Author: Serkadis

Altoona, Iowa | Outsider Architecture

When Paul Dobberstein, a young man studying to be a priest, fell ill, he made one of those promises to God that most people never fulfill. Father Paul Dobberstein promised that if he survived, he would build a great shrine to the virgin Mary. He lived, and completed his end of the bargain by building the massive Grotto of the Redemption.

Begun in 1912, it was built using rare rocks from hundreds of miles away. With shells and semi precious stones donated from across the country, Dobberstein and his helper, the young Father Louis Greving, built the four-story, nine-grotto creation. Each grotto is dedicated to a different religious theme like the Garden of Eden or the Ten Commandments. When Father Dobberstein passed away in 1954, his helper Father Greving took over and continued to work on the grotto until he too passed away in 2002. Together, they spent nearly a century working on the grotto.

We’ve had quite a rally, but among key concerns that currently threaten to blight the fun is the dollar. The greenback has declined steadily since the beginning of the rally in March, and there is widespread agreement that we’ve not seen the bottom yet. What’s not clear-cut, however, is how investors might fight this trend.

Foreign currency funds, precious metals, commodities, and similar alternative asset classes are being mooted as possible ways to shield portfolios from a dollar rout. Those ideas can diversify a portfolio. Yet, a good old foreign bond fund would be up to the task, too, and arguably a more sensible fix for most investors. An unhedged foreign bond fund will buy you exposure to foreign currencies and also offer far more potential for price appreciation than currency funds (which hold essentially cashlike instruments). Precious metals will hold up when paper currencies tumble, but they (most notably, gold) are at record highs these days, and their valuations are questionable. And although commodities’ could also be better stores of value than paper money in the long run, their prices remain vulnerable to business cycles. In comparison, foreign bond funds look like a decent option that investors can incorporate into their portfolios without much head-scratching.

Before discussing a few eligible candidates, some caveats are in order. Currency movements are notoriously unpredictable and will defy the most rational consensus view. Moreover, many investors may already have a measure of nondollar exposure through foreign stock funds or even domestic blue-chip funds that feature many companies that earn sizable chunks of their revenue abroad. Thus, don’t overestimate your need for foreign currency allocation. The following fund examples also are among the world-bond category’s bolder options that deploy a wide range of securities and active currency bets, so make sure you are comfortable with their risks. Also, the securities in these funds can suffer capital losses (which will erode any currency gains), though in the long run you should come out ahead of a cashlike currency fund.

Loomis Sayles Global Bond (LSGLX)

This global bond Analyst Pick had a tough time last year due to the portfolio’s heavy corporate stake, but that very emphasis is powering the fund to a topnotch finish in 2009. The fund’s veteran managers clearly rely heavily on their firm’s global expertise in bottom-up credit research, but they have shown the ability to make well-calculated shifts into other sectors as well. For example, management took profits in many of the portfolio’s biggest corporate winners this year and bought higher-rated government bonds in Norway and Canada (those countries’ currencies have staged some of the biggest moves against the U.S. dollar this year). Strong issue selection should continue to give this fund a significant edge over more passive vehicles for nondollar exposure.

Templeton Global Bond (TPINX)

Unlike the Analyst Pick discussed above, this one sticks to government bonds, but there are plenty of bold statements in the portfolio. For example, the fund currently has a 21% stake in South Korea bonds alone and a combined 14% stake in Brazil and Mexico. Veteran manager Michael Hasenstab argues that those developing countries’ bonds and currencies are backed by a great combination of fiscal responsibility and cheap valuations. This logic underscores a key point in the whole currency debate. Many developed markets (including Japan, United Kingdom, and several in the eurozone) face the same pressures as the U.S. The central banks of these developed countries all have limited ability to support their currencies because of the continued need to bail out or support private debt markets. Thus, Hasenstab’s approach to diversify the fund’s currency exposure beyond the “usual suspect” choices makes sense. Also, he has a great long-term record through many different market environments owing to his patient, valuation-conscious approach.

Oppenheimer International Bond (OIBAX)

This is another example of a veteran manager using a flexible approach to great effect. Skipper Art Steinmetz, who was tapped earlier this year to head up the firm’s entire fixed-income effort, has considerable leeway here to go into emerging markets and corporate bonds and to make active currency bets. The portfolio currently has a 13% combined stake in Brazil and Mexico, for example, which includes several prominent corporate issues. Again, for investors looking to add currency diversification, the key strength to note here is the fund’s ability to deliver plenty of price-appreciation upside on top of the currency gains.

AllianceBernstein Global Bond (ANAGX)

The strategy here is just as distinct as those at the funds already mentioned, although not as well-tested. Management uses a multisector approach that pulls in the entire spectrum of choices in global bond markets including emerging markets, corporate and asset-backed bonds, and currency plays. To boot, management will use leverage as well. This approach took shape in 2007, after a series of incremental strategy changes that gradually gave management greater flexibility. Granted, the record is not long under the mandate, but we like what we’ve seen so far. Management will often be early with its bold valuation calls, but patient shareholders have reaped rewards.

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See Also:

• Toll: Here’s Why Selling McMansions To Rich People Is Awesome These Days
• Marc Faber: Dubai Was Just The Tip of The Sovereign Default Iceberg
• Dubai Teaches Us How Capitalism Works

Dave Allen, who is both a successful musician (founding member of Gang of Four) and a successful digital marketer and strategist for music business models, is preparing for next week’s SFMusicTech event (reminder: Techdirt readers can get a discount) with a brilliant new manifesto of sorts, pointing out that it’s time for musicians to stop blaming others and take charge: Dear Musicians: Please Be Brilliant or Get Out of The Way.

It has been more than a decade since I was last fully immersed in the recorded music business [and then only peripherally as GM of eMusic.com,] and I have long held out hope that musicians would ditch the old media model, both the business and the manufacturing sides, and fully embrace the huge possibilities that the unfettered social web allows them — asymmetrical distribution as opposed to old media distribution silos, two-way communication with music fans as opposed to old media PR, and marketing tactics and an unparalleled universal sandbox in which to experiment.

I am still waiting. Unfortunately my patience is now wearing thin. And my impatience is no longer with the record labels, it’s with the musicians. Despite all the data and untold amounts of writing about the decline in music sales, mainly the fall off of CD sales, musicians appear to be sitting on their hands. The reason I am no longer impatient with record labels is because their business model is transparent — they exist to make money from musicians. On the other hand, musicians are [or ought to be] immersed in their art; no one guarantees a living from the arts, but talk to the average musician about internet music distribution and you will often hear the same refrain — “downloading and file-sharing is killing music and denying me a living..”

That sort of “woe is me, I’m a victim” situation is certainly getting tiresome, especially as we see more and more and more bands take charge of their own future and implement smarter and smater business models that are working wonders for those who embrace them. So, Allen points out, it’s time to stop waiting for others to solve the business model issue, and take charge yourself (or, at the very least, partner with someone who can take charge for you):

Now that the internet has provided disrupting producers with all the tools they need to bypass the existing recorded music system, there should be no excuse for musicians to not go it alone. Yet, the producers — the musicians themselves, remain the problem. I believe that the safety and comfort offered to them in the past — record label deals, publishing deals, old media distribution, plus MTV and commercial radio for the most successful — created a diabolical music Nanny state, an addictive teat at which to suck that they are now having trouble weaning themselves off. I know there are many examples of musicians embracing the web but they have taken only baby steps and are in the minority — the majority are still staring into the headlights. [I purposefully won’t discuss Radiohead and Nine Inch Nails here as much has been written about their successful use of the social web and I consider them special cases.]

The Nanny state reduced risk taking and danger in popular music. The very founding spirit of rock and roll was danger. Danger as perceived by those who didn’t understand the outburst of energy and excitement that this early musical form drew out of teenagers. Parents and adults in authority voiced their concerns and this led to ridiculous moments in musical history such as TV cameramen being told to only film Elvis Presley from the waist up.. If we fast forward to 1975 in the UK, we find that rock and roll, a mere 20 or so years later, with only a few exceptions, had become commercial, flabby, conservative and mostly dull. Then along came a new genre of music delivered by bands like the Sex Pistols, The Clash, Siouxie and the Banshees who injected rock with some street smarts and and sprinkled it with just a soupcon of danger. It was known as Punk Rock.

I bring up punk rock here as it defines a moment in rock music history that was as disruptive in 1976 as online music distribution became in the late 1990’s. Punk rock challenged people’s assumptions that popular music would always be, and could only be, controlled by large, well-capitalized, business organizations. Punk rock drove down production values and just like the Internet, became disruptive and leveled the playing field. Punk bands formed quickly, releasing records as 7″ vinyl singles on their own equally quickly formed record labels. A long term career in music was not the point of this enterprise, many bands flamed out within six months of their existence. Small independent labels sprang up to cater to this avalanche of bands, offering more favorable contracts than the majors had in the past. Business is business though, and the small label owners had plans for growth that ultimately led to punk rock’s demise. Soon enough punk rock was commoditized and, after a brief fling with Post-Punk, quickly fizzled leaving the stage for the New Romantics and their ilk. It wasn’t long until it was business as usual for the record labels — five years of promise had passed very quickly.

So I have to ask – why is there no online music equivalent of punk rock? Why is there no real and passionate embrace of the new?

It’s a great manifesto (this is only a snippet — the full thing is worth reading), and it’s going to make Dave’s session at SFMusicTech next week one not to miss (I just hope he’s not on at the same time I am!).

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There’s no doubt that Dragon Quest IX is a huge title. In fact, so big that its European release is not getting one, not two, but five trademarks. Siliconera went trademark-spotting again and found that the Japanese

Filed under: LA Auto Show, Government/Legal, Lotus

We had a chance to chat with Lotus USA spokesman Kevin Smith at the LA Auto Show and he shared a bit of news with us. He confirmed that while we unfortunately won’t be getting the limited edition Exige Scura/Stealth that debuted at the Tokyo Motor Show, we will will get something close. The problem is the special matte black paint on the Scura. We reported on the rubberized finish at the time after talking with Lotus vehicle engineering director Roger Becker. The matte finish can be marked up, and because of process used to apply it, it’s not possible to do spot repairs on the affected area.

Because of the litigious nature of America when it comes to product liability, Lotus has apparently opted not to offer the special paint job. We will, however, get essentially the rest of the car including the new wheel design that debuted on the Scura. The rest of the mechanical bits are largely the same as the Exige 260 S that we had so much fun with a few months ago. Lotus is still finalizing the spec of the new limited edition model but Smith tells us that it will be available in four colors including Phantom Black. Approximately 20-30 units will be built for the U.S. market in two-to-three months with availability in early spring.

Photos copyright (C)2009 Sam Abuelsamid, Jonathon Ramsey / Weblogs, Inc.

[Source: Lotus]

LA 2009: Lawsuit-happy U.S. kills chances for Lotus Exige Scura, but we’ll get something similar originally appeared on Autoblog on Thu, 03 Dec 2009 13:58:00 EST. Please see our terms for use of feeds.

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The U.S. services sector is once again contracting according to the Institute for Supply Management’s (ISM) Non-Manufacturing Index.

The latest November index value came in at 48.7, surprising consensus economists who expected it to be 51.5. Any value below 50 indicates a contraction of activity, according to the ISM.

This makes it very clear that the services sector improvement we’ve seen all year has suddenly reversed, after only briefly breaking above the key 50-level. See detailed tables about the latest November report here.

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See Also:

• Surprise! The U.S. Services Sector Is Contracting Again
• The ISM Services Index Stops Rebounding, Missing Expectations
• Postal Services Around The World Need A Bailout

Some commentary [Ed note: from Goldman’s 2010 commodity outlook]:

As we start a new decade with the global economy emerging from the worst recession of the post-war era, we expect the commodity supply-side constraints of the past decade to once again reemerge, reinforcing the sustainability of higher long-term commodity prices – a theme we first began discussing at the turn of the current decade. However, the inability to grow supply after a decade of sharply higher prices turns the question of the sustainability of higher long-term commodity prices into one of the sustainability of higher long-term growth. Anemic supply growth of energy and basic materials runs head-on into the ongoing revolution in emerging markets generated by more than a billion people rising into the ranks of the middle class over the next decade.

We maintain that this undesirable outcome is not the inevitable result of dismal Malthusian logic, but rather the result of deliberate choices as expressed through policy. At the beginning of the current decade, we argued that decades of inadequate investment in commodity productive infrastructure were leading to a “Revenge of the Old Economy”, where a constrained supply base would sustain higher commodity prices. Toward the end of the current decade we argued that the “Revenge of the Old Economy” had turned into the “Revenge of the Old ‘Political’ Economy” where significant policy constraints on the free flow of capital, labor and technology were substantially constraining supply growth for many commodities, regardless of price or expected return. Furthermore, these protectionist policies caused capital not to flow to the most efficient commodity investment but rather to the most freely accessible one that was usually inefficient, extremely high cost/tax with poor rates of return, which put more upward pressure on prices, or in some cases the capital did not flow at all, creating outright physical shortages.

Read the whole thing at Zero Hedge >>

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See Also:

• Amazing: John Paulson Makes $50 Million In Five Weeks On A Gold Trade (DGC)
• Here’s The Real Peak In Gold
• Here’s Why The Mint Is Running Out Of Gold Coins

Sony Corporation and FIFA have announced an agreement for selected media rights of the 2010 FIFA World Cup in 3D. FIFA is to produce the world’s first FIFA World Cup in 3D. Up to 25 of the 2010 FIFA World Cup South Africa matches will be produced using Sony’s 3D professional cameras, which will provide coverage of the action that is unprecedented in depth, vividness and excitement to people around the world.

FIFA will utilize Sony’s experience and know-how of 3D content production to spread the passion inside the stadiums at the greatest sport event in the world to more people than ever before.

From 2010, Sony will be incorporating 3D compatibility into a wide range of consumer products such as “BRAVIA” LCD TV, Blu-ray Disc recorders and players, VAIO and PlayStation 3, to provide a multitude of ways in which 3D content – from 3D movies to stereoscopic 3D games – can be enjoyed in the home. By having viewers around the world experience sensational 3D content from the World Cup tournament, Sony aims to accelerate the expansion of 3D from professionals to consumers in 2010 and beyond.

“The transition to 3D is underway, and, we, at Sony, intend to be leaders in every aspect. Our sponsorship of the FIFA World Cup allows us to leverage our cutting-edge 3D technology and premier products with dazzling content to produce a unique and totally compelling viewing experience. 3D viewers around the world will feel as though they are inside the stadiums in South Africa, watching the games in person,” said Sir Howard Stringer, Chairman, CEO and President of Sony Corporation.

“This propels the football fan into a whole new viewing dimension and marks the dawning of a new era in the broadcasting of sport,” said FIFA Secretary General Jerome Valcke. “We are proud that the FIFA World Cup can serve as a platform for advancing technology and the viewing experience, and are truly fortunate to have Sony as a partner in this endeavour.”

Viewers will be able to enjoy 3D experiences at the following locations:

• During the 2010 FIFA World Cup, FIFA will host the “International FIFA Fan Fest” public viewing events in 7 cities around the world (Berlin, London, Mexico City, Paris, Rio De Janeiro, Rome, and Sydney). At Sony’s commercial displays located within the “Fan Fest,” people will be able to enjoy and experience promotional highlight trailers of the FIFA World Cup in 3D.
• In anticipation of the Official 3D Film, viewers will be able to watch promotional trailers for the film of the World Cup in 3D at retail outlets(including Sony stores) that sell Sony products around the world.
• Sony Pictures Home Entertainment plans to produce and distribute the Official 3D Film on the Blu-ray Disc and other formats.

By combining the excitement of the FIFA World Cup with 3D images generated using Sony’s technology and products, Sony and FIFA will seek to deliver 3D images that convey the action and emotion of the World Cup to viewers around the world, and a viewing experience as if they were in the stadium itself.

Filed under: LA Auto Show, Coupe, Performance, Etc., Technology, Lexus

Wow. Lexus brought their new LFA supercar to the LA Auto Show this year. That might not seem particularly wow-worthy, but it definitely becomes more surprising when you hear that they actually brought an LFA and a half. While a white LFA was happily humming along, spinning slowly on a rotating platform in the middle of the booth, another LFA-like creature lay motionless a few feet away.

It seems Lexus had an extra drivetrain they wanted to display, but instead of just parking the engine, transaxle and other mechanical bits on a stand, they decided to make it something of a cutaway. Rather than chopping up one of those exquisitely woven carbon fiber bodies, thankfully, they supported the running gear in a wireframe cutaway of sorts that mimics the overall shape of the production car. It was even done up in white just like the real thing on the other side of the stand. While some saw it as a novel way to display the internals, we think this might be a sneak peek at the cheaper, simpler Lexus LFA we had hoped for. Or, you know, not.

Check out the gallery below, and do yourself a favor – Take a few extra seconds to ogle that engine.

LA 2009: Lexus LFA wireframe cutaway wows us originally appeared on Autoblog on Thu, 03 Dec 2009 13:31:00 EST. Please see our terms for use of feeds.

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Time again for the weekly European PlayStation Store update. Lots of special offers for both PS3 and PSP content this week. European gamers with the exception of those living in Germany are also getting the

Ciara Felder of Mars Hill College received the fourth annual North Carolina Campus Compact Community Impact Student Award during the Compact’s Student Conference held at Western Carolina University Saturday…

I have decided to hold a press conference to confront stories that I was Tiger Woods’ mistress. I’ve never held one before. Nor have I ever met the man, nor am I “inclined” that way. But I figure that now is a good time to jump on the band wagon, especially if magazines are paying up for stories. Stay tuned for the time and place – it might be more entertaining than mortgage banking, and I’ve never been on the cover of “Us”.

I would imagine that plenty of folks at Bank of America, and their clients, are happy. Bank of America Corp. said that it plans to repay its $45 billion in government bailout funds, as soon as this week! Apparently the Bank has that much available cash, without sniffing around in the safe deposit boxes of its customers, and raise $18.8 billion in capital to repay the money. This is great news for shareholders (the stock moved higher on the news). Of the 4 major mortgage investors & servicers, this will leave Citi ($45 billion) and Wells ($25 billion) with owing TARP funds. There is no news from Citi. As for Wells, ever since they accepted their $25 billion of federal bailout assistance last year, management has said that the bank never needed the money, didn’t want it, and shouldn’t have been forced by the government to take it. They keep saying they’d like to pay it back, too, but have not offered up a schedule.

If you went to a mall last weekend to look for Cabbage Patch Dolls, the odds are pretty good that it was owned by General Growth Properties – they own and manage more than 200 of them here in the US. They are in the middle of a Chapter 11 bankruptcy plan after failing to refinance portions of its $27 billion in debt.

more on GGP, MBAA Apps, FHA MI Changes, GMAC Bank, Wells Wholesale, HAFA, Economy and Markers, and more TIBER WOODS JOKES PART 2 <<< CLICK HERE

JPMorgan’s aggregate global manufacturing and services indicators both tell the same unfortunate story — the global economic recovery slowed down in November.

JPMorgan: “The global economic recovery continued in November, but a growth pause in services hit the overall rate of expansion. However, new business is still rising and this should support growth looking ahead. In addition, official activity data continue to advance, suggesting the underlying recovery remains intact.”

Yet while both the global services and manufacturing indices are slightly above the 50-level, which indicates continued expansion, it’s clear that the up-trend in the data has lost steam.

They also aren’t far from suddenly dropping below 50 next month.

(Via JPMorgan, Growth of the economy slowed in November, 3 December 2009) Note that these global indices are built from manufacturing and services indices for countries around the world, such as from the ISM in the U.S. and from Markit for many other countries.

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See Also:

• Banks Change Advertising MO: Convenience Out, Security In
• Morgan Stanley: Here Comes A Brutal 2010
• Morgan Stanley: What’s With USD’s Pathetic Move In Response To Dubai?

To our Clients, Colleagues and Friends

Despite what you might hear or think, banks can raise equity capital this year.

• $72.4 billion in equity capital
• $31.8 billion in senior debt
• $49.7 billion of preferred equity
• $32 billion in Trust Preferreds

This is private capital showing its optimism for the banking sector an portends, in our view, that 2010 will see a real return to stability in banks.

We see it through our strategic planning and M&A Due Diligence projects.

Garrett, Watts & Co.

The MAG beta will be closing down this Saturday at midnight, but Zipper Interactive has one more test for the beta testers a test of mad MAG skills. Think you’ve gotten good these last

Filed under: LA Auto Show, Crossover, Hyundai, Autoline on Autoblog

Hyundai‘s second big unveiling for the LA Auto Show is its next-generation Tucson, its compact crossover. Like the Sonata sedan, we’ve actually already seen the Tucson for some time now, as it previously debuted South Korea and Europe badged as the ix35 or Tucson ix. We actually first saw this shape as the ix-onic concept at Geneva last March and the production model is only mildly toned down.

Even toned down, though, this is a major departure from the outgoing Tucson. Like the Sonata, that model was a competent but utterly invisible CUV. The new Tucson was created by Hyundai’s Frankfurt-based European design studio and features the same “Fluidic Sculpture” surface language used on the Sonata. Like the sedan, the look is attractive, if not entirely original, as the form seems to draw quite a bit inspiration from the Nissan Murano, especially in the rear. Either way, with its bulging fenders and a multitude of curves and creases, the new style is likely to draw a lot more second glances than its predecessor. Wherever the ideas came from, the Tucson appears to be well-executed overall. Follow the jump to learn more Hyundai’s latest CUV.

[Source: Hyundai]

Continue reading 2010 Hyundai Tucson makes the drive to America

2010 Hyundai Tucson makes the drive to America originally appeared on Autoblog on Thu, 03 Dec 2009 13:00:00 EST. Please see our terms for use of feeds.

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It looks like Paulson’s gold obsession is paying off.

John Paulson has been betting big on gold for a few weeks now, and he is launching a new gold only fund in January.

According to Bloomberg, the hedge fund manager of Paulson and Co might have made $45 million in 5 weeks – off of just one of the gold investments in his portfolio.

Bloomberg reports: “Paulson & Co., based in New York, held 10.3 million shares of Toronto-based Detour as of Oct. 31, according to a Nov. 10 regulatory filing. The stock has gained 34 percent since Oct. 31 to C$17.85 a share at 11:09 a.m. in Toronto Stock Exchange trading.”

Paulson’s other gold holdings include shares in Kinross Gold Corp. and Gold Fields Ltd, and he’s also the largest shareholder of AngloGold Ashanti Ltd.

Read the full story on Bloomberg >>

Join the conversation about this story »

See Also:

• John Paulson Hoarding More Gold Than Several Countries Combined
• John Paulson Is A Great Trader Because He’s Grumpy And Negative
• Paulson Starts A New Gold Fund (KGC, AU)

This happens all too frequently. I recently wrote a short post about something that was apparently happening with YouTube and soon after received an angry email from a PR person at the company first scolding me for not contacting Google PR first and then demanding that I insert some PR babble paragraph that said nothing that addressed the key questions raised in the post in “response.” This made no sense to me. If I got something factually wrong, I have no problem having someone point out what was in error, but demanding that I first contact them and then include a meaningless statement is ridiculous. If the PR folks have something to say, they’re free to take it up in our comments.

It seems that Michael Arrington, over at TechCrunch, has run into something similar (and I’m sure it happens to him all the time as well). After briefly (really, in passing) mentioning the infamous Video Professor in his post on marketing scams, the company first tried to get him to post their response, and when he told them no (in less friendly words), the company instead complained to the Washington Post, who syndicated the same TechCrunch post (as it has done for a while with TechCrunch posts). The real issue, of course, is that The Video Professor didn’t like getting called out on its marketing practices. The company is notoriously sensitive over its reputation and has gone legal on people multiple times in the past. At issue is the fact that people are told they’re getting a “free” product, but don’t realize they’re really signing up to pay a lot of money if they don’t follow the fine print carefully. Arrington called this a “scam” and plenty of folks agree. The Video Professor did not agree, but if that’s the case, it has every right to clarify its own marketing material, rather than going after those who call them out on their less-than-clear practices.

But the bigger issue with these types of situations is that companies need to realize that just because someone doesn’t like the way you’re acting and states an opinion, on that subject, it doesn’t mean that they first need to contact you or get a meaningless PR quote from you. You have a right to respond, but on your own website — or within open comments if they’re available (as they are on this site). For too long, companies have hid behind bland PR statements and the willingness of the press to “balance” stories with an accusation and a denial, but no real effort to get to the bottom of things. That’s changing, and it’s time that companies and their PR reps caught up to what’s happening.

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KODE ICD-10 : A63.0 : Genital warts ( Condyloma acuminata )

Condyloma acuminata (kondiloma akuminata, genital warts, kutil kelamin) atau lebih dikenal dengan istilah penyakit Jengger Ayam, mungkin karena bentuknya yang mirip Jengger Ayam pada condyloma yang luas, adalah kelainan kulit berbentuk kutil dengan permukaan berlekuk-lekuk mirip jengger ayam, yang disebabkan oleh Human Papilloma Virus (HPV) tipe tertentu. Jika pembaca pernah melihat kutil (bahasa jawa: caplak, veruka), seperti itulah bentuk condyloma acuminata. Hanya saja kutil tersebut letaknya di kelamin dan sekitarnya. Bahkan dapat menyebar ke anus (condyloma anogenital). Gambar 1: silahkan klik untuk melihat gambar condyloma acuminata di penis.

Identifikasi HPV untuk pertama kali pada tahun 1907. Kini, lebih 120 jenis subtype HPV telah dapat diidentifikasi. Tapi tidak semua type dapat menyebabkan condyloma acuminata. Sekitar 90 % condyloma acuminata diyakini berhubungan dengan type 6 dan type 11. Belasan tye lainnya dijumpai pula pada penderita condyloma acuminata. Para ahli menengarai HPV type tertentu memiliki kecenderungan onkogenk (potensial menjadi kanker), terutama type 16 dan type 18.

Penyebaran Penyakit

Penyebaran condyloma acuminata bersifat kosmopolitan, artinya merambah ke seluruh belahan dunia tanpa memandang ras.

Berdasarkan jenis kelamin, frekuensi kejadian antara pria dan wanita sama besarnya. Sedangkan berdasarkan kelompok umur disebutkan bahwa condyloma acuminata lebih sering dijumpai pada usia dewasa muda dan pada usia tigapuluhan. Hal ini dikaitkan dengan peningkatan aktifitas seksual. ( Gambar 2: silahkan klik untuk melihat condyloma acuminata di vagina )

Penularan dan Perjalanan Penyakit

HPV ditularkan melalui kontak langsung, dari mulut ke organ kelamin, dari jari ke organ kelamin dan sebaliknya, serta melalui hubungan seksual, sehingga condyloma acuminata dikelompokkan sebagai Penyakit Menular Seksual (PMS, STD).

Bagaimana mengenalinya ?

Masa inkubasi condyloma acuminata berkisar antara 3 minggu sampai 8 bulan dengan rata-rata 3 bulan.

Condyloma acuminata relatif mudah dikenali karena bentuknya yang khas, mirip jengger ayam, yakni kutil dengan permukaan berlekuk-lekuk (berjonjot-jonjot) di organ kelamin dan sekitarnya. Kutil-kutil kecil dapat bergabung membentuk kelompok yang lebih besar mirip dengan bunga kol.

Pada umumnya condyloma acuminata berwarna kemerahan, coklat kemerahan, keabu-abuan hingga ada yang berwarna kehitaman.

Jika mengalami infeksi sekunder (oleh garukan, gesekan atau sebab lain), condyloma acuminata berubah warna menjadi kehitaman, mudah berdarah dan berbau tak sedap.

Pada pria, tempat yang paling disukai (predileksi) Condyloma acuminata diantaranya: gland penis (topi baja si cucakrowo), lekukan antara kepala dan batang penis (sulkus koronarius), jaringan tipis di bawah ujung saluran kencing (frenulum), batang penis dan adakalanya di sekitar anus.

Sedangkan pada wanita, tempat yang paling digemari si Condyloma acuminata diantaranya: labium (bibir vagina), vagina dan dapat juga mengenai serviks.

Seorang dokter dapat mendiagnosa condyloma acuminata berdasarkan gejala klinis, yakni dengan melihat bentuk dan predileksi kutil (jonjot-jonjot) pada area kelamin.

Jika meragukan, maka akan dilakukan test sederhana menggunakan asam asetat 5% yang dioleskan di permukaan kutil selama 3-5 menit. Pada condyloma acuminata maka kutil akan berubah warna menjadi putih.

PENGOBATAN

Hingga kini belum ada obat yang benar-benar memuaskan untuk menghilangkan HPV. Pengobatan yang lazim dilakukan adalah untuk menghilangkan condyloma acuminata, meliputi:

• Kemoterapi, yakni pengobatan menggunakan Tinctura Podofilin 25 %, Podofilotoksin 0,5 %, Asam Trikloroasetat 25 % – 50 % dan Krim 5-flurourasil 1-5 %. Pada wanita hamil digunakan obat Asam Trikloroasetat 25-50 % seminggu sekali hingga condyloma acuminata bersih.
• Tindakan Pembedahan, meliputi: Bedah scalpel (menggunakan pisau bedah), Bedah Listrik (elektrokauterisasi) dan Bedah Beku menggunakan Nitrogen cair. Bedah beku merupakan salah satu pilihan untuk pengobatan condyloma acuminata pada wanita hamil selain menggunakan Asam Trikloroasetat.
• Laser karbondioksida. Metode ini lebih sedikit meninggalkan jaringan parut ketimbang Bedah Listrik.
• Interferon. Dikenal 2 bentuk interferon, yakni interferon alfa (berbentuk suntikan dan krim) yang diberikan 3 kali seminggu selama 6 minggu dan interferon beta (suntikan) yang diberikan selama 10 hari.
• Imunoterapi. Metode pengobatan imunoterapi digunakan pada penderita dengan condyloma acuminata yang luas dan resisten (kebal) terhadap pengobatan lain.

Meski mudah kambuh (residif), condyloma acuminata memiliki prognosis yang baik. Artinya tidak berbahaya.

VAKSINASI

Saat ini telah digunakan vaksin Papilloma virus (Gardasil) yang ditujukan untuk pencegahan kanker serviks. Adapun untuk pencegahan terhadap condyloma acuminata oleh HPV type 6 dan type 11, vaksin Gardasil diberikan pada anak laki-laki, pria dewasa dan wanita usia 9-26 tahun.

PENCEGAHAN HPV

Secara garis besar, upaya pencegahan terhadap penularan HPV dapat dilakukan dengan:

• Menjaga hygiene organ genital.
• Menghindari gonta-ganti pasangan.
• Penggunaan pengaman (kondom) ditengarai tidak menjamin terjadinya penularan. Namun demikian tetap dianjurkan menggunakan pengaman (kondom) jika memiliki pasangan dengan riwayat condyloma acuminata.
• Dianjurkan untuk tidak berhubungan intim selama masa pengobatan hingga pengobatan selesai dan benar-benar dinyatakan aman oleh dokter yang merawat.

Semoga bermanfaat.

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Posted in Artikel, Gaya Hidup, Health, Informasi, Kesehatan Tagged: condyloma, genital warts, HPV, kutil kelamin, menular, Penyakit Kulit, PMS, STD