada pasien ini dilakukan operasiparotidektomi radikal dan direncanakan untuk radiasi dan kemoterapi. Sampai saat ini, pasien masihmenolak untuk tatalaksana lebih lanjut pascabedah. Kesimpulan: Karsinoma sel asinus merupakan kasuskeganasan yang memiliki prognosis baik, terutama jika didiagnosis dini dan diterapi secara adekuat. Kata kunci: tumor ganas parotis, sel asinus, biopsi aspirasi jarum halus, parotidektomi.

Latar belakang: Jabir deltopektoral merupakan salah satu pilihan untuk rekonstruksi defek yang luasakibat tindakan ekstirpasi tumor dan pemberian radioterapi pada keganasan kepala leher. Jabir deltopektoralbukan merupakan pilihan utama dalam rekonstruksi defek kepala leher, namun pada kondisi tertentu, jabirtersebut memiliki tingkat keberhasilan yang lebih baik dibandingkan dengan metode jabir yang lain. Tujuan: Mengingatkan kembali para ahli THT tentang indikasi dan teknik penggunaan jabir deltopektoral pada kasusrekonstruksi defek akibat reseksi tumor dengan telaah sistematis kepustakaan. Kasus: Dilaporkan tiga kasuspenggunaan jabir deltopektoral sebagai penutup defek, satu kasus laki-laki 73 tahun dengan unknown primarytumor dengan penyulit diabetes melitus yang dilakukan tindakan diseksi leher radikal. Dua kasus lain dengandefek akibat stoma rekuren pascalaringektomi total. Penatalaksanaan: Pada ketiga kasus ini dilakukanpenutupan defek menggunakan jabir deltopektoral. Kesimpulan: Pada kondisi pemakaian jabir bebasmerupakan kontraindikasi, adanya keterbatasan fasilitas atau dokter ahli serta kondisi sistemik pasien maka jabirdeltopektoral merupakan salah satu alternatif untuk rekonstruksi defek luas pada daerah kepala leher, sebelumatau sesudah radioterapi. Kata kunci : jabir deltopektoral, rekonstruksi, defek kepala leher. ABSTRACT Background: Deltopectoral flap is one of the options for execessive defect caused by tumor ablation andradioterapy in head and neck cancer. Deltopectoral flap is not the main option in head and neck reconstruction,but in some certain condition, it has a better success rate than other flap techniques. Purpose : To presentevidence based case report in order to broaden otolaryngologists’ knowledge about indications and techniquesof deltopectoral flap in reconstruction of defect caused by tumor resection. Cases: We reported 3 cases ofdeltopectoral flap used as a defect closure, one of them was a man 73 years old who had an unknown primarytumor with diabetic status and had undergone radical neck dissection. Two other cases were patients withdefect caused by postlaryngectomy reccurent stoma. Management: We used deltofectoral flap for closing thedefect our patients. Conclusion: In conditions in which the use of free flaps are contraindicated, limitedinstrumentations or experienced surgeons , and poor systemic condition of the patient, deltopectoral flap can beconsidered as an alternative for reconstruction of wide defect of the neck, either pre or post radiotherapy. Keywords : deltopectoral flap, reconstruction , head neck defect.

UNLABELLED:In Indonesia, Nasopharyngeal Carcinoma (NPC) is the most frequent cancer of the head and neck region. At first presentation in the hospital most patients already have advanced NPC. Our previous study showed that general practitioners (GPs) working in Yogyakarta, Indonesia lack the knowledge necessary for early detection of NPC. By providing training on early symptoms of NPC we hope that the diagnosis and referral will occur at an earlier stage. Here we assess the current NPC knowledge levels of GPs in Jakarta, evaluate improvement after training, compare the effectiveness of two training formats, and estimate the loss of recall over a two week period. METHODS:Two Indonesian GPs visited 31 Primary Health Care Centres (PHCCs) and provided a lecture on NPC. The alternative format consisted of a symposium at the Universitas Indonesia, Jakarta, presented by local head and neck surgeons, with all GPs in the region being invited. To evaluate the effect of both formats a questionnaire was conducted before and after. RESULTS:The lecture in the PHCCs was attended by 130 GPs. Sixty-six GPs attended the training in the university hospital and 40 GPs attended both. Pre training the NPC knowledge level was poor with an average of 1.6 symptoms being correctly identified out of a potential maximum of 12, this was increased to 4.9 post training (p

Background: The treatment of persistent and recurrent nasopharyngeal carcinoma (NPC) remains a challenge, especially in Indonesia. We investigated the safety and efficacy of temoporfin mediated photodynamic therapy (PDT) for patients with local persistent and recurrent NPC. Material and methods: Twenty-two patients with persistent and recurrent NPC (maximum tumor depth

Nasopharyngeal carcinoma (NPC) is the most prevalent ENT-tumour in Indonesia. We investigated the primary diagnostic value of Epstein-Barr virus (EBV) DNA load and mRNA detection in noninvasive nasopharyngeal (NP) brushings, obtained prospectively from consecutive Indonesian ENT-patients with suspected NPC (N=106) and controls. A subsequent routine NP biopsy was taken for pathological examination and EBER-RISH, yielding 85 confirmed NPC and 21 non-NPC tumour patients. EBV DNA and human DNA load were quantified by real-time PCR. NP brushings from NPC patients contained extremely high EBV DNA loads compared to the 88 non-NPC controls (p

Background: Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign hormonal related fibrovascular tumor which originates from superoposterior area of sphenopalatine foramen. Purpose: To determineER-s expression of JNA patient at Cipto Mangunkusumo Hospital. Method: Descriptive study to determine s-estrogen receptor (ER-s) on 27 JNA patients who had been treated at Oncology Division ENT Departement Cipto Mangunkusumo Hospital between 2001-2008 was conducted. Results: ER-s expression of JNA in this study is 100%. Based on ER-s staining intensity, 18.5% gave strong intensity, 29.6% with moderate intensity, and 51.9% with weak intensity. According to positive ER-s cellular, it consist of three groups: less than 25% positive, 25-50% positive, and more than 50% positive, and the result is 3.7%, 3.7%, and 92.6% respectively. Conclusion: Immunohistochemical examination revealed 100% ER-s expression. Keywords: Juvenile nasopharyngeal angiofibroma (JNA), ER-s expression Abstrak : Latar belakang: Angiofibroma nasofaring belia (ANB) adalah suatu tumor fibrovaskular jinak, berasal dari area superoposterior foramen sfenopalatina dan diduga berhubungan erat dengan faktor hormonal. Tujuan: Melihat gambaran ekspresi ER-s pada penderita ANB di RS. Cipto Mangunkusumo. Metode: Penelitian deskriptif untuk melihat gambaran ekspresi reseptor estrogen s (ER-s) pada 27 kasus angiofibroma nasofaring belia (ANB) yang berobat dari tahun 2001 hingga 2008 di Divisi Onkologi Departemen Telinga Hidung Tenggorok RS. Cipto Mangunkusumo. Hasil: Didapati ekspresi ER-s pada ANB sebesar 100%. Berdasarkan intensitas pewarnaan terhadap ER-s didapatkan 18,5% mempunyai intensitas pewarnaan yang kuat, 29,6% intensitas pewarnaannya sedang dan 51,9% memiliki intensitas pewarnaan yang lemah. Tiga koma tujuh persen termasuk kelompok dengan jumlah sel yang positif mengandung ER-s kurang dari 25%, 3,7% termasuk kelompok dengan jumlah sel 25-50%, dan 92,6% termasuk kelompok dengan jumlah sel yang positif mengandung ER-s>50%. Kesimpulan: Hasil pemeriksaan imunohistokimia menunjukkan ekspresi ER-s pada semua kasus (100%). Kata kunci: angiofibroma nasofaring belia (ANB), tumor fibrovaskuler, ekspresi ER-s