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Hasil Pencarian

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Respon terapi hormonal dan timbulnya mekanisme resistensi terhadap pemberian tamoxifen pada pasien kanker payudara = Hormonal therapy response and the resistancy mechanism of tamoxifen therapy in breast cancer patients
"[LATAR BELAKANG
Di Indonesia, kanker payudara telah menjadi peringkat pertama dalam urutan kanker tertinggi yang diderita perempuan dan terapi hormonal masih merupakan pilihan terapi yang banyak digunakan pada penderita kanker payudara, termasuk pada kasus lanjut. Telah ditemukan GPR30, yang turut mengikat estrogen, dan hasil akhir dari kaskade yang diinisasi dari GPR30 ini adalah adanya proliferasi atau pertumbuhan sel, survival dari sel (anti-apoptosis), serta migrasi atau metastasis. Perilaku Tamoxifen juga disinyalir berbeda pada ER (estrogen receptor) dan pada GPR30, yang ternyata bersifat agonis terhadap GRP30, dan hasil akhirnya dapat menstimulasi timbulnya proliferasi.
METODE
Penelitian dilakukan secara kohor retrospektif, dilakukan di Poliklinik Bedah Onkologi Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta. Penelitian didasarkan pada data pasien dalam kurun waktu 2 (dua) tahun terakhir yaitu 2008-2010. Jenis kegiatan riset ini berupa literature dan theoritical study. Sampel penelitian dipilih secara consecutive sampling.
HASIL
Sebaran data berdasarkan hasil pemeriksaan didapatkan ER (-) pada 63,6% sampel, PR (-) pada 64,8% sampel, dan C-ERB 2 (-) pada 61,3% sampel. Dari sebaran data sampel berdasarkan status pemberian Tamoxifen didapatkan bahwa 61,4% sampel tidak mendapatkan terapi Tamoxifen. Dari sampel yang mendapatkan terapi Tamoxifen, 25 dari 34 sampel (73,5%) mendapatkan terapi hormonal ini kurang dari 2 tahun dan 26,5% sampel mendapatkan terapi lebih dari 2 tahun. Sebagian besar sampel (59,1%) memiliki compliance yang baik terhadap pengobatan, dan secara keseluruhan sampel, ditemukan adanya metastasis pada 26,1% sampel. Dari sampel penelitian yang ditemukan timbulnya metastasis, sebesar 69,6% sampel sudah terdapat metastasis jauh. Pada sampel yang mendapat terapi Tamoxifen kurang dari 2 tahun, terlihat sebesar 84% sampel tidak didapatkan timbulnya metastasis, sedangkan pada sampel yang mendapat terapi Tamoxifen lebih dari 2 tahun, sebesar 77,7% sampel didapatkan timbulnya metastasis.
KESIMPULAN
Terdapat kecenderungan yang kuat bahwa Tamoxifen, suatu antagonis ER yang parsial, berperan sebagai agonis pada GPR30, dan mengemukakan suatu penemuan baru bahwa sebenarnya terapi anti-estrogen konvensional selama ini, dapat bersifat stimulasi daripada inhibisi perkembangan dari tumor yang resisten terhadap Tamoxifen., BACKGROUNDS
In Indonesia, breast cancer has become number one in the incidence of highest number or cancers which is suffered by women, and hormonal therapy has still been one of the choice, included in advanced cases. GPR30, a novel protein, has been discovered, also binds estrogen, and the end result of this cascade is cell proliferation and growth, cell survival (anti-apoptosis), and migration or even metastases. The effect of Tamoxifen is also found different in ER (estrogen receptor) and GPR30, which is an agonist for GPR30, and resulting proliferation of cells.
METHODS
The research had been done in cohort retrospective, at Oncology Surgery Outpatient Clinic Cipto Mangunkusumo Hospital Jakarta. The research was based from patients data in 2008 until 2010. This is a literature and theoritical study. The samples were selected based from consecutive sampling.
RESULTS
The descriptive data finds ER (-) in 63,6% samples, PR (-) in 64,8% samples, and C-ERB 2 (-) in 61,3% samples. It is also found that 61,4% samples did not get Tamoxifen hormonal therapy. From the samples who got Tamoxifen hormonal therapy, 25 from 34 samples (73,5%) got this hormonal therapy for less than two years, and 26,5% samples got for more than two years. Most of the samples (59,1%) have good compliance in taking the medicines, and based from all samples, metastases were found in 26,1% samples, and from these samples, 69,6% samples has got distant metatases. Based on the samples who got Tamoxifen hormonal therapy for less than two years, 84% samples did not have metastases, whereas in samples who got it for more than two years, metastases were found in 77,7% samples.
CONCLUSION
There is a strong preference that Tamoxifen, a partial ER antagonist, acts as agonist in GPR30, and reveals a novel discovery that our conventional anti-estrogen therapy which has been used all these times, may act in stimulation rather than inhibition the tumor growth which is resistant in Tamoxifen.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Dogma Handal
Karakteristik kaki diabetik di hubungkan dengan penilaian "PEDIS" yang dilakukan Débridement di Divisi Bedah Vaskular RSUPN Dr. Cipto Mangunkusumo = Characteristic of diabetic foot in association with "PEDIS" assessment as do Débridement in the Division Vascular Surgery RSUPN Dr. Cipto Mangunkusumo
"[ABSTRAK
Pendahuluan: Kaki diabetik (KD) merupakan salah satu komplikasi kronik dari Diabetes Mellitus (DM), karena sering berujung pada kecacatan karena tingginya angka amputasi dan bahkan kematian. WHO merekomendasikan klasifikasi Perfusion, Extent/Size, Depth/Tissue Loss, Infection, Sensation (PEDIS) sebagai sarana penegakkan diagnosis dan membantu menentukan tatalaksana KD. Pada beberapa studi yang menggunakan klasifikasi PEDIS dapat memprediksi perlunya perawatan kasus KD di RS dan perkiraan angka amputasi yang hanya di tinjau dari aspek Infection saja. Namun hubungan kriteria PEDIS secara keseluruhan yang dapat memengaruhi outcome belum diketahui. Atas dasar itu perlu dilakukan penelitian untuk mengetahui gambaran KD berdasarkan penilaian PEDIS yang dilakukan tindakan débridement. Metode penelitian: Kohort retrospektif. Hasil penelitian: Didapatkan hubungan bermakna kriteria PEDIS dengan sembuh tidak diamputasi; Perfusi derajat 1 [OR=38,46; p<0,05]. Perfusi derajat 2 [OR=26,86; p<0,05]. Depth derajat 1 [OR=107,25; p<0,05]. Depth derajat 2 [OR=20,20; p<0,05]. Infeksi derajat 2 [OR=18,00; p<0,05]. Infeksi derajat 3 [OR=2,67; p<0,05]. Didapatkan juga hubungan bermakna kriteria PEDIS dengan sembuh diamputasi; Perfusi derajat 3 [OR=0,03; p<0,05]. Depth derajat 3 [OR=0,01; p<0,05]. Dari kategori sensasi [OR=0,29; p<0,05]. Rerata lama rawat subkategori infeksi derajat 1,2,3 dan 4 bermakna (p<0,05). Kesimpulan: Semakin tingginya tingkat keparahan atau derajat dari setiap subkategori kriteria PEDIS, secara statistik bermakna kecenderungan ke arah meningkatnya risiko buruknya outcome. ABSTRACT Background: Diabetic foot (DF) is one of the chronic complications of Diabetes Mellitus (DM). It often lead to disability due to the high number of amputations and even ended in mortality. WHO recommended classification of Perfusion, Extent / Size, Depth / Tissue Loss, Infection, Sensation (PEDIS) as the means of diagnosis and to help determine the treatment of DF. In some studies using PEDIS classification could predict the need for hospital care in cases of diabetic foot and predict the rate of amputations in review to Infection aspect only. However, the overall relationship PEDIS criteria that could influence the outcome is not yet known. Based on that, it is necessary to study the distribution of DF based on PEDIS assessment which undergone debridement. Method: Retrospective cohort. Results: In this study we found a significant association of PEDIS criteria toward the patients outcome recover without amputation with; Perfusion grade 1 [OR=38,46; p<0,05]. Perfusion grade 2 [OR=26,86; p<0,05]. Depth grade 1 [OR=107,25; p<0,05]. Depth grade 2 [OR=20,20; p<0,05]. Infection grade 2 [OR=18,00; p<0,05]. Infection grade 3 [OR=2,67; p<0,05]. The others found a significant associated PEDIS criteria toward the patients outcome were cured in amputation is; Perfusion grade 3 [OR=0,03; p<0,05]. Depth grade 3 [OR=0,01; p<0,05]. From sensation category [OR=0,29; p<0,05]. There are significant differences in the average length of stay of patients from infection subcategories grade 1, 2, 3 and 4 (p<0,05). Conclusions: With increasing of severity or grade of each subcategory of PEDIS criteria, there was a statistically significant trend toward increased risk for adverse outcome.;Background: Diabetic foot (DF) is one of the chronic complications of Diabetes Mellitus (DM). It often lead to disability due to the high number of amputations and even ended in mortality. WHO recommended classification of Perfusion, Extent / Size, Depth / Tissue Loss, Infection, Sensation (PEDIS) as the means of diagnosis and to help determine the treatment of DF. In some studies using PEDIS classification could predict the need for hospital care in cases of diabetic foot and predict the rate of amputations in review to Infection aspect only. However, the overall relationship PEDIS criteria that could influence the outcome is not yet known. Based on that, it is necessary to study the distribution of DF based on PEDIS assessment which undergone debridement. Method: Retrospective cohort. Results: In this study we found a significant association of PEDIS criteria toward the patients outcome recover without amputation with; Perfusion grade 1 [OR=38,46; p<0,05]. Perfusion grade 2 [OR=26,86; p<0,05]. Depth grade 1 [OR=107,25; p<0,05]. Depth grade 2 [OR=20,20; p<0,05]. Infection grade 2 [OR=18,00; p<0,05]. Infection grade 3 [OR=2,67; p<0,05]. The others found a significant associated PEDIS criteria toward the patients outcome were cured in amputation is; Perfusion grade 3 [OR=0,03; p<0,05]. Depth grade 3 [OR=0,01; p<0,05]. From sensation category [OR=0,29; p<0,05]. There are significant differences in the average length of stay of patients from infection subcategories grade 1, 2, 3 and 4 (p<0,05). Conclusions: With increasing of severity or grade of each subcategory of PEDIS criteria, there was a statistically significant trend toward increased risk for adverse outcome., Background: Diabetic foot (DF) is one of the chronic complications of Diabetes Mellitus (DM). It often lead to disability due to the high number of amputations and even ended in mortality. WHO recommended classification of Perfusion, Extent / Size, Depth / Tissue Loss, Infection, Sensation (PEDIS) as the means of diagnosis and to help determine the treatment of DF. In some studies using PEDIS classification could predict the need for hospital care in cases of diabetic foot and predict the rate of amputations in review to Infection aspect only. However, the overall relationship PEDIS criteria that could influence the outcome is not yet known. Based on that, it is necessary to study the distribution of DF based on PEDIS assessment which undergone debridement. Method: Retrospective cohort. Results: In this study we found a significant association of PEDIS criteria toward the patients outcome recover without amputation with; Perfusion grade 1 [OR=38,46; p<0,05]. Perfusion grade 2 [OR=26,86; p<0,05]. Depth grade 1 [OR=107,25; p<0,05]. Depth grade 2 [OR=20,20; p<0,05]. Infection grade 2 [OR=18,00; p<0,05]. Infection grade 3 [OR=2,67; p<0,05]. The others found a significant associated PEDIS criteria toward the patients outcome were cured in amputation is; Perfusion grade 3 [OR=0,03; p<0,05]. Depth grade 3 [OR=0,01; p<0,05]. From sensation category [OR=0,29; p<0,05]. There are significant differences in the average length of stay of patients from infection subcategories grade 1, 2, 3 and 4 (p<0,05). Conclusions: With increasing of severity or grade of each subcategory of PEDIS criteria, there was a statistically significant trend toward increased risk for adverse outcome.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Dion Ade Putra
Karakteristik kemoterapi pada keganasan kolorektal di Rumah Sakit Umum Pusat Rujukan Nasional Cipto Mangunkusumo periode Januari 2010 - Agustus 2012 = The characteristic of chemotherapy in colorectal cancer at Cipto Mangunkusumo Hospital January 2010 - August 2012
"[ABSTRAK
Latar Belakang: Kemoterapi pada kanker kolorektal (KKR) telah mengalami
perkembangan yang amat pesat dalam dua dasawarsa ini. Berikut akan
ditampilkan deskripsi data kemoterapi pada keganasan kolorektal di RSCM
periode Januari 2010-Agustus 2012. Metode: Data didapat dari registrasi rekam
medik Januari 2010-Agustus 2012 secara retrospektif, diolah dengan program
SPSS 11. 5, kemudian dievaluasi. Hasil: Menggambarkan pasien KKR didominasi
jenis kelamin laki-laki 66,7 %. Usia terbanyak pada kategori usia 60-69 tahun.
Ada perbedaan antara kejadian tumor rektum pada pria dan wanita (perbandingan
2:1). Histopatologi terbanyak adalah adenokarsinoma 94,9 %. KKR terletak
paling sering di rektum 48,7 %. Pasien KKR lebih banyak ditemukan pada
stadium III (35,9%), K-Ras terbanyak ditemukan adalah jenis wild-type. Pada 34
kasus (87,2%) KKR dengan nilai CEA di atas normal. Pemberian kemoterapi pada
kanker kolorektal tidak sesuai dengan panduan NCCN 2012 dan Panduan
Nasional Pengelolaan KKR 2004. Efek samping terbanyak adalah vomitus,
anorexia dan dispepsia, sedangkan efek samping lain tersebar merata. Sebanyak
19 pasien (48,7%) tidak menyelesaikan kemoterapi, 11 pasien (28,2%)
menyelesaikan kemoterapi dan 9 orang (23,1%) belum menyelesaikan
kemoterapi. Alasan terbanyak tidak menyelesaikan kemoterapi adalah karena efek
samping. Penggunaan capecitabine seluruhnya mengeluhkan hands and foot
syndrome, sebanyak 7 orang (70%) tingkat 3 dan 3 (30%) orang tingkat 2.
Kesimpulan: Data pasien-pasien KKR di Divisi Bedah Digestif RSCM-FKUI periode Januari 2010-Agustus 2012 menggambarkan bahwa penggunaan regimen kemoterapi belum sepenuhnya mengikuti pedoman kemoterapi pada kanker kolorektal.ABSTRACT Background: Chemotherapy in colorectal cancer (CRC) is growing rapidly todays.
We describe the characteristic data about chemotherapy for CRC in Cipto
Mangunkusumo Hospital January 2010-August 2012. Methods: Data was
collected from the medical record center retrospectively from January 2010August
2012, proceesed by SPSS 11. 5 software, then evaluated. Results: Data
described the characteristic of gender is dominated by male (66.7 %) with ratio
2:1 between male and female. Higher incidence is in category 60-69 years old.
The most histological found is adenocarcinoma type (94.9%). The most location
found is in rectum (48.7%). Patient with CRC often found in stadium III (35.9%).
The most K-Ras result found is wild-type. In 34 cases (87.2%) of CRC with
higher CEA values. Data for patients who undergone chemotherapiutic are
inappropriate with standard protocol from NCCN 2012 and Panduan Nasional
Pengelolaan KKR 2004. All patients complained vomitus, anorexia and
dyspepsia, in spite other sides effect are spread evenly. About 19 patients (48.7%)
did not finish chemotherapy, 11 patients (28.2%) finished chemotherapy, and 9
patients (23.1%) are in chemotherapiutic now. Those reasons are patient
waywardness because side effect, medical record error, inappropriate patients
directing for follow up and unavailable regiment. All patients whom use
capecitabine complained hands and foot syndrome with 7 patients (70%) grade 3
and 3 patients (30%) grade 2. Conclusions: From the data we presented, it
describe that data for patients who undergone chemotherapiutic are inappropriate with standard protocol for chemotherapy for CRC., Background: Chemotherapy in colorectal cancer (CRC) is growing rapidly todays.
We describe the characteristic data about chemotherapy for CRC in Cipto
Mangunkusumo Hospital January 2010-August 2012. Methods: Data was
collected from the medical record center retrospectively from January 2010August
2012, proceesed by SPSS 11. 5 software, then evaluated. Results: Data
described the characteristic of gender is dominated by male (66.7 %) with ratio
2:1 between male and female. Higher incidence is in category 60-69 years old.
The most histological found is adenocarcinoma type (94.9%). The most location
found is in rectum (48.7%). Patient with CRC often found in stadium III (35.9%).
The most K-Ras result found is wild-type. In 34 cases (87.2%) of CRC with
higher CEA values. Data for patients who undergone chemotherapiutic are
inappropriate with standard protocol from NCCN 2012 and Panduan Nasional
Pengelolaan KKR 2004. All patients complained vomitus, anorexia and
dyspepsia, in spite other sides effect are spread evenly. About 19 patients (48.7%)
did not finish chemotherapy, 11 patients (28.2%) finished chemotherapy, and 9
patients (23.1%) are in chemotherapiutic now. Those reasons are patient
waywardness because side effect, medical record error, inappropriate patients
directing for follow up and unavailable regiment. All patients whom use
capecitabine complained hands and foot syndrome with 7 patients (70%) grade 3
and 3 patients (30%) grade 2. Conclusions: From the data we presented, it
describe that data for patients who undergone chemotherapiutic are inappropriate with standard protocol for chemotherapy for CRC.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Liberty Tua Panahatan
Efektivitas preoperatif incentive spirometry terhadap atelktasis pneumonia dan hipoksemia pasca operasi mayor abdomen = Efficacy of incentive spiromtry in reducing atelectasis pneumonia and hypoxemia after major abdominal surgery
"[ABSTRAK
Tujuan dari penelitian ini adalah untuk menilai dampak dari preopratif incentive spirometry terhadap komplikasi paru dan uji fungsi paru di antara pasien dengan operasi abdomen mayor Pasien yang menjalani operasi mayor abdomen tanpa riwayat penyakit paru secara acak dibagi menjadi dua kelompok: kelompok latihan dan kelompok kontrol. Kelompok Latihan diberi 15 menit latihan empat kali sehari selama 2 hari sebelum operasi. Kelompok kontrol tidak menerima latihan. Pengukuran fungsi paru baseline dan pasca operasi diambil pada kedua kelompok. Fungsi paru pasca operasi diukur dari hari pertama sampai hari ketujuh. Semua pasien dinilai untuk komplikasi paru pasca operasi oleh ahli pulmonologi.
Kami merekrut 23 pasien dalam setiap kelompok. Insiden komplikasi paru adalah 56,5% pada kelompok kontrol dan tidak ada komplikasi yang ditemukan di antara pasien pada kelompok latihan. Ada penurunan yang signifikan dari komplikasi paru pada kelompok exrcise (p <0,001). Ada penurunan signifikan dari atelektasis (p <0,01), pneumonia (p 0,025), Hipokemia (p 0,005). Incentive spirometry memiliki efek perlindungan dengan resiko relative (RR) 0,11 (CI 95% 0,02-0,74). Odds Ratio (OR) untuk komplikasi pada kelompok kontrol adalah 3,3 (OR 3,30 CI 95% 1,97-5,54) pada komplikasi paru. Dalam hal fungsi paru, kami menemukan peningkatan yang signifikan pada Vital Capacity (dari 2336,96 + 722,56 mL ke 2541,30 + 718,78 mL dengan p <0,01) dan Force Vital Capacity (dari 2287,39 + 706 , 11 untuk 2469,57 + 676,10 dengan p <0,01) setelah latihan. Sebagai kesimpulan, preoperatif incentive spirometry dapat menurunkan insiden komplikasi paru.ABSTRACT The aim of this study is to assess the impact of preoperative incentive spirometry on pulmonary complication and pulmonary fuction test among patients with major abdominal surgery. Petient underwent major abdominal surgery without any history pulmonary disease were randomized into two group: the exercise group and the control group. Exercise group were given 15 minute exercise four times daily for 2 days prior to surgery. The control group receive no exercise. Baselie and post-surgery pulmonary function measurement were taken in both groups. Post surgery pulmonary function measure in first until seventh day after surgery. All patients were assessed for post operative pulmonary complication by attending
pulmonologist.
We recruited 23 patients in each group. The incidence of pulmonary complication was 56,5% in the control group and no complication were found among patient in the exercise group. There was a significant decrease of pulmonary complication in exrcise group (p <0,001). There were signigicant decrease of atelectasis (p <0,01), pneumonia (p 0,025), Hipoxemia (p 0,005). Incentive spirometry has protective effect with relative risk (RR) 0,11 (CI 95% 0,02-0,74). Odds Ratio (OR) for complication in control group was 3,3 (OR 3,30 CI 95% 1,97-5,54) on pulmonary complication. In terms of pulmonary function, we found significant increase on Vital Capacity (from 2336,96 + 722,56 mL to 2541,30 + 718,78 mL with p<0,01) and Force Vital Capacity (from 2287,39 + 706,11 to 2469,57 + 676,10 with p<0,01) after exercise.
As conclusion, preoperative incentive spirometry may decrease incidence of pulmonary complication. , The aim of this study is to assess the impact of preoperative incentive spirometry on pulmonary complication and pulmonary fuction test among patients with major abdominal surgery. Petient underwent major abdominal surgery without any history pulmonary disease were randomized into two group: the exercise group and the control group. Exercise group were given 15 minute exercise four times daily for 2 days prior to surgery. The control group receive no exercise. Baselie and post-surgery pulmonary function measurement were taken in both groups. Post surgery pulmonary function measure in first until seventh day after surgery. All patients were assessed for post operative pulmonary complication by attending
pulmonologist.
We recruited 23 patients in each group. The incidence of pulmonary complication was 56,5% in the control group and no complication were found among patient in the exercise group. There was a significant decrease of pulmonary complication in exrcise group (p <0,001). There were signigicant decrease of atelectasis (p <0,01), pneumonia (p 0,025), Hipoxemia (p 0,005). Incentive spirometry has protective effect with relative risk (RR) 0,11 (CI 95% 0,02-0,74). Odds Ratio (OR) for complication in control group was 3,3 (OR 3,30 CI 95% 1,97-5,54) on pulmonary complication. In terms of pulmonary function, we found significant increase on Vital Capacity (from 2336,96 + 722,56 mL to 2541,30 + 718,78 mL with p<0,01) and Force Vital Capacity (from 2287,39 + 706,11 to 2469,57 + 676,10 with p<0,01) after exercise.
As conclusion, preoperative incentive spirometry may decrease incidence of pulmonary complication. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Sendi Kurnia Tantinius
Faktor yang Berpengaruh Terhadap Patensi 6 dan 12 Bulan Pasca Single Baloon Angioplasty Pada Stenosis Vena Sentral Pasien Gagal Ginjal Kronik = Factors Influencing 6 and 12 Months Patency after Single Balloon Angioplasty in Central Venous Stenosis in Chronic Kidney Disease Patients
"Latar Belakang: Stenosis vena sentral adalah salah satu permasalahan utama yang dihadapi dalam penggunaan akses hemodialisis FAV. Kondisi ini dapat ditangani dengan tindakan single balloon angioplasty. Namun, tatalaksana ini memiliki angka patensi yang tidak memuaskan akibat respon pembuluh darah terhadap barotrauma. Mengetahui risiko yang mempengaruhi patensi pasca tindakan single baloon angioplasty pada penderita stenosis vena sentral penting untuk memprediksi prognosis pasien. Penelitian ini bertujuan untuk mengetahui faktor yang berpengaruh terhadap patensi 6 dan 12 bulan pasca tindakan single baloon angioplasty pada pasien stenosis vena sentral. Metode: Sebuah penelitian kohort retrospektif multicenter pada Januari 2018 – September 2022 di empat rumah sakit dilakukan untuk menilai faktor yang berpengaruh terhadap patensi 6 dan 12 bulan pasca tindakan single baloon angioplasty pada pasien stenosis vena sentral. Faktor yang diteliti mencakup derajat stenosis, panjang stenosis, jumlah stenosis, lokasi stenosis, residual stenosis, ukuran balon, dan tekanan balon. Hasil: Terdapat total 76 pasien pada penelitian ini. Pada penelitian ditemukan faktor yang berpengaruh pada patensi 6 bulan pasca single balloon angioplasty adalah jenis kelamin laki – laki (78.4% vs 46.2%; p 0.004), panjang stenosis ≥ 2 cm (85.7% vs 56.5%; p 0.042), lokasi stenosis pada vena innominata (75% vs 39.3%; p: 0.002),derajat stenosis ≥ 80% (83.3% vs 42.5%; p : 0.001), dan residual stenosis ≥ 30% (85% vs 53.6%; p 0.013). Tidak ditemukan faktor yang berpengaruh pada patensi 12 bulan pasca single balloon angioplasty. Kesimpulan: Terdapat hubungan antara panjang stenosis, lokasi stenosis, derajat stenosis, dan residual stenosis terhadap patensi single balloon angioplasty
Background: Central venous stenosis is one of the main problems encountered in AVF hemodialysis access. This condition can be treated with a single balloon angioplasty. However, this treatment has a low patency rates due to the response of the vessels to barotrauma. Knowing the risks that affect patency after single balloon angioplasty in patients with central venous stenosis is important to predict the patient's prognosis. This study aims to determine the factors influencing 6 and 12 months patency after single balloon angioplasty in central venous stenosis patient. Methods: A multicenter retrospective cohort study in January 2018 – September 2022 in four hospitals was conducted to assess factors that affect 6 and 12 months patency after single balloon angioplasty in patients with central venous stenosis. Factors studied included the degree of stenosis, length of stenosis, number of stenosis, location of stenosis, residual stenosis, balloon size, and balloon pressure. Results: There were a total of 76 patients in this study. In this study, it was found that the factors that affected the patency 6 months after single balloon angioplasty were male gender (78.4% vs 46.2%; p 0.004), stenosis length ≥ 2 cm (85.7% vs 56.5%; p 0.042),stenosis at the innominate vein (75% vs 39.3%; p: 0.002), stenosis degree ≥ 80% (83.3% vs 42.5%; p : 0.001), and residual stenosis ≥ 30% (85% vs 53.6%; p 0.013). There were no factors that had an effect on patency 12 months after single balloon angioplasty. Conclusion: There is a relationship between the length of the stenosis, the location of the stenosis, the degree of stenosis, and the residual stenosis on the patency of single balloon angioplasty"
Depok: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tesis Membership  Universitas Indonesia Library
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Mustaqim Prasetya
Profil kebutaan pasien tumor otak dan faktor terkait di layanan bedah saraf RSUPN Cipto Mangunkusumo periode september 2013 februari 2014 = The profile for blindness and other related factors in brain tumor patient treated in the neurosurgery facility Cipto Mangunkusumo hospital September 2013-February 2014
"Latar Belakang: Gangguan penglihatan adalah gejala kedua yang sering muncul pada tumor otak setelah nyeri kepala. Gejala gangguan penglihatan yang paling sering terjadi pada tumor otak adalah penurunan visus atau tajam penglihatan (low vision sampai kebutaan), sedang tanda yang paling sering dijumpai adalah atrofi n. optikus dan papilledema. Penurunan tajam penglihatan yang dialami penderita tumor otak dapat sangat berat hingga berupa kebutaan. Sampai saat ini belum terdapat data angka kejadian gangguan penglihatan sampai kebutaan pada tumor otak di Indonesia.
Metode: Sebagai studi potong lintang analitik, dikumpulkanlah data pasien penderita tumor otak di atas usia 6 tahun yang datang berobat ke poliklinik Bedah Saraf FKUIRSCM pasien September 2013 hingga Februari 2014 dari catatan rekam medis.
Hasil: Jumlah pasien tumor otak yang mengalami buta sebanyak 37 orang (34,6 %) dengan usia rata-rata 45,3 (SD 11,3 tahun). Sebesar 86,5 % penderita berada pada usia produktif 15-54 tahun. Dari 37 pasien tumor otak yang buta terlihat proporsi gejala penyerta terbesar adalah sefalgia (terutama sefalgia kronis), diikuti oleh gangguan oftalmologi lain. Data pemeriksaan funduskopi hanya ditemukan pada kurang dari 50 % penderita, dengan temuan yang terbanyak adalah papil atrofi.
Kesimpulan: Besar angka kebutaan pada pasien tumor otak menunjukkan bahwa kondisi ini tidak hanya menjadi masalah medis saja tetapi juga masalah sosial yang serius. Banyaknya jumlah pasien tanpa data funduskopi menandakan masih lemahnya standar pemeriksaan neurooftalmologi ataupun pencatatan yang ada saat ini, padahal pemeriksaan funduskopi berperan sangat penting mendeteksi dini kejadian tumor otak pada pasien dengan gangguan penglihatan.
Background: Vision impairment is the second most common symptom in brain tumor after headache, with decreased visual acuity or low vision as its most common manifestation, and optic nerve atrophy and papilledema as its most common sign. Blindness may be the final outcome of this impairment. Until now, there is no data regarding the prevalence of vision impairment in brain tumor patient in Indonesia.
Method: As a analytic cross-sectional study, data is collected from the medical record regarding brain tumor patient above the age of 6 years old who were seen in the neurosurgery facility in FKUI-RSCM from September 2013 to February 2014.
Result: As much as 37 patient (34,6%) brain tumor patient were found to be blind; mean age was 45,3 years old (SD 11,3 years old), with 86,5% patient was in the productive age 15-54 years old. The commonest related symptoms was headache (especially chronic headache), followed by other ophthalmologic symptoms. Funduscopy data was found only in less than 50% patient; the commonest finding was optic nerve atrophy.
Conclusion: Blindness rate in brain tumor patient is not just a medical issue, but also a social one. Funduscopy usage must be encouraged more to provide early detection for brain tumor patient with vision impairment."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
T58019
UI - Tesis Membership  Universitas Indonesia Library
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Affan Priyambodo Permana
Profil pencitraan resonnasi magnetik preoperasi, temuan intraoperatif dan luaran pada operasi dekompresi mikrovaskular = Profile of preoperative magnetic resonance imaging intraoperative findings, and outcomes in microvascular decompression
"Pendahuluan: Sindrom Disfungsi Hiperaktivitas Nervus Kranialis (SDHNK) merupakan gejala dan tanda yang ditimbulkan karena kontak pada pangkal saraf kranial di dekat batang otak. Neuralgia trigeminal merupakan contoh SDHNK berupa nyeri episodik unilateral pada nervus trigeminus yang menyebabkan nyeri hebat, cepat, dan sensasi tersetrum terutama jika dipicu oleh sentuhan. Diagnosis klinis masih merupakan baku standar dalam penegakkan diagnosis SDHNK. Demi meningkatkan ketepatan diagnosis, penelitian yang menilai pemeriksaan preoperasi semakin meningkat dan terutama difokuskan pada pencitraan resonansi magnetik (magnetic resonance imaging, MRI) dan pengolahan data.
Tujuan: Menelaah pemeriksaan MRI preoperasi yang mendeskripsikan kelainan pada struktur anatomi yang menjadi penyebab SDHNK.
Metode: Penelitian dengan desain potong lintang ada pasien dengan SDHNK yang menjalani dekompresi mikrovaskular di Departemen Bedah Saraf RSUPN Cipto Mangunkusumo selama periode Januari 2014 sampai Juli 2014.
Hasil: Dalam pelayanan Bedah Saraf RSUPN Cipto Mangunkusumo selama periode April 2012 sampai April 2014 telah dilakukan operasi dekompresi mikrovaskular pada 19 pasien SDHNK dengan kasus Neuralgia Trigeminal sebanyak 12 pasien dan Spasme Hemifasial 7 pasien. Usia pasien berkisar antara 49-74 tahun (rerata 56 tahun). Sebaran gender terbagi rata untuk SDHNK dengan rasio laki-laki berbanding perempuan 1:0,9. Dilakukan uji diagnostik dalam menilai adanya offending artery antara MRI preoperatif dengan temuan saat operasi. Sensitivitas didapatkan sebesar 47,4%. Keluaran pasca operasi pada kasus neuralgia trigeminal segera dirasakan pasien pasca operasi dengan tingkat keberhasilan 100%, pada kasus spasme hemifasial 58 % mengalami kesembuhan total dan sisanya 42% reduksi hingga tidak mengganggu, setelah dilakukan operasi dekompresi mikrovaskular.
Kesimpulan: Pemeriksaan MRI dengan prosedur standar untuk evaluasi SDHNK di RSCM memiliki sensitivitas 47,4%, dimana cukup tinggi sebagai pemeriksaan penyaring. Operasi dekompresi mikrovaskuler merupakan prosedur aman, memiliki tingkat keberhasilan tinggi dan rekurensi rendah.n MRI dengan prosedur standar untuk evaluasi SDHNK di RSCM memiliki sensitivitas 47 4 dimana cukup tinggi sebagai pemeriksaan penyaring Operasi dekompresi mikrovaskuler merupakan prosedur aman memiliki tingkat keberhasilan tinggi dan rekurensi rendah.
Introduction: Hyperactive Dysfunction Syndrome of the Cranial Nerve (HDSCN) is the syndrome caused by cranial nerve root contact near the brainstem. Trigeminal neuralgia is one of the HDSCN with the severe, fast, tingling sensation, and unilateral episodic pain, especially when touched. In order to increase the diagnosis acuracy, the study to evaluate preoperative evaluation is increasing, particularly focusing in magnetic resonance imaging (MRI) and data processing.
Objectives: Evaluating preoperative MRI potency in describing anatomical abnormality, which cause HDSCN.
Methods: We used cross sectional study to evaluate the preoperative MRI, intraoperative findings, and outcomes to patients who came to Neurosurgery Department, Cipto Mangunkusumo Hospital in periods January 2012 to July 2014.
Results: There was 19 patients with HDSCN (12 with trigeminal neuralgia and 7 with hemifacial spasm) who seek medical attention to Cipto Mangunkusumo Hospital from April 2012 to April 2014 and performed microvascular decompression. The mean age of them were 56 years old with male-female ratio 1 : 0.9. Diagnostic study was performed to evaluate the finding of offending artery between preoperative MRI and intraoperative findings. The sensitivity of MRI found in this study was 47.4%. Post operative outcome in trigeminal neuralgia was 100% pain free episode, and 58% free spasm episode in hemifacial spasm. The 42% of the hemifacial spasm patient got the symptoms reduced and could perform daily activity normally.
Conclusions: Standard proceudre of MRI to evaluate HDSCN in Cipto Mangunkusumo Hospital has sensitivity 47.4%. This value was quite high to be used as screening tools. Microvascular decompression was a safe procedure with high success rate and low recurrence rate."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
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UI - Tugas Akhir  Universitas Indonesia Library
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Adi Sulistyanto
Profil klinis dan luaran penderita perdarahan intrakranial terkait acquired prothrombin complex deficiency di RSCM 2009-2013 = Clinical profile and outcome of patients with intracranial hemorrhage related to acquired prothrombin complex deficiency in Ciptomangunkusumo hospital 2009-2013
"Pendahuluan: APCD yaitu Acquired Prothrombin Complex Deficiency merupakan gangguan hemostasis yang sering terjadi pada bayi baru lahir. Manifestasi paling berat adalah terjadinya perdarahan intrakranial. Tatalaksana penderita perdarahan intracranial pada APCD membutuhkan kerjasama antara disipln hematologi anak dan bedah saraf untuk mengusuhakan prognosis yang optimal.
Tujuan: Mengetahui profil klinis dan luaran terutama terkait intervensi pembedahan pada penderita perdarahan intracranial terkait Acquired Prothromin Complex Deficiency di Rumah Sakit CiptoMangunkusumo pada kurun waktu 2009 hingga 2013.
Metode: Studi potong lintang deskriptif analitik pada rekam medis pasien-pasien yang mengalami perdarahan intracranial terkait APCD di RSCM pada kurun waktu 2009-2013. Karakteristik dasar, intervensi pembedahan dan faktor luaran dievaluasi dan dianalisis.
Hasil: Terdapat 21 pasien dengan perdarahan intracranial terkait APCD di RSCM selama kurun waktu 2009-2013. Terdapat 4 pasien yang meninggal (22.2%) dan 6 pasien (33.3%) yang mengalami morbiditas neurologis saat pulang rawat. Rasio jenis kelamin laki-laki dibandingkan perempuan adalah 2 : 1. Mayoritas pasien berusia kurang dari 2 bulan (57.1%) dengan puncak kejadian pada usia 1 bulan. Semua kecuali dua pasien terindikasi operasi namun hanya 18 pasien yang dilakukan tindakan. Jenis tindakan mayoritas berupa burrhole (72.8%). Tidak terdapat hubungan yang bermakna antara karakteristik dasar maupun intervensi pembedahan dengan luaran.
Kesimpulan: Tidak terdapat perbedaan bermakna antara jenis tindakan bedah saraf dibandingkan luaran pada pasien perdarahan intracranial terkait APCD berdasarkan penelitian ini. Dibutuhkan penelitian dengan desain lebih baik dan sampel yang lebih banyak di masa mendatang.
Introduction: Acquired Prothrombin Complex Deficiency is an acquired hemostatic disorder which manifests in the newborn period. The most devastating sign is Intracranial Hemrrhage. Treatment for this disorder requires swift cooperation between pediatric hematologist and neurosurgery to ensure optimal outcome.
Objectives: To obtain the clinical profile and outcome especially related to neurosurgical intervention in patients with intracranial hemorrhage related to Acquired Prothrombin Complex Deficiency in CiptoMangunkusumo Hospital during 2009-2013.
Methods: Cross sectional descriptive analytic study using medical records of patients with intracranial hemorrhage related to APCD in RSCM during 2009-2013. Baseline characteristic, surgical intervention and outcomes are evaluated.
Results: There are 21 patients with intracranial hemorrhage related to APCD in RSCM during 2009-2013. There are 4 mortality (22.2%) and 6 patients with immediate neurologic morbidity (33.3%) during hospital discharge. Ratio of male to female are 2 :1. Majority of patients are under 2 months of age (57.1%) with peak incidence at 1 month. All but two patients are indication for neurosurgical intervention but ultimately only 18 patients are operated. Majority of surgery was burrhole (72.8%) There are no significant relationship statistically between all baseline characteristic or intervention with outcome.
Conclusions: There are no significant different in the type of neurosurgical intervention related to outcome in patients with intracranial hemorrhage related to APCD. Study with better design and larger samples is needed in the future to confirm this finding."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
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UI - Tugas Akhir  Universitas Indonesia Library
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Pengaruh Pajanan Logam Magnesium ECAP Dalam Sel Osteoblas Terhadap Ekspresi TGFβ-1 dan BMP-2 (studi in vitro) = Effects of Magnesium ECAP Exposure In Osteoblasts Cell Line Against The Expression of TGFβ - 1 and BMP – 2 (in vitro studies)
"[Trauma pada regio maksilofasial memiliki dampak secara fisik kepada pasien. Oleh karena itu dibutuhkan penatalaksanaan yang lebih baik dalam reposisi dan fiksasi pada fragmen tulang. Imobilisasi diperoleh dengan menggunakan fixation plate dan screw. Bahan plate dan screw yang dianggap berpotensi untuk digunakan adalah magnesium (Mg) dan dianggap merupakan bahan logam yang baik karena kompatibilitasnya, dapat diresorbsi oleh tubuh manusia dan menstimulasi pertumbuhan tulang. Saat ini penggunaan magnesium masih terbentur oleh kecepatan biodegradasi yang perlu dikontrol sehingga dapat sesuai dengan kecepatan penyembuhan jaringan tubuh. Salah satu caranya adalah dengan metode equal channel angular pressing (ECAP). Sel osteoblas berperan membentuk tulang baru dalam proses regenerasi, apabila terjadi fraktur pada tulang. Reaksi jaringan dilihat dengan menginvestigasi respon sel osteoblas terhadap pajanan Mg ECAP dengan melihat produksi/ekspresi faktor pertumbuhan seperti TGFβ-1 dan BMP-2. Metode: kultur sel osteoblas manusia (MG63) dalam jumlah yang cukup, dibagi dalam dua kelompok: kelompok 1 dipajankan dengan Mg murni dan kelompok 2 dipajankan dengan Mg ECAP. Pada hari ke-1, 3, 7 dan 14 setelah pemajanan dilakukan pemeriksaan ekspresi TGFβ-1 dan BMP-2 terhadap kedua kelompok. Hasil yang didapat menunjukkan perbedaan yang signifikan pada ekspresi TGFβ-1 dan BMP-2 pada kedua kelompok. Kesimpulan: Logam Mg memiliki sifat yang menguntungkan apabila bahan logam tersebut dapat digunakan sebagai bahan biomaterial pada kasus fraktur oral dan maksilofasial. Penggunaan Mg sebagai material plate dan screw cukup baik karena dapat diresorbsi oleh tubuh manusia dan menstimulasi pertumbuhan tulang.
, Maxillofacial trauma have a physical impact on the patient. Therefore, it needs a better management of the repositioning and fixation of the bone fragments. Immobilization obtained using plate and screw fixation . Materials plate and screw are considered potentially to be used is magnesium ( Mg ) and is considered a good metal because of its compatibility, can be resorbed by the human body and stimulates bone growth. Currently the use of magnesium was restricted by biodegradation speed that needs to be controlled so as to match the speed of the tissue healing. One way is by the method of equal channel angular pressing ( ECAP ). Osteoblasts form new bone plays a role in the regeneration process, if there is a fracture in the bone. Investigation on the tissue reaction is seen with the osteoblast cell response to exposure to Mg ECAP by examining the production/expression of growth factors such as TGFβ-1 and BMP-2. Methods : cell culture of human osteoblast (MG63), divided into two groups : group 1 were exposed to pure Mg and group 2 were exposed to Mg ECAP. On day 1, 3, 7 and 14 after exposure, we examined the expression of TGFβ-1 and BMP-2 at the two groups. The results showed significant differences in the expression of TGFβ-1 and BMP-2 in both groups. Conclusion : Mg has favorable properties when the metal material was used as a biomaterial in oral and maxillofacial fractures. The use of Mg ECAP as a plate and screw material is quite good because it can be resorbed by the human body and stimulates bone growth.]"
Fakultas Kedokteran Gigi Universitas Indonesia, 2014
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UI - Tugas Akhir  Universitas Indonesia Library
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Fakhrul Hendra
Hubungan Antara Resusitasi Formula Parkland Dan Gagal Paru - Ginjal Pada Pasien Luka Bakar Mayor = The Association Between Parkland Formula Resuscitation And Pulmonary - Renal Failure In Adult Major Burn
"Latar belakang : resusitasi setelah luka bakar , khususnya 24 jam pertama setelah luka bakar masih menjadi masalah bagi seluruh tenaga kesehatan yang bergerak dibidang luka bakar. Pemberian cairan yang adekuat sangat penting untuk mencegah kejadian shok luka bakar dan komplikasi lainnya pada cedera luka bakar. Formula parkland merupakan suatu formula yang diterima sebagai acuan untuk melakukan resusitasi pada pasien luka bakar. Untuk mempertahankan resusitasi yang efektif, Baxter (Formula Parkland) memonitor urin output (UOP). Dalam penelitian ini, dilakukan evaluasi terhadap hubungan antara urin output dan gagal paru - ginjal.
Metode: suatu penelitian retrospective cross sectional yang mengevaluasi hubungan antara urin output dan fungsi paru ? ginjal pada cedera luka bakar. Gagal paru dan ginjal diklasifikasikan menurut SOFA score pada hari ke - 2 dan ke ? 3 setelah dilakukan resusitasi cairan pada 24 jam pertama. Hubungan antara urin output dan gagal paru ? ginjal dianalisa menggunakan Somers?d Test.
Hasil : Hubungan anatara urin output sebagai variabel bebas dan SOFA Score sebagai variabel terikat didapatkan koefisien korelasi (r) -0.640. hal ini mengindikasikan bahwa terdapat hubungan yang kuat. korelasi bernilai negatif (menurut hasil uji Somers'd) menunjukkan terdapat hubungan yang bertolak belakang, artinya semakin besar nilai klasifikasi urine output maka semakin kecil nilai SOFA Score fungsi ginjal.
Kesimpulan : Parameter yang baik diperlukan untuk mencegah terjadinya gagal ginjal akut. Urin output sebagai parameter fisiologis penting untuk memonitor efikasi resusitasi. Urin output perjam digunakan sebagai pedoman terbaik untuk memonitor resusitasi dan perfusi organ. Namun urin output yang digunakan untuk menilai perfusi yang adekuat masih memiliki sejumlah kekurangan, sehingga memerlukan metode lain yang lebih baik untuk sebagai monitor.
Background : Resuscitation after burn, specifically in the first 24 h after injury, has been and remains a taxing assignment for all burn care providers. Adequate fluid administration is critical to the prevention of burn shock and other complications of thermal injury. Parkland formulas are accepted as guidelines for the resuscitation of burned patients. To maintain effective resuscitation, Baxter (Parkland Formula) monitored the urine output (UOP). In the context of this study, we set out to evaluate association of urine output from Parkland Formula resuscitation on pulmonary - renal failure.
Methods: A retrospective cross sectional study evaluating the association between urine output and pulmonary - renal function following thermal injury. Pulmonary and renal failure will be classified acording to SOFA score at day-2 and day-3 after fluid resuscitation in the first 24 hour. association between urine output and pulmonary - renal failure will be analyzed by Somers?d Test.
Result : Correlation between urine output as independent variables and SOFA Score as the dependent variable have correlation coefficient ( r ) -0.640 which indicates that the correlation is strong . Negative correlation (according to Somers?d test) indicates that there is a contradiction. The greater the urine output the lower the value of SOFA Score of renal function.
Conclusion : good parameter is needed to avoid acute renal failure. Urine output as physiologic parameters is important for monitoring the efficacy of resuscitation. Urine output per hour continues to be used as the best guide to monitor adequate resuscitation and end organ perfusion, regardless of the amount of fluid given. In addition, there are numerous failure of urine output to assess adequate global perfusion. The limitations of these traditional guides to resuscitation have led to interest in more advanced methods of endpoint monitoring."
Fakultas Kedokteran Universitas Indonesia, 2014
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UI - Tugas Akhir  Universitas Indonesia Library
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