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"Endoskopi saluran cerna merupakan prosedur pemeriksaan saluran cerna secara langsung. Prosedur ini dapat digunakan untuk tujuan diagnostik maupun terapeutik. Pasien yang menjalani prosedur endoskopi dapat mengalami kecemasan yang diakibatkan karena kurangnya informasi mengenai prosedur, efek samping prosedur maupun hasil pemeriksaan yang akan diterima. Penelitian ini bertujuan mengidentifikasi tingkat kecemasan pasien yang akan menjalani prosedur endoskopi saluran cerna di Rumah Sakit Pusat Angkatan Darat Gatot Soebroto Ditkesad Jakarta. Penelitian ini menggunakan metode deskriptif, dengan jumlah sampel sebesar 38 orang. Instrumen yang digunakan adalah Spielberg State-Trait Axiety Inventory (STAI) yang telah dimodifikasi. Hasil penelitian ini menemukan bahwa sebanyak 73,7% pasien yang akan menjalani prosedur endoskopi mengalami kecemasan tingkat ringan dan jumlah responden yang paling banyak mengalami kecemasan tingkat ringan, sedang, dan berat ditemukan pada responden yang berusia dewasa madya. Diharapkan perawat dapat memberikan intervensi untuk mengatasi atau mengurangi tingkat kecemasan yang dialami oleh pasien yang akan menjalani prosedur endoskopi.

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Gastrointestinal endoscopy is a procedure that used to examine that gastrointestinal tract. This procedure can be used for diagnostic and therapeutic purpose. The patient who undergo this procedure can feel anxious due to the lack of information about the procedure, the side effects of the procedure, and the result of the examination. Some studies found that gastrointestinal endoscopy arise anxiety to the patient.

This research aim to identify the anxiety level of the patient who will undergo the endoscopy procedure at Gatot Soebroto Army Center Hospital Jakarta. This research used descriptive method, with 38 respondents as sample. The instrument used in this research was Spielberg State-Trait Axiety Inventory (STAI) that have been modified.

The results showed that 73,7 percent of the respondents who will undergo the endoscopy procedure had low level of anxiety and the largest amount of respondents which has had low, moderate, and severe level of anxiety was found in the middle adult respondents. Nurses are expected to give interventions to overcome or minimize patient’s anxiety before undergoing endoscopy."

"Latar belakang. Kombinasi spray lidokain dan anestetika intravena saat ini merupakan pilihan utama pada prosedur endoskopi saluran cerna, namun spray lidokain mempunyai kekurangan berupa iritasi lokal, mual, muntah dan rasa pahit. Gel lidokain merupakan alternatif pilihan anestetik lokal. Gel lidokain memiliki keuntungan karena dapat mengurangi gesekan mukosa dengan endoskop saat insersi serta memungkinkan pemberian lidokain yang tebal dan lengket sehingga menghasilkan anestesia lokal yang lebih baik pada rongga mulut dan orofaring dibandingkan spray lidokain. Pada penelitian ini kami ingin mengetahui perbandingan keefektifan gel lidokain dengan spray lidokain dalam mengurangi jumlah penggunaan propofol. Metode. Penelitian ini merupakan uji klinis acak tersamar ganda terhadap pasien endoskopi saluran cerna atas dengan sedasi di Rumah Sakit Cipto Mangunkusumo pada bulan Juli-September 2015. Sebanyak 52 subyek diambil dengan metode consecutive sampling dan dibagi ke dalam 2 kelompok (kelompok gel lidokain 2% dan spray lidokain 10%). Pasien secara acak diberikan gel lidokain 2% atau spray lidokain 10% sebagai anestetik lokal. Total dosis propofol, angka kejadian gag refleks, hipotensi, bradikardia, dan desaturasi dicatat pada masing-masing kelompok. Analisis data dilakukan dengan uji t-test tidak berpasangan. Hasil. Rerata dosis propofol berbeda bermakna diantara 2 kelompok, dimana rerata dosis propofol pada grup gel lidokain 2% adalah 186,92±43,52 mg, sedangkan rerata dosis propofol pada grup spray lidokain 10% adalah 218,85±61,01 mg (p=0.035, IK 95%=31,92). Simpulan. Gel lidokain 2% lebih efektif dibandingkan spray lidokain 10% dalam mengurangi dosis propofol pada pasien endoskopi saluran cerna atas.

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Background. A combination of lidocaine spray and intravenous anesthetics is currently the common choice in gastrointestinal endoscopy procedures, but lidocaine spray has some side efects like local irritation, nausea, vomiting and bitter taste. Lidocaine jelly is an alternative choice of local anesthetic. Lidocain jelly reduce friction of endoscope and enables to apply thick and sticky lidocaine resulting in better local anesthesia in the oral cavity and oropharynx compared to lidocaine spray. In this study, we want to compare the effectiveness between lidocaine jelly and lidocaine spray to reduce the propofol dose.

Methods. This study was a randomized double-blind control trial on upper gastrointestinal endoscopy patiens with sedation in Cipto Mangunkusumo Hospital in July to September 2015. A total of 52 subjects were taken with consecutive sampling method and divided into 2 groups (2 % lidocaine jelly group and 10% lidocaine spray group). Patients were randomly given 2% lidocaine jelly or 10% lidocaine spray as a local anesthetic. Total propofol dose, the incidence of gag reflex, hypotension, bradycardia and desaturation recorded in each group. Data analysis was performed by unpaired t-test.

Results. Mean propofol dose significantly different between 2 groups. The Mean propofol dose 2% lidocaine jelly was 186.92 ±43.52 mg, while the mean propofol dose in10% lidocaine spray group was 218.85 ± 61.01 mg (p = 0.035, CI 95% = 31.92).

Conclusion. 2% Lidocaine gel was more effective than 10% lidocaine spray in reducing the propofol dose in patients with upper gastrointestinal endoscopy."

"Latar belakang: Laparotomi merupakan teknik operasi untuk membuka akses kavitas peritoneum dengan membentuk sayatan terbuka di area abdomen. Cedera mukosa akibat trauma pembedahan mengganggu homeostasis epitel, merusak ekosistem mikrobiom, meningkatkan produksi sitokin proinflamasi dan berkaitan dengan kejadian komplikasi pascaoperatif. Probiotik Lactobacillus acidophillus memperkuat sawar usus, mempertahankan ekosistem mikrobiom dan berpotensi memodulasi respon imun. Namun, belum terdapat penelitian mengenai dampak pemberian Lactobacillus acidophilus terhadap kadar c-reactive protein (CRP) pascalaparotomi gastrointestinal sebagai penanda inflamasiTujuan: Penelitian ini bertujuan untuk mengetahui dampak pemberian Lactobacillus acidophilus terhadap kadar CRP pascalaparotomi gastrointestinalMetode: Penelitian ini merupakan uji klinis acak tersamar ganda. Sebanyak 56 subjek yang akan menjalani operasi laparotomi gastrointestinal dimasukkan ke dalam penelitian. Subjek penelitian diberikan kapsul probiotik Lactobacillus acidophilus 109 (kelompok probiotik) atau diberikan kapsul laktosa (kelompok plasebo) selama 3 hari sebelum operasi. Kadar CRP diukur 3 hari sebelum prosedur dan 3 hari sesudah prosedur.Hasil: Lima puluh enam subjek dengan 28 subjek pada tiap kelompok, mengikuti penelitian hingga selesai. Pada hari ketiga pascaoperatif, probiotik secara efektif menurunkan peningkatan respon inflamasi dengan nilai akhir CRP pada kelompok probiotik lebih rendah dibandingkan kelompok plasebo (median probiotik 89,65 mg/L vs. plasebo 204 mg/L, p < 0,001). Perubahan peningkatan nilai CRP lebih rendah pada kelompok probiotik dibandingkan kelompok plasebo (median probiotik 84,8 mg/L vs. plasebo 187,6 mg/L, p < 0,001). Terdapat efek samping yang signifikan (mual, diare, muntah dan rasa kembung di perut) pada kelompok probiotik selama penelitian (p = 0,04).Simpulan: Pemberian probiotik preoperatif menurunkan secara signifikan peningkatan CRP pada pasien pascalaparotomi gastrointestinal

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Background: Laparotomy is a surgical technique to open access to the peritoneal cavity by forming an open incision in the abdominal area. Mucosal injury due to surgical trauma can disrupt epithelial homeostasis, impair the microbiome ecosystem, increase the production of proinflammatory cytokines and relating to the incidence of postoperative complications. Lactobacillus acidophillus probiotic administration improve the intestinal barrier function, maintains the microbiome ecosystem and potentially modulate immune responses. However, there has been no research on the impact of Lactobacillus acidophilus administration on C-Reactive Protein (CRP) levels after gastrointestinal laparotomy as a marker of inflammation.

Objective: This study aimed to determine the impact of Lactobacillus acidophilus on CRP levels after gastrointestinal laparotomy

Methods: This study is a randomized controlled trial. Fifty six subjects scheduled gastrointestinal laparotomy surgery were enrolled. Subjects received Lactobacillus acidophilus 109 probiotic capsules (probiotic group) or lactose capsules (placebo group) for 3 days before surgery. CRP levels were measured 3 days before the procedure and 3 days after the procedure.

Results: Fifty-six subjects with 28 subjects in each group completed the study. On the third postoperative day, probiotics effectively suppressed the elevating inflammatory response with the final CRP value in the probiotic group lower than the placebo group (median probiotic 89.65 mg/L vs. placebo 204 mg/L, p < 0.001). Elevated CRP values ​​were lower in the probiotic group than in the placebo group (median probiotic 84.8 mg/L vs. placebo 187.6 mg/L, p < 0.001). There was a significant side effects (nausea, diarrhea, vomiting, and bloating) in the probiotic group during study (p = 0.04).

Conclusions: Preoperative probiotic administration significantly reduced elevated CRP in patients After Undergoing Gastrointestinal Laporotomy."

"ABSTRACTPurpose: Gastrointestinal complications after lung transplantation (LTx) are an important postoperative morbidity associated with malnutrition and the malabsorption of drugs. We reviewed our experience of managing gastrointestinal complications after LTx.Methods: Between June, 2008 and April, 2017, 160 lung transplants were performed at our institution, as living-donor lobar lung transplants in 77 patients, and as deceased-donor lung transplants in 83. We reviewed, retrospectively, the incidence, type and management of gastrointestinal complications.Results: Among the 160 LTx recipients, 58 (36.3%) suffered a collective 70 gastrointestinal complications, the most frequent being gastroparesis, followed by gastroesophageal reflux disease. Two complications were managed surgically, by Nissen fundoplication for gastroesophageal reflux disease in one recipient and Hartmann's operation for sigmoid colon perforation in one. The other 68 complications were managed medically. Two patients died of complications: one, of aspiration pneumonia caused by gastroparesis; and one, of panperitonitis caused by a gastric ulcer. There were no significant differences in overall survival or chronic lung allograft dysfunction-free survival between the patients with and those without gastrointestinal complications.Conclusions: Gastrointestinal complications are not uncommon in LTx recipients and may be serious; therefore, early detection and appropriate treatment are imperative. Surgical management is required for some complications, but most can be managed medically."

"ABSTRAK Latar Belakang: Tingkat kesesuaian pemeriksaan biopsi perkolonoskopi merupakan salah satu ukuran kualitas dari suatu tindakan kolonoskopi sehingga perlu diidentifikasi.Tujuan: Mengetahui tingkat kesesuaian tindakan biopsi perkolonoskopi dibandingkan dengan pemeriksaan histopatologi secara pembedahan.Metode: Studi potong lintang ini menggunakan rekam medik pasien tumor kolon yang telah melakukan pemeriksaan histopatologi secara biopsi perkolonoskopi dan dikonfirmasi dengan pemeriksaan histopatologi secara pembedahan di PESC RSPUN dr. Cipto Mangunkusumo dalam periode 1 Januari 2006-31 Desember 2015. Tingkat kesesuaian dicari dengan menggunakan uji komparatif kesesuaian kategorik, sehingga didapatkan nilai kappa.Hasil: Terdapat 48 subjek pada penelitian ini. Diagnosis utama tindakan biopsi perkolonoskopi pada kasus tumor kolon adalah massa rektosigmoid sebanyak 12 pasien 25 , hasil histopatologi terbanyak pada biopsi secara pembedahan adalah adenokarsinoma kolon bediferensiasi baik sebanyak 28 pasien 58,3 , topografi terbanyak pada kasus tumor kolon adalah C.18.9 pada kolon dengan lokasi yang tidak spesifik sebanyak 21 pasien 43,7 dan morfologi adenokarsinoma sebanyak 46 pasien 95,8 . Pada penelitian ini kasus suspek ganas kami masukkan kedalam kelompok histopatologi jinak. Dari 48 kasus, 37 77,1 kasus ganas menjadi ganas, 10 20,8 kasus jinak menjadi ganas, dan 1 2,1 kasus jinak tetap menjadi jinak. Pada penelitian ini didapatkan perhitungan kesesuaian nyata sebesar 79 , kesesuaian karena peluang sebesar 77 , kesesuaian bukan karena peluang sebesar 2 , potensi kesesuaian bukan karena peluang sebesar 23 , tingkat kesesuaian murni nilai kappa sebesar 0,134.Simpulan: Tingkat kesesuaian pemeriksaan histopatologi secara biopsi perkolonoskopi dibandingkan dengan pemeriksaan histopatologi secara pembedahan di PESC RSCM tahun 2006-2015 adalah kurang baik. Nilai kappa dipengaruhi oleh prevalensi, pada kasus jarang seperti pada penelitian ini nilai kappa yang rendah tidak selalu mencerminkan rendahnya kesesuaian secara keseluruhan.

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ABSTRACTBackground Level of agreement comparison between biopsy per colonoscopy examination is used to measure of the quality of a colonoscopy examination and needed to be identifiedAim To identify level of agreement comparison between histopathologic examination of biopsy per colonoscopy and histopathologic examination per surgicalMethods A cross sectional study using medical records from patients with colon tumor who had undergone histopathologic examination with biopsy per colonoscopy and then confirmed by surgical procedure in PESC RSPUN dr. Cipto Mangunkusumo between 1st January, 2006 31st December, 2015. Level of agreement calculated using comparative agreement category test in order to obtain the value of kappa.Result There are 48 subjects in this study. The first diagnosis from per colonoscopy biopsy examination was rectosigmoid mass as much as 12 25 patients. The top histopathologic result from biopsy per surgery was adenocarcinoma with good differentiated as much as 28 patients 58,3 , top topography result in the case of colon tumors was C.18.9 the colon with no specific location as much as 21 patients 43.7 , and top morphology was adenocarcinoma as much as 46 patients 95,8 . We were put in histopathologic suspected malignancy cases in benign cases. From 48 cases, 37 77,1 malignancy cases become malignancy, 10 20,8 benign cases become malignancy, and 1 2,1 benign cases become benign. Level of real agreement was 79 , level of agreement by chance was 77 , level of agreement not by chance was 23 , kappa value was 0,134. Conclusion The level of agreement comparison between histopathologic examination of biopsy per colonoscopy compared with histopathologic examination per surgical at PESC RSCM between 2006 2015 period was not good, kappa value was influenced by the prevalence, in rare cases such as in this study lower kappa value do not always reflect low overall level of agreement "

"It has been proposed that minor oral surgery can be performed safely in patients taking antithrombotic therapy without interrupting treatment; however, there is little evidence-based guidance about how to manage postoperative hemorrhage in patients taking antithrombotics, and few randomized trials that help to inform the risk–benefit ratio of continuing or suspending antithrombotic therapy. The aim of this study was to identify risk factors for postoperative hemorrhage to create a protocol for patients undergoing minor oral surgery with antithrombotic therapy. One hundred and two patients were enrolled, who subsequently underwent 142 minor oral surgical procedures while taking antithrombotic therapy. Demographic details including age and sex, laboratory coagulation investigations, and episodes of postoperative hemorrhage were recorded. The prothrombin time-international normalized ratio (PT-INR) of participants taking warfarin was <3.0 in all cases (mean 1.89 ± standard deviation 0.52; range 1.11–2.82). The activated partial thromboplastin time (APTT) was significantly associated with postoperative hemorrhage, which was significantly increased in patients taking warfarin alone or in combination with an antiplatelet agent compared with an antiplatelet agent alone. In 7 cases, postoperative hemorrhage continued for 4 days and more, requiring additional local hemostatic management. Our findings suggest that minor oral surgery can be performed under antithrombotic therapy without the need of discontinuing the antithrombotic agents. Local hemostatic materials did not suppress postoperative hemorrhage. APTT is a possible prediction factor for postoperative hemorrhage in such patients and, therefore, should be determined prior to minor oral surgery in addition to PT-INR value."