Hasil Pencarian  ::  Simpan CSV :: Kembali

"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).

---

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)"

"[Ureteropelvic junction obstruction (UPJO) merupakan salah satu kelainan kongenital traktus urinarius dengan insidensi 5/100.000 per tahun. Tindakan bedah yang minimal invasif dapat memberikan waktu operasi yang lebih singkat, morbiditas minimal, penurunan kebutuhan analgesia pascaoperasi, waktu rawat yang lebih singkat, dan penyembuhan yang lebih cepat daripada operasi terbuka. Meskipun demikian, tatalaksana optimal ureteropelvic junction obstruction masih dalam perdebatan. Banyak studi yang membandingkan endopielotomi dan pieloplasti per laparoskopi. Angka kesuksesan endopielotomi dan pieloplasti dilaporkan bervariasi dalam berbagai studi.TujuanUntuk mengidentifikasi tatalaksana optimal dari ureteropelvic junction obstruction.MetodeMeta-analisis dari studi kohor yang dipublikasi sebelum Februari 2014 dilakukan dengan menggunakan data Medline. Kriteria inklusi adalah tatalaksana ureteropelvic junction obstruction dengan endopielolitotomi (antegrad dan atau retrograd) dan pieloplasti per laparoskopi (transperitoneal atau retroperitoneal). Kriteria eksklusi adalah perbaikan UPJO sekunder dan fungsi ginjal yang buruk. Kriteria sukses didefinisikan sebagai tidak adanya gejala klinis dan dikombinasikan dengan penurunan hidronefrosis secara signifikan yang ditunjukkan dengan diuretic IVU atau ultrasonografi dan tidak ada tanda obstruksi pada diuretic IVU atau renografi diuretik atau tes Whitaker. Random-effect model dengan metode DerSirmonian-Laird digunakan untuk menghitung risk ratio (RR) dan 95% interval kepercayaan (IK) gabungan. Heterogenitas dinilai dengan menggunakan statistik I2. Semua analisis dilakukan dengan menggunakan Stata statistical software, versi 12.0 (StataCorp).HasilKami menganalisa 4 studi kohor. Angka kesuksesan dari 479 pasien (233 pieloplasti per laparoskopi, 246 endopielotomi), 21 bulan pascaoperasi, adalah 92.3% (215/233) setelah pieloplasti per laparoskopi, 63.8% (157/246) setelah endopielotomi. Berdasarkan angka keberhasilan tatalaksana UPJO, pieloplasti lebih baik daripada endopielotomi (risk ratio keseluruhan adalah 1.35 (95% CI 0.97 hingga 1.88); p<0.0001 dan I2=90.6 %).KesimpulanPieloplasti per laparoskopi memiliki angka keberhasilan yang lebih tinggi daripada endopielotomi. Metaanalisis ini dapat membantu ahli urologi sebelum memulai tindakan terapi UPJO., The ureteropelvic junction obstruction (UPJO) is one of the most common congenital abnormalities of the urinary tract with a reported incidence of 5/100,000 annually. Minimal invasive surgeries have emerged giving short operative time, minimal morbidity, decreased postoperative analgesic requirements, shorter hospitalization, and early recovery and convalescence compared to open surgery. Yet, the optimal management of ureteropelvic junction obstruction is still in debate. Many studies have been conducted comparing endopyelotomy and laparoscopic pyeloplasty. The success rates of endopyelotomy and pyeloplasty are reported in various success rate in many studies.ObjectiveTo identify the optimal management of ureteropelvic junction obstruction .MethodA meta-analysis of cohort study published before February 2014 was performed using Medline databases. Management of ureteropelvic junction obstruction treatment using endopyelolitotomy (anterograde and or retrograde) and laparoscopic pyeloplasty (transperitoneal or retroperitoneal) were included. Publication using secondary UPJO repair, poor functioning kidney were excluded. Success was defined as absence of any clinical symptoms and combined with significant reduction of hydronephrosis showed with on diuretic IVU or ultrasonography result, and no sign of obstruction on diuretic IVU or diuretic renography or Whitaker test. A random-effects model with DerSirmonian-Laird method was used to calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CI). We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Stata statistical software, version 12.0 (StataCorp).Result We analized 4 cohort studies. The success rate from 479 patients (233 laparoscopic pyeloplasty, 246 endopyelotomy), 21 months postoperatively, was 92.3% (215/233) after laparoscopic pyeloplasty, 63.8% (157/246) after endopyelotomy. Based on success rate in ureteropelvic junction obstruction management, laparoscopic pyeloplasty is better than endopyelotomy (overall risk ratio was 1.35 (95% CI 0.97 to 1.88); p<0.0001 and I2=90.6 %).]"

"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)

---

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)"

"Contingency management (CM) interventions usually reinforce submission of drug-negative specimens, but they can also reinforce adherence with goal-related activities. This study compared the efficacy of the 2 approaches. Substance-abusing outpatients (N = 131) were randomly assigned to 1 of 3 12-week treatments: standard treatment (ST), ST with CM for submitting negative urine toxicology screens, or ST with CM for completing goal-related activities. CM patients remained in treatment longer and achieved more abstinence than ST patients, but the CM condition that reinforced submission of negative samples resulted in better outcomes than the CM condition that reinforced goal-related activities. Abstinence at 6- and 9-month follow-ups did not differ by group, but longest duration of abstinence achieved during treatment was associated with abstinence posttreatment."

"Tujuan: Membandingkan distribusi dosis respon akhir RE dan efek samping akut RE teknik konvensional dan teknik konformal pada kasus kanker serviks lokal lanjut Metode Dilakukan studi kohort retrospektif terhadap pasien kanker serviks II B dan III B yang mendapat RE pra brakiterapi di Dept Radioterapi RSCM. Hasil: Didapat 51 pasien menjalani RE teknik konvensional 25 dengan Cobalt 60 26 dengan Linac dan 29 pasien menjalani teknik konformal Sesuai ketentuan ICRU 50 dan 62 prescribed dose dan cakupan volume target teknik konvensional Cobalt lebih kecil p 0 001 dan 1 kasus dari 25 pasien mendapatkan PTV 95 Prescribed dose dan cakupan volume target teknik konvensional Linac lebih besar p 0 001 dibanding teknik konformal Rerata conformity index teknik konvensional sebesar 2 dan teknik konformal 1 02 p 0 001 Dosis dan volume pada buli rektosigmoid dan bowel teknik konvensional lebih besar p 0 001 Respon komplit akhir RE teknik konvensional adalah 42 dan teknik konformal adalah 58 p 0 001 Faktor independen respon akhir RE yaitu stadium FIGO dini dan ukuran tumor sebelum RE kecil le 4cm Pada semua kasus tidak didapatkan efek samping akut lokal yang berat RTOG grade 3 4 Proporsi efek samping ringan RTOG grade 1 2 pada gastrointestinal vesikourinaria dan kulit lebih banyak pada teknik konvensional secara berurutan 72 Vs 28 p 0 002 78 Vs 22 p 0 003 dan 78 Vs 22 p 0 01. Kesimpulan: RE teknik konformal lebih unggul dibanding teknik konvensional dalam distribusi prescribed dose dan cakupan volume target atau organ kritis yang berdampak pada respon tumor akhir RE dan efek samping.

---

Purpose: To compare the dose distribution acute tumor response and acute side effects between conventional and conformal techniques EBRT in locally advanced uterine cervical cancerMethods and materials Retrospective cohort study was done in stage II B and III B uterine cervical cancer underwent EBRT before brachytherapy in Dept Radioterapi RSUPN Cipto Mangunkusumo.

Results: Fifety one patients underwent conventional technique EBRT and 29 patients of conformal technique EBRT The average of target prescribed dose and volume coverage of 2 techniques EBRTwas in accordance with criteria of ICRU 50 and 62 smaller p 0 001 only 1 case of Cobalt conventional technique EBRT showed PTV 95 Conformity index of conventional technique EBRT was 2 and conformal technique EBRT was 1 02 p 0 001 Dose and volume of vesicourinary rectosigmoid and distal large bowel of conventional technique EBRT was greater p 0 001 Complete response of conventional technique was 42 and conformal technique was 58 p 0 001 Independent factors were early FIGO stage and tumor size before EBRT le 4cm There were no severe acute side effects RTOG grade 3 4 in both groups Acute side effects RTOG grade 1 2 of conventional techniques was more than conformal gastrointestinal vesikourinaria and skin respectively 72 vs 28 p 0 002 78 vs 22 p 0 003 and 78 vs 22 p 0 01.

Conclusion: Conformal technique EBRT was superior to conventional technique EBRT in prescribed dose distribution target volume coverage and organ at risk dose that impact on acute tumor response and side effects "

"Pendahuluan: Masalah fungsional dan kosmetik semakin meningkat akibat adanya defek pada area craniofacial termasuk mandibula yang membentuk bagian bawah wajah. Rekonstruksi mandibula bertujuan memberikan kemungkinan maksimal dari hasil fungsional dan estetik. Hasil yang optimal dari fungsi rekonstruksi mandibula adalah salah satu tujuan dari penggunaan teknik flap bebas fibula. Dengan bantuan dari perkembangan system proses komputer dalam desain dan pembuatan, operasi craniomaxillofacial dapat dilakukan dengan bantuan komputer melalui berbagai bentuk dan variasi tujuan. Dalam rangka menelaah kualitas dari penelitian yang telah tersedia dan memberikan informasi untuk pengambilan keputusan, kajian mengenai perbadingan operasi dengan bantuan komputer (CAS) dengan metode konvensional freehand (CFS) menjadi penting untuk dilakukan. Metode: Pencarian pustaka sistematis dilakukan pada pusat data PubMed, ProQuest, Cochrane Library, EBSCOhost, Wiley Library, Science Direct, dan Scopus, mencakup semua studi dengan data utama yang membandingkan hasil akurasi, efisiensi, komplikasi, dan fungsional diantara kelompok CAS dan CFS. Risiko bias studi dinilai menggunakan Newcastle-Ottawa Scale (NOS). Meta-analisis dilakukan melalui Review Manager. Hasil: Enam belas studi kohort memenuhi kriteria eligibilitas dari 355 studi pada pencarian awal. Studi dengan hasil yang sama (akurasi, efisiensi, komplikasi, dan fungsional) dibandingkan antara kelompok CAS dan CFS. Sebanyak 13 studi menunjukkan hasil signifikan secara statistik pada penilaian efisiensi: waktu ischemia lebih singkat (-34.84 menit, 95% CI: -40.04 to -29.63; p<0.00001; I2=94%), total waktu operasi lebih singkat (-70.04 menit, 95% CI: -84.59 to -55.49; p<0.00001; I2=77%), waktu rekonstruksi lebih singkat (-41.86 minutes, 95% CI: -67.15 to -16.56; p=0.001; I2=93%), dan lama rawat inap yang lebih singkat(-2.98 days, 95% CI: -4.35 to -1.61; p=0.0001; I2=7%) pada kelompok CAS dibanding kelompok CFS. Kesimpulan: Kajian sistematis dan meta-analysis menunjukkan hasil yang lebih baik pada kelompok CAS dibandingkan dengan CFS yang signifikan pada hasil efisiensi, Namun beberapa studi melaporkan berbagai analisis statistik dengan berbagai parameter untuk kategori hasil komplikasi, akurasi, dan fungsional. Seluruh studi sepakat bahwa CAS memberikan manfaat yang lebih dibandingkan CFS, walaupun CFS masih dapat menjadi pilihan.

---

Background: Major functional and cosmetic problems will arise from defects in craniofacial regions, including mandible which constructs the shape of lower third of the face. The aim of mandibular reconstruction is to achieve the best possible functional and aesthetic outcomes. The optimal return of mandibular bone function is one of the reconstruction goals using free fibular flap (FFF). With aid of the evolving computer processing system for design and manufacturing, craniomaxillofacial surgery can be conducted with computer-aided surgery in many forms and varied proposes. In order to evaluate the quality of available article and to provide information for decision-making, review of comparison between computer-aided surgery (CAS) and conventional freehand surgery (CFS) need to be evaluated.

Methods: A systematic search was conducted on PubMed, ProQuest, Cochrane Library, EBSCOhost, Wiley Library, Science Direct, and Scopus, including all studies with primary data that compared accuracy, efficiency, complication, and functional outcomes between CAS and CFS group. Risk of bias for included studies were assessed based on Newcastle-Ottawa Scale. Meta-analysis was performed in Review Manager.

Results: Sixteen cohort studies were included that meet the eligibility criteria from initial searches of 355 studies. Studies with the same outcome (accuracy, efficiency, complication, and functional) are compared in CAS and CFS group. Thirteen studies demonstrated statistically significant efficiency outcomes: shorter ischemia time (-34.84 minutes, 95% CI: -40.04 to -29.63; p<0.00001; I2=94%), shorter total operative time (-70.04 minutes, 95% CI: -84.59 to -55.49; p<0.00001; I2=77%), shorter reconstruction time (-41.86 minutes, 95% CI: -67.15 to -16.56; p=0.001; I2=93%), and shorter length of hospital stay (-2.98 days, 95% CI: -4.35 to -1.61; p=0.0001; I2=7%) in CAS group than CFS group.

Conclusion: Systematic review and meta-analysis demonstrated higher outcomes CAS group compared to conventional group significantly in efficiency outcomes. However, some studies performed diverse statistical analysis on several parameters for outcomes category such as complications, accuracy, and functional. All studies agreed that CAS group has higher benefits than conventional method, although the conventional method is still an option."