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"Kami melaporkan hasil 31 pankreatikoduodenektomi dari 141 tumor periampula pada peroide 1994-2002. Di antara kasus, terdapat 16 perempuan; rentang usia 17-68 tahun. Ikterus adalah keluhan tersering, 14 penderita dengan kadar albumin di bawah 3,5 g/dl dan 10 penderita dengan kadar bilirubin lebih dari 10 mg/dl. Telah dilakukan 17 Whipple klasik, 11 pankreatiokoduodenektomi dengan preservasi pilorus dan 3 total pankreatektomi+duodenektomi. Rerata lama operasi 436 menit (290-570). Penderita dikelompokkan dalam 2 periode, antara 1994-1999 dan sesudahnya. Dengan meningkatnya pengalaman, perdarahan intra operatif menurun dari rerata 2000 ml ke 400 ml. Gambaran histopatologi menunjukkan 11 adeno karsinoma kaput pankreas, 11 adeno karsinoma ampula Vater, 4 adeno karsinoma duodenum, 2 kista jinak kaput pankreas dan 3 tumor jinak. Mortalitas operatif terjadi pada 4 penderita dari 12 penderita periode pertama, dan hanya 1 pada 19 penderita sisanya. Komplikasi tersering adalah kebocoran anastomosis ke pankreas yang terjadi pada 14 penderita, dan 4 dari kebocoran tersebut menyebabkan mortalitas operatif. Rentang rawat antara 12 - 47 hari pasca bedah. Sampai akhir laporan ini, 7 penderita hidup tanpa penyakit, dan 4 penderita putus kontak. Rekurensi terjadi pada 13 penderita dari 22 penderita yang terjadi antara 4-24 bulan sesudah operasi, dan 12 penderita meninggal 2-3 minggu kemudian. Tiga penderita meninggal karena sebab yang lain. Kesimpulan: pankreatikoduodenektomi adalah tehnik yang efektif, dan mortalitas operatif dapat diturunkan, khususnya morbidas kebocoran pankreas yang dapat ditangani. (Med J Indones 2004; 13: 166-70).

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We reported our experience on 31 pancreaticoduodenectomy out of 141 periampullary tumors during 1994 until 2002; 16 of them were female, and age average 17-68 years. Jaundice was the most common presenting sign; 14 patients showed plasma albumin lower than 3.5 g/dl, and 10 patients had bilirubin level more than 10 mg/dl. We performed classical Whipple technique in 17, pyloric preserving pancreaticoduodenectomy in 11, and total pancreaticoduodenectomy in 3 patients. The mean of operative time was 436 minutes (290-570 minutes). The patients were grouped into 2 periods, between 1994-1999 and thereafter. With experience, the amount of blood loss has decreased from 2000 ml to 400 ml. Histopathologic results showed adenocarcinoma of the pancreas head in 11, adenocarcinoma of the ampulla of Vater in 11, carcinoma of duodenum in 4, head of pancreas benign cyst in 2, and benign tumor in 3 patients. The surgical mortality was 4 in the first 12 patients, in contrast to only 1 in the last 19 patients. The most serious complication was pancreatic leakage in 14 patients, in 4 of them it was responsible as the cause of death. The length of stay after operation varied between 12 and 47 days. Until the end of this report 7 patients are still alive, and 4 patients lost of contact. Recurrence was detected in 13 out of 22 survivors, occurring between 4 to 24 months after operation and 12 patients died 2-3 months later. Three patients died due to other causes. We conclude that pancreoticoduodenectomy is an effective technique, and the operative mortality is decreasing. Furthermore, morbidity especially from pancreatic leakages can be treated in our hospital. (Med J Indones 2004; 13: 166-70)."

"ABSTRAKLatar belakang: Nilai normal Kecepatan Hantar Saraf KHS pada saraf perifer, dipengaruhi oleh faktor-faktor fisiologis, antara lain usia, tinggi badan dan indeks massa tubuh, dan faktor non fisiologis seperti teknik pengukuran dan suhu. Referensi nilai normal tiap laboratorium elektrofisiologi berbeda-beda, sehingga dibutuhkan penelitian untuk memperoleh referensi nilai normal KHS yang sesuai dengan populasi di Indonesia, khususnya di RSUPN dr. Cipto Mangukusumo Jakarta..Metode:Penelitian ini merupakan penelitian prospektif. Responden sehat didapatkan sesuai kriteria inklusi dan eksklusi diambil secara concecutive, usia 18-60 tahun sebanyak 210 subyek. Dilakukan penapisan neuropati perifer dengan wawancara dan kuesioner Brief Peripheral Neuropathy Screening Tool BPNS Tool . Subyek yang memenuhi persyaratan dilakukan pemeriksaan Kecepatan Hantar Saraf KHS motorik dan sensorik pada ekstremitas atas dan bawah, meliputi n.medianus, n.ulnaris, n.radialis, n.peroneus, dan n.suralis. Hasil:Didapatkan sebanyak 210 dari 215 subyek yang memenuhi kriteria inklusi. Subyek penelitian terdiri dari 91 sampel ekstremitas laki-laki dan 119 sampel perempuan. Subjek diambil pada usia dewasa rentang 18-60 tahun, dengan nilai tengah 33 tahun. Subyek terbanyak usia 31-40 tahun, sebanyak 68 sampel 32,4 , jenis kelamin wanita sebanyak 119 sampel 56,7 . Usia subyek dengan nilai tengah 33 22,0-53,4 tahun, dengan tinggi badan subyek 1,6 1,49;1,74 m, dan nilai tengah indeks massa tubuh IMT 24.84 18,5- 31,3 kg/m2.Nilai kecepatan hantar saraf KHS digunakan nilai tengah, dengan batas bawah persentil lima dan batas atas persentil sembilan puluh lima. Nilai KHS motorik pada n.medianus 60 50;73,2 m/det, n.ulnaris 66,6 53;80 m/det, pada n.radialis 67 48,1; 81,8 m/det. n.peroneus 55 39,6;69,8 m/det, n.tibialis 59,5 46,5;75 m/det. Hasil pemeriksaan sensorik, didapatkan KHS sensorik pada n.medianus 66,3 49,6;83 m/det, n.ulnaris 52 41,5;70 m/det, n.radialis 46,7 38,4: 59 m/det. n.peroneus superfisialis 62 44;82 m/det, pada n.suralis 62 48;79 m/det. Kesimpulan:Nilai normal kecepatan hantar saraf motorik pada n.medianus ge;50 m/det, n.ulnaris ge;53 m/det, n.radialis ge;48 m/det, n.peroneus ge;40 m/det, n.tibialis ge;46 m/det. Nilai normal kecepatan hantar saraf KHS pada saraf sensorik pada n.medianus ge; 50 m/det, n.ulnaris ge; 41 m/det, n.radialis ge;38 m/det, n.peroneus superfisialis ge;44 m//det, n.suralis ge;48 m/det.

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ABSTRACT<>br>Background The normal value of nerve conduction velocity NCV in peripheral nerves, is influenced by physiological factors, including age, height and body mass index, and non physiological factors such as measurement and temperature techniques. Reference to the normal values of each electrophysiological laboratory is different, so research is needed to obtain references to normal NCV values that are appropriate to the population in Indonesia, especially in dr. Cipto Mangunkusumo Hospital Jakarta. Method This research is a prospective study. Healthy respondents were obtained according to the inclusion and exclusion criteria were taken concecutive, aged 18 60 years as many as 210 subjects.Peripheral neuropathy screening was performed by interview and questionnaire of the Brief Peripheral Neuropathy Screening Tool BPNS Tool . Subjects meeting the requirements were examined for motor and sensory velocity NCV at the upper and lower extremities, including n.medianus, n.ulnaris, n.radialis, n.peroneus, and n.suralis. Result There were 210 out of 215 subjects who met the inclusion criteria. The subjects consisted of 91 samples of male limbs and 119 female samples. Subjects were takenat an adult age range of 18 60 years, with a median of 33 years. Most subjects aged 3140 years, as many as 68 samples 32.4 , gender of women as much as 119 samples 56.7 . Age of subjects with a mean of 33 22.0 53.4 years, with a subjectheight of 1.6 1.49, 1.74 m, and a median body mass index IMT of 24.84 18.5 31.3 kg m2.The value of nerve conduction velocity NCV is used in the middle value, with thelower limit of the fiveth percentile and the upper limit of the ninety five percentile.The value of motor KHS at n.medianus 60 50 73,2 m s, n.ulnaris 66.6 53 80 m s, on n.radialis 67 48,1,81,8 m det. n.peroneus 55 39,6,69,8 m s, n.tibialis 59,5 46,5,75 m s. The results of sensory examination, obtained sensory KHS atn.medianus 66.3 49.6 83 m s, n.ulnaris 52 41,5 70 m s, n.radialis 46,7 38.4 59 m s. n.peroneus superfisialis 62 44 82 m s, on n.suralis 62 48 79 m s. Conclusion The normal value of motor neural conduction velocity in n.medianus ge 50 m s, n.ulnaris ge 53 m s, n.radialis ge 48 m s, n.peroneus ge 40 m s, n.tibialis 46 m s. In the sensory nerves is obtained nerve velocity n.medianus ge 50 .m s, n.ulnaris ge 41 m s, n.radialis ge 38 m s, n.peroneus superfisialis ge 44 m s, n.suralis ge 48 m s. "

"Penelitian ini bertujuan untuk mengetahui efikasi latihan otot-otot pernafasan yang spesifik terhadap pasien Penyakit Paru Obstruksi Kronis (PPOK). Untuk mencapai tujuan ini digunakan jenis deskriptif-analitis. Metode deskriptif untuk menghasilkan informasi yang menyangkut masing-masing variabel dependen ,dan variabel independen .Sedangkan metode analitis ,yaitu randomized clinical trial untuk mengetahui efek latihan otot pernafasan. Dilakukan alokasi random sehingga didapatkan 8 pasien PPOK yang masuk dalam latihan pernafasan, dan 8 pasien yang masuk dalam latihan pemulihan. Sedangkan 7 orang pasien PPOK lagi tidak diberikan intervensi dan tidak melalui alokasi random ,dimasukkan sebagai kontrol dalam penelitian ini. Kelompok pernafasan mendapat latihan pernafasan diafragma + Pursed Lip Breathing (PLB). Latihan pernafasan dilakukan tiap hari di rumah , dan 3 kali se minggu datang ke Instalasi Rehabilitasi Medik untuk latihan dengan supervisi. Kelompok pemulihan berlatih dengan sepeda statis. Kelompok pemulihan berlatih 3 kali se minggu di Instalasi Rehabilitasi Medik, berlatih di bawah supervisi. Intervensi diberikan selama 8 minggu. Metoda analisis dilakukan sebagai berikut : Analisis univariat untuk mengetahui frekuensi karakteristik masing-masing kelompok. Sedangkan analisis bivariat (uji-t berpasangan, uji Wilcoxon) untuk mengetahui efek akibat intervensi. Hasil dari penelitian sebagai berikut: Pada kelompok pernafasan didapati kekuatan otot ekspirasi (MEP) tampak meningkat bermakna. (p< 0,05), derajat sesak berkurang ( p>O,05), dan kemampuan berjalan meningkat dengan bermakna (p(0,05). Namun, pada kelompok pernafasan dijumpai pula peningkatan tahanan jalan udara (Raw) (p>0,05). Pada kelompok pemulihan didapati penurunan udara residu (RV] paling besar meskipun tidak bermakna (p>0,05), kesegaran jasmani (V02 maksimum) meningkat (p>0,05). Pada kelompok kontrol didapati penurunan kekuatan otot ekspirasi (MEP) mendekati bermakna (p>0,05). Kekuatan otot inspirasi (MIP) memberikan hasil tidak seperti harapan, meskipun tidak bermakna tampak MIP justru menurun pada ke dua kelompok dengan intervensi, dan meningkat pada kontrol (p>0,05). Dari hasil penelitian tersebut di atas diperoleh kesimpulan sebagai berikut: latihan pemafasan dan pemulihan, ke duanya memperbaiki kualitas hidup yang dibuktikan dengan meningkatnya kemampuan berjalan. Keberhasilan ke duanya didapat dengan pendekatan yang berbeda, latihan pemafasan dengan meningkatnya kekuatan otot ekspirasi, menyebabkan sesak berkurang, dengan demikian kualitas hidup membaik. Latihan pemulihan dengan terjadinya peningkatan kesegaran jasmani, didapati kualitas hidup yang membaik. Dengan demikian disarankan pemberian latihan otot pernafasan, bila latihan yang diberikan dimaksudkan untuk mengontrol sesak, dan latihan pemulihan bila bertujuan meningkatkan kesegaran jasmani. Selain hal tersebut di atas harus diingat bahwa pada latihan pernafasan diafragma + PLB, dijumpai peningkatan tahanan jalan udara. Sedangkan latihan pemulihan meskipun udara residu menurun paling besar, hal tersebut menyebabkan kekuatan otot inspirasi menurun.

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The purpose of this study was to examine the efficacy of targeted respiratory muscle training in patient with Chronic Obstructive Pulmonary Disease (COPD). The study was conducted using descriptive-analytical method. The descriptive method would result in information related to any dependent and independent variable. The analytical method of randomized clinical trial based the study of the effect of respiratory muscle training.

A random allocation was done resulted in 8 (eight) patients with COPD belonged the breathing exercise group, 8 (eight) patients received general exercises reconditioning. The other 7 (seven) patients with COPD belonged to a control group with no intervention and without random allocation. The respiration group underwent diaphragmatic breathing exercises + Pursed Lip Breathing (PLB). Breathing exercises were done daily at home and 3 (three) times a week, under supervision at The Instalation of Rehabilitation Medicine, Dr.Cipto Mangunkusumo Hospital. The recoditioning group received exercises with ergocycle, 3 (three) times a week which lasted for 8 (eight) weeks under supervision at The Institution. The method of analysis was done as follows : Univariat analysis was conducted to study the frequency characteristics of groups. Bivariat analysis (paired-t test, Wilcoxon test) was conducted to study the effect of intervention.

Result of the study were as follows: The respiration group showed increased expiration muscle strength (MEP) significantly (p<0,05), degree of dyspnea decreased (p>0,05) and walking ability increased significantly (p'(0,05). However, the airway resistance (Raw) increased (p>0,05). In the reconditioning group decreased of residual volume (RV) was observed insignificantly (p>0,05) physical fitness (V02 Max) increased (p>0,05). In the control group decrease of respiratory muscles strength was observed almost significantly (p>O,05). The inspiratory muscle strength did not show result as expected, but decreased insignificantly in both groups with intervention and increased in the control group (p>0,05).

The conclusion of the study were as follows: Breathing excercises and reconditioning resulted in better quality of life as shown by increase in walking ability Both successes derived of different approaches: breathing exercises group by increase of expiratory muscle strength resulted in decrease of dyspnea and increase in quality of life. On the other side, reconditioning group resulted in better physical fitness and to better quality of life. Respiratory muscle training was recommended when the excersises were intended to control dyspnea and reconditioning was done if physical fitness was intended. We have to be aware of the increase of airway resistance in the diaphragmatic breathing excersises group + PLB. In the reconditioning group inspite of most decrease of residual air, there were decrease of inspiratory muscle strength."