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"Latar Belakang. Terapi baku emas dalam penutupan defek septum ventrikel (DSV) adalah pembedahan. Prosedur pembedahan mempunyai morbiditas yang terkait dengan torakotomi, pintasan jantung paru, komplikasi prosedur, jaringan parut bekas operasi, dan trauma psikologis. Oleh karena itu, timbul usaha pendekatan transkateter untuk menutup DSV yang bersifat relatif kurang invasif. Tujuan. Mengetahui perbandingan hasil penutupan DSV perimembran, komplikasi prosedur, lama rawat di rumah sakit, dan total biaya prosedur antara prosedur transkateter dengan prosedur pembedahan. Metode. Penelitian retrospektif analitik dengan data berupa rekam medis pasien anak dengan DSV perimembran yang datang ke Pelayanan Jantung Terpadu Rumah Sakit dr. Cipto Mangunkusumo dan dilakukan penutupan defek dengan salah satu prosedur dalam periode Januari 2010-Desember 2013. Hasil. Sebanyak 69 kasus anak dengan DSV perimembran masuk dalam penelitian, terdiri dari 39 kasus dengan prosedur pembedahan dan 30 kasus dengan prosedur transkateter. Prosedur pembedahan dan prosedur transkateter mempunyai tingkat keberhasilan yang serupa (89,7% vs 96,7%, p=0,271). Prosedur pembedahan mempunyai komplikasi yang lebih banyak dibandingkan prosedur transkateter (46,7% vs 7,7%, p < 0,001). Prosedur pembedahan juga mempunyai lama rawat di rumah sakit yang lebih panjang dibandingkan prosedur transkateter (8 hari vs 3 hari, p<0,0001), dan semua prosedur pembedahan membutuhkan perawatan di ruang rawat intensif. Tidak ada perbedaan total biaya antara prosedur transkateter dengan prosedur pembedahan (Rp. 55.032.636 vs Rp. 58.593.320 p = 0,923). Simpulan. Prosedur penutupan DSV perimembran secara transkateter mempunyai efektivitas dan biaya yang sama dengan prosedur pembedahan dan mempunyai komplikasi yang lebih sedikit serta lama rawat di rumah sakit yang lebih pendek.

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Background. Surgery has become standard therapy for ventricular septal defect (VSD) closure, but it has significant morbidity related to sternotomy, cardiopulmonary bypass, complication, residual scar, and trauma. Non-surgical and less invasive approaches with transcatheter device were developed to occlude VSD.

Objectives. To compare efficacy, complication, length of hospital stay, and total cost of perimembran VSD closure procedure between transcatheter closure and surgery.

Methods. A retrospective analysis was performed on children with perimembran VSD admitted to Cardiology Center of Cipto Mangunkusumo Hospital from January 2010-December 2031. The patients received transcatheter closure or surgical closure. Data were obtained from medical record.

Results. A total of 69 perimembran VSD cases were included in study, consisted of 39 cases underwent transcatheter closure and 30 cases underwent surgical closure. The efficacy of both procedur were not statistically different (89.7% vs 96.7%, p=0.271). However, surgery procedure had more complication than transcatheter closure (46.7% vs 7.7%, p < 0.001). Hospital stay were also significantly longer for surgery procedure than transcatheter closure (8 days vs 3 days, p<0.0001), and all surgical subjects requiring intensive care. Transcatheter closure had median total cost Rp. 55.032.636 as compared with Rp. 58.593.320 for surgery procedure (p =0.923).

Conclusion. Perimembran VSD transcatheter closure had similar efficacy and costs with surgical closure. Complication rate was lower, and the length of hospital stay was shorter."

"Latar belakang: Defek septum ventrikel DSV adalah salah satu penyakitjantung bawaan yang paling sering ditemukan. DSV dapat menutup secaraspontan atau harus dilakukan tindakan untuk penutupan defek. Penutupan DSVmelalui operasi masih menjadi baku emas, namun saat ini telah berkembangpenutupan DSV secara transkateter yang dinilai lebih efisien dan memilikiefektivitas yang hampir sama.Tujuan: Penelitian ini bertujuan membandingkan luaran jangka menengah ataupanjang pasca-penutupan DSV secara transkateter dengan pasca-penutupan DSVsecara operasi. Metode: Penelitian potong lintang ini dilakukan dari 1 Maret-31 Mei 2017terhadap 68 pasien DSV yang telah menjalani penutupan penutupan DSV secaratranskateter atau operasi di RSUPN Dr. Cipto Mangunkusumo dari 1 Januari 2010-30 April 2017. Subyek adalah pasien DSV perimembranosa outlet PMO atau doubly committed subarterial DCSA lesi tunggal, usia 2-18 tahun, beratbadan di atas 8 kg, dan tidak ada aritmia. Data dikumpulkan dari rekam medikpasien serta dari pemeriksaan elektrokardiografi dan ekokardiografi. Luaranjangka menengah atau panjang aritmia, regurgitasi katup, dan sisa pirau dianalisis dengan uji Chi square atau Fisher exact dan T independen denganinterval kepercayaan 95 dan nilai kemaknaan 0,05. Hasil: Rerata waktu prosedur penutupan DSV secara transkateter dan operasimasing-masing 108,2 37,8 menit dan 157,2 23 menit. Incomplete RBBB,complete RBBB, blok AV derajat I, serta junctional rhythm ditemukan pada10,3 , 2,9 , 2,9 , dan 1,5 pasien secara berurutan. Aritmia dijumpai pada14,7 pasien transkateter dan 20,6 pasien operasi, serta tidak ditemukanperbedaan bermakna antara kedua prosedur p>0,05. Proporsi peningkatanderajat regurgitasi katup lebih banyak pada prosedur transkateter dibandingkanoperasi 47,1 vs. 32,4 dan tidak terdapat perbedaan bermakna secara statistik p>0,05 . Sisa pirau trivial ditemukan pada 5,9 pasien pasca-penutupan secaratranskateter dan 8,8 secara operasi, dan tidak ditemukan perbedaan bermaknasecara statistik p>0,05. Simpulan: Luaran jangka menengah atau jangka panjang pasca-penutupan DSVsecara transkateter tidak berbeda dibandingkan secara operasi.

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Background: Ventricle septal defect VSD is the most common congenital heartdisease VSD may close spontaneously or a procedure must be performed to closethe defect. Surgical closure of VSD has been the gold standard, but transcatheterclosure of VSD has been developed that seem to be more efficient with similareffectivity.

Objective: To compare mid term or long term outcomes between transcatheterclosure and surgical closure of VSDs.

Methods: A cross sectional study was performed from March 1st until May 31st 2017 to 68 patients with VSDs who underwent transcatheter or surgical closure ofVSD in Dr. Cipto Mangunkusumo hospital from January 1st 2010 until April 30th2017. Subject were patient with single lesion outlet perimembranous VSD ordoubly committed subarterial DCSA, aged 2 to18 years old, body weight morethan 8 kgs, without arrhythmia. Data was collected from patient medical record,electrocardiography and echocardiography examination. Mid term or long termoutcomes arrhythmia, valve regurgitation, and residual shunt was analyzed byChi square or Fisher's exact test and independent T test with 95 confidenceinterval and significance level of 0.05.

Results: The procedure mean time for transcatheter closure and surgical closureof VSDs was 108.2 37,8 minutes and 157.2 23 minutes. Incomplete RBBB,complete RBBB, first degree AV block, and junctional rhythm occurred in 10.3 ,2.9 , 2.9 , and 1.5 patients, respectively. Arrhytmia occurred in 14.7 trancatheter closure patients and 20.6 in surgical closure patients p 0,05. Thedegree of regurgitation proportion in transcatheter closure is higher compared tothe degree of valve regurgitation proportion surgical closure, although there is nostatistical significant difference 47.1 vs. 32.4 , p 0.05 . Trivial residual shuntwas found in 5.9 patients after transcatheter closure and 8.8 surgical closure, also without statistical significant difference p 0,05.

Conclusion: There are no mid term or long term difference outcomes betweenVSDs post transcatheter and surgery closure."

"AbstrakDespite the advancement of bone reconstruction in the past decade, large bone defect remains a challenge for orthopedic surgery. As mesenchymal stem cells (MSCs) emerges as one of the possible treatment of these defects, we evaluate the effect of its transplantation, particularly in combination with hydroxyapatite-calcium sulphate pellets. Methods: Twenty eight rabbits were randomly assigned into four different treatment groups. Each group received a different type of grafts (Autograft, hydroxyapatite-calcium sulphate [HA-CaSO4], HA-CaSO4 combined with marrow aspirate, or HA-CaSO4 combined with 2x106 MSCs). One centimeter long bone defects were created then immediately fixated with mini plate-screw and two cerclage wires. It was followed by the graft transplantation. Callus thickness was measured from the x-rays taken at 4, 8, 12 week after transplantation by two authors working independently. At the end of the study, histological staining along with osteocyte index were obtained by sacrificing the rabbits. These data were analyzed by one-way ANOVA test.Results: At the fourth week, callus thickness showed significant difference (p = 0.018). Although statistically insignificant, callus in MSCs group at the eighth week seemed to be thicker than any other groups of intervention (p = 0.546). The MSCs group also tend to have a higher osteocyte index at the follow-up weeks.Conclusion: MSC transplantation on bone defect results in faster callus formation and tends to generate a thicker callus."

"ABSTRAK Latar Belakang Pada penatalaksanaan fraktur maksilofasial secara internal fiksasi diperlukan pemasangan alat miniplate dan screw sampai terjadi penyembuhan tulang Magnesium memiliki potensi sebagai miniplate dan screw pada tulang rahang dengan syarat bersifat biokompatibel dan biodegradasi sehingga tidak diperlukan operasi kembali untuk pengambilan miniplate dan screw Proses equal channel angular pressing ECAP merupakan salah satu metode untuk mengontrol laju korosi logam magnesium dan meningkatkan sifat mekanisnya Untuk pembuatan desain miniplate dan screw dari magnesium ECAP dengan merujuk dari desain safety factor bahan titanium yang biasanya telah digunakan perlu disesuaikan dengan material properti magnesium agar dapat mencegah kerusakan Tujuan menganalisa perbandingan desain miniplate dan screw logam magnesium ECAP terhadap titanium Metode Untuk penelitian ini kami menggunakan metode finite elemen yaitu formulasi perpindahan untuk menghitung perpindahan komponen strain dan tekanan di bawah beban internal dan eksternal Kemudian desain miniplate dan screw dari magnesium ECAP dilakukan analisa simulasi pembebanan yang dianalisa menggunakan teori Von Misses Hasil Hasil desain miniplate dan screw magnesium ECAP yang diharapkan dapat digunakan pada penatalaksanaan fraktur maksilofasial telah dilakukan simulasi pembebanan dengan dilakukan analisa desain menggunakan teori Von Misses kemudian desain direkayasa untuk mengurangi stress yang diterima desain rekayasa magnesium ECAP dibuat menjadi dua tipe yaitu tipe 1 dengan menambah jumlah screw menjadi 8 screw dengan berat total miniplate dan screw sebesar 118 212 mg dan tipe ke 2 dengan merubah diameter head screw menjadi 2x lebih besar dari bentuk semula sehingga berat totalnya sebesar 169 414 mg Kesimpulan Desain alternatif miniplate dan screw magnesium ECAP tipe 1 dapat lebih efektif untuk digunakan pada penatalaksanaan fraktur maksilofasial ABSTRACT Background In the internal fixation management of maxillofacial fractures the placement of miniplate and screw is necessary until bone repair takes place Magnesium has the potential as a miniplate and screw for the jaws with it rsquo s biocompatibility and biodegradability so that a follow up surgery to remove the miniplate and screw is not necessary The equal channel angular pressing ECAP process is a method to control the corrosion rate of magnesium and increase the mechanical properties In the making of miniplate and screw design from ECAP magnesium referring the safety factor of the titanium design that is already being used adjustments must be made with the characteristics of magnesium so damage can be avoided Objectives to analyze the comparison between magnesium ECAP miniplate and screw design against titanium Methods For this research we used the finite element method which is displacement formulation to calculate component movement strain and pressure under the internal and external load Afterwards the magnesium ECAP miniplate and screw design undergoes a loading simulation which is analyzed with the Von Misses theory Result Design of miniplate and screw magnesium ECAP which expected to be used in the management of maxillofacial fractures has been tested with the stress simulation using Von Misses theory then the design engineered to reduce stress received Engineering design of magnesium ECAP divided into two types type 1 by increasing the number of screw into 8 screws with a total weight miniplate and screws with a total weight miniplate and screw amounted to 118 212 mg and type 2 by changing the diameter of the head screw becomes large than its original shape so that the total weight of 169 414 mg Conclusion Design alternative of miniplate and screw magnesium ECAP type 1could be more effective to be used in the management of maxillofacial fracture ;Background In the internal fixation management of maxillofacial fractures the placement of miniplate and screw is necessary until bone repair takes place Magnesium has the potential as a miniplate and screw for the jaws with it rsquo s biocompatibility and biodegradability so that a follow up surgery to remove the miniplate and screw is not necessary The equal channel angular pressing ECAP process is a method to control the corrosion rate of magnesium and increase the mechanical properties In the making of miniplate and screw design from ECAP magnesium referring the safety factor of the titanium design that is already being used adjustments must be made with the characteristics of magnesium so damage can be avoided Objectives to analyze the comparison between magnesium ECAP miniplate and screw design against titanium Methods For this research we used the finite element method which is displacement formulation to calculate component movement strain and pressure under the internal and external load Afterwards the magnesium ECAP miniplate and screw design undergoes a loading simulation which is analyzed with the Von Misses theory Result Design of miniplate and screw magnesium ECAP which expected to be used in the management of maxillofacial fractures has been tested with the stress simulation using Von Misses theory then the design engineered to reduce stress received Engineering design of magnesium ECAP divided into two types type 1 by increasing the number of screw into 8 screws with a total weight miniplate and screws with a total weight miniplate and screw amounted to 118 212 mg and type 2 by changing the diameter of the head screw becomes large than its original shape so that the total weight of 169 414 mg Conclusion Design alternative of miniplate and screw magnesium ECAP type 1could be more effective to be used in the management of maxillofacial fracture ;Background In the internal fixation management of maxillofacial fractures the placement of miniplate and screw is necessary until bone repair takes place Magnesium has the potential as a miniplate and screw for the jaws with it rsquo s biocompatibility and biodegradability so that a follow up surgery to remove the miniplate and screw is not necessary The equal channel angular pressing ECAP process is a method to control the corrosion rate of magnesium and increase the mechanical properties In the making of miniplate and screw design from ECAP magnesium referring the safety factor of the titanium design that is already being used adjustments must be made with the characteristics of magnesium so damage can be avoided Objectives to analyze the comparison between magnesium ECAP miniplate and screw design against titanium Methods For this research we used the finite element method which is displacement formulation to calculate component movement strain and pressure under the internal and external load Afterwards the magnesium ECAP miniplate and screw design undergoes a loading simulation which is analyzed with the Von Misses theory Result Design of miniplate and screw magnesium ECAP which expected to be used in the management of maxillofacial fractures has been tested with the stress simulation using Von Misses theory then the design engineered to reduce stress received Engineering design of magnesium ECAP divided into two types type 1 by increasing the number of screw into 8 screws with a total weight miniplate and screws with a total weight miniplate and screw amounted to 118 212 mg and type 2 by changing the diameter of the head screw becomes large than its original shape so that the total weight of 169 414 mg Conclusion Design alternative of miniplate and screw magnesium ECAP type 1could be more effective to be used in the management of maxillofacial fracture "

"Pembedahan masih menjadi standar emas terapi kuratif untuk obstruksi saluran empedu maligna, namun hanya 10-20% kasus yang dianggap dapat dioperasi. Oleh karena itu, terapi paliatif untuk menghilangkan rasa sakit, kolestasis, dan obstruksi saluran empedu, merupakan pengobatan utama bagi sebagian besar pasien. Perkembangan drainase bilier transhepatik perkutan dan drainase bilier endoskopi telah menghasilkan pengobatan invasif minimal untuk obstruksi bilier ganas, yang memiliki morbiditas dan mortalitas lebih rendah dibandingkan drainase bedah. Pilihan teknik drainase tergantung pada jenis tumor, lokasi obstruksi, serta ketersediaan tenaga ahli dan instrumentasi.

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Surgery is still the golden standard of curative therapy for malignant biliary obstruction, but only 10-20% of cases considered resectable. Therefore, palliative therapy to relieve pain, cholestasis, and biliary obstruction, is the main treatment for most patients. The development of percutaneous transhepatic biliary drainage and endoscopic biliary drainage had brought about minimally invasive treatment for malignant biliary obstruction, which had lower morbidity and mortality than surgical drainage. The choice of drainage technique depends on type of tumor , site of obstruction, also the available expert and instrumentation."

"ABSTRAK Penatalaksanaan Fistel Enterokutan masih sangat beragam dan sulit dengan tingkat kekambuhan dan kematian pasca pembedahan yang masih tinggi. Tujuan dari penatalaksanaan pasien dengan fistel enterokutan adalah koreksi defisit metabolik dan nutrisi, penutupan fistel dan mengembalikan kesinambungan saluran cerna. Tujuan dari penelitian ini adalah untuk melakukan evaluasi penatalaksanaan bedah pada fistel enterokutan yang dirawat di RSUPN Cipto Mangunkusumo selama tahun 2014-2015. Penelitian ini dirancang secara retrospektif analitik dengan mengambil data rekam medik penderita di RSUPN Cipto Mangunkusumo pada periode 2014-2015. Ditemukan 27 kasus fistel enterokutan, dimana 21 kasus yang di evaluasi, rentang umur 27-65 tahun, terbanyak pada kelompok 40-60 tahun (52,38%), letak fistel terbanyak di ileum (57,14%), high output (71,43%), gizi buruk (52,38%), dilakukan tindakan operatif (85,71%), lama rawat <20 hari (66,67%), rekurensi fistel (19,05%) dan angka kematian (14,29%).ABSTRACT Management of enterocutaneous fistula still varies and frustrating with high recurrence and mortality rate. The goal of management for patient with enterocutaneous fistula are correct metabolic and nutritional deficits, close the fistula and reestablish continuity of the gastrointestinal tract. The purpose of this study was to evaluate the surgical management of the enterocutaneous fistula treated at Cipto Mangunkusumo Hospital during 2014-2015. This study designed analytic retrospectively by taking the patient medical record data at Cipto Mangunkusumo Hospital ini the period 2014-2015. Found 27 cases of enterocutaneous fistula which 21 cases were evaluated, age range 40-60 years (52,38%), the location of the fistula largest in the ileum (57,14%), high output (71,43%), malnutrition (52,38%), operative management (85,71%), length of stay in hospital <20 days (66,67%), fistula recurrence (19,05%) and mortality rate (14,29%).;Management of enterocutaneous fistula still varies and frustrating with high recurrence and mortality rate. The goal of management for patient with enterocutaneous fistula are correct metabolic and nutritional deficits, close the fistula and reestablish continuity of the gastrointestinal tract. The purpose of this study was to evaluate the surgical management of the enterocutaneous fistula treated at Cipto Mangunkusumo Hospital during 2014-2015. This study designed analytic retrospectively by taking the patient medical record data at Cipto Mangunkusumo Hospital ini the period 2014-2015. Found 27 cases of enterocutaneous fistula which 21 cases were evaluated, age range 40-60 years (52,38%), the location of the fistula largest in the ileum (57,14%), high output (71,43%), malnutrition (52,38%), operative management (85,71%), length of stay in hospital <20 days (66,67%), fistula recurrence (19,05%) and mortality rate (14,29%).;Management of enterocutaneous fistula still varies and frustrating with high recurrence and mortality rate. The goal of management for patient with enterocutaneous fistula are correct metabolic and nutritional deficits, close the fistula and reestablish continuity of the gastrointestinal tract. The purpose of this study was to evaluate the surgical management of the enterocutaneous fistula treated at Cipto Mangunkusumo Hospital during 2014-2015. This study designed analytic retrospectively by taking the patient medical record data at Cipto Mangunkusumo Hospital ini the period 2014-2015. Found 27 cases of enterocutaneous fistula which 21 cases were evaluated, age range 40-60 years (52,38%), the location of the fistula largest in the ileum (57,14%), high output (71,43%), malnutrition (52,38%), operative management (85,71%), length of stay in hospital <20 days (66,67%), fistula recurrence (19,05%) and mortality rate (14,29%)."

"Penelitian ini bertujuan mengetahui faktor-faktor yang berhubungan dengan keterlambatan operasi elektif di kamar bedah RS Awal Bros Pekanbaru. Variabel yang diteliti adalah kedatangan tim operasi, kedatangan pasien, waktu persiapan pasien, operasi cito sebelumnya,keterlambatan operasi sebelumnya, kelengkapan sarana operasi, kelengkapan administrasi dan kondisi medis pasien.Penelitian ini adalah penelitian gabungan kuantitatif dan kualitatif, menggunakan data retrospektif dengan desain penelitian cross sectional dilanjutkan dengan metode concensus decision making grup CDMG. Sampel dalam penelitian ini menggunakan penghitungan rumus penelitian Slovin, dengan jumlah sampel 100 sampel. Pengumpulan data menggunakan instrumen penelitian dan data sekunder dari laporan kinerja kamar bedah. Uji statistik yang digunakan dalam penelitian ini adalah analisis univariat dan analisis bivariat menggunakan uji chi square.Hasil penelitian pada uji statistic bivariat, dari semua variabel yang diteliti ada 3 yang memiliki hubungan signifikan dengan keterlambatan operasi elektif,yaitu kedatangan pasien, waktu persiapan pasien, dan keterlambatan operasi sebelumnya. Kesimpulan pada penelitian ini didapatkan bahwa angka keterlambatan operasi elektif adalah 81,15 menit jauh diatas standar mutu RS yang ditetapkan yaitu

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This study aims to determine the factors associated with the delay in elective surgery in the operating room of Awal Bros Pekanbaru Hospital. The variables studied were the arrival of the surgical team, the arrival of the patient, the patient 39 s preparation time, the previous citosurgery, the previous surgical delay, the completeness of the surgical means, the administrative completeness and the patient 39 s medical condition.

This research is a quantitative and qualitative combined research, using retrospective data with cross sectional research design followed by concensus decision making grup CDMG. The sample in this study used Slovin formula calculation, with sample size of 100 samples. Data collection using research instruments and secondary data from surgical room performance reports. The statistical test used in this research is univariate and bivariate analysis using chi square test.

Result of the research on bivariate statistic test, from all variables studied there are 3 which have significant relation with elective surgery delay, that is patient arrival, patient preparation time, and previous operational delay. The conclusion of this research is that the elective operation delay is 81.15 minutes far above the defined standard of hospital quality."

"This study aimed to compare the efficiency of isosulfan blue (ISB) and colloid methods in determining metastatic conditions of axillary lymph node in sentinel lymph node biopsy (SLNB). this prospective study was performed between April 2005 and July 2009 at Gulhane Medical Faculty, Department of General Surgery. a total of 102 female patients diagnosed with breast cancer were enrolled in the clinic of Gulhane School of Medicine. According to the diagnostic protocols of SLN, the patients were divided into three groups as follows: ISB (group I), colloid (group II), and ISB and colloid (group III). SLN was identified in 49 of 52 patients (94.2%) in the ISB group; the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and false negativity (FN) ratio were found to be 90.9%, 75.8%, 96.1%, 55.5%, and 9.1%, respectively. On the contrary, the sentinel lymph node was identified in 38 of 38 (100%) patients in the colloid group; the sensitivity, specificity, PPV, NPV, and FN were found to be 88.2%, 100%, 100%, 91.3%, and 11.8%, respectively. In ISB and colloid groups; SLN was identified in 12 of 12 (100%) patients in the ISB and colloid groups; the sensitivity, specificity, PPV, NPV, and FN were found to be 100%, 100%, 100%, and 0%, respectively. this study showed that the combined methods applied to heterogeneous groups of patients for SLNB in breast cancer cases were minimally invasive and effective and hence could be used for evaluating nodal metastases."