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A novel preoperative predictor of pancreatic fistula using computed tomography after distal pancreatectomy with staple closure
"PURPOSE: A thick pancreas has proven to be a conspicuous predictor of pancreatic fistula (PF) following distal pancreatectomy (DP) using staples. Other predictors for this serious surgical complication currently remain obscure. This study sought to identify novel predictors of PF following DP.
METHODS: One hundred and twenty-two patients were retrospectively assessed to determine the correlation between PF occurrence and the clinicopathological findings and radiologic data from preoperative computed tomography (CT). CT assessments included the thickness of the pancreas (TP) and pancreatic CT number (pancreatic index; PI), calculated by dividing the pancreatic CT by the splenic CT density.
RESULTS: Twenty-four patients (19.7%) developed a clinically relevant PF. TP was identified as an independent risk factor for PF in multivariate analyses (odds ratio 1.17; P = 0.0095). In subgroup analyses, a lower PI in a thick pancreas was a significant predictor of PF (P = 0.032). The combination of these two prediction parameters, known as the TP-to-PI ratio (TPIR), showed a significantly better prediction ability than TP alone (area under the receiver operating characteristic curve for the incidence of PF, TPIR 0.80 vs. TP 0.69; P = 0.037).
CONCLUSION: Combining the CT number with TP substantially improves the prediction ability for the incidence of PF following DP with staple use."
Tokyo: Springer, 2017
AJ-Pdf
Artikel Jurnal  Universitas Indonesia Library
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Yulia S.
Analisis praktik residensi keperawatan medikal bedah dan studi kasus pemberian asuhan keperawatan pada pasien kanker pankreas dengan pendekatan model adaptasi roy = Analysis of medical surgical nursing residency practice and case study of nursing care delivery on patient with pancreatic carcinoma using roy adaptation model approach
"Pelaksanaan praktek klinik selama masa residensi Keperawatan Medikal Bedah peminatan Digestif bertujuan untuk mampu menampilkan peran perawat spesialis sebagai pemberi asuhan keperawatan lanjut, pendidik, advokat, konselor, kolaborator, pembaharu dan peneliti secara khusus pada keahlian Digestif. Peran pemberi asuhan keperawatan lanjut dilakukan dengan menggunakan Model Adaptasi Roy pada pasien dengan kanker pankreas dan 30 kasus pasien dengan masalah digestif lainnya. Salah satu karaktristik perawat spesialis adalah memberikan intervensi keperawatan berbasis bukti Evidence-based Nursing practice , yang dilakukan melalui penggunaan Animal Naming Test ANT untuk mengidentifikasi gangguan fungsi kognitif pada pasien sirosis hepatis yang sedang dirawat. Animal Naming Test ANT yang diterapkan pada 16 pasien sirosis telah berhasil mengidentifikasi lebih banyak pasien yang mengalami gangguan kognitif dibandingkan dengan asesmen klinis yang sudah ada di ruang perawatan. Inovasi dalam pelayanan keperawatan yang dilakukan melalui program inovasi kelompok berupa penerapan kegiatan ERAS yakni memberikan minuman karnohidrat Maltodextrin, mobilisasi dini dan mengunyah permen, terbukti berhasil meningkatkan pemulihan perawatan pasien pembedahan sistem pencernaan.
The purpose of Clinical learning practice during Medical Surgical Nursing Residency Program, with specialisation in digestive, is to facilitate the student in developing capability to perform the roles of nurse specialist as advanced nursing care provider, educator, advocator, counselor, collaborator, innovator and researcher. Advance nursing care provider role is implemented by using Roy Adaptation Model on pancreatic carcinoma patiet and 30 other digestive cases. Evidence Based Nursing Practice as other character of nurse specialist practice was performed by applying animal naming test ANT to identify cognitive problem in hospitalized cirrhotic patients. It is based on the importance for nurse to recognize early cognitive dysfunction to provide better nursing care especially in latent asymptomatic hepatic encephalopathy that common happens in cirrhosis patient. ANT was tested on 16 hospitalized cirrhotic patients and succeeded in identifying more cirrhosis patient with cognitive dysfunction compared to available assessments in ward. The innovation program which was implementing ERAS activities carbohydrate loading, early mobilization and chewing gum have proven to be effective perioperative management in digestive surgery. "
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2018
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Inge Friska Widjaya
Korelasi nilai t2 pankreas dengan nilai t2 jantung pada pasien thalassemia mayor = Correlation between pancreatic t2 score with cardiac t2 score in thalassemia major patients
"Latar belakang dan tujuan : Hemosiderosis jantung dan pankreas merupakan komplikasi transfusi pada pasien thalassemia mayor. Evaluasi hemosiderosis pankreas dan jantung dilakukan dengan pemeriksaan MRI sekuens T2*. Kedua organ tersebut mempunyai kesamaan dalam penyimpanan besi dan tehnik pemeriksaan T2* pankreas lebih mudah dan cepat dibandingkan tehnik pemeriksaan jantung, sehingga diharapkan evaluasi hemosiderosis jantung dipermudah dengan menghitung nilai T2* pankreas.
Metode : Uji korelatif dengan pendekatan potong lintang pada nilai T2* pankreas dan nilai T2* jantung dihitung menggunakan perangkat lunak CMRtools™ pada 30 subjek thalassemia mayor.
Hasil : Tidak terdapat korelasi antara nilai T2* pankreas dengan nilai T2* jantung (R = 0,05, p = 0,798).
Kesimpulan : Tidak terdapat korelasi antara nilai T2* pankreas dengan nilai T2* jantung pada pasien thalassemia mayor.
Background and objective : Cardiac and pancreatic hemosiderosis are transfusion complication in major thalassemia patients. Evaluation of cardiac and pancreatic hemosiderosis assessed by MRI T2* examination. Both organs have same iron deposition, pancreatic T2* examination easier and faster than cardiac. Pancreatic T2* score can be used to evaluate cardiac hemosiderosis.
Method : A cross sectional correlation study between pancreatic and cadiac T2*score calculated with CMRtools™ software conducted in 30 major thalassemia patients.
Result : There is no correlation between pancreatic and cardiac T2* score (R = 0,05, p = 0, 79)
Conclusion : There is no correlation between pancreatic and cardiac T2* score in major thalassemia patients."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Yassir
Microlithiasis in recurrent acute pancreatitis diagnosis and management
"Recurrent acute pancreatitis is often caused by excessive alcohol intake and bile stones. Patients suffering from more than one episode of acute pancreatitis are diagnosed with recurrent acute pancreatitis. The etiology of recurrent acute pancreatitis is known in 70 to 90% of patients after evaluation incorporating history taking, physical examination, routine laboratory assessment, and transabdominal ultrasonography or CT scan. However, the etiology of 10 to 30% of patients with recurrent acute pancreatitis remains undetermined. Further more sensitive evaluation is often performed, such as ERCP, ultrasound endoscopy, or MRCP, in order to determine the cause for recurrent acute pancreatitis. These tests are usually able to diagnose microlithiasis, sphincter oddi dysfunction, or pancreatic division,3-4'5-6>7.
Medina- Perez M, Garcia Ferris G, Caballow Gomes J, Hospital de la Merced, and Ossuna Sevilla reported a rare case on a 33-year old woman with recurrent acute pancreatitis related with an anatomical abnormality in the form of a duplicate duodenal ampulla with multiple stones2 Even though several researches were able to detect microlithiasis in less than 10% of all patients with recurrent acute pancreatitis, most of them found microlithiasis in approximately two thirds of the patients.3"
2003
AMIN-XXXV-3-JuliSep2003-140
Artikel Jurnal  Universitas Indonesia Library
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Assyifa Millitania
Efek pemberian ketoprofen suppositoria terhadap pencegahan pankreatitis pasca ercp : uji klinis acak tersamar ganda = Effect of rectal ketoprofen to prevent post ercp pancreatitis pep a randomized controlled trial
"ABSTRAK
Latar Belakang : Pada studi invivo, seperti indometasin dan diklofenak,, ketoprofen menghambat aktifitas enzim fosfolipase A2 yang memainkan peran penting dalam patogenesis pankreatitis. Tujuan : Mengetahui efektifitas ketoprofen suppositoria terhadap pencegahan pankreatitis pasca ERCP Metode : Uji klinis acak tersamar ganda ini dilakukan di Pusat Endoskopi Saluran Cerna dan ruang rawat inap Rumah Sakit Pusat Nasional Dr Cipto Mangunkusumo pada bulan oktober 2016 sampai dengan Januari 2017 terhadap 74 pasien ikterus obstruktif dewasa atau dengan indikasi ERCP lainnya. Pasien yang memenuhi kriteria penerimaan diberikan ketoprofen suppositoria atau plasebo dosis tunggal sesaat sebelum tindakan ERCP dan dievaluasi tanda dan gejala pankreatitis akut serta evaluasi ulang amilase lipase 24 jam pasca tindakan untuk menentukan adanya pankreatitis pasca ERCP. Derajat pankreatitis akut dinilai berdasarkan kriteria imrie modified glasgow pada 48 jam pasca ERCP Hasil : 74 subjek yang memenuh kriteria penelitian dirandomisasi menjadi dua kelompok, masing-masing terdiri dari 37 pasien, terdapat 1 pasien dari setiap kelompok yang tidak dapat dikanulasi. Dilakukan analisis dengan prinsip intention to treat analysis, kedua kelompok sebanding dalam karakteristik demografis dan klinis termasuk faktor risiko terkait pasien dan prosedur. Insidens PPE pada kelompok ketoprofen sebanyak 13,5 5 sedangkan pada kelompok plasebo sebanyak 21,6 8 , Absolute Risk Reduction ARR = 0,081, Relative Risk RR = 0,625, Relative risk reduction RRR = 0,375, Number Needed to Treat NTT =12 95 IK=-9-25 . Terdapat laporan adverse event berupa perforasi usus pada 1 subjek. Kesimpulan: ketoprofen suppositoria menurunkan insidens pankreatitis pasca ERCP Kata Kunci : ketoprofen, insidens, pankreatitis pasca ERCP
ABSTRACT Background An invitro study showed ketoprofen as well as indomethacin and diclofenac inhibits the activity of phospholipase A2 that is supposed to play a major role in the pathogenesis of pancreatitis. Objectives To determine the effect of rectal suppository ketoprofen to prevent post ERCP pancreatitis Methods This randomized double blind controlled trial performed at Gastrointestinal Endoscopy Center and inpatient unit in Cipto Mangunkusumo National General Hospital during October 2016 to January 2017 among patients with obstructive jaundice and patients with other indications of ERCP. All subjects with inclusion criteria were treated with rectal ketoprofen or rectal placebo suppository single dose immediately before ERCP. Sign and symptoms of acute pancreatitis and serum amylase and lipase level observed in 24 hours after ERCP to determine post ERCP pancreatitis. Acute pancreatitis was graded according to the Imrie rsquo s modified Glasgow severity criteria in 48 hours after ERCP. Result In total, 74 subjects were randomized into two groups containing 37 subjects in each group. One patient in each group was failed for cannulation. We used intention to treat analysis, both groups were comparable regarding demographic and clinical factors. The incidence of PEP was 13,5 5 in ketoprofen group and 21,6 8 in placebo group, Absolute Risk Reduction ARR 0,081, Relative Risk RR 0,625, Relative risk reduction RRR 0,375, and Number Needed to Treat NTT 12 95 CI 9 ndash 25 . Reported adverse event was bowl perforation in 1 subject. Conclusion Rectal ketoprofen reduced the incidence of post ERCP pancreatitis Key Words Ketoprofen, Incidence, Post ERCP pancreatitis"
2017
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UI - Tugas Akhir  Universitas Indonesia Library
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Novel intraoperative use of the "Tensipresser" to assess factors predictive of pancreatic fistula after pancreaticoduodenectomy
"PURPOSES: Pancreatic fistula (PF) is a challenging complication of pancreaticoduodenectomy (PD). Soft pancreas is reported as a risk factor for PF; however, palpation by the surgeon is not an objective method of evaluating pancreatic texture. We conducted this study to investigate whether a texture analyzer called a Tensipresser can be used to quantify pancreatic tissue hardness and predict the development of postoperative PF.
METHODS: We assessed pancreatic texture in 85 patients who underwent PD. After surgeons assessed the texture of the pancreas subjectively, the physical properties were measured on the pancreatic margin intraoperatively, by the two-bite method using the Tensipresser. The incidence and severity of PF were based on the definitions of the International Study Group on Pancreatic Fistula.
RESULTS: Symptomatic PF (grade B and C) developed in 16% of the patients. Patients were divided into two groups based on the Tensipresser measurement: those with a soft and fragile pancreas with hardness < 2070 gw/cm2 and cohesiveness < 0.65 (SF group); and all other patients (non-SF group). In the univariate and multivariate analysis, a small pancreatic duct diameter (<4 mm), no conduction of preoperative chemoradiation therapy, and inclusion in the SF group were significant predictors of PF.
CONCLUSION: The Tensipresser can evaluate pancreatic texture objectively, helping to define intraoperatively, those at risk of the development of PF."
Tokyo: Springer, 2017
AJ-Pdf
Artikel Jurnal  Universitas Indonesia Library
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Naoki Umezaki
Number of acinar cells at the pancreatic stump predicts pancreatic fistula after pancreaticoduodenectomy
"ABSTRACT
Purpose: To establish if the number of pancreatic acinar cells at the pancreatic cut end is a predictor of postoperative pancreatic fistula (POPF).
Methods: The number of acinar cells was assessed histologically in 121 consecutive patients who underwent pancreaticoduodenectomy (PD) between April, 2012 and July, 2016.
Results: POPF developed in 23 of the 121 patients. Univariate analysis revealed that male sex, long operating time, high volume of blood loss, soft remnant pancreas, large pancreatic duct, and the number of pancreatic acinar cells were significantly associated with POPF. Multivariate analysis revealed that male sex (p = 0.022) and the number of pancreatic acinar cells (p < 0.0001) were independently associated with POPF. In the receiver operating characteristic (ROC) curve analysis, the area under curve was 0.83895 when the cut off value of the number of pancreatic acinar cells to predict POPF was 890. Sensitivity and specificity of the number of pancreatic acinar cells were 82.6 and 77.6%, respectively.
Conclusions: A large number of pancreatic acinar cells at the cut end of the stump is predictive of POPF after PD. Although POPF is associated with multiple factors and the number of acinar cells is only one of these, our study is the first to confirm this common intuition of surgeons, which has not been assessed definitively before."
Tokyo: Springer, 2018
617 SUT 48:8 (2018)
Artikel Jurnal  Universitas Indonesia Library
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RM Ardani Fitriansyah SY
Penilaian pankreas intraoperatif yang memengaruhi kejadian fistula pankreas pascaoperasi pankreatikoduodenektomi = Pancreatic's assessment intraoperatively incorrelation with pancreatic fistula after pancreaticoduodenectomy
"Pendahuluan. Fistula pankreas masih merupakan komplikasi paling sering setelah pankreatikoduodenektomi yang menyebabkan masa rawat lama dan biaya besar.  Fistula ini terjadi sampai 45%.  Kebocoran anastomosis pankreatikojejunostomi merupakan faktor yang paling penting. Belum ada data tentang faktor pankreas yang dapat memengaruhi fistula pankreas di Jakarta, khususnya RS Cipto Mangunkusumo sehingga dilakukan penelitian ini.

Metode.  Penelitian cross sectional ini dilakukan pada 70 orang penderita yang dilakukan pankreatikoduodenektomi. Data dikumpulkan dari data sekunder rekam medis tahun 2016-2019 berupa tekstur pankreas, diameter duktus pankreatikus, teknik anastomosis pankreatikojejunal, dan penggunaan stent pada pankreatikojejunal sebagai variabel bebas. Fistula pankreas sebagai variabel terikat. Data diuji dengan uji Spearman dikarenakan abnormalitas distribusi data.

Hasil.  Didapatkan 70 subjek. Tidak ada kejadian fistula pankreas sebanyak 21,4% dan ada fistula pankreas sebanyak  78,6%. Diameter duktus pankreatikus tidak melebar sebanyak 78,6% dan melebar sebanyak 21,4%. Tekstur pankreas soft sebanyak 22,9% dan hard sebanyak 77,1%. Penggunaan stent sebanyak 21,4% dan tidak ada penggunaan sebanyak 78,6%. Tipe anastomosis pankreatikojejunal dunking atau invaginasi sebanyak 82,9% dan duck to mucosa sebanyak 17,1%.  Faktor risiko yang bermakna pada analisis bivariat adalah diameter duktus pankreatikus (p=0,007). 

Kesimpulan. Penilaian diameter duktus pankreatikus intraoperatif mempunyai hubungan bermakna dalam memperkirakan kejadian fistula pankreas pascaoperasi pankreatikoduodenektomi.

 

Introduction. Pancreatic fistula is the most common complication after pancreaticoduodenectomy that cause longer hospital stay and higher cost. It happens 45%. Pancreaticojejunostomy anastomosis leakage is the most important factor. No data about pankreas’ factor that can influence pancreatic fistula in Cipto Mangunkusumo hospital so this study is held.

Method. This cross sectional study was done for 70 patients. Data was collected from medical record in 2016-2019.   The data are pancreatic texture, pancreatic duct diameter, pancreaticojejunal anastomotic technique, and use of  stent in pancreaticojejunal as the independent variables. Pancreatic fistula as the dependent variable.   We analyzed  using Spearman test due to abnormality data distribution.

 

Results. There are 70 subjects enrolled. Subjects with no pancreatic fistula about 21,4% and with pancreatic fistula 78,6%.   No dilated pancreatic duct diameter about 78,6% and dilated about 21,4%. Soft texture pancreas about 22,9% and hard 77,1%. Use of stent about 21,4% and no stent 78,6%. Pancreaticojejunal anastomotic type of dunking or invaginating about 82,9% and duck to mucosa about 17,1%.  The significant risk factor in bivariate analysis is diameter of the pancreatic duct (p=0,007). 

Conclusion. Intraoperative assessment of the pancreatic duct diameter associated significantly in predicting pancreatic fistula after pancreaticoduodenectomy.

 

"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Siahaan, Ferdinan Manuel
Computed Tomography (CT) image reconstruction using Matlab programming
"X-ray computed tomography (CT) has been playing an important role in current medical practice for diagnostic procedure. Beside its delicate technology, the 'hidden' software of CT image reconstruction has contributed almost half of total cost of a CT-scanner unit. Since Algebraic Reconstruction Technique (ART) is a basic to understand an iterative method of CT image reconstruction algortihm, and since it is difficult to find a clear description of fan beam ART algorithm in university literatures, it is important to develop an own algorithm and to begin a basic systematic research of this iterative method. After a long term of trial and error work, the research had succeded in developing an ART algorithm for third generation CT image reconstruction. By comparing the result of the research with more popular technique like Filtered Back Projection (FBP), the algorithm has been proved applicable to reconstruct a low dimension object matrix (32x32 and 64x64). By the resulted computer program, then basically a simple and low cost third generation CT-scanner can be designed for medical physics or biomedical imaging research. Finding a way of shortening the massive number of iterations process then, will be able to open the possibility of using the software for higher object matrix dimensions."
Depok: Fakultas Matematika dan Ilmu Pengetahuan Alam Universitas Indonesia, 2008
T21394
UI - Tesis Open  Universitas Indonesia Library
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Three-dimensional observation of mouse tongue muscles using micro-computed tomography
"The aim of this study is to obtain information about the mouse tongue muscle rendered using micro-computed tomography (μCT) at low, middle, and high magnifications. Three-dimensional (3D) μCT is used in various fields. Most μCT observations are restricted to hard tissue in biomaterial samples. Recently, with the use of osmium tetroxide, μCT has been effectively employed to observe soft tissue; it is now believed that μCT observation of soft tissue is feasible. On the other hand, the structure of the tongue muscle has been well studied, but cross-sectional imaging enhanced by 3D rendering is lacking. We chose the mouse tongue as a soft tissue case study for μCT and generated cross-sectional images of the tongue enhanced by 3-D image rendering with histological resolution. During this observation, we developed new methods of low-magnification observation to show the relation between the tongue muscles and surrounding tissues. We also applied high-resolution μCT in high-magnification observation of muscle fiber fascicles. Our methodological techniques give the following results: (1) For low-magnification observation (field of view: 12,000 μm), pretreatment with decalcification and freeze drying is suitable for observing the area between the muscle of the tongue and the bone around the tongue using μCT. (2) For middle-magnification observation (Field of view: 3,500 μm), the use of osmium tetroxide to observe the muscle arrangement of the tongue by μCT is suitable. (3) For high-magnification observation (Field of view: 450 μm), high-resolution μCT is suitable for observation of the transversus muscle fiber fascicles."
ODO 103:1 (2015)
Artikel Jurnal  Universitas Indonesia Library
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