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"ASBTRACTPurpose: Splenic infarction may occur if the splenic branches are injured or ligated accidentally during gastrectomy. We used three-dimensional computed tomography (3D-CT) imaging to distinguish the vascular anatomy of the splenic hilum in individual patients, focusing on the splenic polar branches and the gastric branches.Methods: The subjects of this study were 104 patients who underwent computed tomography (CT) with intravenous contrast before gastrectomy. SYNAPSE 3D® (Fujifilm Medical, Tokyo, Japan) was used to generate the 3D-CT images. The total spleen volume and the area supplied by the superior polar artery (SPA) in each patient were estimated using the "liver analysis" function.Results: The SPA without the gastric branch (supplying only the spleen), the SPA with the gastric branch (supplying both the stomach and the spleen), and the posterior gastric artery (supplying only the stomach) were present in 14, 45, and 18% of the patients, respectively. The SPA supplied 12% of the total spleen volume on average; however, it supplied over 30% in two patients.Conclusion: We identified the vascular anatomy around the splenic hilum in over 100 patients. Based on our findings, we recommend preservation of the SPA when it is supplying a large area of the spleen. Preoperative 3D-CT analysis provides useful information to optimize safe gastrectomy."

"A reduction in lung capacity to oxygenize blood as well as in cardiovascular capacity to distribute blood may cause hypoxemia, which could then lead to tissue hypoxia and cellular death. The aim of oxygen treatment is to supply the minimum oxygen concentration needed to achieve adequate tissue oxygenation. There are various methods that can be used to supply oxygen, and the amount of oxygen requirement could also be calculated. Treatment methods are classified into STOT and LTOT. The benefit of oxygen treatment is increased survival, influence on the blood vessels, improved exercise capacity, and positive influence on the respiratory and neuropsychological systems. As with the case with pharmacological treatment, oxygen should be administered at certain doses to achieve greatest efficacy with the least toxicity."

"Penyakit jantung koroner merupakan salah satu penyebab kematian terbanyak, yang dapat dialami oleh baik laki-laki ataupun perempuan. Salah satu tata laksana yang dapat dilakukan untuk kondisi ini adalah Coronary Artery Bypass Graft (CABG). Tujuan dari penelitian ini adalah mengetahui hubungan antara lama rawat, jumlah pembuluh arteri koroner yang tersumbat, dan hipertensi terhadap kematian pasien CABG di Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita. Desain penelitian yang dipilih adalah restrospective cohort. Data penelitian ini diperoleh dari rekam medik pasien yang tercatat di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita. Data pada penelitian ini melibatkan 66 subjek penelitian. Data yang dikumpulkan kemudian diuji dengan Chi-square dan Fisher untuk menentukan nilai probabilitas (p).Hasil penelitian ini menunjukkan bahwa tidak ada hubungan bermakna antara mortalitas dengan lama rawat (RR=1,57 IK95%=0,60-4,08 p=0,35), jumlah pembuluh arteri koroner yang tersumbat (RR=0,90 IK95%=0,25-3,27 p=1,00), dan riwayat hipertensi (RR=1,59 IK95%=0,41-6,21 p=0,72). Faktor lama rawat, jumlah pembuluh darah arteri koroner yang tersumbat, dan riwayat hipertensi tidak memiliki hubungan yang bermakna terhadap mortalitas subjek penelitian dalam waktu 6 tahun pasca tindakan coronary artery bypass graft.

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Coronary artery disease is one of the most common cause of death, that can be found both in men and women. This condition can be treated with some surgical intervention such as Coronary Artery Bypass Graft (CABG). The purpose of this study is to determine the association between length of stay, the number of diseased coronary artery vessel, and hypertension with mortality in post-CABG patients after 6 years in National Cardiovascular Center Harapan Kita. This study uses retrospective cohort as its design. Data used in this study involving 66 subjects. The data is then tested using Chi-square and Fisher to see the value of probability (p).Based on data analysis, it is found that there is no significant association between mortality with length of stay (RR=1.57 95%CI=0,60-4,08 p=0.346), the number of diseased coronary artery vessel (RR=0.90 95%CI=0.25- 3.27 p=1.000), and hypertension (RR=1.59 95%CI=0.41-6.21 p=0.716). Length of stay, the number of diseased coronary artery vessel, and hypertension are not associated with the mortality of post-coronary artery bypass graft patients after 6 years."

"ABSTRAKCoronary Artery Bypass Grafting (CABG) merupakan prosedur pembedahan revaskularisasi yang digunakan untuk memperbaiki dan meningkatkan aliran darah ke jantung. Masalah paling umum yang timbul pada pasien pasca CABG adalah nyeri pasca CABG/Post CABG pain (PCP). Latihan peregangan otot pernafasan merupakan suatu latihan untuk memelihara dan mengembangkan fleksibilitas atau kelenturan otot pernafasan dan dapat mengurangi nyeri. Beberapa jenis latihan untuk mengurangi nyeri telah banyak diidentifikasi seperti latihan aerobik dan anaerobik, namun hanya sedikit penelitian yang telah mengkaji keefektifan latihan peregangan otot dan latihan nafas dalam pada pasien CABG khususnya terhadap nyeri. Tujuan penelitian ini untuk mengidentifikasi keefektifan latihan peregangan otot pernafasan terhadap penurunan nyeri pada pasien pasca coronary artery bypass grafting di rumah sakit jantung dan pembuluh darah Harapan Kita Jakarta. Penelitian quasi experiment ini menggunakan sampel 30 responden, masing-masing 15 responden untuk kelompok intervensi dan kelompok kontrol. Instrumen yang digunakan untuk mengukur nyeri adalah visual analog scale (VAS) dengan kombinasi numeric pain scale dengan skala 1-10. Pengumpulan data dilakukan sendiri oleh peneliti dan data yang diperoleh dianalisa secara univariat, bivariat dan general linear model (GLM) menggunakan t test, anova, korelasi dan GLM repeated measures. Hasil penelitian menunjukkan ada perbedaan yang bermakna antara tingkat nyeri sebelum dan sesudah latihan peregangan otot pernafasan pada kelompok intervensi dan kontrol (p=0.018, α=0.05). Penelitian ini diharapkan dapat bermanfaat bagi layanan keperawatan dan perkembangan ilmu keperawatan dalam menggunakan latihan peregangan otot sebagai salah satu terapi modalitas keperawatan untuk mengurangi nyeri. Direkomendasikan untuk penelitian lanjut tentang latihan ini pada pasien pasca bedah kardiotorak lainnya.

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ABSTRACTCoronary Artery Bypass Grafting (CABG) is a revascularization surgery procedure which is done to repair and improve the blood circulation to heart. The most common problem encountered by patient during post CABG is Post CABG pain (PCP. Respiratory muscle stretching exercise is an exercise to maintain and develop flexibility of respiratory muscle and gon reduce pain. Some kinds of exercise to reduce pain have been identified such as aerobic and anaerobic exercises, though only a few researches which have studied the effectiveness of muscle stretching exercises and deep breathing for CABG patients especially towards pain. The purpose of this research is to identify the effectiveness of respiratory muscle stretching towards the decrease of pain on patients post coronary artery bypass grafting in Harapan Kita Cardiovascular Hospital Jakarta. This Quasi Experimental research used the sample of 30 respondents, each 15 respondent for intervention and control groups. Instrument used to measure pain is visual analog scale (VAS) by the combination of numeric pain scale at 1-10. Collection of the data was carried out by the researcher herself and the collected data was analyzed in univariate, bivariate, and general linear model (GLM) by using i test, anova, correlation and general linear model (GLM) repeated measures. The result of the research shows that there was a significant difference between the degree of pain before and after the respiratory muscle exercises on the intervention and control group (p=0.018, a 0.05). This research is expected to be beneficial for nursing service and development of nursing science in using muscle stretching exercises as one of the nursing modality therapy in reducing pain. It is also recommended for the further research about this kind of exercise for the other cardiothorac post surgery patients."

"Latar Belakang: Beberapa penelitian telah membuktikan faktor-faktor yang berpengaruh pada maturasi fistula arteriovenosa, namun pengaruh profil lipid(LDL,HDL, Trigliserida, Kolesterol total) belum terlalu jelas.Tujuan: Untuk mengetahui pengaruh profil lipid pada maturasi fistula arteriovenosapada pasien penyakit ginjal tahap akhir dengan komorbid diabetes mellitus tipe 2.Metode: Desain yang digunakan adalah desain potong lintang. Penelitian inimengambil data sekunder dari penelitian dr. Dedy Pratama, SpBSubVE yangmelakukan penelitian di RSUPN Dr. Cipto Mangunkusumo, RS Hermina Bekasi Barat,dan RS Hermina Depok pada pasien penyakit gagal ginjal tahap akhir dengan diabetesmellitus tipe 2 dan dilakukan operasi fistula arteriovenosa brachiocefalica.Hasil: Total sampel 67, sampel terbanyak berjenis kelamin laki-laki 34 (50,7%)sedangkan perempuan sebanyak 33 (49,3%). Sebanyak 47 (70,1%) matur, sedangkanyang tidak matur 20 (29,9%). Didapatkan nilai rerata LDL pada sampel matur FAV110,13(32,786) dan tidak matur 135,6(39,317) P=0,008. Didapatkan diameter arteribrachialis pre operasi 4,25 mm(0,68) pada kelompok matur, 3,85(0,69) pada tidak maturP=0,029. Volume aliran pasca operasi 568,48(44,9-1451) pada kelompok matur,347,12(43,1-1295) pada kelompok tidak matur dengan P=0,031. Usia, hipertensi,merokok, gula darah sewaktu, indeks massa tubuh, trigliserida, HDL, kolesterol total,volume aliran pre operasi, IMT feeding artery, PSV feeding artery per dan pascaoperasi tidak berpengaruh pada maturasi.Simpulan: Nilai LDL lebih tinggi dari 119,5 mg/dL dapat menurunkan angka maturasiFAV pada pasien PGTA dengan DM tipe 2. Sedangkan kolesterol total, HDL, dantrigliserida pada penelitian ini tidak berpengaruh pada maturasi FAV.

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Background: Several studies have shown the factors that influence the maturation of

arteriovenous fistulas, but the effect of the lipid profile (LDL, HDL, triglycerides, total

cholesterol) is not clear.

Objective: To determine the effect of lipid profiles on the maturation of arteriovenous

fistulas in end-stage renal disease patients with comorbid type 2 diabetes mellitus.

Method: The design used is a cross-sectional design. This study took secondary data

from the research of dr. Dedy Pratama, SpBSubVE who conducted research at RSUPN

Dr. Cipto Mangunkusumo, West Bekasi Hermina Hospital, and Hermina Depok

Hospital in patients with end-stage renal failure with type 2 diabetes mellitus and

undergoing surgery for fistula arteriovenosa brachiocefalica.

Results: The total sample was 67, the largest sample was male 34 (50.7%), while the

female was 33 (49.3%). A total of 47 (70.1%) were mature, while 20 (29.9%) were not

mature. The average value of LDL in the mature FAV sample was 110.13 (32.786) and

the immature sample was 135.6 (39.317) P = 0.008. The preoperative brachial artery

diameter was 4.25 mm (0.68) in the mature group, 3.85 (0.69) in the immature P =

0.029. Postoperative flow volume was 568.48 (44.9-1451) in the mature group, 347.12

(43.1-1295) in the immature group with P = 0.031. Age, hypertension, smoking,

temporary blood sugar, body mass index, triglycerides, HDL, total cholesterol,

preoperative flow volume, BMI of artery feeding, PSV feeding arteries per and

postoperatively had no effect on maturation.

Conclusion: LDL values higher than 119.5 mg/dL can reduce the maturation rate of

AVF in ESRD patients with type 2 diabetes. Meanwhile, total cholesterol, HDL, and

triglycerides in this study had no effect on FAV maturation."

"Profit lipid yang abnormal merupakan faktor risiko mayor untuk penyakit jantung koroner (PJK) dan beberapa penelitian sebelumnya menunjukkan adanya hubungan dengan gangguan pertumbuhan prenatal (BBLR) atau postnatal. Penelitian ini bertujuan untuk mengetahui besarnya risiko mempunyai profil lipid yang abnormal pada individu dengan gangguan pertumbuhan prenatal. Penelilian dilakukan pada populasi kohort di Kecamatan Tanjungsari Kabupaten Sumedang Sawa Barat yang lahir tahun 1988-1990. Kriteria BBLR berdasarkan pada bayi lahir > 37 minggu dengan berat badan lahir 2700 gram. Kriteria inklusi, BBLR dan non-BBLR dengan pertumbuhan postnatal sampai usia 36 bulan adekuat, mempunyai catatan lengkap BB lahir, TB lahir sampai usia 36 bulan dan catatan BB, TB pada usia 12-14 tahun, bersedia ikut dalam penelitian.Setelah dilakukan pemeriksaan profil lipid, validitas data dan stratifikasi, dari 871 orang subyek yang diteliti, hanya 229 yang memenuhi kriteria yang telah ditentukan. Ditentukan sebanyak 105 subyek penelitian melalui simple random yang mengalami dislipidemia dimasukkan kedalam kelompok kasus, untuk kelompok kontrol, diambil jumlah yang sama dengan matching. Untuk membandingkan data-data antara kedua kelompok dipakai uji student t-test, sedangkan menjawab masalah utama yaitu besarnya risiko mengalami dislipidemia digunakan perhitungan odds ratio dengan menggunakan table 2x2.Hasi penelitian karakteristek umum kedua kelompok (umur, jenis kelamin, berat badan dan tinggi bada) tidak ada perbedaan bermakna p<0,05. Tidak ada perbedaan yang bermakna kadar kolesterol total dan kolesterol LDL remaja dengan BBLR dibandingkan remaja yang non BBLR, p>0,05. Radar trigliserida lebih tingi bermakna pada remaja dengan BBLR dibandingkan dengan remaja non BBLR, p=0,00004, sedangkan kadar kolesterol HDL lebih rendah bermakna pads remaja dengan BBLR dibandingkan remaja non-BBLR, p=0,00004.. Pada remaja dengan BBLR mempunyai risiko lebih besar untuk teijadi dislipidemia dibandingkan remaja non BBLR dengan odds ratio 3,26 95%CI 1,77-6,02; p=0,00003.Kesimpulan : Remaja dengan gangguan pertumbuhan prenatal mempunyai risiko lebih besar untuk terjadi dislipidemia.

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Abnormal lipid profile is an independent risk factor for coronary artery disease. Some studies have shown that small for gestational age (SGA) was associated with abnormal plasma lipid profile in adolescent and adulthood. This study was conducted to asses whether SGA children are more prone to have abnormal plasma lipid profile.

This study was performed to cohort population in Kecamatan Tanjungsari Kabupaten Sumedang-West Java who was born between 1988-1990. The criteria of SGA are term infants, gestational age of > 37 weeks, birth weight : 2700 grams and birth length 45-50 centimeters. Appropriate gestational age (AGA) are term infants, gestational age > 37 weeks; birth weight > 2700 grams and birth length > 47 centimeters. Inclusion criteria were SGA and AGA with postnatal growth up to 36 months adequately, complete birth weight and birth length records up to 36 months as well and birth weight and birth length during 12-14 years of age, willing to accompany in this study.

After lipid profile examination was performed, validity and stratification data of 871 subjects, 229 subjects were complied with including criteria. With the simple random, I05 subjects of dislipidemia were decided as the case group and the same number of control group were included as matching. The significance of differences between two groups was examined using student t -test and Mann Whitney. A p level of 0.05 was considered statistically significant.

There were no differences in general characteristic of both group (age, gender, birth length) p>0.05. No significant differences between total cholesterol and LDL cholesterol levels in subject with SGA compared with AGA, p>0 05. Triglyceride level was higher found significant in subject SGA compared with AGA, p=0.00004, however the HDL cholesterol level have a significant more less in subject SGA compared with AGA, p=0.00004. Subject with SGA have an increase risk to develop of dislipidaemia compare with subject AGA, odds ratio of 3.26, 95%CI 1.77-6.O2;p=0.00003.

Conclusion :

Subject with prenatal growth retardation have an increase risk for dislipidaemia in adult life."

"Latar Belakang: Derajat kompleksitas lesi koroner yang berat merupakan prediktor mortalitas dan Major Adverse Cardiovascular Event (MACE) serta penentuan revaskularisasi pada penyakit jantung koroner (PJK). Fragmented QRS (fQRS) dinilai sebagai penanda iskemia atau cedera miokardium PJK. Hubungan fQRS dan derajat kompleksitas lesi koroner perlu diteliti lebih lanjut pada pasien PJK di Indonesia. Tujuan: Mengetahui hubungan fQRS dan derajat kompleksitas lesi koroner pada pasien penyakit jantung koroner. Metode: Penelitian potong lintang di Rumah Sakit Cipto Mangunkusumo, mengambil data sekunder pada 172 pasien jantung koroner yang menjalani percutaneous coronary intervention (PCI) di Cath Lab pada bulan Januari-Juni 2018 secara total sampling. Pasien dibagi berdasarkan adanya tidaknya fQRS. Data demografi, klinis, dan deajat kompleksitas (skor Gensini) diteliti. Hubungan antara adanya fQRS dan derajat kompleksitas lesi koroner dianalisis dengan uji kesesuaian. Hasil: Sembilan puluh empat (54,6%) subjek terdapat gambaran fQRS. Pada analisis didapatkan hubungan antara fQRS dengan kategori skor Gensini ringan-sedang dan ringan-berat dengan kesesuaian baik (kappa 0,721 dan 0,820; p <0,001). Hubungan dengan kesesuaian yang baik juga didapatkan antara fQRS dan PJK signifikan (kappa 0,670; p <0,001) serta fQRS dan PJK multivessel (kappa 0,787; p <0,001). Simpulan: Terdapat hubungan fragmented QRS complexes dan derajat kompleksitas lesi koroner pada pasien penyakit jantung koroner.

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Background. The severity of coronary artery lesion is used as a predictor of mortality, major adverse cardiovascular event, and revascularization in coronary artery disease (CAD). Fragmented QRS complex (fQRS) as a novel marker of myocardial ischemia/scar in patients with coronary artery disease. The relationship between the two in Indonesia should be studied further.

Purpose. To determine the relationship between fQRS and the severity of coronary lesion in coronary artery disease.

Methods. A cross sectional study was conducted at Cipto Mangunkusumo Hospital. Secondary data were taken from 172 patients with CAD who underwent percutaneous coronary intervention (PCI) from January-June 2018 with total sampling. Patients were divided based on the existence of fQRS. Demographic, clinical, and severity of coronary artery lesion (Gensini score) characteristics were studied. Data were analysed using Cohens kappa agreement test.

Results. fQRS was present in 94 subjects (54.6%). Bivariate analysis showed a significant difference between fQRS with mild-moderate Gensini score as well as mild-severe Gensini score (kappa 0,721 and 0,820; p<0,001), fQRS with significant CAD (kappa 0.670; p<0,001), and fQRS with multivessel CAD (kappa 0.787; p<0,001).

Conclusion. There is a significant relationship between fQRS and the degree of severity of coronary lesion in coronary artery disease patients."

"Tujuan : Menilai korelasi antara kelentutan atrioventrikular (Cn) dengan tekanan sistolik arteri pulmonal dan besarnya penurunan tekanan arteri pulmonal segera setelah dilakukan komisurotomi mitral transvena perkutan (KMTP). Latar Belakang : Pada pasien stenosis mitral (SM) terjadinya peningkatan tekanan arteri pulmonal dan beratnya gambaran klinis tidak selalu berkaitan dengan area efektif katup mitral (MVA) serta perbedaan tekanan transmitral (MVG) karena beberapa penelitian menunjukkan bahwa kelenturan atrioventrikular (Cn) juga mempengaruhi. Metode : Merupakan studi potong lintang yang dilakukan pada 30 pasien SM berat yang menjalani KMTP di PJNHK dari bulan Januari 2008 s/d oktober 2010. Pasien dibagi 2 kelompok, yakni kelompok I dengan Cn ::; 4 ml/mmHg dan kelompok II dengan Cn > 4 ml/mmHg. Pemeriksaan ekokardiografi dengan Vivid 7 dilakukan sebelum KMTP dan dalam 24 sampai 72 jam setelah KMTP. Cn ditentukan dengan persamaan : Cn = 1,270 (MV A I E-wave downslope), dan tekanan sistolik arteri pulmonal (sPAP) =Tricuspid valve gradient (TVG) + 10 mmHg. Hasil : Dari 194 subjek yang menjalani KMTP didapatkan sampel 30 orang yang memenuhi kriteria inklusi dan eksklusi. Proporsi kasus SM pada penelitian ini lebih banyak pada perempuan yaitu 70% dan usia rata- rata 36 tahun. Perbandingan sPAP pada kedua kelompok, baik sebelum ( 66,8 ± 21,7 mmHg V s 71,5 ± 31,5 mmHg, P = 0,64) maupun setelah KMTP ( 49,3 ± 10,8 mmHg Vs 56,4 ± 19,9 mmHg, P = 0,31) tidak berbeda bermakna, demikian pula besamya penurunan sPAP setelah KMTP pada kedua kelompok tidak berbeda bermakna ( 17,7 ± 15 mmHg Vs 15,7 ± 15,8 mmHg, P = 0,60). Kesimpulan : Kelenturan atrioventrikular (Cn) tidak mempengaruhi tekanan arteri pulmonal dan besamya perubahan tekanan arteri pulmonal segera setelah KMTP.

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Objectives : The purpose of this study is to evaluate the correlation beetwen Cn with systolic artery pulmonal and the magnitude of decreasing systolic pulmonary pressure after balloon mitral valvuloplasty. Background : In patients with mitral stenosis (MS), the increase in pulmonary arterial pressure and severity of the clinical symptom are not only related to the mitral valve area and mitral vave gradient, but also related to the atrioventricular compliance (Cn). Methods : This is a cross sectional study in Thirty patients with severe mitral stenosis underwent Balloon Mitral Valvuloplasthy (BMV) procedure in NCCHKfrom January 2008 until October 20 I I. The patients were divided into two group, group I with Cn ~ 4 ml/mmHg and group II with Cn > 4 ml/mmHg. Echocardiograpy was done before BMV and 24 unti/72 hours after BMVwith vivid 7. Cn was derivedfrom the equation that has been previously validated (ie, Cn = I270 x [MV area by PHT I mitral Ewave downslope] and systolic pulmonary artery pressure(sPAP) = Tricuspid valve gradient (TV G) + I 0 mmHg. Results : There were I94 patients underwent BMV, but only 30 patients meet the inclusion and exclusion criteria. The women proportion were 70% and average of ages were 36 years old. The systolic pulmonary artery pressure in both group were not difference before ( 66,8 ± 2I, 7 mmHg Vs 7I,5 ± 3I,5 mmHg, P = 0,64) and after BMV ( 49,3 ± I0,8 mmHg Vs 56,4 ± I9,9 mmHg, P = 0,3I) and also the magnitude of decreasing systolic pulmonary artery pressure after BMV not difference between the groups. Conclusion: In patients with severe mitral stenosis, atrioventricular compliance was not affected systolic pulmonary artery pressure before and after BMV nor the magnitude of systolic pulmonaty artery pressure after BMV."