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"Works of salvage or ship saving is one of type of service work at technical field shipping. At sea trnasport operation in sea,ship can experience of the aground accident is above rock even sink to sea floor....."

"Timbulan sampah DKI Jakarta yang terus meningkat dan belum dapat tertangani dengan baik memaksa tiap sumber sampah untuk melakukan pengelolaan sendiri. Pengelolaan sampah di sumber bertujuan untuk mengurangi sampah yang diangkut dan dibuang ke TPA. Salah satu sumber sampah yang paling dominan dalam menyumbang sampah kota adalah pemukiman. Namun hingga saat ini masih banyak kawasan pemukiman yang belum melakukan pengelolaan sampah dengan baik. Hal ini dapat disebabkan oleh beberapa faktor, salah satunya adalah kondisi dari pemukiman tersebut. Rumah Susun Pinus Elok merupakan rumah susun yang ditujukan bagi masyarakat relokasi dengan tingkat ekonomi menengah kebawah. Dengan segala keterbatasan fasilitas dan pelayanan persampahan menyebabkan masalah sampah yang cukup serius di rumah susun ini.Penelitian ini bertujuan untuk mengetahui jumlah timbulan dan komposisi sampah sebagai dasar alternatif perencanaan sistem pengelolaan sampah yang dapat diterapkan di rumah susun ini.Dari hasil penelitian diperoleh bahwa rata-rata berat timbulan sampah di Rumah Susun Pinus Elok sebesar 0,229 kg/orang/hari dengan volume 1,829 L/orang/hari. Adapun komposisi sampah yang dihasilkan terdiri dari organik (65,03%), lain-lain (14,03%), plastik (12,56%), kertas (6,06%), kaca (1,37%), dan logam (0,95%). Potensi reduksi sampah di Rumah Susun Pinus Elok berkisar antara 60% - 62%.Rekomendasi sistem pengelolaan sampah yang diajukan dititikberatkan pada aspek teknis operasional. Aspek teknis operasional yang direncanakan meliputi pewadahan, pengumpulan, pemindahan, pengolahan dan pengangkutan. Konsep perencanaan aspek teknis operasional rumah susun didukung oleh aspek peraturan, peran serta masyarakat, pembiayaan, dan lembaga.

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Increasing of solid waste generation in DKI Jakarta encourages the waste sources to manage their own garbage. Waste management in source will reduce the amount of solid waste disposed to landfill site. One of the most dominant source of waste in the municipal solid waste is settlement area. However, there are many neighborhoods that have not done its solid waste management. This can be caused by several factors, one of them is a condition of that settlement. Pinus Elok is a flats that intended for the relocation of the middle-low economy level. With all the limitations of facilities and waste service, it causes a serious waste problem in this flats.This study aims to determine the solid waste generation and composition as a basis for planning alternative waste management system that can be applied in this flats.The result showed that the generation of solid waste in Pinus Elok Flats is 0,229 kg/person/day with a volume of 1,829 L/person/day. The composition of waste generated consists of organic (65,03%), others (14,03%), plastics (12,56%), paper (6,06%), glass (1,37%), and metals (0,95%). Potential waste reduction in Pinus Elok Flats is in a range of 60%?62%.Recommendations of solid waste management system focused on the technical aspects of the operation. Technical aspects of the operation include storage, collection, processing, and transportation. The concept of the technical aspects of operation supported by regulatory aspects, community participation, financial, and institutions."

"In the late 19th century, an intrepid, reckless group of men ruled the ocean. Known as "wreckers," they earned their living by rescuing and raising sunken ships, even in the face of monstrous waves and fierce weather. To some, they were heroes, helping to rescue both passengers and ships with courage and skill. To others they were ruthless pirates, who exploited these ship wrecks purely for their treasure. In Taking the Sea, Dennis M. Powers uncovers a fascinating, yet largely unknown, period in our history. Here he traces the journey of these legendary men through the story of Captain Thomas P. H. Whitelaw, the most important ship salvager of his day. From their early beginnings when greedy villagers would lure ships to the rocky coasts of Europe to their heyday during the era of the fast but vulnerable American clipper ships and their founding of the city of Key West, Powers offers a compelling portrait of the wrecker captains and the dangerous lives they and their men led. From the East Coast to the Pacific, we travel along with these men as they faced the savage seas to save ships and plunder untold wealth. Beautifully written and vividly told, this is a magnificent look at the untold history of the fearless and often mercenary men who made their living from the sea."

"Periosteal osteosarkoma merupakan tumor ganas tulang yang jarang didapat, dibentuk dari sarkoma tulang dengan didominasi komponen tulang rawan yang berdiferensiasi dan tumbuh pada permukaan tulang. Penelusuran kepustakaan tidak banyak menyebutkan mengenai kasus ini. Laporan kasus ini terakhir dilaporkan oleh Klinik Mayo tahun 1999. Kami laporkan satu kasus periosteal osteosarkoma pada penderita laki-laki berusia 17 tahun. Penderita menjalani tindakan pembedahan berupa prosedur ?limb salvage?, dengan pra dan pasca bedah penderita mendapat kemoterapi (neo-ajuvan dan ajuvan). Tidak ditemukan rekurensi lokal dan metastasis di paru, pada follow up sampai dengan 14 bulan pasca bedah. (Med J Indones 2003; 12: 166-70)

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Periosteal osteosarcoma is a rare type of malignant bone neoplasm, with predominantly cartilaginous component and arising on the bone surface. Reports of the case in the literature were rare. Last case was reported by Mayo Clinic in 1999. We report a case of periosteal osteosarcoma in a 17-year-old male, who was treated surgically with a limb salvage procedure, neoadjuvant and adjuvant chemotherapy were also given to the patient. There was no local recurrence and lung metastases up to 14 months after surgery. (Med J Indones 2003; 12: 166-70)"

"Pendahuluan: Osteosarkoma adalah tumor ganas tulang paling sering ditemukan di RS Cipto Mangunkusumo (RSCM). Penatalaksanaan osteosarkoma dengan limb-salvage surgery (LSS) makin berkembang disamping tindakan amputasi. Penelitian ini bertujuan untuk mengetahui perbandingan luaran hasil LSS dan amputasi pada pasien osteosarkoma di RSCM. Metode: Studi ini menggunakan desain kohort retrospektif pada pasien osteosarkoma periode tahun 1995-2014 di RSCM. Dilakukan evaluasi angka kesintasan, rekurensi lokal, metastasis, komplikasi, skor fungsional menurut Musculoskeletal Tumor Society Scoring system (MSTS) pada pasien yang dilakukan LSS dan amputasi. Metode Kaplan-Meier digunakan untuk mendeskripsikan kesintasan, sintasan bebas rekurensi lokal antara LSS dan amputasi. Hubungan karakteristik pasien dianalisis dengan uji log rank. Uji Kai kuadrat, Eksak Fischer dan Mann-Whitney U digunakan untuk menganalisis hubungan antara skor MSTS dan karakteristik pasien, angka rekurensi, metastasis serta komplikasi. Untuk melihat pengaruh katakteristik terhadap sintasan dilakukan analisis regresi Cox dan uji Wald serta analisis multivariat backward stepwise. Temuan: Penelitian dan Diskusi Kesintasan 5 tahun pasien osteosarkoma 14,6%. Kesintasan 5 tahun LSS 34,8%, kesintasan 5 tahun amputasi 15,9%. Kesintasan bebas rekurensi lokal 5 tahun untuk LSS 96,2% dan untuk amputasi 86,5%. Kesintasan dipengaruhi metastasis, tipe operasi dan ukuran tumor. Metastasis merupakan faktor paling berpengaruh berdasarkan analisis multivariat. Metastasis terbanyak ditemukan di paru. Gejala awal dan staging Enneking mempengaruhi metastasis (p=0,02 dan 0,007). Infeksi adalah komplikasi tersering. Tipe biopsi FNAB memberi komplikasi yang paling sedikit. LSS memberi skor fungsional yang lebih tinggi (83,3%) daripada amputasi (61,7%). Pasien dengan rekurensi lokal cenderung mempunyai skor fungsional buruk (p=0,023). Kesimpulan: Kesintasan paling tinggi pada pasien osteosarkoma RSCM yang dilakukan LSS. Luaran fungsional dengan skor MSTS baik (83,3%) didapatkan pada pasien yang dilakukan LSS dan bebas rekurensi lokal. Skor MSTS buruk dijumpai pada pasien amputasi dengan rekurensi lokal, komplikasi dan metastasis.

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Introduction: Osteosarcoma is the most common malignant bone tumor seen in Cipto Mangunkusumo Hospital (CMH). Treatment for osteosarcoma includes limb-salvage surgery (LSS), and it is increasingly more frequently performed compared to amputation. This study aims to analyze the outcome of LSS compared to amputation for osteosarcoma patients in CMH.

Methods: This is a retrospective cohort study to review osteosarcoma patients during 1995-2014 period in CMH. Analysis was performed on survival rate, local recurrence, metastasis, complication, and functional score according to Musculoskeletal Tumor Scoring System (MSTS) for patients underwent LSS or amputation. Kaplan-Meier method was used to determine survival rate, and disease-free survival rate between LSS and amputation. Log-rank analysis was used to determine relationship between patients characteristic. Chi-Square, Exact-Fischer, and Mann-Whitney U tests were used to analyze the correlation between MSTS score and patient characteristics, rate of recurrence, metastasis, and complication. To determine the influence of patient characteristics to survival, Cox regression analysis, Wald Test and backward stepwise multivariate analysis were performed.

Results: and discussion 5-year survival rate osteosarcoma patients was 14.6%, 5-year survival rate for LSS was 34.8% compared to 15.9% for amputation. Disease-free survival for LSS was 96,2%, while amputation was 86,5%. Survival were influenced by metastasis, type of surgical intervention, and tumor size. According to multivariate analysis, survival was most influenced by metastasis. Metastasis were found predominantly in lungs. Initial symptoms and Enneking stage were correlated to metastasis (p=0.02 and 0.007, respectively). Infection was the most common complication. FNAB gave the least complication compared to other types of biopsy. LSS gave the highest functional score (83.3%) compared to amputation (61.7%). Patients with local recurrence tend to have poor functional score (p=0.023).

Conclusion: The highest survival rate for osteosarcoma patients in CMH was found on patients who underwent LSS. Good functional outcome according to MSTS score (83.3%) were found on patients who underwent LSS and free of local recurrence. Poor MSTS score were seen on patients undergone amputation, patients who had had local recurrence, complication and metastasis"

"Pendahuluan: Pendekatan muskuloskeletal dalam bidang onkologi, dengan fokus khusus pada bedah ortopedi, telah mengalami kemajuan yang signifikan, menghasilkan strategi bedah baru dalam pengelolaan osteosarcoma. Keefektifan limb-saving surgery telah meningkat, seiring dengan peningkatan pada pencapaian hasil fungsional optimal, penutupan luka, dan hasil kosmetik, semuanya dengan mematuhi prinsip onkologi. Kami menekankan pentingnya mempertimbangkan berbagai faktor untuk menentukan pengobatan yang paling sesuai untuk osteosarkoma. Kami juga menggarisbawahi penggunaan alat penilaian seperti skala penilaian Musculoskeletal Tumor Society (MSTS) untuk evaluasi pasien dengan sarkoma ekstremitas.Metode: Penelitian ini menggunakan pendekatan analitik observasional dengan desain cross-sectional untuk menganalisis pasien terdiagnosis osteosarkoma yang menjalani prosedur megaprostesis di rumah sakit tertentu. Penelitian ini menggunakan metode pengambilan sampel total dan menetapkan kriteria inklusi dan eksklusi bagi para peserta, dengan fokus pada pasien yang menjalani Limb Salvage Surgery menggunakan teknik megaprosthesis dan mengecualikan mereka yang memiliki masalah infeksi atau informasi klinis yang tidak memadai.Hasil: Pada penelitian ini, 32 pasien osteosarkoma menjalani operasi penyelamatan anggota tubuh dengan megaprostesis. Rata-rata usia pasien adalah 22,84 tahun dengan mayoritas berjenis kelamin laki-laki (59,4%). Lokasi tersering adalah femur distal (50%) diikuti tibia proksimal (40,6%). Tingkat rekurensi, metastasis, komplikasi dan survival rate masing-masing adalah 21,9%;43,8%;6,3%; dan 78,1%. Median Skor MSTS adalah 28. Berdasarkan hasil penelitian, terdapat hubungan kuat antara LDH dengan skor MSTS, namun hubungan ini tidak signifikan secara statistik (p>0.05). Berdasarkan hasil penelitian, terdapat hubungan antara usia dengan kejadian metastasis tumor, dimana hubungan ini signifikan secara statistik (p<0.05). Perbedaan rerata pada usia terhadap survival signifikan secara statistik (p<0,05). Terdapat hubungan antara durasi gejala dengan luaran survival tumor, dimana hubungan ini signifikan secara statistik (p<0.05).Diskusi: Penelitian ini berfokus pada pemanfaatan Megaprostesis, yang masih relatif jarang dilakukan di Indonesia karena kendala biaya dan teknis. Penelitian ini mencatat karakteristik pasien, termasuk usia, jenis kelamin, lokasi tumor, ALP, dan tingkat LDH di antara pasien yang menderita osteosarkoma. Insiden yang lebih tinggi pada pria mungkin disebabkan oleh faktor hormonal, genetika, dan peningkatan risiko osteoporosis pada pria. Osteosarcoma biasanya muncul di dekat metafisis tulang panjang atau lempeng pertumbuhan, terutama di tibia proksimal dan femur distal. Peran LDH, yang mempengaruhi berbagai proses biologis seperti proliferasi sel, kelangsungan hidup, apoptosis, angiogenesis, metabolisme zat besi dan glukosa, juga dieksplorasi dalam kaitannya dengan osteosarkoma. Namun, terbatasnya ukuran sampel penelitian ini dapat menghambat kemampuan penelitian ini untuk secara akurat mewakili tren populasi yang lebih luas.Kesimpulan: Terdapat hubungan yang bermakna antara usia dan angka kejadian metastasis osteosarcoma. Selain itu, ditemukan perbedaan rerata pada usia terhadap survival signifikan secara statistik.

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Introduction: The field of musculoskeletal oncology, with a specific focus on orthopedic surgery, has witnessed notable progress, resulting in the development of novel surgical strategies for the management of osteosarcoma. The efficacy of limb-saving surgery has increased, as it now emphasizes the attainment of optimal functional outcomes, wound covering, and cosmetic results, all while adhering to oncologic principles. We emphasizes the significance of considering multiple factors in order to determine the most suitable treatment for osteosarcoma. We also underscores the utilization of assessment tools such as the Musculoskeletal Tumor Society rating scale (MSTS) for the evaluation of patients with extremity sarcoma.

Method: The study uses an observational analytical approach with a cross-sectional design to analyze patients diagnosed with osteosarcoma who underwent megaprosthesis procedure at specific hospitals. The study has employed total sampling method and defined inclusion and exclusion criteria for the participants, focusing on patients who had Limb Salvage Surgery using the megaprosthesis technique and excluding those with infection problems or insufficient clinical information.

Results: Thirty-two patients with osteosarcoma had limb-saving surgery using a megaprosthesis in this study. Patients' average age was 22.84 years, and 59.4% of them were men. The proximal tibia (40.6%) and distal femur (50%) were the most often reported locations. The rates of complications, recurrence, metastasis, and survival were, in order, 78.1%, 6.3%, 43.8%, and 21.9%. 28 is the median MSTS score. The study's findings indicate a substantial correlation between LDH and MSTS score, however this correlation is not statistically significant (p>0.05). Age and the incidence of tumor metastasis are related, according to the research findings, and this association is statistically significant (p<0.05). A statistically significant difference in survival was seen between the mean ages (p<0.05). There is a relationship between the duration of symptoms and tumor survival outcomes, where this relationship is statistically significant (p<0.05).

Dicussion: This study focused on the utilization of Megaprosthesis, which remains relatively rare in Indonesia due to cost and technical challenges. It examined patient characteristics, including age, gender, tumor location, ALP, and LDH levels among those with osteosarcoma. The higher incidence in males might be attributed to hormonal factors, genetics, and an elevated risk of osteoporosis in men. Osteosarcoma typically arises near long bone metaphysis or growth plates, notably in the proximal tibia and distal femur. The role of LDH, which influences various biological processes such as cell proliferation, survival, apoptosis, angiogenesis, iron and glucose metabolism, was also explored. However, the study's limited sample size may hinder its ability to accurately represent broader population trends.

Conclusion: Age is a key factor in the incidence of metastasis from osteosarcoma. Furthermore, a statistically significant variation in the mean age of survivors was discovered."