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Riko Satriyo Wibowo
Analisis Faktor Praoperatif Dan Intraoperatif Yang Mempengaruhi Pascaoperatif, Luaran Fungsional Dan Onkologi Pada Pembedahan Tumor Muskuloskeletal Malignant Anak Di RS Cipto Mangunkusumo Jakarta = Analysis of Preoperative and Intraoperative Factors Affecting The Postoperative, Functional and Oncologic Outcome In Pediatrics Malignant Musculosceletal Surgery At Ciptomangunkusumo Hospital, Jakarta
"Pendahuluan: Pembedahan pada anak berbeda dengan orang dewasa, khususnya pada pembedahan tumor malignant muskuloskeletal anak. Kompleksitas kondisi preoperatif, termasuk status nutrisi, kemoterapi neoadjuvant, kondisi klinis umum yang buruk serta jenis pembedahan dapat mempengaruhi kondisi pascaoperatif, dan luaran baik klinis dan onkologi. Penelitian ini bertujuan untuk mengevaluasi kondisi preoperatif, intraoperatif yang mempengaruhi pascaoperatif, luaran fungsional dan onkologi.
Metode: Penelitian ini secara retrospektif meninjau delapan puluh tiga subjek pasien tumor muskuloskeletal ganas pediatrik yang menjalani operasi baik sebagai salavage atau prosedur amputasi dari 2017-2021. Data perioperatif, hasil fungsional dan onkologis pada tindak lanjut 1 tahun dikumpulkan.     
Hasil: Dari 83 subjek penelitian, osteosarkoma adalah tumor yang paling banyak ditemukan (90,4%), Ewing sarkoma (3,6%), rhabdomyosarcoma (3,6%), Ewing sarkoma ekstraskeletal (1,2%), dan limfoma ganas (1,2%). Tingkat kelangsungan hidup 1 tahun adalah 72,3%, dan 37,3%. Usia, jenis tumor, tormbosit praoperatif, albumin, dan ASA dihubungkan dengan durasi operasi (p<0,01). Faktor-faktor yang terkait dengan jumlah kehilangan darah adalah usia, jenis operasi, dan kadar albumin (p<0,01). Usia dan kehilangan darah memiliki hubungan dengan hasil fungsional (p<0,01).
Kesimpulan: Faktor praoperatif yang mempengaruhi hasil adalah usia. Pada kelompok subjek yang memiliki komplikasi pasca operasi relatif memiliki tingkat metastasis yang lebih tinggi. Kehilangan darah intraoperatif adalah salah satu faktor prognostik untuk komplikasi pasca operasi yang dikaitkan dengan jenis tumor, usia, dan tingkat albumin. 
Introduction: Surgical procedure in children is different from adults, especially in pediatric malignant musculoskeletal surgery. The complexity of preoperative condition, including nutritonal status, neoadjuvant chemoteraphy, anemic, poor general condition and type of surgery that may affect the postoperative and outcome. This study aims to evaluate preoperative, intraoperative parameters that affect the postoperative, functional and oncologic outcome.
Methods: The study retrospectively reviewed eighty-three subjects of pediatric malignant musculoskeletal tumor patients who underwent surgery either as salavage or ablation procedures from 2017-2021. Perinoperative data, functional and oncological outcomes on a 1-year follow-up were collected.           
Results: Of  the 83 study subjects, osteosarcoma was the most common tumor (90.4%), Ewing sarcoma (3.6%), rhabdomyosarcoma (3.6%), extraskeletal Ewing sarcoma (1.2%), and malignant lymphoma (1.2%). The 1-year survival rate was 72.3%, and 37.3%. Usia, tumor type, preoperative tormbocytes, albumin, and ASA were associated with surgical duration (p<0.01). Factors associated with the amount of blood loss are age, type of surgery, and albumin levels (p<0.01). Age and  blood loss have a relationship with functional outcomes (p<0.01).
Conclusion: The preoperative factor influencing outcomes is age. In the group of subjects who had postoperative complications relatively had a higher rate of metastases. Intraoperative blood loss is one of the prognostic factors for postoperative complications associated with tumor type, age, and albumin levels. "
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Astuti Pitarini
Luaran onkologi dan fungsional tata laksana tumor tulang yang dilakukan prosedur Limb salvage surgery (Lss) dengan megaprostesis di RS Cipto Mangunkusumo Jakarta = Oncological and functional outcome of Limb salvage surgery (Lss) in bone tumor with megaprosthesis at Cipto Mangunkusumo Hospital Jakarta
"ABSTRAK
Pendahuluan Penggunaan megaprostesis sebagai pilihan dalam manajemen LSS
memberikan harapan baru bagi pasien tumor tulang di Indonesia. Namun, sampai
saat ini belum ada data hasil luaran dari tata laksana ini.
Metode Penelitian ini merupakan prospektif observational pada 34 pasien tumor
tulang di RS Cipto Mangunkusumo pada tahun 2011-2015. Diagnosis ditegakkan
melalui Clinical Pathological Conference. Evaluasi pascaoperasi dilakukan pada
bulan ke-3, 6, 9, 12, 24, 36, dan 48 dengan menggunakan skoring dari MSTS.
Luaran onkologi dievaluasi dengan adanya rekurensi dan metastasis jauh.
Komplikasi berupa infeksi, dislokasi, cedera saraf dan pembuluh darah, serta
gangguan mekanisme ekstensor juga dievaluasi.
Hasil Dua orang ahli bedah muskuloskeletal onkologi melakukan operasi LSS dan
rekonstruksi dengan megaprostesis. Dua pasien dieksklusi karena keputusan
intraoperatif untuk memakai non modular endoprostesis. Kehilangan darah
intraoperatif memiliki median (RAK) 890,0 (700,0?1200,0) ml. Skor MSTS
sebagian besar pasien menunjukkan kategori baik dan sangat baik, yaitu 67.9%
baik pada MSTS 6 bulan, 79,2% baik pada MSTS 9 bulan, 63.4% sangat baik
pada 12 bulan, 90% sangat baik pada 24 bulan dan 100% sangat baik pada MSTS
36 bulan. Terdapat hubungan bermakna antara karakteristik pasien yaitu jenis
tumor (p=0,001), usia (p=0,039), jenis kelamin (p=0,049), dan hasil laboratorium
ALP (p=0,031) dengan luaran fungsional MSTS 3 bulan. Terdapat hubungan
bermakna antara karakteristik pasien yaitu perdarahan intraoperatif (p=0,013) dan
ALP (p=0,009) dengan mortalitas; dan juga antara tumor tulang yang menjalani
rekonstruksi jaringan lunak ekstensif dengan komplikasi (p=0,019) namun antara
lokasi tumor dan komplikasi tidak terdapat hubungan bermakna.
Kesimpulan Luaran fungsional pada pasien yang dilakukan rekonstruksi
megaprostesis adalah baik dan sangat baik sehingga dapat menjadi tatalaksana
pilihan bagi pasien tumor tulang yang akan menjalani LSS. Luaran onkologi pada
pasien yang dilakukan prosedur LSS baik dengan rendahnya rekurensi lokal, metastasi, dan komplikasi. ABSTRACT
Introduction Advancement in bone tumor management has elaborated surgeon?s
choice of treatment not merely sentenced the patients into a limb ablation.
Likewise, patients with bone tumors, regardless its malignant nature and limited
survival time, had an equal privileges to opt for LSS to experience a better quality
of life. In this study, we manage to evaluate the functional and oncologic outcome
of lower extremity bone tumors following a LSS using megaprosthesis.
Methods Thirty-four patients with lower extremity bone tumors were
prospectively reviewed between 2011 and 2015 in a tertiary referral general
hospital. All patients were managed through a Clinical Pathology Conference.
Functional outcome was evaluated using MSTS score and follow up was recorded
at 3, 6, 12 months; and 2, 3, 4 years.
Results Two orthopedic musculoskeletal oncologic surgeons were performing the
surgeries. Two patients were excluded because the final instruments used were
not a modular type. The final result of functional score was good to excellent with
67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,
90% excellent at 24 months and 100% excellent at 36 months. Complications
occurred and varied. A statistical significant result was found between age
(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months
functional outcome; between intraoperative blood loss (p=0,013) and mortality,
as well as SAP with mortality (p=0,009); between tumor that underwent extensive
soft tissue reconstruction procedure and complication (p=0,019).
Conclusion Megaprosthesis reconstruction in bone tumors gives a good and
excellent result, which provides orthopaedic oncologic surgeons a rationalization
to make a selective decision-making in tumor cases regardless its survival and
tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?s
choice of treatment not merely sentenced the patients into a limb ablation.
Likewise, patients with bone tumors, regardless its malignant nature and limited
survival time, had an equal privileges to opt for LSS to experience a better quality
of life. In this study, we manage to evaluate the functional and oncologic outcome
of lower extremity bone tumors following a LSS using megaprosthesis.
Methods Thirty-four patients with lower extremity bone tumors were
prospectively reviewed between 2011 and 2015 in a tertiary referral general
hospital. All patients were managed through a Clinical Pathology Conference.
Functional outcome was evaluated using MSTS score and follow up was recorded
at 3, 6, 12 months; and 2, 3, 4 years.
Results Two orthopedic musculoskeletal oncologic surgeons were performing the
surgeries. Two patients were excluded because the final instruments used were
not a modular type. The final result of functional score was good to excellent with
67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,
90% excellent at 24 months and 100% excellent at 36 months. Complications
occurred and varied. A statistical significant result was found between age
(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months
functional outcome; between intraoperative blood loss (p=0,013) and mortality,
as well as SAP with mortality (p=0,009); between tumor that underwent extensive
soft tissue reconstruction procedure and complication (p=0,019).
Conclusion Megaprosthesis reconstruction in bone tumors gives a good and
excellent result, which provides orthopaedic oncologic surgeons a rationalization
to make a selective decision-making in tumor cases regardless its survival and
tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?s
choice of treatment not merely sentenced the patients into a limb ablation.
Likewise, patients with bone tumors, regardless its malignant nature and limited
survival time, had an equal privileges to opt for LSS to experience a better quality
of life. In this study, we manage to evaluate the functional and oncologic outcome
of lower extremity bone tumors following a LSS using megaprosthesis.
Methods Thirty-four patients with lower extremity bone tumors were
prospectively reviewed between 2011 and 2015 in a tertiary referral general
hospital. All patients were managed through a Clinical Pathology Conference.
Functional outcome was evaluated using MSTS score and follow up was recorded
at 3, 6, 12 months; and 2, 3, 4 years.
Results Two orthopedic musculoskeletal oncologic surgeons were performing the
surgeries. Two patients were excluded because the final instruments used were
not a modular type. The final result of functional score was good to excellent with
67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,
90% excellent at 24 months and 100% excellent at 36 months. Complications
occurred and varied. A statistical significant result was found between age
(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months
functional outcome; between intraoperative blood loss (p=0,013) and mortality,
as well as SAP with mortality (p=0,009); between tumor that underwent extensive
soft tissue reconstruction procedure and complication (p=0,019).
Conclusion Megaprosthesis reconstruction in bone tumors gives a good and
excellent result, which provides orthopaedic oncologic surgeons a rationalization
to make a selective decision-making in tumor cases regardless its survival and
tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?s
choice of treatment not merely sentenced the patients into a limb ablation.
Likewise, patients with bone tumors, regardless its malignant nature and limited
survival time, had an equal privileges to opt for LSS to experience a better quality
of life. In this study, we manage to evaluate the functional and oncologic outcome
of lower extremity bone tumors following a LSS using megaprosthesis.
Methods Thirty-four patients with lower extremity bone tumors were
prospectively reviewed between 2011 and 2015 in a tertiary referral general
hospital. All patients were managed through a Clinical Pathology Conference.
Functional outcome was evaluated using MSTS score and follow up was recorded
at 3, 6, 12 months; and 2, 3, 4 years.
Results Two orthopedic musculoskeletal oncologic surgeons were performing the
surgeries. Two patients were excluded because the final instruments used were
not a modular type. The final result of functional score was good to excellent with
67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,
90% excellent at 24 months and 100% excellent at 36 months. Complications
occurred and varied. A statistical significant result was found between age
(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months
functional outcome; between intraoperative blood loss (p=0,013) and mortality,
as well as SAP with mortality (p=0,009); between tumor that underwent extensive
soft tissue reconstruction procedure and complication (p=0,019).
Conclusion Megaprosthesis reconstruction in bone tumors gives a good and
excellent result, which provides orthopaedic oncologic surgeons a rationalization
to make a selective decision-making in tumor cases regardless its survival and
tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?s
choice of treatment not merely sentenced the patients into a limb ablation.
Likewise, patients with bone tumors, regardless its malignant nature and limited
survival time, had an equal privileges to opt for LSS to experience a better quality
of life. In this study, we manage to evaluate the functional and oncologic outcome
of lower extremity bone tumors following a LSS using megaprosthesis.
Methods Thirty-four patients with lower extremity bone tumors were
prospectively reviewed between 2011 and 2015 in a tertiary referral general
hospital. All patients were managed through a Clinical Pathology Conference.
Functional outcome was evaluated using MSTS score and follow up was recorded
at 3, 6, 12 months; and 2, 3, 4 years.
Results Two orthopedic musculoskeletal oncologic surgeons were performing the
surgeries. Two patients were excluded because the final instruments used were
not a modular type. The final result of functional score was good to excellent with
67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,
90% excellent at 24 months and 100% excellent at 36 months. Complications
occurred and varied. A statistical significant result was found between age
(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months
functional outcome; between intraoperative blood loss (p=0,013) and mortality,
as well as SAP with mortality (p=0,009); between tumor that underwent extensive
soft tissue reconstruction procedure and complication (p=0,019).
Conclusion Megaprosthesis reconstruction in bone tumors gives a good and
excellent result, which provides orthopaedic oncologic surgeons a rationalization
to make a selective decision-making in tumor cases regardless its survival and
tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence."
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Simbolon, Edi Leonardo
Perbandingan luaran onkologi dan fungsional tata laksana giant cell tumor tulang yang dilakukan kuretase dan wide resection periode 1995-2014 di RS Cipto Mangunkusumo Jakarta = Giant cell tumor of bone oncological and functional outcome undergoing curettage or wide resection of longterm follow up / Edi Leonardo Simbolon
"[ABSTRAK
Pendahuluan: GCT tulang merupakan lesi jinak tetapi secara lokal dapat bersifat agresif pada daerah epifisis. Angka rekurensi yang tinggi, dilaporkan mencapai 75%. Tumor dapat bermetastasis ke paru (2-9%) dan tercatat 0-37% angka mortalitas akibat metastasis. Beberapa penelitian menghasilkan variasi berbeda penanganan tumor ini terhadap luaran onkologi dan fungsional serta angka kematian paska pembedahan. Penelitian ini bertujuan melaporkan pengalaman dalam penatalaksanaan pembedahan tumor ini dan untuk melihat adanya hubungan antara tatalaksana pembedahan dengan dampak klinis.
Metode: Penelitian ini merupakan kohort retrospektif, sebanyak 99 pasien GCT tulang menjalani tindakan kuretase ataupun wide resection di Rumah Sakit Cipto Mangunkusumo pada 1995 - 2014. Luaran onkologi berdasarkan angka rekurensi lokal, metastasis tumor serta mortalitas dan luaran fungsional berdasarkan sistem penilaian Musculoskeletal Tumor Society (MSTS).
Hasil: Lokasi tumor terutama di distal femur (25,2%). Rekurensi lokal terjadi pada 4 pasien, terutama di distal femur (50%). Rekurensi lokal terjadi seimbang pada wide resection dan kuretase dan secara statistik tidak bermakna (p 0.578, uji eksak Fischer). Tidak dijumpai kejadian rekurensi lokal pada seluruh pasien yang mengalami metastasis. Metastasis terjadi pada kelompok wide resection. Kematian terjadi pada 4 pasien yang mengalami metastasis. Sebagian besar pasien (51,1%) menunjukkan luaran fungsional kategori sangat baik (skor MSTS di atas 75%). Analisis kesintasan bebas rekurensi lokal secara statistik tidak bermakna (p 0.564). Analisis multivariat (regresi Cox) hanya faktor metastasis yang berpengaruh pada mortalitas (p. 0.001)
Kesimpulan: Terdapat hubungan yang bermakna antara stadium tumor dengan metastasis dan jenis tindakan operasi. Tidak terdapat perbedaan bermakna antara kejadian rekurensi lokal dan metastasis serta luaran fungsional dengan jenis tindakan operasi.
ABSTRACT
Introduction: Giant cell tumor of bone is benign lesion with ability to be locally aggressive in epiphysis. Its recurrence rate was reported as high as 75%. Tumor can metastasize to lungs (2-9%) and up to 37% mortality rate due to metastasis. Several studies have reported different rates of local recurrence, lung metastasis, mortality rate, and functional outcome. This study aims to report our experience and analyze the correlation between surgery and clinical findings.
Methods: In this retrospective cohort, 99 patients GCT of bone undergone curettage or wide resection in Cipto Mangunkusumo Hospital during 1995-2014. Oncological outcome were analyzed according to local recurrence rate, metastasis, and mortality rate, while functional outcome were measured according to Musculoskeletal Tumor Society Score (MSTS).
Results: Tumor location were predominantly in distal femur (25.2%). Local recurrence were observed in 4 patient and mainly in distal femur (50%). Local recurrence were evenly balanced between surgical curettage and wide resection (50% each) and thus not statistically significant (Exact Fischer, p=0.578). Metastasis were observed in patients who undergone wide resection, however, no significant correlation were found between metastasis incidence and types of surgical intervention (Exact Fischer, p=0.318). Four have died related to metastasis. No local recurrence were observed in patients suffering from metastasis. In more than half of patients (51.5%), the functional status were very good (MSTS >75. Recurrence-free survival analysis not significant statistically (p 0.564).Multivariate analysis (Cox regression) showed that only metastasis was found to be significantly correlated to mortality (p. 0.001).
Conclusion: Tumor stage was correlated to metastasis, and type of surgical intervention. No significant correlation were found between local recurrence, metastasis, and functional outcome to types of surgical intervention., Introduction: Giant cell tumor of bone is benign lesion with ability to be locally aggressive in epiphysis. Its recurrence rate was reported as high as 75%. Tumor can metastasize to lungs (2-9%) and up to 37% mortality rate due to metastasis. Several studies have reported different rates of local recurrence, lung metastasis, mortality rate, and functional outcome. This study aims to report our experience and analyze the correlation between surgery and clinical findings.
Methods: In this retrospective cohort, 99 patients GCT of bone undergone curettage or wide resection in Cipto Mangunkusumo Hospital during 1995-2014. Oncological outcome were analyzed according to local recurrence rate, metastasis, and mortality rate, while functional outcome were measured according to Musculoskeletal Tumor Society Score (MSTS).
Results: Tumor location were predominantly in distal femur (25.2%). Local recurrence were observed in 4 patient and mainly in distal femur (50%). Local recurrence were evenly balanced between surgical curettage and wide resection (50% each) and thus not statistically significant (Exact Fischer, p=0.578). Metastasis were observed in patients who undergone wide resection, however, no significant correlation were found between metastasis incidence and types of surgical intervention (Exact Fischer, p=0.318). Four have died related to metastasis. No local recurrence were observed in patients suffering from metastasis. In more than half of patients (51.5%), the functional status were very good (MSTS >75. Recurrence-free survival analysis not significant statistically (p 0.564).Multivariate analysis (Cox regression) showed that only metastasis was found to be significantly correlated to mortality (p. 0.001).
Conclusion: Tumor stage was correlated to metastasis, and type of surgical intervention. No significant correlation were found between local recurrence, metastasis, and functional outcome to types of surgical intervention.]"
2015
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Muhammad Rizqi Adhi Primaputra
Analisis Luaran Klinis dan Fungsional Pasien Cedera Pleksus Brachialis Traumatik Pasca Tindakan Pembedahan Saraf dan Otot di RSUPN Cipto Mangunkusumo periode 2010-2017 = Clinical and Functional Outcome Analysis in Patients with Traumatic Brachial Plexus Injury After Nerve and Muscle Procedure in Cipto Mangunkusumo Hospital 2010-2017
"Pendahuluan: Cedera pleksus brachialis traumatik merupakan cedera pada ekstremitas atas yang menimbulkan disabilitas motorik dan sensorik yang berakhir pada penurunan kualitas hidup. Prosedur pembedahan saraf atau otot masih menjadi terapi pilihan untuk menangani cedera pleksus brachialis, akan tetapi belum menunjukkan hasil yang memuaskan. Penelitian mengenai luaran pasien dengan cedera pleksus brachialis traumatik pasca prosedur pembedahan, khususnya di Indonesia, belum pernah dilakukan. Prosedur pembedahan cedera pleksus brachialis di RSUPN dr. Cipto Mangunkusumo sudah berlangsung sejak tahun 2010, namun belum ada hasil luaran yang terdokumentasikan dengan baik. Studi ini diharapkan menjadi gambaran awal mengenai hasil luaran klinis dan fungsional pasien cedera pleksus brachialis setelah dilakukan tindakan pembedahan.
Metode: Penelitian ini merupakan studi analitik observasional dengan metode potong lintang. Data pasien diambil minimum follow up 6 bulan pasca pembedahan. Luaran klinis dinilai dengan mengukur kekuatan motorik (Medical Research Council Scale) dan ruang lingkup gerak dari sendi abduksi bahu dan fleksi siku. Luaran fungsional dinilai melalui sistem skoring Disabilities of the Arm, Shoulder, and Hand (DASH). Analisis bivariat dan multivariat dilakukan untuk mencari hubungan antara berbagai faktor (usia, jenis kelamin, penyebab cedera, awitan cedera, tipe cedera, tindakan pembedahan, rehabilitasi) dengan luaran klinis dan fungsional (skor DASH dan perubahan skor DASH).
Hasil Penelitian: Sebanyak 67 dari 139 pasien cedera pleksus brachialis traumatik yang menjalani pembedahan di RSUPN Cipto Mangunkusumo periode 2010-2017 dimasukkan ke dalam penelitian dengan rerata waktu follow up 28 bulan pasca pembedahan. Laki-laki (82,2%) dengan nilai rerata usia 26 tahun dengan penyebab cedera tumpul karena kecelakaan lalu lintas. Tipe cedera terbanyak adalah postganglionik tipe total (56,7%). Sebagian besar subjek (65,7%) menjalani rehabilitasi. Rerata skor DASH 71,7 dengan perubahan skor DASH sebesar 17,5.
Diskusi: Luaran klinis dan fungsional pada pasien cedera pleksus brachialis traumatik baik dipengaruhi oleh awitan cedera, tipe cedera, jenis tindakan pembedahan, dan rehabilitasi pasca pembedahan. Analisis multivariat menunjukkan bahwa rehabilitasi menjadi faktor prediktor terhadap seluruh luaran klinis, sementara rehabilitasi dan tipe cedera dapat digunakan untuk memprediksi skor DASH.
Introduction: Traumatic brachial plexus injury (TBPI) is a disease that cause disability in motoric and sensory upper extremity that leads to decrease in quality of life. Nerve or muscle surgeries are still the treatment of choice for treating brachial plexus injury, despite the result is still not satisfying. Study on the outcomes of brachial plexus injury after surgical procedures, especially in Indonesia, has not been conducted. Surgical procedure for brachial plexus injury in RSUPN Dr. Cipto Mangunkusumo has been performed since 2010, but no study had recorded outcome result yet. This study aim to give a brief clinical and functional outcome of patient with brachial plexus injury after surgical procedure.
Methods: We performed an observational analytic study using cross-sectional method. Data was taken with minumum follow up 6 months after surgery. Clinical outcome was measured with motoric strengh using Medical Research Council Scale and range of motion shoulder abduction and elbow flexion. Functional outcome was assessed through DASH scoring. Bivariate and multivariate analysis was performed to find relationships between various factors (age, sex, injury onset, type of injury, type of surgery, rehabilitation) and clinical and functional outcomes (DASH score and change in DASH score).
Results: A total of 67 from 139 traumatic brachial plexus injury patients had surgery at Cipto Mangunkusumo General Hospital from 2010-2017 with mean of follow up for 28 months. Male contributed major patient (82.2%) and had median age of 26 years. The most common type of brachial plexus injury was postganglionic total type (56.7%). Most subjects (65.7%) underwent rehabilitation. Mean DASH score was 71,7 with DASH score changed 17,5.
Discussion: Clinical and functional outcomes in TBPI patients who underwent surgery were influence with onset, type of TBPI, choice of surgery performed, and rehabilitation after surgery. Multivariat analysis showed rehabilitation is the main predictor factor in determine clinical outcome. Rehabilitation and type of injury can be predicted for DASH score. Multivariate analysis showed that rehabilitation was predictive of shoulder abduction ROM and motoric function, and also elbow flexion ROM and motoric function. Rehabilitation and type of injury can be used to predict DASH scores."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T57657
UI - Tesis Membership  Universitas Indonesia Library
cover
Indah Kartika Murni
Luaran jangka pendek pasca-bedah jantung anak dan faktor risiko komplikasi berat di RSUPN Dr. Cipto Mangunkusumo Jakarta = Outcome of paediatric cardiac surgery and risk factors of major complication after cardiac surgery at the Dr. Cipto Mangunkusumo Hospital Indonesia
"[ABSTRAK
Latar belakang: Luaran pasca-bedah jantung penting diketahui untuk menilai kinerja pelayanan bedah jantung anak, sehingga kualitas pelayanan dapat ditingkatkan.
Tujuan: Mengetahui luaran jangka pendek (mortalitas, komplikasi pasca-bedah berat lain, dan komplikasi pasca-bedah yang berat) pada anak yang dilakukan bedah jantung. Selain itu, ingin mengetahui faktor risiko terjadinya komplikasi berat pasca-bedah jantung dan membuat sistem skor dari faktor-faktor risiko tersebut.
Metode: Setiap anak dengan penyakit jantung yang dilakukan operasi jantung di RSUPN Dr Cipto Mangunkusumo Jakarta sejak April 2014 sampai Maret 2015 diikuti setiap hari sampai pasien pulang atau meninggal. Data demografis, mortalitas, morbiditas atau komplikasi pasca-bedah jantung, dan faktor risiko terjadinya morbiditas pasca-operasi yang berat diambil dari rekam medis. Pasien yang sudah pulang dari rumah sakit, dalam waktu 30 hari pasca-operasi dihubungi untuk mendapatkan data kondisi pasien dalam waktu tersebut (hidup atau meninggal).
Hasil: Selama penelitian didapatkan 258 anak dilakukan bedah jantung. PJB terbanyak yang dilakukan bedah jantung adalah ventricle septal defect (28,7%) dan tetralogy of Fallot (24,4%). Komplikasi pasca-bedah jantung terjadi pada 217 (84,1%) anak dan komplikasi berat terjadi pada 49 anak (19%). Komplikasi pasca-bedah jantung terbanyak adalah hipokalsemia pada 163 (63,2%) anak, hiperglikemia 159 (61,6%), low cardiac output syndrome 52 (20,2%), aritmia 48 (18,6%), sepsis 45 (17,4%), dan efusi pleura 39 (15,1%). Komplikasi berat meliputi in-hospital mortality terjadi pada 33 (12,7%) anak dan mortalitas dalam waktu 30 hari pasca-bedah jantung terjadi pada 35 (13,6%) anak, henti jantung 13 (5%), operasi jantung ulang 10 (3,9%), dan gagal organ multipel 19 (7,4%). Faktor risiko yang berhubungan dengan meningkatnya komplikasi pasca-bedah jantung yang berat adalah peningkatan kadar laktat darah [OR 30,7 (IK 95% 8,1-117,6)], PJB sianotik [OR 4,4 (IK 95% 1,2-15,8), dan pemakaian inotropik yang tinggi [OR 7,8 (IK 95% 1,6-38,9)]. Skor faktor risiko ≥ 3 mampu memprediksi anak yang mengalami komplikasi berat pasca-bedah jantung dengan sensitivitas skor 93,9% dan spesifisitas skor 84,2%, dan area di bawah kurva receiver operating characteristic (ROC) adalah 0,94.
Simpulan: Mortalitas di rumah sakit pasca-bedah jantung anak sebesar 12,7% dan mortalitas 30 hari pasca-bedah 13,6%. Komplikasi berat lain pasca-bedah 13,6%. Faktor risiko yang berhubungan dengan meningkatnya komplikasi pasca-bedah jantung yang berat adalah peningkatan kadar laktat darah, PJB sianotik, dan pemakaian inotropik tinggi pasca-bedah jantung. Skor faktor risiko ≥ 3 mampu memprediksi anak yang mengalami komplikasi berat pasca-bedah jantung dengan sensitivitas skor 93,9% dan spesifisitas skor 84,2%.
ABSTRACT
Background: Outcome of children with cardiac surgery is important to evaluate the performance of cardiac surgery program. Identifying the risk factors for major adverse events after cardiac surgery is also important to improve patient care.
Objective: To evaluate the incidence of short-term outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events (major complications) at the Dr Cipto Mangunkusumo Hospital, Indonesia.
Methods: A prospective observational study was conducted from April 2014 until March 2015. All children conducted cardiac surgery, were monitored from the time the cardiac surgery performed until patients were discharged or deceased. During the follow up of all recruited patients, factors associated with the risk of developing major adverse events were identified.
Results: A total of 258 patients were recruited during the study period. Of the total, 134 (51.9%) were female. The mean age of the patients was 53.3±3.8 months. Among the patients, 217 (84.1%) had complications. The most complications occurred after cardiac surgery were hypocalcaemia in 163 (63.2%), hyperglycemia in 159 (61.6%), low cardiac output syndrome in 52 (20.2%), arrhythmia in 48 (18.6%), sepsis in 45 (17.4%), and pleural effusion in 39 (15.1%) children. Further, 49 (19%) of recruited patients had major adverse events (major complications), including in-hospital mortality in 33 (12.7%) and 30-day mortality in 35 (13.6%), cardiac arrest in 13 (5%), the need for re-operation in 10 (3.9%), and multiple organ failure in 19 (7.4%) children. Factors associated with the occurrence of major complications were increase in blood lactate [OR 30.7 (95% CI 8.1-117.6)], cyanotic congenital heart disease [OR 4.4 (95% CI 1.2-15.8), and high inotropes on leaving operating room [OR 7.8 (95% CI 1.6-38.9)]. Risk factor score ≥3 could predict major complications after cardiac surgery with sensitivity of 93.9% and specificity of 84.2%, and area under receiver operating characteristic (ROC) curve was 0.94.
Conclusion: In-hospital mortality after paediatric cardiac surgery at Dr Cipto Mangunkusumo hospital is 12,7% and 30-day mortality is 13,6%. Increase in blood lactate, cyanotic congenital heart disease, and high inotropes on leaving operating room are associated with mortality and other major complications in children following cardiac surgery. Risk score ≥ 3 can predict the development of major complication in children after cardiac surgery with sensitivity 93,9% and specificity 84,2%.;Background: Outcome of children with cardiac surgery is important to evaluate the performance of cardiac surgery program. Identifying the risk factors for major adverse events after cardiac surgery is also important to improve patient care.
Objective: To evaluate the incidence of short-term outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events (major complications) at the Dr Cipto Mangunkusumo Hospital, Indonesia.
Methods: A prospective observational study was conducted from April 2014 until March 2015. All children conducted cardiac surgery, were monitored from the time the cardiac surgery performed until patients were discharged or deceased. During the follow up of all recruited patients, factors associated with the risk of developing major adverse events were identified.
Results: A total of 258 patients were recruited during the study period. Of the total, 134 (51.9%) were female. The mean age of the patients was 53.3±3.8 months. Among the patients, 217 (84.1%) had complications. The most complications occurred after cardiac surgery were hypocalcaemia in 163 (63.2%), hyperglycemia in 159 (61.6%), low cardiac output syndrome in 52 (20.2%), arrhythmia in 48 (18.6%), sepsis in 45 (17.4%), and pleural effusion in 39 (15.1%) children. Further, 49 (19%) of recruited patients had major adverse events (major complications), including in-hospital mortality in 33 (12.7%) and 30-day mortality in 35 (13.6%), cardiac arrest in 13 (5%), the need for re-operation in 10 (3.9%), and multiple organ failure in 19 (7.4%) children. Factors associated with the occurrence of major complications were increase in blood lactate [OR 30.7 (95% CI 8.1-117.6)], cyanotic congenital heart disease [OR 4.4 (95% CI 1.2-15.8), and high inotropes on leaving operating room [OR 7.8 (95% CI 1.6-38.9)]. Risk factor score ≥3 could predict major complications after cardiac surgery with sensitivity of 93.9% and specificity of 84.2%, and area under receiver operating characteristic (ROC) curve was 0.94.
Conclusion: In-hospital mortality after paediatric cardiac surgery at Dr Cipto Mangunkusumo hospital is 12,7% and 30-day mortality is 13,6%. Increase in blood lactate, cyanotic congenital heart disease, and high inotropes on leaving operating room are associated with mortality and other major complications in children following cardiac surgery. Risk score ≥ 3 can predict the development of major complication in children after cardiac surgery with sensitivity 93,9% and specificity 84,2%., Background: Outcome of children with cardiac surgery is important to evaluate the performance of cardiac surgery program. Identifying the risk factors for major adverse events after cardiac surgery is also important to improve patient care.
Objective: To evaluate the incidence of short-term outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events (major complications) at the Dr Cipto Mangunkusumo Hospital, Indonesia.
Methods: A prospective observational study was conducted from April 2014 until March 2015. All children conducted cardiac surgery, were monitored from the time the cardiac surgery performed until patients were discharged or deceased. During the follow up of all recruited patients, factors associated with the risk of developing major adverse events were identified.
Results: A total of 258 patients were recruited during the study period. Of the total, 134 (51.9%) were female. The mean age of the patients was 53.3±3.8 months. Among the patients, 217 (84.1%) had complications. The most complications occurred after cardiac surgery were hypocalcaemia in 163 (63.2%), hyperglycemia in 159 (61.6%), low cardiac output syndrome in 52 (20.2%), arrhythmia in 48 (18.6%), sepsis in 45 (17.4%), and pleural effusion in 39 (15.1%) children. Further, 49 (19%) of recruited patients had major adverse events (major complications), including in-hospital mortality in 33 (12.7%) and 30-day mortality in 35 (13.6%), cardiac arrest in 13 (5%), the need for re-operation in 10 (3.9%), and multiple organ failure in 19 (7.4%) children. Factors associated with the occurrence of major complications were increase in blood lactate [OR 30.7 (95% CI 8.1-117.6)], cyanotic congenital heart disease [OR 4.4 (95% CI 1.2-15.8), and high inotropes on leaving operating room [OR 7.8 (95% CI 1.6-38.9)]. Risk factor score ≥3 could predict major complications after cardiac surgery with sensitivity of 93.9% and specificity of 84.2%, and area under receiver operating characteristic (ROC) curve was 0.94.
Conclusion: In-hospital mortality after paediatric cardiac surgery at Dr Cipto Mangunkusumo hospital is 12,7% and 30-day mortality is 13,6%. Increase in blood lactate, cyanotic congenital heart disease, and high inotropes on leaving operating room are associated with mortality and other major complications in children following cardiac surgery. Risk score ≥ 3 can predict the development of major complication in children after cardiac surgery with sensitivity 93,9% and specificity 84,2%.]"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
T58651
UI - Tesis Membership  Universitas Indonesia Library
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Valery Ivanov Arwadi
Morbiditas dan Mortalitas Tumor Parotis Ganas di RSUPNCM serta Faktor Prognosis yang Berhubungan = Morbidity and Mortality of Malignant Parotid Gland Tumor in Cipto Mangunkusumo Hospital and Related Prognostic Factors
"Latar belakang: tumor kelenjar liur merupakan tumor yang jarang pada keganasan kepala leher. Histopatologinya sangat heterogen demikian juga kejadian dan klinik epidemiologinya. Perbedaan karakteristik dari tumor parotis di banyak pusat kesehatan memengaruhi survival rate.
Metode: penelitian ini adalah uji retrospektif analitik dengan uji kesintasan. Data didapatkan dari rekam medik pasien tumor parotis ganas yang dirawat di RSUPNCM periode Januari 2005 sampai Desember 2011.
Hasil: ada 75 kasus tumor parotis ganas. Laki-laki lebih banyak dibandingkan perempuan, dengan umur rata-rata 50 tahun. Delapan puluh persen ditemukan dalam stadium klinis lanjut. Mukoepidermoid karsinoma merupakan histopatologi yang paling sering ditemukan. Pembedahan merupakan terapi pilihan utama. Enam puluh persen kasus ditemukan penurunan indeks masa tubuh (IMT). Komplikasi tersering adalah paralisis nervus fasialis sekitar 30,7%. Mortalitas dalam 1 tahun didapati sebesar 25,3%. Rekurensi ditemukan sebesar 17,3%. Analisis bivariat antara tatalaksana dengan morbiditas menunjukkan signifikan dengan nilai p=0.001, dan dalam hubungannya dengan mortalitas didapati signifikan dengan tatalaksana, sedangkan stadium klinis dan histopatologi tidak. Histopatologi signifikan dalam hubungannya dengan rekurensi. Pada analisis multivariat antara stadium klinis I-II dengan status nutrisi dan mortalitas menunjukkan hubungan yang signifikan dengan nilai p = 0.006. Terdapat hubungan signifikan antara tatalaksana dengan survival rate, sedangkan untuk jenis kelamin, usia, histopatologi dan stadium klinis tidak ditemukan hubungan yang signifikan. Disease free survival untuk kasus keganasan ini adalah 61,5%.
Kesimpulan: karakteristik tumor parotis ganas di RSUPNCM tidak berbeda dengan yang ditemukan pada literatur, hubungan yang signifikan ditemukan antara histopatologi dan tatalaksana sebagai faktor prognosis survival rate.
Background: salivary gland tumor is a rare case found in head and neck tumor. The histopathology is very heterogeneous, as well as the incident and clinical epidemiology. Different characteristics of parotid gland tumor in many health centers affecting survival rate.
Method: This is a survival study with retrospective analytical method. Data is obtained from medical record in Cipto Mangunkusumo Hospital in period of January 2005 to December 2011.
Results: There are 75 patients with malignant parotid gland tumor. Male is affected more than female, the mean age is 50 years old. 80% of cases found are in late stage. Mucoepidermoid carcinoma is the most frequent histopathology found. Surgery remains the treatment of choice. 60% patients experienced a decreased of body mass index. Postoperative complication such as facial nerve paralysis occurred in 30.7%. One year mortality is found in 25.3% cases. Recurrence is found in 17,3%. Bivariate analysis between clinical management and morbidity has a significant correlation with p=0,001, and significant also found between clinical management with mortality but not for tumor stage and histopathology. Histopathology found significant in correlation with recurrence. Multivariate analysis between nutritional status and tumor stage showed significancy with p = 0.006 in stage I-II. There is significant relationship between clinical management and survival rate, but there is no significancy between sex, age, histopathology, and tumor stage. Disease Free Survival is among 61,5%.
Conclusion: malignant parotid gland tumor in Cipto Mangunkusumo Hospital contributes the same characteristics with those found in publications. There is significant relationship between variables from survival analysis of prognostic factors."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
T58683
UI - Tesis Membership  Universitas Indonesia Library
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Caecilia Herawati S.R. Dewi
Evaluasi diagnostik kanker ovarium praoperatif potong beku dan histopatologi di RS Cipto Mangunkusumo Jakarta = Diagnostic evaluation of ovarian cancer preoperative frozen section and histopathology at Cipto Mangunkusumo Hospital Jakarta
"Latar belakang: Kanker ovarium merupakan penyebab kematian kelima terbanyak karena kanker pada wanita. Diperlukan uji diagnostik preoperatif dan intraoperatif yang tajam dan akurat untuk menurunkan morbiditas dan mortalitas karena kanker ovarium.
Tujuan: Mengetahui nilai diagnostik RMI, Skor Purwoto, dan potong beku terhadap pemeriksaan histopatologi pada tumor ovarium suspek ganas.
Metode: Penelitian ini menggunakan desain potong lintang (cross-sectional) dari data sekunder yang berasal dari 114 rekam medis pasien suspek keganasan ovarium yang menjalani pembedahan antara bulan Januari 2010 hingga Desember 2010 di RSCM.
Hasil: Nilai diagnostik untuk RMI adalah sensitivitas 85%, spesifisitas 63%, NDP 68%, NDN 82%, RKP 2,29, RKN 0,23, akurasi 74%, dan AUC 0,800. Nilai diagnostik untuk Skor Purwoto adalah sensitivitas 80%, spesifisitas 59,3%, NDP 65%, NDN 76%, RKP 1.97, RKN 0,34, akurasi 69%, dan AUC 0,780. Nilai diagnostik untuk potong beku adalah sensitivitas 93%, spesifisitas 98%, NDP 98%, NDN 94%, RKP 54,7, RKN 0,07, akurasi 96%, dan AUC 0,968.
Kesimpulan: RMI dan skor Purwoto dapat digunakan untuk evaluasi diagnostik keganasan ovarium praoperatif. Meskipun telah dilakukan evaluasi kemungkinan keganasan praoperatif, tetap diperlukan pemeriksaan potong beku. Hasil evaluasi RMI dan Skor Purwoto jinak dapat ditatalaksana di pusat pelayanan dengan fasilitas yang tidak memerlukan surgical staging. Meskipun hasil evaluasi RMI dan skor Purwoto jinak sebaiknya tetap dilakukan pemeriksaan potong beku untuk menyingkirkan kemungkinan keganasan yang masih belum dapat dibuktikan dengan pasti melalui evaluasi praoperatif.
Introduction: Ovarian cancer is the fifth leading cause of death from cancer in women. The sharp and accurate preoperative and intraoperative diagnostic tests are needed in reducing morbidity and mortality due to ovarian cancer.
Purpose: This study aims to determine the diagnostic value of RMI, Purwoto Score, and frozen section compared to histopathologic examination in suspected malignant ovarian tumors.
Methods: This study used cross-sectional design of secondary data from the medical records of 114 patients with suspected ovarian malignancy who underwent surgery between January 2010 and December 2010 at Cipto Mangunkusumo Hospital.
Results: The diagnostic value for RMI are sensitivity 85%, specificity 63%, PPV 68%, NPV 82%, positive likelihood ratio 2.29, negative likelihood ratio 0.23, accuracy 74%, and AUC 0,800. Diagnostic value for Purwoto Score are sensitivity 80%, specificity 59.3%, PPV 65%, NPV 76%, positive likelihood ratio 1.97, negative likelihood ratio 0.34, accuracy 69%, and AUC 0.780. Diagnostic value of frozen section are sensitivity 93%, specificity 98%, PPV 98%, NPV 94%, positive likelihood ratio 54.7, negative likelihood ratio 0.07, accuracy 96%, and AUC 0.968.
Conclusion: RMI and Purwoto Score can be used for preoperative diagnostic evaluation of ovarian malignancies. Although it has been performed preoperative evaluation of malignancy, is still required frozen section examination. Benign case of RMI and Purwoto Score can be managed at the service center with facilities that do not require surgical staging and still need to be confirmed with frozen section examination to rule out malignancy that still has not been proven with certainty through preoperative evaluation."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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Samuel Raymond Rumantir Wardhana
Pengaruh Karakteristik Tumor dan Embolisasi Preoperatif terhadap Jumlah Perdarahan Intraoperatif pada Pasien Juvenile Nasopharyngeal Angiofibroma di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo = Effect of Tumor Chartacteristics and Preoperative Embolization on the Amount of Intraoperative Bleeding in Juvenile Nasopharyngeal Angiofibroma in Cipto Mangunkusumo National Hospital
"Latar belakang: Juvenile Nasopharyngeal Angiofibroma (JNA) merupakan tumor jinak nasofaring yang bersifat hipervaskular, agresif lokal, dan destruktif. Pencitraan sebelum pembedahan untuk menentukan ukuran dan perluasan tumor, serta embolisasi preoperatif dapat mempengaruhi jumlah perdarahan intraoperatif, yang merupakan salah satu faktor morbiditas pada pasien JNA. Penelitian ini bertujuan untuk menilai pengaruh karakteristik tumor antara lain ukuran tumor, staging, dan pembuluh darah yang memperdarahi tumor, serta efek dari embolisasi preoperatif terhadap jumlah perdarahan intraoperatif.
Metode: Penelitian dilakukan pada pasien JNA yang menjalani embolisasi preoperatif dan operasi pengangkatan tumor di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo sejak tahun 2018 hingga Maret 2022. Dilakukan penilaian ukuran tumor dan staging, serta identifikasi feeding artery menggunakan CT/MRI dan juga DSA embolisasi preoperatif, kemudian dilakukan analisis perbandingan dan korelasi terhadap jumlah perdaran intraoperatif.
Hasil: Terdapat 21 pasien JNA yang menjalani embolisasi preoperatif dan pengangkatan tumor. Didapatkan perbedaan jumlah perdarahan intraoperatif yang bermakna antara pasien JNA stadium III dibandingkan dengan stadium I-II (p=0,006). Jumlah perdarahan intraoperatif lebih banyak pada tumor yang berukuran lebih besar, namun didapatkan korelasi yang lemah (R=0,43; p=0,051). Jumlah perdarahan intraoperatif juga berbeda bermakna pada tumor JNA dengan feeding artery dari kedua sisi arteri maksilaris interna dengan tumor JNA yang mendapatkan feeding artery satu sisi arteri maksilaris interna saja (p=0,009), serta keterlibatan feeding artery dari cabang arteri karotis interna (p=0,023). Persentase pembuluh darah yang dilakukan embolisasi preoperatif, juga mengurangi jumlah perdarahan intraoperatif (R=-0,36; p=0,113).
Kesimpulan: Pencitraan preoperatif pada pasien JNA memegang peranan penting dalam menentukan perluasan tumor (staging), ukuran tumor, dan feeding artery yang berpengaruh terhadap jumlah perdarahan intraoperatif pada pasien JNA. Tindakan embolisasi preoperatif juga memiliki peranan penting dalam mengurangi jumlah perdarahan intraoperatif
Background: Juvenile Nasopharyngeal Angiofibroma (JNA) is a benign tumor of the nasopharynx that is hypervascular, locally aggressive, and destructive. Imaging before surgery to determine the size and extent of the tumor, as well as preoperative embolization can affect the amount of intraoperative bleeding, which is one of the morbidity factors in JNA patients. This study aimed to assess the effect of tumor characteristics such as tumor size, staging, and blood vessels supplying the tumor, as well as the effect of preoperative embolization on the amount of intraoperative bleeding.
Methods: The study was conducted on JNA patients who underwent preoperative embolization and surgical removal of tumors at the Cipto Mangunkusumo National General Hospital from 2018 to March 2022. Tumor size and staging were assessed, as well as identification of feeding arteries using CT/MRI and DSA preoperative embolization, then we performed a comparative and correlation analysis of the amount of intraoperative bleeding.
Results: There were 21 JNA patients who underwent preoperative embolization and tumor removal. There was a significant difference in the amount of intraoperative bleeding between patients with stage III JNA compared to stage I-II (p = 0.006). The amount of intraoperative bleeding was higher in larger tumors, but a weak correlation was found (R=0.43; p=0.051). The amount of intraoperative bleeding was also significantly different in JNA tumors with feeding arteries from both sides of the internal maxillary artery compared to JNA tumors with feeding arteries on one side of the internal maxillary artery only (p=0.009), and the involvement of feeding arteries from the internal carotid artery branch (p=0.023). The percentage of vessels that underwent preoperative embolization also reduced the amount of intraoperative bleeding (R=-0.36; p=0.113).
Conclusion: Preoperative imaging in JNA patients plays an important role in determining tumor expansion (staging), tumor size, and feeding arteries that affect the amount of intraoperative bleeding in JNA patients. Preoperative embolization also have an important role in reducing the amount of intraoperative bleeding."
Depok: Fakultas Kedokteran Universitas Indonesia, 2022
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Ayu Suciah Khaerani
Konstipasi fungsional pada anak dan faktor-faktor yang berhubungan di RSUPN Cipto Mangunkusumo tahun 2013-2016 = Factors associated with childhood functional constipation in Cipto Mangunkusumo Hospital in the year 2013-2016
"ABSTRAK
Latar Belakang: Konstipasi pada anak merupakan masalah kesehatan dengan prevalensi yang cukup tinggi di dunia. Konstipasi pada anak memiliki dampak penurunan kualitas hidup pada orang tua dan anak, serta menimbulkan beban ekonomi untuk segi pelayanan kesehatan. Konstipasi fungsional pada anak bersifat multifaktorial. Faktor-faktor risiko konstipasi anak bervariasi pada setiap tempat. Penelitian ini bertujuan untuk mengetahui faktor-faktor risiko konstipasi fungsional pada anak di Rumah Sakit Cipto Mangunkusumo Jakarta tahun 2013-2016. Metode: Penelitian ini menggunakan data sekunder rekam medis yang terdapat di Departemen Ilmu Kesehatan Anak RSCM dengan desain penelitian potong lintang. Hasil: Hasil penelitian menunjukkan prevalensi konstipasi anak di RSCM adalah 6,85 dengan 84 diantaranya merupakan konstipasi fungsional. Melalui analisis bivariat, didapatkan hasil konsumsi ASI eksklusif p=0,088, status gizi p=1,000, riwayat keluarga p=0,332, urutan anak dalam keluarga p=0,076, dan riwayat toilet training p=1,000 tidak berhubungan bermakna dengan kejadian konstipasi fungsional anak. Pada analisis multivariat dengan menggunakan regresi logistik, didapatkan variabel yang paling berhubungan dan signifikan terhadap konstipasi fungsional anak adalah jenis kelamin OR 6,696; IK95 1,224-36,620; p=0,028. Kesimpulan: Jenis kelamin adalah faktor paling berhubungan terhadap konstipasi fungsional anak, hasil ini berbeda dengan penelitian sebelumnya.
ABSTRACT
Background Childhood constipation is one of the health problem with high prevalence worldwide. It affects both patients and parents quality of life. It also causes economic burdens especially for health services. Childhood constipation is multifactorial. Risk factors of childhood functional constipation differs from one place to another. This study aimed to determine factors associated with childhood functional constipation in Cipto Mangunkusumo hospital Jakarta year of 2013 2016. Methods This cross sectional study used secondary data from medical records in the Pediatrics Department RSCM. Results The results showed that the prevalence of childhood constipation is 6.85 with 84 among those are functional constipation. Through the bivariate analysis, it was found that exclusive breast milk consumption p 0.088, nutritional status p 1.000, family history p 0.332, the order of children in the family p 0.076, and history of toilet training p 1.000 were not significantly related with childhood functional constipation. On multivariate analysis with logistic regression, it was found that gender was associated with childhood functional constipation OR 6.696 IK95 1.224 36.620 p 0.028 . Conclusion It was found that gender was associated with childhood functional constipation. This result differs from other previous studies. "
2017
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UI - Skripsi Membership  Universitas Indonesia Library
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Zecky Eko Triwahyudi
Kualitas hidup dan luaran fungsional pasien tumor ekstremitas bawah yang menjalani prosedur amputasi di RSUPN dr. Cipto Mangunkusumo = Quality of life and functional outcome of oncology patient after lower extremity amputation in Cipto Mangunkusumo Hospital
"Jumlah kasus tumor muskuloskeletal di Indonesia semakin meningkat. Di antara pilihan tata laksana yang ada, tindakan amputasi masih menjadi salah satu modalitas utama. Penelitian ini bertujuan untuk enilai hubungan antara faktor-faktor klinis dan demografis dengan kualitas hidup dan luaran fungsional pasien-pasien dengan tumor ekstremitas bawah yang menjalani amputasi Penelitian ini merupakan studi analitik observasional potong lintang dengan subjek seluruh pasien tumor ekstremitas bawah di RSUPN dr. Cipto Mangunkusumo selama 2014-2019. Kualitas hidup dan luaran fungsional diukur menggunakan instrumen SF-36 dan MSTS. Total 72 pasien memiliki rerata usia 31 tahun dan 65% pria, 33 di antaranya teridentifikasi hidup. Mayoritas subjek memiliki diagnosis osteosarkoma (58%), dilakukan amputasi transfemoral (50%) dan lokasi tumor di distal femur (44,4%). Rerata SF-36 adalah 61,63, sementara skor MSTS adalah 35%. Hanya 1 pasien yang menggunakan prosthesis, di mana skor SF-36 pasien tersebut paling baik (74) di antara subjek lain. Rerata SF-36 lebih baik pada pria dibandingkan wanita (p=0,011). Skor MSTS lebih baik pada tingkat pendapatan menengah ke atas (p=0,04). Kesintasan 3 tahun pasca amputasi sebesar 45,8%. Tidak ada perbedaan kesintasan antara osteosarkoma dan tumor lain. Kualitas hidup berkaitan dengan faktor jenis kelamin dan penggunaan alat bantu gerak, sementara luaran fungsional berkaitan dengan tingkat pendapatan.
The number of musculoskeletal tumors in Indonesia is increasing. Among all treatment options, amputation is still frequently performed. The purpose of this study is to identify demographical and clinical characteristics associated with quality of life and functional outcome of patients with lower extremity tumor who underwent amputation. This study was a cross-sectional study with subjects from all lower extremity tumor patients who underwent amputation in Cipto Mangunkusumo Hospital during the 2014-2019. Quality of life and functional outcome were measured using SF-36 and MSTS questionnaires.There were 72 subjects, consisted of 65% men and have average age of 31 years. Among the patients, 33 of whom were identified alive and interviewed. Mean SF-36 score is 61.63, while mean MSTS score is 35%. There was only 1 patient who wore prosthesis, scoring the best SF-36 of 74. Mean SF-36 of male is better than female (p=0.011). Better MSTS score was found in subjects with better education level (p=0.04). The 3-year survival rate of our patients was 45.8%. There was no difference of survival rate between patients with osteosarcoma and other diagnosis. Quality of life is associated with gender and use of walking aids, while functional outcome is associated with level of income."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
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UI - Tugas Akhir  Universitas Indonesia Library
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