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"Tulisan ini membahas dan melaporkan ruptura uteri saat kehamilan dan persalinan pada kasus pasca miomektomi perlaparoskopi. Laporan kasus kejadian ruptur uterus pada pasien yang sebelumnya mengalami laparoskopi operatif miomektomi miom intramural Æ 3.5 cm, yang 6 bulan kemudian mengalami kehamilan. Tidak ada gejala ke arah ruptura uteri saat kehamilan namun pada saat usia gestasi 34 minggu, pasien mengalami gejala ruptura uteri. Pada saat laparotomi; ditemukan fetus 2100 gram mati, dan robekan jaringan 5 cm pada sikatriks bekas miomektomi. Pada pasien yang mengalami miomektomi per laparoskopi khususnya miom intramural mempunyai risiko ruptura uteri pada saat persalinan. (Med J Indones 2004; 14: 113-6)

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Following laparoscopic myomectomy, uterine rupture during pregnancy or delivery in the area of the scar is a very rare but dangerous complication. Individual cases of uterine rupture during pregnancy are described in the literature. Case report of uterine rupture during delivery in a patient who had previously undergone laparoscopic myomectomy. In the case presented here, the patient conceived 6 months after an 3.5 cm intramural myoma, had been laparoscopically removed. No symptoms suggesting uterine rupture were observed during the pregnancy, but in the first stage of delivery the condition of the patient deteriorated and symptoms of oligaemic shock developed. A laparotomy was performed, which showed the presence of 2100 gr fresh dead fetus in the abdominal cavity and ruptured uterine muscle in the scarred area about 5 cm. In patients who have previously undergone a laparoscopic myomectomy, there is some risk of uterine rupture at delivery. This is also the case where unappropriate suturing of the uterine muscle had been required. (Med J Indones 2004; 14: 113-6)"

"ABSTRAKNama : Chika Gabriela NainggolanProgram Studi : IlmuKeperawatanJudul : Asuhan Keperawatan Pada Pasien dengan Obstruksi Mekanis Strangulata Pasca Laparatomi Hartman procedure di Ruang Rawat Intermediate Ward Lantai 4 Gedung A RSUPN Cipto Mangunkusumo Jakarta Obstruksi mekanik strangulata, merupakan obstruksi yang terjadi akibat adanya hambatan pada dua titik atau area. Tujuan penulisan karya ilmiah ini adalah untuk menggambarkan asuhan keperawatan pada pasien obstruksi mekanik strangulata e.c volvulus sigmoid, hernia strangulata, adhesi, pasca laparatomi hartman procedure adheliolisis. Pasienperempuan berusia 40 tahunmengeluh nyeri kolik abdomen, tidak bisa BAB selama 7 hari, dan perut membesar sebelum masuk rumah sakit. Faktor resiko terjadinya obstruksi adalah riwayat konstipasi kronik sejak kecil, riwayat pembedahan hernia tahun 2007, dan kebiasaan mengkonsumsi makanan rendah serat. Pasien dilakukan tindakan pembedahanhartman procedure karena ditemukan redondan usus atau volvulus pada daerah sigmoid sepanjang 70 cm. Asuhan keperawatan mulai diberikan pada hari ketiga paska pembedahan sampai dengan tiga hari perawatan, dan ditemukan masalah keperawatan yaitu nyeri akut, nutrisi kurang dari kebutuhan tubuh, gangguan citra tubuh, resiko infeksi, kurang pengetahuan, dan kesiapan untuk meningkatkan pengetahuan. Metode penulisan yang digunakan adalah studi kasus. Kesimpulan yang diperoleh, adalah terjadi peningkatan pengetahuan pasien terkait manajemen perawatan paska pembedahan laparatomi hartman prosedur, dan keluarga mampu untuk mempratekkan perawatan kolostomi. Rekomendasi bagi perawat adalah perlunya edukasi kesehatan tentang pencegahan volvulus berulang akibat konstipasi dengan mengkonsumsi makanan berserat dan minum air yang cukup, dan edukasi perawatan kolostomi pada pasien yang pertama kali terpasang kolostomi. Kata kunci : edukasi kesehatan, konstipasi kronik, laparatomi hartman procedure, obstruksi mekanis strangulata, volvulus sigmoid.

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ABSTRACTName Chika Gabriela NainggolanStudy Program Nursing ScienceTitle The Nursing Care of Patient with Mechanical Obstruction strangulata Patient who had Undergone Laparatomi Hartman procedure In the Intermediate Ward Floor Fourth Care Room Building A RSUPN Cipto Mangunkusumo Jakarta Mechanical obstruction strangulata,was one of the health problems that often occur in urban areas. The purpose of this case report was discribed patients with diagnosed strangulatory mechanical obstruction e.c sigmoid volvulus, strangulata hernia, adhesion, post laparatomyhartman procedure adheliolysis. In this case report, a 40 year old female patient admitted to the hospital with abdominal pain, was unable to defecate for 7 days, and the abdomen was enlarged.The risk factors for obstruction in this case were a history of chronic constipation since childhood, a history of 2007 hernia surgery, and the habit of consuming low fiber foods. Patients performed hartman procedure procedure because redondan found intestine or volvulus in the sigmoid area along 70 cm. Treatment started post surgery the third day and found nursing problems that were acute pain, less nutrition than body needs, body image disturbances, infection risk, lack of knowledge, and readiness to improve knowledge. The method of writing this scientific paper was by case study. Conclusions obtained during 3 days of treatment, was an increase in knowledge related to post surgical management laparatomilaparatomihartman procedures, and families were able to care colostomy. Recommendations for nurses were the need for health education on prevention of recurrent volvulus from constipation by increasing fluid intake and fiber consumption, and colostomy care to the first patient whose have colostomy Keywords chronic constipation, health education, lapartomihartman procedure, mechanical obstruction strangulata, sigmoid volvulus "

"Hipertiroidisme merupakan salah satu masalah kesehatan yang sering terjadi di area perkotaan. Salah satu jenis pengobatan hipertiroidisme adalah dengan tindakan pembedahan yang berpotensi menimbulkan gejala ketidaknyamanan leher. Tujuan penulisan ini adalah untuk menjelaskan konsep dasar keperawatan kesehatan masyarakat perkotaan khususnya penyakit hipertiroid, menerapkan asuhan keperawatan dari pengkajian sampai evaluasi pada pasien dengan hipertiroid pasca tiroidektomi, dan menganalisis evidence-based practice yang sudah dilakukan. Hasil penerapan evidence-based practice berupa latihan peregangan leher pada pasien pasca tiroidektomi terbukti efektif dalam mengurangi gejala ketidaknyamanan leher pasca pembedahan. Rekomendasi penulisan ini ialah agar perawat perlu mengajarkan latihan peregangan leher pada pasien pasca tiroidektomi untuk mengurangi gejala ketidaknyamanan leher.

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Hyperthyroidism is one of the health problems that often occur in urban areas. One of the treatments of hyperthyroidism is a surgery that potentially cause symptoms of neck discomfort. This paper aimed to explain the basic concepts of public health nursing in particular urban with hyperthyroid, to implement nursing care from assessment to evaluation in patients who had undergone thyroid surgery, and analyze evidence-based practice that has been done. The results of evidence-based practice application of neck stretching exercises in patients who had undergone thyroid surgery had effectively reduced postoperative neck symptoms discomfort after thyroid surgery. Recommendation of this paper is that nurses need to teach stretching exercises in patients with post thyroidectomy to reduce neck discomfort symptoms"

"ABSTRAK Severe gingival enlargement (GE) is one of the most commonly observed adverse effects in patients who have undergone renal transplants due to the use of cyclosporine A. Objectives: We aimed to gain more insight into the prevalence of GE in patients with renal transplants. Methods: We searched the PubMed and Web of Science databases for relevant studies from January 1990 to January 2018. Using random effects models, we calculated summary incidence rates and 95% confidence intervals (CIs). Results: A total of 595 patients from 10 studies were included. Patients using cyclosporine A with or without any other drugs had a 62.6% (95% CI, 41.9% until 79.5%) incidence of GE. Subgroup analysis according to diagnostic criteria showed that the incidence of GE was lower when using well defined diagnostic criteria or scoring system. The incidence of GE was 88.2% (95% CI, 80.9% until 93.0%) in patients using cyclosporine A with nifedipine. Cyclosporine A without nifedipine was associated with a significantly decreased risk of GE incidence when compared with the combination of cyclosporine A and nifedipine (odds ratio:0.198, 95% CI, 0.083 until 0.473, P < 0.001). Conclusions: It is important for all clinicians to know the effects of the aforementioned drugs and the treatment options. "

"Seorang ibu primigravida berumur 20 tahun hamil 38 minggu dengan komplikasi tumor uterus intraligamenter kiri yang besar dan padat. Operasi dimulai dengan seksio sesarea untuk melahirkan bayi. Diberikan uterotonika intramural dan kontraksi uterus baik; diberikan infus oksitosin intra dan postoperatif selama 24 jam. Teknik jahitan ?double circle? dilakukan pada bagian lateral mioma sebelum miomektomi. Tidak diberikan transfusi darah. Histopatologinya adalah leiomioma. Pasien tersebut pulang dalam keadaan sehat 4 hari setelah operasi. (Med J Indones 2004; 13: 66-8)

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A 20-year-old primigravida with 38th weeks of gestation complicated with a left large solid intraligamentous uterine tumor. The operation started with lower segment cesarean section to delivere the fetus. Intramural uterotonica was given and the uterus contracted well; intra- and up to 24 hours post-operatively oxytocin infusion was administered. Double circle stitching technique was performed on lateral side of the mioma before starting myomectomy. No blood transfusion was given. The histopatological report was leiomyoma. She was discharged in healthy condition 4 days post-operatively. (Med J Indones 2004; 13: 66-8)"

"Dalam kurun waktu Juni 2003 sampai dengan Juni 2004, pasien-pasien yang menderita adenomiosis berdasarkan ultrasonografi transvaginal dan memiliki keluhan menorhagia, dismenore, mcmpun nyeri pelvis diikulsertakan dalam penelitian. Randomisasi dilakukan untuk mengalokasikan subjek ke dalam kelompok reseksi dan kelompok miolisis. Semua pasien dan kedua kelompok mendapal GnRH analog 3 siklus pasca-laparnskopi operatif. Penilaian dilakukan dalam jangka waktu 6 bulan, baik secara subjektif melalui kuesioner maupun secara objektif melalui evaluasi volume adenomiosis per ultrasonografi transvaginal di akhir semester. Terdapat 20 pasien yang menjalani pembedahan, 10 dalam kelompok reseksi dan JO dalam kelompok miolisis. Komplikasi bermakna tidak ditemukan pada kedua kelompok. Evaluasi subyektif dapat dilakukun pada semua pasien sedangkan evaluasi objektif hanya dapal dilakukan pada 17pasien. Tidak didapatkan perbedaan bermakna antar-kelompok dalam penentuan skor keluhan menorhagia (p = 0.399) dan dismenorea (p=0.213). Tidak ditemukan perbedaan bermakna dalam median penambahan volume adenomiosis (p = 0.630) antara kelompok reseksi (medicui= +15,35% (-100 - 159)) dengan kelompok miolisis (median=+48,43% (-100 - 553)). Lima pasien hamil, 3 dari kelompok reseksi, 2 dari kelompok miolisis, dengan satu kasus ruptur uteri pada usia kehamilan 8 bulan pada kelompok miolisis. Efektifitas reseksi adenomiosis per laparoskopi tidak berbeda bermakna dengan miolisis adenomiosis per laparoskopi dalam penataksanaan adenomiosis bergejala. Miolisis tidak disarankan bagi wanitayang masih ingin hamil. (Med J Indones 2006; 15:9-17).

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Effective therapy preserving reproductive function in adenomyosis is warranted. From June 2003 to June 2004, patients diagnosed as having adenomyosis by transvuginal ultrasound and had symptoms of menorrhagta, dysmenorrhea, and pelvic pain were randomly allocated to either receive laparoscopic resection or myolysis. GnRH analog was given for 3 cycles after surgery. Within 6 months, symptoms were evaluated using questionnaires and at the end of follow up, adenomyosis volume was assessed by transvaginal ultrasound. There were 20 patients included, 10 patients had resection and the rest underwent myolysis. Both procedures did not yield significant complications. Subjective evaluation by questionnaires was done in all patients. Three patients could not be evaluated objectively by transvaginal ultrasound, 2 patients resigned and I was pregnant. There was no significant difference in menorrhagia and dysmenorrhea reduction score between the 2 groups (p=0.399 and 0.213, respectively). In both groups, dysmenorrhea was reduced significantly after treatment. No significant statistical difference was found in median adenomyosis volume increment (p=0.630) between the resection (median= + !5.35% (-100-159)) and myolysis groups (median=+48.43% (-100-553)). Five patients were pregnant, 3 from the resection group and 2 from the myolysis group. Uterine rupture was found in I patient (from the myolysis group) at the age of 8 months of pregnancy. The effectiveness of laparoscopic adenomyosis resection was not significantly different compared with la-parascopic myolysis as an alternative conservative surgery in treating symptomatic adenomyosis. Myolysis was not recommended for women who wish to be pregnant. (MedJ Indones 2006; 15:9-17)"

"Ketuban pecah dini umum terjadi pada kehamilan preterm. Ketuban pecah dini preterm ditandai dengan pecahnya selaput ketuban sebelum usia kehamilan 37 minggu, tidak ada kontraksi, dan terasa nyeri. Ketuban pecah dini preterm merupakan penyebab umum morbiditas dan mortalitas pada ibu maupun janin. Ibu hamil bekerja yang terpapar dengan lingkungan perkotaan menjadi faktor risiko terjadinya ketuban pecah dini. Karya ilmiah akhir ners ini membahas analisa masalah keperawatan dengan konsep terkait keperawatan kesehatan masyarakat perkotaan. Implementasi keperawatan mengacu pada diagnosa keperawatan yang muncul pada saat pemeriksaan antenatal dan postnatal. Pada evaluasi keperawatan, disimpulkan bahwa edukasi kesehatan merupakan intervensi utama yang dapat meningkatkan aspek kognitif dan psikomotor klien.

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Premature rupture of membranes is common in preterm pregnancy. Preterm premature rupture of membranes characterized by rupture of the membranes before 37 weeks' gestation, no contractions, and pain. Preterm premature rupture of membranes is a common cause of morbidity and mortality in mother and fetus. Pregnant women who are exposed to working with the urban environment be risk factors for premature rupture of membranes. This final scientific paper will explain about analysis nursing problems associated with the concept of urban public health nursing. Implementation of nursing refers to nursing diagnoses that appear during antenatal and postnatal. In nursing evaluation, concluded that health education is a major intervention that can improve cognitive and psychomotor aspects of the client."

"PURPOSE: To clarify the risk factors for complications after diverting ileostomy closure in patients who have undergone rectal cancer surgery.METHODS: The study group comprised 240 patients who underwent a diverting ileostomy at the time of lower anterior resection or internal anal sphincter resection, in our department, between 2004 and 2015. Univariate and multivariate analyses of 18 variables were performed to establish which of these are risk factors for postoperative complications.RESULTS: The most common complications were intestinal obstruction and wound infection. Univariate analysis showed that an age of 72 years or older (p = 0.0028), an interval between surgery and closure of 6 months or longer (p = 0.0049), and an operation time of 145 min or longer (p = 0.0293) were significant risk factors for postoperative complications. Multivariate analysis showed that age (odds ratio, 3.4236; p = 0.0025), the interval between surgery and closure (odds ratio, 3.4780; p = 0.0039), and operation time (odds 2.5179; p = 0.0260) were independent risk factors.CONCLUSIONS: Age, interval between surgery and closure, and operation time were independent risk factors for postoperative complications after diverting ileostomy closure. Thus, temporary ileostomy closure should be performed within 6 months after surgery for rectal cancer."