Selasa, 30 November 2010

Penyebab dan Gejala Tumor Otak

Tumor disebabkan oleh mutasi DNA di dalam sel. Akumulasi dari mutasi-mutasi tersebut menyebabkan munculnya tumor. Sebenarnya sel kita memiliki mekanisme perbaikan DNA (DNA repair) dan mekanisme lainnya yang menyebabkan sel merusak dirinya dengan apoptosis jika kerusakan DNA sudah terlalu berat. Apoptosis adalah proses aktif kematian sel yang ditandai dengan pembelahan DNA kromosom, kondensasi kromatin, serta fragmentasi nukleus dan sel itu sendiri. Mutasi yang menekan gen untuk mekanisme tersebut biasanya dapat memicu terjadinya kanker.

Selama tahun 1988–1990 tereatat sejumlah 112 penderita tumor otak berbagai jenis yang dirawat di RSPAD Gatot Soebroto Jakarta. Sebagian dari penderita tumor otak tersebut memang pada mulanya ditemukan di klinik Neurologi karena umumnya menunjukkan gejala-gejala yang sifatnya neurologis.

Di kalangan medis pada umumnya sudah dikenal trias gejala tumor otak yaitu nyeri kepala, muntah dan ditemukannya edema papil pada pemeriksaan fundus. Tetapi sebenarnya gejala klinis tumor otak sering tidak sejelas itu, apalagi pada fase dini. Tumor otak bisa memberikan gejala klinis beragam tergantung kepada lokasi dan ukurannya. Gejala itu bisa khas, tapi bisa pula kabur, sehingga bila kita tidak waspada bisa terkecoh dengan dugaan yang keliru.

GEJALA TUMOR OTAK
Tumor otak bisa mengenai segala.usia, tapi umumnya pada usia dewasa muda atau pertengahan, jarang di bawah usia 10 tahun atau di alas 70 tahun. Sebagian ahli menyatakan insidens pada laki-laki lebih banyak dibanding wanita, tapi sebagian lagi menyatakan tak ada perbedaan insidens antara pria dan wanita. Gejala umum yang terjadi disebabkan karena gangguan fungsi serebral akibat edema otak dan tekanan intrakranial yang meningkat. Gejala spesifik terjadi akibat destruksi dan kompresi jaringan saraf, bisa berupa nyeri kepala, muntah, kejang, penurunan kesadaran, gangguan mental, gangguan visual dan sebagainya. Edema papil dan defisit neurologis lain biasanya ditemukan pada stadium yang lebih lanjut.


Nyeri Kepala (Headache)
Nyeri kepala biasanya terlokalisir, tapi bisa juga menyeluruh. Biasanya muncul pada pagi hari setelah bangun tidur dan berlangsung beberapa waktu, datang pergi (rekuren) dengan interval tak teratur beberapa menit sampai beberapa jam. Serangan semakin lama semakin sering dengan interval semakin pendek. Nyeri kepala ini bertambah hebat pada waktu penderita batuk, bersin atau mengejan (misalnya waktu buang air besar atau koitus). Nyeri kepaia juga bertambah berat waktu posisi berbaring, dan berkurang bila duduk. Penyebab nyeri kepala ini diduga akibat tarikan (traksi) pada pain sensitive structure seperti dura, pembuluh darah atau serabut saraf. Nyeri kepala merupakan gejala permulaan dari tumor otak yang berlokasi di daerah lobus oksipitalis.

Muntah
Lebih jarang dibanding dengan nyeri kepala. Muntah biasanya proyektil (menyemprot) tanpa didahului rasa mual, dan jarang terjadi tanpa disertai nyeri kepala.

Edema Papil
Keadaan ini bisa terlihat dengan pemeriksaan funduskopi menggunakan oftalmoskop. Gambarannya berupa kaburnya batas papil, warna papil berubah menjadi lebih kemerahan dan pucat, pembuluh darah melebar atau kadang-kadang tampak terputus-putus. Untuk mengetahui gambaran edema papil seharusnya kita sudah mengetahui gambaran papil normal terlcbih dahulu. Penyebab edema papil ini masih diperdebatkan, tapi diduga akibat penekanan terhadap vena sentralis retinae. Biasanya terjadi bila tumor yang lokasi atau pembesarannya menckan jalan aliran likuor sehingga mengakibatkan bendungan dan terjadi hidrocepallus.

Kejang
Ini terjadi bila tumor berada di hemisfer serebri serta merangsang korteks motorik. Kejang yang sifatnya lokal sukar dibedakan dengan kejang akibat lesi otak lainnya, sedang kejang yang sifatnya umum atau general sukar dibedakan dengan kejang karena epilepsi. Tapi bila kejang terjadi pertama kali pada usia dekade III dari kehidupan harus diwaspadai kemungkinan adanya tumor otak.

Minggu, 28 November 2010

PASSIVE VOICE

Rumus umum untuk membentuk suatu kalimat Pasif

Aktif : S + Verb (Kata Kerja) + Objek + dll
Pasif : Objek + to be + Verb 3 (Kata Kerja Bentuk III) ( + by subjek) + dll

To be yang digunakan

Present : is, am, are
Past : was, were
Perfect : been (di depan have, has, atau had)
Future : be (setelah modals)
Continuous : being (di depan salah satu dari 7 to be di atas)

Hal-hal yang perlu diketahui dan diingat
Untuk menyatakan suatu kalimat dalam bentuk pasif, tenses tidak berubah. Tenses harus sama dengan kalau kita menyatakannya dalam bentuk aktif. Yang berubah hanya kata kerja-nya.
Kata kerja yang tidak memiliki objek (Kata Kerja Intransitif) tidak dapat diubah menjadi kalimat pasif, seperti, menangis, mendidih, terbit, dll.

Contoh-contoh kalimat aktif dan pasif
Jack sings a song (active)
A song is sung by Jack (Passive)
Jack sang a song yesterday (active)
A song was sung by Jack yesterday (passive)
Jack has sung a song (active)
A song has been sung by Jack (passive)
Jack will sing a song (active)
A song will be sung by Jack (passive)
Jack is singing a song (active)
A song is being sung by Jack (passive)
Jack can sing a song (active)
A song can be sung by Jack (passive)

Beberapa Bentuk Kalimat Passive

1) Passive Imperative Sentence

Rumus:

Let + objek + be + Kata Kerja Bentuk III
Help the poor (active)
Let the poor be helped (passive)
2) Passive Infinitive: It is/was time

Rumus:

It is/was time for + objek + to be + kata kerja III
It is time to send the letter (active)
It is time for the letter to be sent (passive)
3) Negative Passive Imperative Sentence

Rumus:

Subjek + be + Kata kerja III + not to + infinitive

(kata kerja III yang sering digunakan adalah: advised, asked, begged, commanded, requested)
Don�t wait for me (active)
You are advised not to wait for me (passive)
4) Passive Sentence with Verbs of Perception

Rumus

Subjek + be + adjectives + when + subjek + be + kata kerja III

(kata kerja yang digunakan adalah: taste, smell, feel)
This food tastes delicious (active)
This food is delicious when it is tasted (passive)
5) Passive Sentence with Certain Verbs followed by �that-clause�

Kata kerja yang digunakan adalah: accept, admit, agree, assume, believe, decide, expect, find out, intend, plan, point out, presume, prove, regret, report, say, think, understand.
We regretted that the principal had to resign from office (active)
It was regretted that the principal had to resign from office (passive)
6) Passive Sentence with Nouns or Adjectives as Complements
I consider her very pretty (active)
She is considered very pretty (passive)
7) Passive Sentence with two objects
He gave me a book (active)
A book was given to me by him (passive 1)
I was given a book by him (passive 2)
8) Passive Sentence with Gerund Verbs
The teacher enjoyed teaching the students (active)
The students enjoyed being taught by the teacher (passive)
9) Agent consisting long expression at the end of sentence

Dalam kalimat pasif, jika pelaku terdiri dari ekspresi yang panjang, sebaiknya subjek tersebut ditempatkan di akhir kalimat setelah by.
We were all surprised by her sudden announcement to get married
I was confused by his plan to stop the ongoing project and begin a new one.
10) Passive Sentence with unique verbs

Kata kerja yang digunakan adalah: require, deserve, need
This wall needs to be painted (sama dengan)
This wall needs painting.

Jumat, 26 November 2010

TENSES



T E N S E S
I. PRESENT
   1. Simple Present Tense
    POLA:
Subject + Verb 1 + ….
They /   We
I   /   You
Subject + Verb s-es + ….    
He  /   She
 It
           
     FUNGSI:       
     a. Untuk menyatakan suatu kebiasaan (habitual action) atau kegiatan yang terjadi berulang – ulang dan terus menerus.
   Contoh :
* The students go to school everyday.
* She studies English twice a week.
* I go to church on Sundays
* We celebrate our independence day once in a year.
     b. Untuk menyatakan kebenaran umum (general truth).
         Contoh:
* The sun rises in the east and sets down in the west.
* The earth revolves round the sun.
* The pineapple never grows up on a tree.
      c. Digunakan dalam bahasa drama, komentar radio dan sejenisnya.
When the curtain rises, Juliet is writing on her desk. Suddenly the window opens and a masked man enters.

      KETERANGAN WAKTU:
  1. Every morning/day/week/month/year
  2. Once, twice, three times, four times, …
  3. Adverb of frequency : always, usually, sometimes, often, never, seldom.


    2. Present Continuous Tense
      POLA :
Subyek + to be (is, am, are) + V-ing
      FUNGSI;
  1. Untuk menyatakan suatu kegiatan yang sedang berlangsung pada waktu diucapkan.
Contoh:
* They are still playing at the moment.
* She is reading a novel now.
  1. Untuk menyatakan kegiatan yang sedang berlangsung tetapi belum tentu sedang berlangsung ketika pernyataan diucapkan.
Contoh:
*       I am learning French this year.
*       Mr. Brown is teaching English.
      KETERANGAN WAKTU:    Now, at the moment, this afternoon, this evening, right now, today.
      Note : Ketika ada kata kerja seperti: Look!, Listen!, Watch!, Notice! ( Imperative), maka tenses
                nya Present Continuous.
      Contoh:     *  Look! The man is climbing.
                 *  Listen! The girls next door are singing my favourite song.


3. Present Perfect Tense
    POLA:
Subject + Have  +  Verb 3 + ….
                 Has

    FUNGSI :
    a. Untuk menyatakan suatu perbuatan yang terjadi pada waktu lampau dan waktunya tidak tertentu.
     Contoh :
*       William Shakespeare has written many short stories.
*       I have swept the floor. It looks clean now.

  1. Untuk menyatakan peristiwa yang pernah dilakukan dan mungkin dilakukan lagi di waktu yang akan datang.
Contoh:
*       My friends and I have gone to Bali.
*       Shinta has visited her grand parents many times.

      KETERANGAN WAKTU: Since, for, just (baru saja), already, yet, so far.


4. Present Perfect Continuous Tense
    POLA :
Subject + Have  + Been + Verb-ing
                 Has

    FUNGSI :
Untuk menyatakan suatu kegiatan yang mulai dilakukan pada waktu lampau dan sampai sekarang masih berlangsung.
Contoh:
*       My sister has been studying English for three months.
*       The students have been doing the test since 11 o’clock.

     KETERANGAN WAKTU: For, since.



5. Simple Past Tense
        POLA:
Subject + Verb 2 + Object + ….

       FUNGSI:
Untuk menyatakan kegiatan yang terjadi pada waktu tertentu di masa lampau.
Contoh:
*       I met my music teacher yesterday.
*       My mother bought a new carpet last Sunday.
*       Rendy closed the window five minutes ago.
*       The students presented their project work this morning.

       KETERANGAN WAKTU:
-          Last ….                         -       …ago                                -       This afternoon
-          Just now            -       This morning                     -       Yesterday


6. Past Continuous Tense
         POLA:
Subject + was  + Verb- ing
                were

         FUNGSI:
  1. Untuk menggambarkan peristiwa yang sedang terjadi pada masa lampau.
 Contoh:
*       I was studying at my friend’s house.
*       My parents were chatting in the living room.
  1. Untuk menggambarkan suatu peristiwa yang sedang berlangsung pada waktu lampau, dimana peristiwa lain juga terjadi .
Contoh:
*       When I was studying, someone knocked the door.
*       When I was walking to school, I met Dian sastro.

7.  Past Perfect tense
   POLA:
Subject + Had + Verb 3

     FUNGSI:
Untuk menyatakan kegiatan yang terjadi sebelum kegiatan lain di waktu lampau muncul.
Contoh:  
*       The teachers went home after they had finished teaching.
*       When I arrived Kridosono, my favourite artist had performed.

    KETERANGAN WAKTU: when, after, before.
8. Future Tense
       POLA:
Subject + shall  + Verb 1 + …
                will

       FUNGSI:
  1. Untuk menggambarkan suatu peristiwa yang akan terjadi.
Contoh:
*       Bobby will come here tomorrow.
*       I shall call my parents when I get home.

  1. Untuk menyatakan sesuatu yang terjadi di masa mendatang yangbukan merupakan keinginan atau kehendak.
Contoh:
*       Tomy will be fourteen years old next year.
*       We shall die one day.

      KETERANGAN WAKTU: Tomorrow, next week/month/year, the day after tomorrow.

Future Perfect Tense

I will have sung
The future perfect tense is quite an easy tense to understand and use. The future perfect tense talks about the past in the future.

How do we make the Future Perfect Tense?

The structure of the future perfect tense is:
subject
+
auxiliary verb WILL
+
auxiliary verb HAVE
+
main verb
 
invariable

invariable
 
past participle
will
have
V3
Look at these example sentences in the future perfect tense:

subject
auxiliary verb

auxiliary verb
main verb

+
I
will

have
finished
by 10am.
+
You
will

have
forgotten
me by then.
-
She
will
not
have
gone
to school.
-
We
will
not
have
left.

?
Will
you

have
arrived?

?
Will
they

have
received
it?
In speaking with the future perfect tense, we often contract the subject and will. Sometimes, we contract the subject, will and have all together:
I will have
I'll have
I'll've
you will have
you'll have
you'll've
he will have
she will have
it will have
he'll have
she'll have
it'll have
he'll've
she'll've
it'll've
we will have
we'll have
we'll've
they will have
they'll have
they'll've
 
We sometimes use shall instead of will, especially for I and we.

How do we use the Future Perfect Tense?

The future perfect tense expresses action in the future before another action in the future. This is the past in the future. For example:
  • The train will leave the station at 9am. You will arrive at the station at 9.15am. When you arrive, the train will have left.
The train will have left when you arrive.
past
present
future


Train leaves in future at 9am.
9

9.15

       



You arrive in future at 9.15am.
Look at some more examples:
  • You can call me at work at 8am. I will have arrived at the office by 8.
  • They will be tired when they arrive. They will not have slept for a long time.
  • "Mary won't be at home when you arrive."
    "Really? Where will she have gone?"
You can sometimes think of the future perfect tense like the present perfect tense, but instead of your viewpoint being in the present, it is in the future:
present perfect tense

future perfect tense

|
have |
done |
> |

 


will |
have |
done |
> |



past
now
future

past
now
future



SPEAK NOW

I am not the kind of girl
Who should be rudely barging in
On a white veil occasion
But you are not the kind of boy
Who should be marrying the wrong girl

I sneak in and see your friends
And her snotty little family
All dressed in pastel

And she is yelling at a bridesmaid
Somewhere back inside a room
Wearing a gown shaped like a pastry

This is surely not
What you thought it would be
I lose myself in a daydream
Where I stand and say:

Don't say yes, run away now
I'll meet you when you're out
Of the church at the back door

Don't wait or say a single vow
You need to hear me out
And they said "speak now"

Fun gestures are exchanged
And the organ starts to play
A song that sounds like a death march

And I am hiding in the curtains
It seems I was uninvited
By your lovely bride-to-be

She floats down the aisle
Like a pageant queen
But I know you wish it was me
You wish it was me, don't you?

Don't say yes, run away now
I'll meet you when you're out
Of the church at the back door

Don't wait or say a single vow
You need to hear me out
And they said "speak now"




Don't say yes, run away now
I'll meet you when you're out
Of the church at the back door

Don't wait or say a single vow
Your time is running out
And they said, "speak now"

Ooh, la, oh
Ooh, ooh

I hear the preacher say
"Speak now or forever hold your peace"
There's a silence, there's my last chance
I stand up with shaking hands, all eyes on me

Horrified looks from
Everyone in the room
But I'm only looking at you

I am not the kind of girl
Who should be rudely barging in
On a white veil occasion
But you are not the kind of boy
Who should be marrying the wrong girl

So don't say yes, run away now
I'll meet you when you're out
Of the church at the back door

Don't wait or say a single vow
You need to hear me out
And they said, "speak now"

And you say
Let's run away now
I'll meet you when
I'm out of my tux at the back door

Baby, I didn't say my vows
So glad you were around when they said
"Speak now"