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"ABSTRAKDefek septum atrium (DSA) berpotensi meningkatkan resistensi vaskular paru (RVP). Pada studi-studi terdahulu peningkatan RVP ditandai dengan pembentukan takik pada kurva spektral Doppler pulmonal. Terdapat perbedaan pola pembentukan takik pada jenis HP yang berbeda. Salah satu parameter penilaian pola ini yaitu notch ratio (NR). Belum terdapat studi yang menilai korelasi antara NR dengan RVP pada pasien DSA sekundum. Penelitian ini bertujuan untuk mengetahui korelasi antara NR dengan RVP pada pasien DSA sekundum. Penelitian ini merupakan studi potong lintang dengan consecutive sampling pada pasien DSA sekundum berusia ≥18 tahun yang menjalani kateterisasi jantung pada bulan Maret-Oktober 2019 di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita. Uji korelasi Pearson atau Spearman dilakukan menggunakan parameter NR dari ekokardiografi dan pulmonary artery resistance index (PARI) dan pulmonary vascular resistance/systemic vascular resistance (PVR/SVR) dari kateterisasi jantung. Dari 50 pasien yang dianalisis, didapatkan NR dan RVP memiliki korelasi negatif sedang signifikan untuk PARI (r = -0,410; p = 0,03) dan PVR/SVR (r = -0,430; p = 0,002). Variabel perancu yang memiliki korelasi signifikan dengan NR yaitu stroke volume/pulse pressure (r = 0,384; p = 0,006), yang tereliminasi dari analisis multivariat dengan metode backward. Terdapat korelasi negatif sedang antara NR dan RVP pada pasien DSA sekundum.

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ABSTRACTAtrial septal defect (ASD) potentially increases pulmonary vascular resistance (PVR). In previous studies high PVR was marked by pulmonary Doppler spectral curve notching. There were distinct patterns of notch formation in different types of PH. One of the parameter to assess these patterns is notch ratio (NR). There is no study yet assessing correlation between NR and PVR in secundum ASD patients. This study aims to evaluate correlation between NR and PVR in this population. Cross sectional study with consecutive sampling was conducted in secundum ASD patients ≥18 years old undergoing cardiac catheterization from March until October 2019 in National Cardiovascular Center Harapan Kita. Pearson or Spearman correlation analysis was done using NR parameter from echocardiography and pulmonary artery resistance index (PARI) and pulmonary vascular resistance/systemic vascular resistance (PVR/SVR) from cardiac catheterization. From 50 patients analyzed, NR and PVR have significant moderate negative correlations for PARI (r = -0,410; p = 0,03) and PVR/SVR (r = -0,430; p = 0,002). Confounding variable with significant correlation with NR is stroke volume/pulse pressure (r = 0,384, p = 0,006), which was eliminated from multivariate analysis with backward method. There is a moderate negative correlation between NR and RVP in secundum ASD patients."

"Latar belakang: Intervensi endovaskular aorta perkutan rutin dilakukan dan menjadi pilihan tatalaksana invasif aneurisma atau diseksi aorta serta penyakit katup aorta. Komplikasi vaskular pasca intervensi sering terjadi pada pasien dengan diameter arteri femoralis komunis yang lebih kecil. Namun terdapat perbedaan bermakna dari diameter arteri femoralis komunis antara populasi Kaukasia dan Asia terkait komplikasi vaskular. Pada populasi Indonesia belum ada data terkait diameter arteri femoralis komunis dengan komplikasi vaskular. Tujuan: Mengetahui diameter minimal arteri femoralis komunis sebagai prediktor komplikasi vaskular pasca intervensi endovaskular aorta perkutan pada populasi Indonesia. Metode: Pasien yang dilakukan intervensi endovaskular aorta perkutan, diukur diameter arteri femoralis komunis dengan CT scan. Pasien dievaluasi kejadian komplikasi vaskular selama perawatan pasca tindakan. Hasil: Terdapat 101 pasien dengan 135 arteri femoralis komunis yang menjadi sampel penelitian. Dibagi menjadi dua kelompok ukuran diameter arteri femoralis komunis berdasarkan median 7,6 mm, yaitu diameter ≥7,6 mm dan diameter <7,6 mm. Dari analisis multivariat, tidak terdapat hubungan bermakna antara kategori diameter arteri femoralis komunis dengan komplikasi vaskular pasca intervensi endovaskular aorta perkutan (p 0,38). Variabel lain yang berhubungan dengan kejadian komplikasi vaskular adalah jenis kelamin perempuan (p 0,03) dan RSAF ≥0,82 (p <0,001). Kesimpulan: Diameter arteri femoralis komunis tidak dapat menjadi prediktor kejadian komplikasi vaskular pasca intervensi endovaskular aorta perkutan pada populasi Indonesia karena berdasarkan analisis multivariat tidak ditemukan hubungan yang bermakna.

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Background: Percutaneus endovascular aorta repair has been routinely performed and become the primary choice of invasive therapy for aortic aneurism, aortic dissection and aortic valve disease. The occurrence of vascular complications resulting from intervention, often occurs in patients with smaller common femoral artery. However there is a significant difference in the diameter of common femoral artery between the Caucasian and Asian populations related to the incidence of vascular complications. Objectives: To investigate the minimal diameter of common femoral artery as a predictor of vascular complications after percutaneus endovascular aorta repair in the Indonesian population. Methods: Patients who performed percutaneus endovascular aorta repair, measured the diameter of the common femoral artery with a CT scan and than evaluated for the occurrence of vascular complications after procedure. Results: 101 patients with 135 common femoral arteries are divided into two groups based on median of common femoral arteries (7,6 mm), diameter ≥7,6 mm and diameter <7,6 mm. From multivariate analysis, there is no significant association between the common femoral artery diameter and vascular complications after percutaneous aortic endovascular repair (p 0,38). Other variables that related to the incidence of vascular complications were female (p 0.03) and RSAF ≥0.82 (p <0.001). Conclusion: Diameter of common femoral artery can not be used as predictor of vascular complications after percutaneus endovascular aorta repair in the Indonesian population because based on multivariate analysis there was no significant relationship."

"In Diabetes and peripheral vascular disease, a panel of distinguished leaders in the field of medicine, podiatry, and vascular and endovascular therapy assimilate the latest literature on these issues and others for an in-depth review of the management of peripheral vascular disease. Providing an overview of the management of diabetes and diabetic foot changes as well as providing a view of cutting-edge and emerging topics in optimization of arterial status, this important title addresses pathophysiology, anatomy, diagnosis and management of diabetic peripheral vascular disease, emphasizing a multi-disciplinary approach. The first chapter of the book provides an overview of this complex disease process and discusses the teamwork required for optimal management. The chapters continue with the basic pathophysiology of diabetic atherosclerosis and a contemporary review of the management of diabetes. The genesis of diabetic foot ulceration and prevention and management strategies is covered, as is the effects of neuropathy and microvascular changes in the diabetic foot. In addition, Diabetes and Peripheral Vascular Disease covers the microbiology of diabetic foot infections, the role of endovascular interventions and vascular surgery as well as the management of the complications of these procedures, the process of amputation for those patients who have progressed beyond a limb salvage situation, and the effects of diabetes on the cerebrovascular system as well as its implications in patients with aortoiliac disease."

"Tujuan dari penelitian ini adalah untuk menilai terjadinya aktivasi endotel sebagai mekanisme palagenesis pada preeklampsia, dengan melihat pengaruh pajanan serum penderita preeklampsia pada kultur sel endotel vena umbilikalis terhadap produksi VCAM-1.RANCANGAN PENELITIAN: Penelitian ini merupakan studi eksperimental. Kultur sel endotel yang padat (confluent) dipajankan dengan medium yang mengandung 20% serum dad wanita preeklampsia (n = 12) atau wanita hamil normal (n = 12) dengan usia, usia kehamilan dan paritas yang tidak berbeda berrnakna secara statistik. Setelah pajanan selama 24 jam, diukur kadar VCAM-1 terlarut (sVCAM-1) dalam supematan kultur sel endotel dari ke-2 populasi tersebut. Jumlah sel endotel hidup dari kultur sel endotel pasca pajanan dihitung, baik pasca pajanan serum preeklampsia maupun wanita hamil normal. Diukur juga kadar sVCAM-1 dalam medium yang mengandung 20% serum dari wanita yang sama, yang tidak dipajankan dengan preeklampsia.HASIL: Kadar sVCAM-1 dalam supematan kultur setelah pajanan pada 10.000 set endotel selama 24 jam dengan serum preeklampsia (1.366 + 0.714 ng/ml) lebih tinggi secara bermakna (P < 0.05) dibandingkan setelah pajanan dengan serum wanita hamil normal (0.735 + 0.372 nglml). Jumlah sel endotel dari kultur sel endotel setelah pajanan dengan serum preeklampsia (9.00 x 104 + 3.77 x 104) lebih rendah dibandingkan setelah pajanan dengan serum wanita hamil normal (12.67 x 104 + 6.23); tetapi perbedaannya secara statistik tidak bermakna (P > 0.05). Kadar sVCAM-1 dalam medium kuttur yang mengandung 20% serum preeklampsia yang tidak dipajankan pada kultur sel endotel (11.0516 } 5.404 ng/lml) lebih tinggi dibandingkan serum wanita hamil normal (10.417 + 6.870 ng/ml); tetapi perbedaannya secara statistik tidak bermakna (P > 0,05)KESIMPULAN: Pajanan serum penderita preeklampsia pada kultur sel endotel vena umbilicalis menyebabkan terjadinya peningkatan produksi VCAM-1 oleh sel endotel, sehingga dapat disimpulkan bahwa pads preeklampsia terjadi aktivasi endotel akibat adanya suatu zat dalam serum penderita preeklampsia. Kata kunci: Preeklampsia, aktivasi endotel, kultur set endotel vena umbilikalis, Vascular Cell Adhesion Molecule-1.

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The Effect Of Preeclamptic Sera Exposure To Human Umbilical Vein Endothelial Cell Culture To The Production Of Vascular Cell Adhesion Molecul-1 (VCAM-1)OBJECTIVE: To determine endothelial activation as a pathogenic mechanism of preeclampsia, by identifying the effect of preeclamptic sera exposure to human umbilical vein endothelial cell culture on the production of VCAM-1.STUDY DESIGN: The study was an experimental study. Confluent endothelial cell culture exposed to medium with 20 % preeclamptic sera (n=12) on women with normal pregnancy sera (n=12) with the same age, gestational age and parity. After 24-hour of exposure, cultured media were removed for measurement of VCAM-1. The concentration of sVCAM-1 in medium with 20 % sera from the same women that was not exposed to cultured endothelial cell were also measured.RESULTS : The concentration of sVCAM-1 from 10.000 cultured endothelial cells media after 24-hour exposure with preeclamptic sera (1.366 + 0.714 nglml) was significantly higher than exposure with normal pregnant women sera (0.735 + 0.372). The amount of cultured endothelial cells after exposure to preeclamptic sera (9.00 x 104 + 3.77 x 104) was lower than after exposure to normal pregnant women sera (12.67 x 104 + 6.23); but the difference was not statistically significant (P a 0.05). Without exposure to cultured endothelial cells, the concentration of sVCAM-1 in the medium with 20 % preeclamptic sera was higher (11.0516 + 5.404 nglml) than in the medium with 20% sera from normal pregnant women (10.417 + 6.870 nglml), although the difference was not statistically significant (P > 0.05).CONCLUSIONS: Exposure of human umbilical vein endothelial cell culture to preeclamptic sera increased the production of VCAM-1 by the endothelial cells. It was concluded that there was endothelial activation in preeclampsia caused by factor or factors in preeclamptic sera."

"[ABSTRAK Latar Belakang : pengukuran VPW dari modalitas foto toraks merupakanpemeriksaan yang non invasif, cepat dan mudah untuk memprediksi kondisihipervolemia. Namun belum terdapat konsensus nilai rerata VPW yang dipakaisecara global, sehingga penggunaan nilai rerata VPW dari penelitian sebelumnyaterhadap populasi diluar populasi penelitian tersebut mungkin tidak relavan. DiIndonesia khususnya di Rumah Sakit Cipto Mangunkusumo belum terdapat datadasar nilai rerata VPW.Tujuan Penelitian: Mengetahui rerata nilai VPW dewasa normal IndonesiaDesain Penelitian: Retrospektif potong lintangMetode: Pengukuran jarak antara tepi terluar arteri subklavia kiri dengan tepiterluar vena kava superior yang melewati bronkus utama kanan (VPW),pengukuran rasio VPW terhadap diameter jantung terluas dan rasio VPW terhadapdiameter terluas rongga toraks. Pengukuran dilakukan pada radiografi toraks PAdari 104 subyek normal yang terdiri dari 52 laki-laki dan 52 perempuan, dihitungrerata dan standar deviasi. Pengukuran serupa juga dilakukan pada topogram CTscan toraks (radiografi toraks AP supine) dan CT scan toraks dari 103 subyekyang terdiri dari 51 laki-laki dan 52 perempuan.Hasil: Pada pemeriksaan toraks PA didapatkan rerata VPW 48,0 mm ± 5,5 mm,rerata VPCR 40,3% ± 4,6 %, dan rerata VPTR 17,2% ± 1,7%. Pada pemeriksaantopogram CT scan didapatkan rerata VPW 50,3 mm ± 6,2 mm, rerata VPTR 45%± 5,1%, dan rerata VPTR 19,8% ± 2,5%. Rerata VPW pada CT scan toraks 50,4 ±6,1 mm. Pengukuran pada foto toraks AP sekitar 10 % lebih besar dibandingkanpada foto toraks PA, dan pengukuranVPW pada foto toraks terbukti memilikiakurasi yang tinggi.Kesimpulan: Rerata VPW pada pemeriksaan foto toraks PA tegak dewasa normalIndonesia adalah 48 ± 5,5 mm, ternyata tidak berbeda bermakna dengan rerataVPW pada populasi barat ( 48 ± 5mm). Rerata VPCR pada foto toraks PAadalah 40,3 % ± 4,6 % dan VPTR adalah 17,2 % ± 1,7 %.

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ABSTRACTBackground: Vascular pedicle width (VPW) is the distance, from a perpendicularline at the takeoff point of the left subclavian artery off the aorta to the point atwhich the superior vena cava. Measurement of VPW on chest x-ray is relativelynon-invasive, fast and easy technique as hypervolemia predictor, but nowordwide consensus has been proposed.Objective: to investigate mean vascular pedicle witdh of Indonesian adultStudy design: Retrospective cross sectionalMethods : VPW is the distance, measure in millimeters, from a perpendicular lineat the takeoff point of the left subclavian artery to the point at which the superiorvena cava crosses the right main bronchus, than calculate VPW ratio to a widesthorizontal diameter of cardiac dan thoracic wall.Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CTscan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scantopogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, andmean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1mm. Measurements on the AP chest x-ray about 10% greater than in the PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved tohave high accuracy.Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5mm, no significant different between westerns population ( 48 ± 5mm).;Background: Vascular pedicle width (VPW) is the distance, from a perpendicularline at the takeoff point of the left subclavian artery off the aorta to the point atwhich the superior vena cava. Measurement of VPW on chest x-ray is relativelynon-invasive, fast and easy technique as hypervolemia predictor, but nowordwide consensus has been proposed.Objective: to investigate mean vascular pedicle witdh of Indonesian adultStudy design: Retrospective cross sectionalMethods : VPW is the distance, measure in millimeters, from a perpendicular lineat the takeoff point of the left subclavian artery to the point at which the superiorvena cava crosses the right main bronchus, than calculate VPW ratio to a widesthorizontal diameter of cardiac dan thoracic wall.Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CTscan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scantopogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, andmean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1mm. Measurements on the AP chest x-ray about 10% greater than in the PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved tohave high accuracy.Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5mm, no significant different between westerns population ( 48 ± 5mm).;Background: Vascular pedicle width (VPW) is the distance, from a perpendicularline at the takeoff point of the left subclavian artery off the aorta to the point atwhich the superior vena cava. Measurement of VPW on chest x-ray is relativelynon-invasive, fast and easy technique as hypervolemia predictor, but nowordwide consensus has been proposed.Objective: to investigate mean vascular pedicle witdh of Indonesian adultStudy design: Retrospective cross sectionalMethods : VPW is the distance, measure in millimeters, from a perpendicular lineat the takeoff point of the left subclavian artery to the point at which the superiorvena cava crosses the right main bronchus, than calculate VPW ratio to a widesthorizontal diameter of cardiac dan thoracic wall.Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CTscan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scantopogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, andmean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1mm. Measurements on the AP chest x-ray about 10% greater than in the PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved tohave high accuracy.Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5mm, no significant different between westerns population ( 48 ± 5mm)., Background: Vascular pedicle width (VPW) is the distance, from a perpendicularline at the takeoff point of the left subclavian artery off the aorta to the point atwhich the superior vena cava. Measurement of VPW on chest x-ray is relativelynon-invasive, fast and easy technique as hypervolemia predictor, but nowordwide consensus has been proposed.Objective: to investigate mean vascular pedicle witdh of Indonesian adultStudy design: Retrospective cross sectionalMethods : VPW is the distance, measure in millimeters, from a perpendicular lineat the takeoff point of the left subclavian artery to the point at which the superiorvena cava crosses the right main bronchus, than calculate VPW ratio to a widesthorizontal diameter of cardiac dan thoracic wall.Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CTscan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scantopogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, andmean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1mm. Measurements on the AP chest x-ray about 10% greater than in the PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved tohave high accuracy.Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5mm, no significant different between westerns population ( 48 ± 5mm).]"

"Latar Belakang: Ulkus diabetik merupakan komplikasi diabetes melitus yang menjadi salah satu masalah utama di bidang kesehatan. Di Indonesia, angka mortalitas ulkus diabetik mencapai 17-30%, dengan laju amputasi sekitar 15-30%. Pemberian terapi oksigen hiperbarik (TOHB) dapat meningkatkan oksigenasi endotel dan merangsang produksi vascular endothelial growth factor (VEGF) yang merupakan faktor pertumbuhan paling spesifik dan poten untuk proses angiogenesis sehingga dapat mempercepat proses penyembuhan luka. Tujuan: Penelitian ini bertujuan untuk mengetahui apakah TOHB berpengaruh terhadap peningkatan kadar VEGF pasien ulkus diabetik. Metode: Dilakukan penelitian uji ktinis eksperimental dari bulan Februari 2006 sampai April 2006 terhadap 12 pasien ulkus diabetik yang mendapat TOHB 3 X 30 menit per hari selama 5 hari (kelompok TOHB) dan 10 pasien ulkus diabetik yang tidak mendapat TOHB (kelompok non-TOHB, kelompok kontrol). Kadar VEGF pada kedua kelompok diukur pada hari pertama dan hari kelima. Hasil: Pada kelompok TOHB kadar VEGF hari pertama menunjukkan nilai rerata 1241,325 + 237,6533 pg/ml dan setelah 5 hari nilat rerata menjadi 1244,458 + 264,5641 pg/ml, (p = 0,583). Sedangkan pada kelompok non-TOHB kadar VEGF hari pertama menunjukkan nilai rerata 1262,350 + 227,9603 pg/ml kemudian pada hari ke-5 nilai rerata menjadi 1112,460 + 220,3795 pg/ml, (p = 0,093). Tidak didapatkan perbedaan yang bermakna nilai rerata kadar VEGF antara kelompok TOHB dan kelompok nonTOHB pada hari pertama (p= 1) maupun hari kelima (p = 0,872). Kesimpulan: Terapi oksigen hiperbarik selama 5 hari tidak meningkatkan kadar VEGF pada pasien ulkus diabetik.

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Background: Diabetic ulcer is a complication of diabetes mellitus which one of the main health problem. In Indonesia the mortality rate of diabetic ulcer is about 17-30%, while the amputation rate is about 15-30%. Hyperbaric oxygen therapy (TOHB) increase endothelial oxygenation and stimulates vascular endothelial growth factor (VEGF) as the most specific and potent growth factor for angiogenesis and increases wound heating process.

Aim of the study: The aim of the study is to know if TOHB can increase the level of VEGF in diabetic ulcer patients.

Methods: Clinical experimental study was conducted from February 2006 until April 2006 of 12 diabetic ulcer patients who received TOHB 30 minutes, 3 times a day for 5 days (TOHB group) and 10 diabetic ulcer patients as a control group who did not receive TOHB (non-TOHB group). The VEGF level in both groups was measured on days 1 and 5.

Results: In TOHB group the mean level of VEGF on day 1 was 1241.325 + 237.6533 pg/ml and became 1244.458 + 264.5641 pg/ml (p = 0.583) on day 5, while in non-TOHB group the mean level of VEGF on day | was 1262.350 + 227.9603 pg/ml and became 1112.460 + 220.3795 pg/ml (p = 0.093) on day 5. There were no significant differentiation of VEGF level between TOHB group and non-TOHB, group both on day 1 (p = 1) and day 5 (p = 0.872).

Conclusion: Hyperbaric oxygen therapy for 5 days did not increase the VEGF level of diabetic ulcer patients."