http://localhost:8080/xmlui/handle/123456789/8468 Thu, 09 Apr 2026 00:46:20 GMT 2026-04-09T00:46:20Z http://localhost:8080/xmlui/handle/123456789/8599 Title: Ganglion Impar Block and Neurolysis for Perineal Pain in Anal Adenocarcinoma: A Case Report Authors: Asmaranto, Asmaranto; Susila, Dedi Abstract: Background: Anal adenocarcinoma is a rare malignancy with symptoms including tenesmus, rectal bleeding, and pain during defecation. The pain can significantly reduce a patient's quality of life and there is currently no effective treatment for it. Ganglion impar block and neurolytic are one methods for managing pain in such cases. Case: A 60-year-old woman with anal adenocarcinoma and chronic pain in the anal region for two years despite oral medication underwent ganglion impar block and neurolytic treatment using a mixture of 96% alcohol and levobupivacaine 0.25%. Conclusion: Ganglion impar block with neurolysis using 96% alcohol can be an option for managing perineal pain, especially when previous medication therapy is ineffective. This combination is safe for patients and can reduce pain levels. Keywords: Impar Ganglion Block; Neurolysis; 96% Alcohol; Anal adenocarcinoma; Perineal pain; Pain management Mon, 01 Jan 2024 00:00:00 GMT http://localhost:8080/xmlui/handle/123456789/8599 2024-01-01T00:00:00Z http://localhost:8080/xmlui/handle/123456789/8598 Title: A Girl with McCune-Albright Syndrome: Case Study Authors: Khairunnisa, Khairunnisa; Faizi, Muhammad; Rochmah, Nur; Hisbiyah, Yuni; Kurnia Perwitasari, Rayi Abstract: McCune-Albright syndrome (MAS) is a rare genetic disease characterized by skeletal, cutaneous, and endocrine system involvement. We report a 6-year-old girl with fibrous dysplasia, café-au-lait macula, and multiple hyperfunctional endocrinopathies. Treatment was palliative, the patient was planned for surgery on bilateral femur fractures and a rehabilitation program Mon, 01 Jan 2024 00:00:00 GMT http://localhost:8080/xmlui/handle/123456789/8598 2024-01-01T00:00:00Z http://localhost:8080/xmlui/handle/123456789/8597 Title: Challenges in the Diagnosis and Management of Congenital Adrenal Hyperplasia: A Case Report Authors: Pratama Biyang, Ganesha; Sa'adi, Ashon Abstract: Background: Congenital adrenal hyperplasia (CAH) is an autosomal recessive endocrine disorder resulting in 21-hydroxylase enzyme deficiency. Nonclassical congenital adrenal hyperplasia is commonly found in adult patients with menstrual disorders, growth delays, secondary sexual characteristic abnormalities, or infertility. Diagnosing and managing CAH presents several challenges that can hinder patients from achieving therapeutic targets. Case Presentation: A 19-year-old female was referred from the Internal Medicine Polyclinic to the Reproductive Endocrinology and Infertility Polyclinic at Dr. Soetomo General Academic Hospital (RSUD Dr. Soetomo), presenting with primary amenorrhea and no breast development. Examination revealed signs of virilization, such as hirsutism, acne, and clitoromegaly. Ultrasound examination showed a hypoplastic uterus with normal ovaries. Elevated serum 17-OHP and testosterone from laboratory examination confirmed the diagnosis. Treatment with glucocorticoid replacement therapy using hydrocortisone, along with antiandrogenic contraceptive pills, showed therapeutic progress within six months. Discussion: Diagnosing CAH is challenging and often results in delays in patients receiving appropriate care. The primary therapeutic goal of CAH is to prevent hyperandrogenism and provide glucocorticoid replacement therapy to suppress ACTH activity. Long-term administration of hydrocortisone and contraceptive pills for puberty induction is a viable and accessible option. However, long-term therapy can lead to side effects that impact the patient. Conclusion: There are several challenges in diagnosing and managing congenital CAH. Long-term management should be personalized, prioritizing the patient's goals and maximizing the benefits of multidisciplinary therapy. KeyWords: Congenital adrenal hyperplasia, 21-hydroxylase, Disorder of sexual development. Mon, 01 Jan 2024 00:00:00 GMT http://localhost:8080/xmlui/handle/123456789/8597 2024-01-01T00:00:00Z http://localhost:8080/xmlui/handle/123456789/8596 Title: Compression of Common Hepatic Duct (CHD) Caused by Dilated Cystic Duct, is it Another Variant or New Type of Mirizzi Syndrome: A Case Report Authors: Sumarki Budipramana, Vicky Abstract: Background: Narrowing or obstructing of Common Bile Duct (CBD) by gallstone impacted in distal cystic duct is known as Mirizzi Syndrome (MS). However, the compression of Common Hepatic Duct (CHD) because of the enlargement of cystic duct due to the impacted stone in the distal cystic duct has never been reported. Case Report: A 60 year old man, Indonesian Javanese ethnicity, came to the hospital with bile duct stone and obstructive jaundice due to the compression of Common Hepatic Duct (CHD) because of the enlargement of cystic duct. In this case, the stone just lies in the tip of the cystic duct causing obstruction of cystic duct but the stone does not directly compress the CBD. Long cystic duct with mid or low insertion into CBD possibly occurs in this case. The diagnosis of this case is common hepatic duct obstruction caused by the enlargement of cystic duct. Two surgeries were performed, the first surgery was only cholecystectomy, and the second surgery was taking out the remnant of cystic duct including the stone inside. The outcome of the surgery was good, and the patient was allowed to go home from the hospital without further complaints. This rare case cannot be grouped into the existing classification of Mirizzi syndrome. May this case be grouped as another variant or a new type of Mirizzi Syndrome ? This case could be grouped as type I-a of Mirizzi syndrome according to the classification of Mc. Sherry, Beltran or Csendes. Conclusion: In Mirizzi syndrome the obstruction of CBD is not only caused directly by the stone in distal cystic duct, but also it can be caused by the enlargement of the cystic duct. This type of bile duct obstruction has never been reported before and this rare case cannot be grouped into the existing classification of Mirizzi syndrome. It is important for surgeons to recognize similar cases in the future, misinterpretation of imaging findings of bile duct obstruction makes surgery difficult and harmful for the patient. Keywords: Common Hepatic Duct obstruction, Cystic duct dilatation, Mirizzi Syndrome. Mon, 01 Jan 2024 00:00:00 GMT http://localhost:8080/xmlui/handle/123456789/8596 2024-01-01T00:00:00Z