PAKET UMROH BULAN FEBRUARI MARET APRIL MEI 2018




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saco-indonesia.com, Kanker hati primer merupakan penyakit di mana sel kanker yang tumbuh berasal dari organ hati. Beberapa tipe kanker hati primer telah diberi nama sesuai dengan asal tumbuh sel kanker tersebut. Hepatocellular carcinoma (HCC) atau dikenal hepatoma yang tumbuh dari sel utama hati yang disebut hepatocytes dan juga merupakan 85% dari kasus kanker primer. Jenis kanker hati primer yang tidak begitu umum terjadi berasal dari sel berada pada garis saluran empedu yang disebut cholangiocytes, sehingga kanker tipe ini juga lebih dikenal sebagai kanker cholangiocarcinoma atau kanker saluran empedu.

Organ hati juga merupakan tempat dari tumbuhnya satu tipe kanker yang disebut kanker hati sekunder (kanker metastatik). Pada kondisi ini kanker utama sebenarnya berasal dari bagian tubuh yang lain dan telah membentuk deposit sekunder pada hati. Contoh umum dari kasus yang sering terjadi adalah kanker kolorektal yang telah menyebar ke organ hati melalui pembuluh darah.

Umumkah Kanker Hati?

Secara global, kanker hati primer umumnya telah terjadi pada pria dua kali lipat lebih sering dibandingkan pada wanita. Kanker hati juga merupakan kanker paling umum urutan ke-5 dan ke-7 bagi pria dan wanita. Negara-negara Asia juga mempunyai 80% pasien kanker hati primer secara global di mana sekitar 600.000 kasus terdiagnosa setiap tahunnya.

Apa yang menjadi faktor resiko penyebab kanker hati?

Terdapat tiga faktor utama yang dapat menyebabkan tumbuhnya HCC (kanker hati primer paling umum) yaitu infeksi kronis Hepatitis B, infeksi kronis Hepatitis C, dan konsumsi alkohol yang berlebihan. Resiko bagi individual dengan infeksi kronis Hepatitis B untuk terkena HCC adalah 100x dari individu normal.

Faktor lain yang dapat menjadi resiko meliputi aflatoxin (racun yang telah ditemukan pada kacang yang berjamur, gandum, dan kedelai), kondisi yang telah diwariskan (misal haemochromatosis, defisiensi alpha-1 anti-trypsin) dan penyebab cirrhosis (luka sepanjang hati) seperti hepatitis autoimun atau primary biliary cirrhosis. Banyak kanker hati juga dapat dicegah melalui peran masyarakat dalam mengurangi paparan terhadap faktor-faktor resiko yang telah diketahui.

 
Apa saja gejala-gejala kanker hati

Pasien yang terkena HCC biasanya tidak memiliki gejala-gejala yang berbeda dengan penyakit hati kronik lainnya. Dengan gejala yang memburuk dari penyakit hati kronis seperti pembengkakan perut akibat cairan (ascites), encephalopathy (berubahnya kondisi mental), sakit kuning, atau pendarahan pada sistem saluran pencernaan dapat meningkatkan kemungkinan berkembangnya HCC. Disamping itu, beberapa pasien juga mungkin merasakan rasa nyeri pada perut bagian atas, kehilangan berat badan, mudah kenyang, letih lesu, anoreksia, atau benjolan yang dapat dirasakan pada perut bagian atas.

 
Apakah dapat dilakukan skrining untuk kanker hati

Ya, skrining juga dapat membantu dokter untuk dapat menemukan dan mengobati HCC sedini mungkin, saat kanker masih setempat saja dan lebih mudah diangkat melalui proses bedah. Hal ini juga dapat meningkatkan tingkat keselamatan. Mereka yang telah mengidap infeksi Hepatitis B kronis dan luka hati (cirrhosis) karena hepatitis C atau sebab lain memiliki resiko tinggi terkena penyakit ini dan harus melalukan skrining guna untuk mendeteksi kanker hati.

Proses skrining meliputi:

    Tes darah untuk alpha-fetoprotein (AFP) 3-6 bulan sekali.
    Scan ultrasound pada bagian hati 6-12 bulan sekali.

 
Diagnosis dan Penilaian
          

Bagaimana proses diagnosa kanker hati?

Rangkaian tes dan prosedur berikut bisa dilakukan untuk dapat mendiagnosa HCC dan untuk dapat menunjukkan stadium kanker:

    Pemeriksaan fisik untuk kesehatan secara umum. Pemeriksaan bagian perut dilakukan untuk dapat mendeteksi adanya gumpalan keras atau ascites.
    Tes darah untuk kesehatan secara umum, fungsi hati dan jumlah/kadar AFP. Jumlah AFP pada penderita HCC lebih tinggi daripada pada orang normal.
    Scan ultasound pada hati dengan menggunakan gelombang suara untuk dapat menghasilkan citra hati. Prosedur tes ini juga tidak menimbulkan rasa sakit dan hanya perlu beberapa saat untuk dapat dilakukan. Citra yang dihasilkan dapat menunjukkan ada tidaknya tumor pada hati.
    Scan pencitraan Tomografi terkomputasi (CT) atau Magnetic Resonance Imaging (MRI) pada bagian perut juga akan memberikan gambar 3 dimensi dari hati. Gambar tersebut juga dapat menunjukkan ukuran dan posisi tumor, serta penyebarannya.

            
Walau diagnosa HCC dapat dibuat berdasarkan kadar AFP dalam darah dan pada hasil scan CT atau MRI, biopsi hati kadang kala juga perlu dilakukan untuk dapat memastikan hasil diagnosa. Bila kanker belum dapat menyebar dan masih dapat diangkat, maka biopsi tidak perlu dilakukan. Hal ini juga disebabkan oleh adanya resiko kecil penyebaran kanker sebagai akibat dari pengangkatan kanker oleh jarum biopsi. Pada situasi seperti ini, diagnosa dipertegas setelah bedah pengangkatan tumor.

 
Pengobatan dan Perawatan

Bagaimana cara mengobati kanker hati?

Tipe pengobatan untuk pasien kanker hati sangat tergantung pada stadium kanker (yaitu ukuran dan tingkat penyebaran kanker) dan kondisi kesehatan pasien secara umum. Prosedur pengobatan utama yang digunakan adalah bedah, ablasi tumor, kemoterapi, terapi kanker terarah dan radioterapi.
Pembedahan
          
Ablasi tumor

Pembedahan telah memiliki potensi penyembuhan dan juga merupakan prosedur pengobatan pilihan untuk pasien dengan HCC tahap dini. Bila hanya bagian tertentu dari hati yang terkena kanker dan bagian hati lainnya sehat, maka prosedur bedah juga dapat dilakukan untuk bisa mengangkat bagian yang terkena kanker. Prosedur bedah tipe ini juga disebut reseksi hati. Bentuk prosedur lain dari pembedahan adalah cangkok hati. Prosedur ini telah melibatkan pengangkatan seluruh organ hati dan menggantinya dengan organ hati donor yang masih sehat. Prosedur bedah besar seperti ini telah dilakukan bila kanker hanya terdapat pada hati dan donor hati tersedia. Bila prosedur bedah tidak memungkinkan, maka metode pengobatan lain akan diberikan guna untuk mengendalikan pertumbuhan kanker, dengan begitu mengurangi efek/gejala kanker serta meningkatkan kualitas hidup pasien.
          

Ablasi tumor bertujuan untuk dapat menghancurkan sel kanker hati primer dengan menggunakan panas (ablasi frekuensi radio: RFA) atau dengan alkohol (percutaneous ethanol injection; PEI). Prosedur ini umumnya hanya dilakukan di departemen scanning dimana ultrasound atau CT dapat membantu dokter untuk dapat mengarahkan jarum melalui kulit dan masuk ke dalam kanker yang berada di hati. Prosedur ini juga menggunakan anastesi lokal. Pengobatan RFA dengan menggunakan sinar laser atau gelombang radio yang dihantarkan melalui jarum menuju kanker guna untuk menghancurkan sel kanker. Pengobatan PEI dengan mengunakan alkohol yang disuntikkan masuk melalui jarum untuk dapat menghancurkan sel-sel kanker. Ablasi tumor juga dapat dilakukan berulang-ulang apabila tumor kembali tumbuh.
            
Kemoterapi
          
          
Kemoterapi adalah penggunaan obat-obatan anti kanker untuk dapat menghancurkan sel kanker atau menghentikan pertumbuhannya. Prosedur ini juga dapat membantu mengendalikan kanker dengan menyusutkan kanker serta memperlambat pertumbuhannya. Obat-obatan kemoterapi pada umumnya telah diberikan melalui suntikan pada pembuluh darah (secara intravena), walau terkadang dapat pula diberikan dalam bentuk tablet. Kemoterapi juga dapat diberikan sebagai bagian dari pengobatan yang disebut kemo embolisasi. Porses kemo embolisasi juga melibatkan suntikan obat kemoterapi langsung pada kanker dalam hati, bersamaan dengan sebuah jel atau titis plastik kecil untuk dapat menghambat aliran darah menuju kanker (embolisasi). Tidak semua pasien dapat menjalani prosedur kemoterapi ini karena prosedur ini telah memerlukan hati yang masih bisa berfungsi dengan baik.
            
Terapi kanker terarah
          
Radioterapi

Terapi kanker terarah (Targeted Cancer Therapy) dengan menggunakan obat-obatan atau pengobatan lainnya untuk dpat mencegah pertumbuhan serta penyebaran kanker dengan melakukan interfensi pada molekul tertentu yang terlibat dalam pertumbuhan kanker. Satu obat untuk terapi kanker terarah bernama Sorafenib dapat digunakan untuk dapat mengobati pasien dengan HCC tahap lanjut. Sorafenib menyerang kanker dengan cara mencegah kanker mengembangkan pembuluh darahnya sendiri. Sel kanker juga memerlukan asupan darah untuk dapat membawa nutrisi dan oksigen. Sorafenib juga berfungsi untuk dapat membatasi kemampuan kanker untuk berkembang. Sorafenib telah melalui dua uji klinis besar pada pasien dengan HCC tahap lanjut, dibandingkan dengan mereka yang dirawat hanya dengan perawatan pendukung. Sorafenib adalah tablet yang umumnya diberikan 2 kali sehari. Efek samping yang diberikan termasuk diare, cepat letih, mual dan tekanan darah tinggi.
          

Radioterapi dengan menggunakan sinar energi tinggi untuk dapat menghancurkan sel kanker atau menghentikan pertumbuhannya. Radioterapi eksternal dengan menggunakan mesin yang digunakan secara eksternal dari tubuh untuk dapat menghantarkan radiasi pada kanker. Prosedur pengobatan ini juga jarang digunakan pada penderita kanker HCC karena hati tidak dapat terpapar oleh radiasi tinggi. Namun, prosedur ini juga dapat mengurangi rasa sakit, seperti misalnya pada pasien yang kankernya telah menyebar hingga ke tulang. Sebagai prosedur alternatif, radiasi internal yang menggunakan zat radioaktif dihantarkan secara selektif menuju kanker melalui pembuluh darah arteri yang mengantarkan darah ke hati.

 
Apakah kanker hati dapat dicegah?

Tentu saja. Ada beberapa hal yang dapat kita lakukan untuk dapat mencegah kanker hati:

    Vaksinasi terhadap virus hepatitis B
    Hindari mengkonsumsi bahan-bahan yang mengandung karsinogen hati, khususnya alkohol.
    Hindari daging berlemak dan lemak hewani. Hindari kacang dan gandum berjamur.
    Lakukan skrining secara regular bila Anda termasuk dalam kelompok dengan resiko kanker yang tinggi

 
Dukungan apa yang tersedia?
          

CanHOPE, adalah badan non-profit yang bergerak di bidang layanan konseling dan dukungan terhadap penderita kanker yang diprakarsai oleh Parkway Cancer Centre.

Sebagai bagian dari sebuah pendekatan holistik untuk dapat mengobati kanker, CanHOPE juga bekerjasama dengan tim medis dan ahli-ahli kesehatan professional yang telah menawarkan sumber daya serta informasi yang luas mengenai kanker untuk dapat membantu pasien dan keluarga mereka agar dapat mengambil keputusan yang tepat selama perjalanan mereka menuju kesembuhan.


Editor : dian sukmawati

KANKER HATI

Bekasi, Saco-Indonesia.com - Tidak Bedanya seperti tubuh, otak juga membutuhkan nutrisi. Untuk energi, otak perlu glukosa yang mudah dimetabolisme dari karbohidrat. Untuk perlindungan, otak perlu berbagai vitamin dan antioksidan. Sementara itu untuk performanya, otak perlu asam lemak.
Dapatkan berbagai nutrisi yang diperlukan otak dari sumber-sumber terbaik berikut.

Karbohidrat
Pilihlah serelia utuh seperti tepung gandum, oatmeal, dan jewawut yang merupakan karbohidrat sehat yang cepat dicerna untuk menghasilkan glukosa. Cara yang paling banyak digunakan untuk mengkonsumsi padi-padian adalah melalui nasi dan roti, walaupun biskuit dan sereal juga sama bernutrisinya.

Berdasarkan "Advanced Nutrition and Human Metabolism," glukosa adalah bahan bakar utama otak. Sedikitnya 100 gram karbohidrat perlu dimakan setiap hari untuk menyediakan cukup glukosa sebagai kekuatan otak. Gandum utuh juga sumber vitamin B, selenium, dan serat larut. Serat larut bisa mengatur kadar kolesterol dalam darah, yang mengurangi risiko penyakit kardiovaskular dan stroke.

Lemak ikan
Ikan berlemak seperti salmom, makarel, tuna, herring, dan sardin tidak hanya kaya protein. Ikan ini juga sumber vitamin B, kalsium, dan asam lemak. Salah satunya asam lemak omega 3 yang penting untuk fungsi otak dan sistem saraf.

Dalam "Biochemical, Physiological and Molecular Aspects of Human Nutrition," disebutkan asam lemak omega 3 penting untuk pembentukan mielin, lapisan pelindung saraf yang memungkinkan aliran cepat impuls otak. Asam lemak omega 3 juga berperan penting  dalam perilaku dan kecerdasan. Kekurangan omega 3 menyebabkan gangguan seperti depresi dan disleksia.

Buah berry yang kaya antioksidan
Blueberry adalah buah yang kaya antioksidan, yang bekerja untuk melindungi pembuluh darah dan otak dari stres oksidatif yang dihasilkan radikal bebas.

Salah satu antioksidan adalah vitamin E  yang mencegah penurunan kognitif karena faktor usia. Penelitian yang terbit dalam "Nutritional Neuroscience"  edisi 2005 mennyebutkan, rutin makan bluberry akan meningkatkan kapasitas belajar, memori dan kemampuan motorik pada tikus yang semakin tua. Anthocyanin pada blueberry juga meningkatkan pertumbuhan neuron baru pada area amigdala di otak.

Kacang dan biji-bijian
Beberapa kacang dan biji-bijian adalah sumber yang baik untuk protein, mineral, vitamin E, asam lemak omega 6 dan beberapa asam amino penting. Contohnya, labu dan wijen yang kaya tirosin.

Tirosin adalah asam amino yang dibutuhkan untuk pembentukan sintesis dopamine. Dopamine adalah neurotranmitter yang mengatur mood dan mengkoordinasikan gerakan.

Beberapa kacang dan biji-bijian adalah sumber vitamin B yang baik. Misalnya walnuts, almonds, cashews, hazelnuts, flaxseeds dan biji bunga matahari.

Vitamin B-6 diperlukan untuk produksi dopamine dan serotonin yang penting untuk komunikasi antar neuron. Sedangkan kekurangan vitamin B 12 berdampak pada gejala yang sama dengan Alzheimer. Sementara asam folat diperlukan otak untuk memperbaiki memori dan konsentrasi.

Sumber :LiveStrong/kompas.com
Editor :  Maulana Lee
Beberapa Makanan untuk Kesehatan Otak

Saddan Mohamad Raisan yang berusia (17) tahun salah satu siswa di Pondok Pesantren Al Mukmin, Ngruki, Cemani, Solo, Jawa Tengah hanyut dibawa air, saat berenang di sungai, Selasa (11/3) kemarin sore. Meski sudah dilakukan pencarian, siswa yang juga tinggal di dalam ponpes tersebut hingga malam tadi belum ditemukan.

Humas tim Basarnas Surakarta Yohan Tri Anggoro juga mengatakan, sebelum hanyut Raisan bersama 2 orang temannya berenang dari bawah jembatan di dekat Ponpes Al Mukmin Ngruki.

"Sekitar jam 15.30 WIB, 3 siswa berenang dari jembatan dekat pondok Al Mukmin Ngruki. Dua siswa bisa berenang, tapi yang 1 ternyata belum bisa, akhirnya hanyut terbawa arus," ujar Yohan.

Menurut Yohan, arus sungai cukup dalam dan deras, setelah Selasa sore terjadi hujan lebat. Saat ini pihaknya bersama tim SAR sedang berupaya untuk dapat mencari keberadaan korban.

"Sementara malam ini kami melakukan penyanggongan di 3 titik. Tim pertama menunggu di Jembatan Dawung, kedua di daerah Plalan dan ketiga di Nusupan," pungkasnya.

siswa Ponpes Ngruki Solo hilang

saco-indonesia.com, Presiden Susilo Bambang Yudhoyono pagi ini akan meninjau pabrik pembuatan tahu di Sumedang, Jawa Barat. Dengan didampingi Ibu Negara, Ani Yudhoyono, SBY juga akan meninjau ke lokasi pabrik tahu Palasari pukul 09.00 pagi WIB.

"Peninjauan rencananya akan dilakukan mulai pukul 09.00 pagi WIB ," seperti yang telah tertulis di website www.presidenri.go.id, Senin (3/2).

Selain meninjau pabrik tahu, SBY juga direncanakan akan meninjau RSUD Sumedang. Peninjauan itu untuk dapat melihat langsung penerapan BPJS Kesehatan yang telah diluncurkan.

Rangkaian kegiatan ini juga merupakan kunjungan kerja SBY ke Jawa Barat dan Jawa Tengah. Sejak Minggu pagi (2/2) kemarin , SBY bersama rombongan telah berada di Jatinangor, dan kunker ini akan berlangsung hingga Rabu (4/2) siang.

Berdasarkan situs www.presidenri.go.id, SBY diagendakan menuju kompleks Makam Cut Nyak Dien, Gunung Puyuh, Sumedang Selatan. Kemudian dilanjutkan dengan peninjauan ke PT Sinjaraga Santika Sport.

Sore harinya, SBY juga akan melakukan kunjungan ke Kabupaten Majalengka. SBY juga akan menerima laporan dri Gubernur Jawa Barat Ahmad Heryawan terkait dalam pembangunan megaproyek infrastruktur di antaranya, pembangunan Bandar Udara Internasional Kertajati dan pembangunan jalan Tol Cisumdawu (Cileunyi-Sumedang-Dawuan). Dan juga, Jalan Tol Cikapali (Cikampek-Palimanan).

Usai dalam melakukan kegiatan tersebut, SBY dan Bu Ani juga akan menanam pohon di Alun-alun Majalengka. Kemudian, SBY beserta rombongan menginap dan berkantor di Kuningan Jawa Barat.

Rombongan yang ikut dalam kunker kali ini yakni Menko Perekonomian Hatta Rajasa, Menteri Koperasi dan UKM Syarief Hasan, Mendikbud M Nuh, Menkes Nafsiah Mboi, Menteri PU Djoko Kirmanto, Menko Kesra Agung Laksono, Mensesneg Sudi Silalahi, Wakil Menteri Perindustrian Alex Retraubun dan Dirut Badan Penyelenggara Jaminan Sosial.


Editor : Dian Sukmawati

SBY TINJAU PABRIK TAHU DAN RSUD DI SUMEDANG

Kapolda Jawa Barat Irjen Mohammad Iriawan menegaskan pelaku penembak Briptu Nurul Affandi yakni berinisial KK dan S adalah spesialis pencurian sepeda motor (curanmor). Keduanya sudah sering keluar masuk penjara dalam kasus serupa.

"Pelaku berinisial KK yang ditangkap di Lampung Timur, Lampung pada Senin (27/1) subuh, perannya hanya sebatas joki atau yang membawa motor. Justru S lah sebagai pelaku utama dan yang hingga saat ini masih buron," kata Iriawan di Bogor, Selasa (28/1).

Lebih lanjut ia menjelaskan, KK ditangkap setelah pihaknya bersama Polda Jabar, Polda Metro, Polda Lampung, Polres Bogor dan Depok melakukan penyelidikan yang cukup lama.

"Saat ditangkap di rumahnya, kita juga berhasil mengamankan barang bukti 10 sepeda motor yang diduga hasil curian," katanya.

Saat ini pihaknya masih melakukan pengembangan, untuk mengejar pelaku utama berinisial S. "Untuk sementara tidak ada motif lain. Ini murni pencurian sepeda motor, karena pelaku kepergok hendak mencuri sepeda motor dan ditegur oleh korban," ungkapnya.

Iriawan menambahkan, tidak menutup kemungkinan ada pelaku lain dalam kasus penembakan ini. "Maka dari itu kita masih melakukan penyelidikan dan pengembangan. Tapi yang jelas pelaku ini adalah pernah masuk penjara atau residivis," katanya.

Seperti diberitakan sebelumnya, Briptu Nurul Affandi anggota Unit Reserse dan Kriminal Polsek Klapanunggal tewas ditembak saat mempergoki pelaku pencurian sepeda motor di samping warung gado-gado dekat PT Nippres, Jalan Raya Narogong, Klapanunggal, Kabupaten Bogor, Jumat (10/1).

PENEMBAK BRIPTU NURUL SPESIALIS CURANMOR

Judge Patterson helped to protect the rights of Attica inmates after the prison riot in 1971 and later served on the Federal District Court in Manhattan.

Robert Patterson Jr., Lawyer and Judge Who Fought for the Accused, Dies at 91

Mr. Tepper was not a musical child and had no formal training, but he grew up to write both lyrics and tunes, trading off duties with the other member of the team, Roy C. Bennett.

Sid Tepper Dies at 96; Delivered ‘Red Roses for a Blue Lady’ and Other Songs

UNITED NATIONS — Wearing pinstripes and a pince-nez, Staffan de Mistura, the United Nations envoy for Syria, arrived at the Security Council one Tuesday afternoon in February and announced that President Bashar al-Assad had agreed to halt airstrikes over Aleppo. Would the rebels, Mr. de Mistura suggested, agree to halt their shelling?

What he did not announce, but everyone knew by then, was that the Assad government had begun a military offensive to encircle opposition-held enclaves in Aleppo and that fierce fighting was underway. It would take only a few days for rebel leaders, having pushed back Syrian government forces, to outright reject Mr. de Mistura’s proposed freeze in the fighting, dooming the latest diplomatic overture on Syria.

Diplomacy is often about appearing to be doing something until the time is ripe for a deal to be done.

 

 

Now, with Mr. Assad’s forces having suffered a string of losses on the battlefield and the United States reaching at least a partial rapprochement with Mr. Assad’s main backer, Iran, Mr. de Mistura is changing course. Starting Monday, he is set to hold a series of closed talks in Geneva with the warring sides and their main supporters. Iran will be among them.

In an interview at United Nations headquarters last week, Mr. de Mistura hinted that the changing circumstances, both military and diplomatic, may have prompted various backers of the war to question how much longer the bloodshed could go on.

“Will that have an impact in accelerating the willingness for a political solution? We need to test it,” he said. “The Geneva consultations may be a good umbrella for testing that. It’s an occasion for asking everyone, including the government, if there is any new way that they are looking at a political solution, as they too claim they want.”

He said he would have a better assessment at the end of June, when he expects to wrap up his consultations. That coincides with the deadline for a final agreement in the Iran nuclear talks.

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Whether a nuclear deal with Iran will pave the way for a new opening on peace talks in Syria remains to be seen. Increasingly, though, world leaders are explicitly linking the two, with the European Union’s top diplomat, Federica Mogherini, suggesting last week that a nuclear agreement could spur Tehran to play “a major but positive role in Syria.”

It could hardly come soon enough. Now in its fifth year, the Syrian war has claimed 220,000 lives, prompted an exodus of more than three million refugees and unleashed jihadist groups across the region. “This conflict is producing a question mark in many — where is it leading and whether this can be sustained,” Mr. de Mistura said.

Part Italian, part Swedish, Mr. de Mistura has worked with the United Nations for more than 40 years, but he is more widely known for his dapper style than for any diplomatic coups. Syria is by far the toughest assignment of his career — indeed, two of the organization’s most seasoned diplomats, Lakhdar Brahimi and Kofi Annan, tried to do the job and gave up — and critics have wondered aloud whether Mr. de Mistura is up to the task.

He served as a United Nations envoy in Afghanistan and Iraq, and before that in Lebanon, where a former minister recalled, with some scorn, that he spent many hours sunbathing at a private club in the hills above Beirut. Those who know him say he has a taste for fine suits and can sometimes speak too soon and too much, just as they point to his diplomatic missteps and hyperbole.

They cite, for instance, a news conference in October, when he raised the specter of Srebrenica, where thousands of Muslims were massacred in 1995 during the Balkans war, in warning that the Syrian border town of Kobani could fall to the Islamic State. In February, he was photographed at a party in Damascus, the Syrian capital, celebrating the anniversary of the Iranian revolution just as Syrian forces, aided by Iran, were pummeling rebel-held suburbs of Damascus; critics seized on that as evidence of his coziness with the government.

Mouin Rabbani, who served briefly as the head of Mr. de Mistura’s political affairs unit and has since emerged as one of his most outspoken critics, said Mr. de Mistura did not have the background necessary for the job. “This isn’t someone well known for his political vision or political imagination, and his closest confidants lack the requisite knowledge and experience,” Mr. Rabbani said.

As a deputy foreign minister in the Italian government, Mr. de Mistura was tasked in 2012 with freeing two Italian marines detained in India for shooting at Indian fishermen. He made 19 trips to India, to little effect. One marine was allowed to return to Italy for medical reasons; the other remains in India.

He said he initially turned down the Syria job when the United Nations secretary general approached him last August, only to change his mind the next day, after a sleepless, guilt-ridden night.

Mr. de Mistura compared his role in Syria to that of a doctor faced with a terminally ill patient. His goal in brokering a freeze in the fighting, he said, was to alleviate suffering. He settled on Aleppo as the location for its “fame,” he said, a decision that some questioned, considering that Aleppo was far trickier than the many other lesser-known towns where activists had negotiated temporary local cease-fires.

“Everybody, at least in Europe, are very familiar with the value of Aleppo,” Mr. de Mistura said. “So I was using that as an icebreaker.”

The cease-fire negotiations, to which he had devoted six months, fell apart quickly because of the government’s military offensive in Aleppo the very day of his announcement at the Security Council. Privately, United Nations diplomats said Mr. de Mistura had been manipulated. To this, Mr. de Mistura said only that he was “disappointed and concerned.”

Tarek Fares, a former rebel fighter, said after a recent visit to Aleppo that no Syrian would admit publicly to supporting Mr. de Mistura’s cease-fire proposal. “If anyone said they went to a de Mistura meeting in Gaziantep, they would be arrested,” is how he put it, referring to the Turkish city where negotiations between the two sides were held.

Secretary General Ban Ki-moon remains staunchly behind Mr. de Mistura’s efforts. His defenders point out that he is at the center of one of the world’s toughest diplomatic problems, charged with mediating a conflict in which two of the world’s most powerful nations — Russia, which supports Mr. Assad, and the United States, which has called for his ouster — remain deadlocked.

R. Nicholas Burns, a former State Department official who now teaches at Harvard, credited Mr. de Mistura for trying to negotiate a cease-fire even when the chances of success were exceedingly small — and the chances of a political deal even smaller. For his efforts to work, Professor Burns argued, the world powers will first have to come to an agreement of their own.

“He needs the help of outside powers,” he said. “It starts with backers of Assad. That’s Russia and Iran. De Mistura is there, waiting.”

With Iran Talks, a Tangled Path to Ending Syria’s War

At the National Institutes of Health, Dr. Suzman’s signature accomplishment was the central role he played in creating a global network of surveys on aging.

Richard Suzman, 72, Dies; Researcher Influenced Global Surveys on Aging

The bottle Mr. Sokolin famously broke was a 1787 Château Margaux, which was said to have belonged to Thomas Jefferson. Mr. Sokolin had been hoping to sell it for $519,750.

William Sokolin, Wine Seller Who Broke Famed Bottle, Dies at 85

A former member of the Boston Symphony Orchestra, Mr. Smedvig helped found the wide-ranging Empire Brass quintet.

Rolf Smedvig, Trumpeter in the Empire Brass, Dies at 62

Mr. Miller, of the firm Weil, Gotshal & Manges, represented companies including Lehman Brothers, General Motors and American Airlines, and mentored many of the top Chapter 11 practitioners today.

Harvey R. Miller, Renowned Bankruptcy Lawyer, Dies at 82
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Many bodies prepared for cremation last week in Kathmandu were of young men from Gongabu, a common stopover for Nepali migrant workers headed overseas. Credit Daniel Berehulak for The New York Times

KATHMANDU, Nepal — When the dense pillar of smoke from cremations by the Bagmati River was thinning late last week, the bodies were all coming from Gongabu, a common stopover for Nepali migrant workers headed overseas, and they were all of young men.

Hindu custom dictates that funeral pyres should be lighted by the oldest son of the deceased, but these men were too young to have sons, so they were burned by their brothers or fathers. Sukla Lal, a maize farmer, made a 14-hour journey by bus to retrieve the body of his 19-year-old son, who had been on his way to the Persian Gulf to work as a laborer.

“He wanted to live in the countryside, but he was compelled to leave by poverty,” Mr. Lal said, gazing ahead steadily as his son’s remains smoldered. “He told me, ‘You can live on your land, and I will come up with money, and we will have a happy family.’ ”

Weeks will pass before the authorities can give a complete accounting of who died in the April 25 earthquake, but it is already clear that Nepal cannot afford the losses. The countryside was largely stripped of its healthy young men even before the quake, as they migrated in great waves — 1,500 a day by some estimates — to work as laborers in India, Malaysia or one of the gulf nations, leaving many small communities populated only by elderly parents, women and children. Economists say that at some times of the year, one-quarter of Nepal’s population is working outside the country.

Nepal’s Young Men, Lost to Migration, Then a Quake

The live music at the Vice Media party on Friday shook the room. Shane Smith, Vice’s chief executive, was standing near the stage — with a drink in his hand, pants sagging, tattoos showing — watching the rapper-cum-chef Action Bronson make pizzas.

The event was an after-party, a happy-hour bacchanal for the hundreds of guests who had come for Vice’s annual presentation to advertisers and agencies that afternoon, part of the annual frenzy for ad dollars called the Digital Content NewFronts. Mr. Smith had spoken there for all of five minutes before running a slam-bang highlight reel of the company’s shows that had titles like “Weediquette” and “Gaycation.”

In the last year, Vice has secured $500 million in financing and signed deals worth hundreds of millions of dollars with established media companies like HBO that are eager to engage the young viewers Vice attracts. Vice said it was now worth at least $4 billion, with nearly $1 billion in projected revenue for 2015. It is a long way from Vice’s humble start as a free magazine in 1994.

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At the Vice after-party, the rapper Action Bronson, a host of a Vice show, made a pizza. Credit Jesse Dittmar for The New York Times

But even as cash flows freely in Vice’s direction, the company is trying to keep its brash, insurgent image. At the party on Friday, it plied guests with beers and cocktails. Its apparently unrehearsed presentation to advertisers was peppered with expletives. At one point, the director Spike Jonze, a longtime Vice collaborator, asked on stage if Mr. Smith had been drinking.

“My assistant tried to cut me off,” Mr. Smith replied. “I’m on buzz control.”

Now, Vice is on the verge of getting its own cable channel, which would give the company a traditional outlet for its slate of non-news programming. If all goes as planned, A&E Networks, the television group owned by Hearst and Disney, will turn over its History Channel spinoff, H2, to Vice.

The deal’s announcement was expected last week, but not all of A&E’s distribution partners — the cable and satellite TV companies that carry the network’s channels — have signed off on the change, according to a person familiar with the negotiations who spoke on the condition of anonymity because the talks were private.

A cable channel would be a further step in a transformation for Vice, from bad-boy digital upstart to mainstream media company.

Keen for the core audience of young men who come to Vice, media giants like 21st Century Fox, Time Warner and Disney all showed interest in the company last year. Vice ultimately secured $500 million in financing from A&E Networks and Technology Crossover Ventures, a Silicon Valley venture capital firm that has invested in Facebook and Netflix.

Those investments valued Vice at more than $2.5 billion. (In 2013, Fox bought a 5 percent stake for $70 million.)

Then in March, HBO announced that it had signed a multiyear deal to broadcast a daily half-hour Vice newscast. Vice already produces a weekly newsmagazine show, called “Vice,” for the network. That show will extend its run through 2018, with an increase to 35 episodes a year, from 14.

Michael Lombardo, HBO’s president for programming, said when the deal was announced that it was “certainly one of our biggest investments with hours on the air.”

Vice, based in Brooklyn, also recently signed a multiyear $100 million deal with Rogers Communications, a Canadian media conglomerate, to produce original content for TV, smartphone and desktop viewers.

Vice’s finances are private, but according to an internal document reviewed by The New York Times and verified by a person familiar with the company’s financials, the company is on track to make about $915 million in revenue this year.

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Vice showed a highlight reel of its TV series at the NewFronts last week in New York. Credit Jesse Dittmar for The New York Times

It brought in $545 million in a strong first quarter, which included portions of the new HBO deal and the Rogers deal, according to the document. More of its revenue now comes from these types of content partnerships, compared with the branded content deals that made up much of its revenue a year ago, the company said.

Mr. Smith said the company was worth at least $4 billion. If the valuation gets much higher, he said he would consider taking the company public.

“I don’t care about money; we have plenty of money,” Mr. Smith, who is Vice’s biggest shareholder, said in an interview after the presentation on Friday. “I care about strategic deals.”

In the United States, Vice Media had 35.2 million unique visitors across its sites in March, according to comScore.

The third season of Vice’s weekly HBO show has averaged 1.8 million viewers per episode, including reruns, through April 12, according to Brad Adgate, the director of research at Horizon Media. (Vice said the show attracted three million weekly viewers when repeat broadcasts, online and on-demand viewings were included.)

For years, Mr. Smith has criticized traditional TV, calling it slow and unable to draw younger viewers. But if all the deals Vice has struck are to work out, Mr. Smith may have to play more by the rules of traditional media. James Murdoch, Rupert Murdoch’s son and a member of Vice’s board, was at the company’s presentation on Friday, as were other top media executives.

“They know they need people like me to help them, but they can’t get out of their own way,” Mr. Smith said in the interview Friday. “My only real frustration is we’re used to being incredibly dynamic, and they’re not incredibly dynamic.”

With its own television channel in the United States, Vice would have something it has long coveted even as traditional media companies are looking beyond TV. Last year, Vice’s deal with Time Warner failed in part because the two companies could not agree on how much control Vice would have over a 24-hour television network.

Vice said it intended to fill its new channel with non-news programming. The company plans to have sports shows, fashion shows, food shows and the “Gaycation” travel show with the actress Ellen Page. It is also in talks with Kanye West about a show.

It remains to be seen whether Vice’s audience will watch a traditional cable channel. Still, Vice has effectively presold all of the ad spots to two of the biggest advertising agencies for the first three years, Mr. Smith said.

In the meantime, Mr. Smith is enjoying Vice’s newfound role as a potential savior of traditional media companies.

“I’m a C.E.O. of a content company,” Mr. Smith said before he caught a flight to Las Vegas for the boxing match on Saturday between Floyd Mayweather Jr. and Manny Pacquiao. “If it stops being fun, then why are you doing it?”

As Vice Moves More to TV, It Tries to Keep Brash Voice

With 12 tournament victories in his career, Mr. Peete was the most successful black professional golfer before Tiger Woods.

Calvin Peete, 71, a Racial Pioneer on the PGA Tour, Is Dead

Ms. von Furstenberg made her debut in the movies and on the Broadway stage in the early 1950s as a teenager and later reinvented herself as a television actress, writer and philanthropist.

Betsy von Furstenberg, Baroness and Versatile Actress, Dies at 83

The 2015 Met Gala has only officially begun, but there's a clear leader in the race for best couple, no small feat at an event that threatens to sap Hollywood of every celebrity it has for the duration of an East Coast evening.

That would be Marc Jacobs and his surprise guest (who, by some miracle, remained under wraps until their red carpet debut), Cher.

“This has been a dream of mine for a very, very long time,” Mr. Jacobs said.

It is Cher's first appearance at the Met Gala since 1997, when she arrived on the arm of Donatella Versace.

– MATTHEW SCHNEIER

Cher and Marc Jacobs

Over the last five years or so, it seemed there was little that Dean G. Skelos, the majority leader of the New York Senate, would not do for his son.

He pressed a powerful real estate executive to provide commissions to his son, a 32-year-old title insurance salesman, according to a federal criminal complaint. He helped get him a job at an environmental company and employed his influence to help the company get government work. He used his office to push natural gas drilling regulations that would have increased his son’s commissions.

He even tried to direct part of a $5.4 billion state budget windfall to fund government contracts that the company was seeking. And when the company was close to securing a storm-water contract from Nassau County, the senator, through an intermediary, pressured the company to pay his son more — or risk having the senator subvert the bid.

The criminal complaint, unsealed on Monday, lays out corruption charges against Senator Skelos and his son, Adam B. Skelos, the latest scandal to seize Albany, and potentially alter its power structure.

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Preet Bharara, the United States attorney in Manhattan, discussed the case involving Dean G. Skelos and his son, Adam. Credit Eduardo Munoz/Reuters

The repeated and diverse efforts by Senator Skelos, a Long Island Republican, to use what prosecutors said was his political influence to find work, or at least income, for his son could send both men to federal prison. If they are convicted of all six charges against them, they face up to 20 years in prison for each of four of the six counts and up to 10 years for the remaining two.

Senator Kenneth P. LaValle, of Long Island, who serves as chairman of the Republican conference, emerged from a closed-door meeting Monday night to say that conference members agreed that Mr. Skelos should be benefited the “presumption of innocence,” and would stay in his leadership role.

“The leader has indicated he would like to remain as leader,” said Mr. LaValle, “and he has the support of the conference.” The case against Mr. Skelos and his son grew out of a broader inquiry into political corruption by the United States attorney for the Southern District of New York, Preet Bharara, that has already changed the face of the state capital. It is based in part, according to the six-count complaint, on conversations secretly recorded by one of two cooperating witnesses, and wiretaps on the cellphones of the senator and his son. Those recordings revealed that both men were concerned about electronic surveillance, and illustrated the son’s unsuccessful efforts to thwart it.

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Adam Skelos took to using a “burner” phone, the complaint says, and told his father he wanted them to speak through a FaceTime video call in an apparent effort to avoid detection. They also used coded language at times.

At one point, Adam Skelos was recorded telling a Senate staff member of his frustration in not being able to speak openly to his father on the phone, noting that he could not “just send smoke signals or a little pigeon” carrying a message.

The 43-page complaint, sworn out by Paul M. Takla, a special agent for the Federal Bureau of Investigation, outlines a five-year scheme to “monetize” the senator’s official position; it also lays bare the extent to which a father sought to use his position to help his son.

The charges accuse the two men of extorting payments through a real estate developer, Glenwood Management, based on Long Island, and the environmental company, AbTech Industries, in Scottsdale, Ariz., with the expectation that the money paid to Adam Skelos — nearly $220,000 in total — would influence his father’s actions.

Glenwood, one of the state’s most prolific campaign donors, had ties to AbTech through investments in the environmental firm’s parent company by Glenwood’s founding family and a senior executive.

The accusations in the complaint portray Senator Skelos as a man who, when it came to his son, was not shy about twisting arms, even in situations that might give other arm-twisters pause.

Seeking to help his son, Senator Skelos turned to the executive at Glenwood, which develops rental apartments in New York City and has much at stake when it comes to real estate legislation in Albany. The senator urged him to direct business to his son, who sold title insurance.

After much prodding, the executive, Charles C. Dorego, engineered a $20,000 payment to Adam Skelos from a title insurance company even though he did no work for the money. But far more lucrative was a consultant position that Mr. Dorego arranged for Adam Skelos at AbTech, which seeks government contracts to treat storm water. (Mr. Dorego is not identified by name in the complaint, but referred to only as CW-1, for Cooperating Witness 1.)

Senator Skelos appeared to take an active interest in his son’s new line of work. Adam Skelos sent him several drafts of his consulting agreement with AbTech, the complaint says, as well as the final deal that was struck.

“Mazel tov,” his father replied.

Senator Skelos sent relevant news articles to his son, including one about a sewage leak near Albany. When AbTech wanted to seek government contracts after Hurricane Sandy, the senator got on a conference call with his son and an AbTech executive, Bjornulf White, and offered advice. (Like Mr. Dorego, Mr. White is not named in the complaint, but referred to as CW-2.)

The assistance paid off: With the senator’s help, AbTech secured a contract worth up to $12 million from Nassau County, a big break for a struggling small business.

But the money was slow to materialize. The senator expressed impatience with county officials.

Adam Skelos, in a phone call with Mr. White in late December, suggested that his father would seek to punish the county. “I tell you this, the state is not going to do a [expletive] thing for the county,” he said.

Three days later, Senator Skelos pressed his case with the Nassau County executive, Edward P. Mangano, a fellow Republican. “Somebody feels like they’re just getting jerked around the last two years,” the senator said, referring to his son in what the complaint described as “coded language.”

The next day, the senator pursued the matter, as he and Mr. Mangano attended a wake for a slain New York City police officer. Senator Skelos then reassured his son, who called him while he was still at the wake. “All claims that are in will be taken care of,” the senator said.

AbTech’s fortunes appeared to weigh on his son. At one point in January, Adam Skelos told his father that if the company did not succeed, he would “lose the ability to pay for things.”

Making matters worse, in recent months, Senator Skelos and his son appeared to grow wary about who was watching them. In addition to making calls on the burner phone, Adam Skelos said he used the FaceTime video calling “because that doesn’t show up on the phone bill,” as he told Mr. White.

In late February, Adam Skelos arranged a pair of meetings between Mr. White and state senators; AbTech needed to win state legislation that would allow its contract to move beyond its initial stages. But Senator Skelos deemed the plan too risky and caused one of the meetings to be canceled.

In another recorded call, Adam Skelos, promising to be “very, very vague” on the phone, urged his father to allow the meeting. The senator offered a warning. “Right now we are in dangerous times, Adam,” he told him.

A month later, in another phone call that was recorded by the authorities, Adam Skelos complained that his father could not give him “real advice” about AbTech while the two men were speaking over the telephone.

“You can’t talk normally,” he told his father, “because it’s like [expletive] Preet Bharara is listening to every [expletive] phone call. It’s just [expletive] frustrating.”

“It is,” his father agreed.

Dean Skelos, Albany Senate Leader, Aided Son at All Costs, U.S. Says

Ms. Crough played the youngest daughter on the hit ’70s sitcom starring David Cassidy and Shirley Jones.

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