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Djony Edward Tjandra
Korelasi peak sistolik velocity arteri brakialis dan volume flow draining vein intraoperatif dihubungkan dengan maturitas pada arterovenous fistula brakiosefalika = Coleralation peak sistolik velocity brachial artery and bloodflow rate intraoperative relation with maturation of brachiocephalic fistula
"ABSTRAK
Hemodialisis merupakan tatalaksana renal replacement yang tersering pada pasien gagal ginjal
kronik stadium 5, Akses vaskular dan morbiditas sebagai akibat komplikasi akses merupakan
penyebab utama perawatan di rumah sakit. Kegagalan maturitas merupakan hambatan utama
penggunaan arteriovenous fistula. Tujuan dari penelitian ini adalah untuk mengkaji korelasi peak
sistolik velocity arteri brakialis dan volume flow draining vein intraoperatif dengan
menggunakan ultrasonografi doppler untuk memprediksi maturasi AVF. Uji statistik yang
digunakan adalah uji Mann Whitney dan uji Chi Squere. Hasil yang didapatkan tidak ditemukan
korelasi antara PSV arteri brakialis dengan maturitas. Rerata nilai titik potong volume flow
draining vein intraoperatif 259,43 ml/min dan paska operatif 679,22 ± 65,36 ml/min
dihubungkan dengan maturitas, ini dapat menjadi acuan menetukan perlu tidaknya melakukan
tindakan revisi saat intraoperatif, yang pada akhirnya diharapkan dapat menurunkan angka
kegagalan maturasi AVF. ABSTRACT
Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.
Vascular access for hemodialysis its associated problems is the leading cause for hospital
admission and morbidity.Maturation failure is impeded by issues of maturation. The result from
this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate
measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict
AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV
with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week
679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure
was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF
maturation failure.
;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.
Vascular access for hemodialysis its associated problems is the leading cause for hospital
admission and morbidity.Maturation failure is impeded by issues of maturation. The result from
this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate
measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict
AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV
with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week
679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure
was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF
maturation failure.
;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.
Vascular access for hemodialysis its associated problems is the leading cause for hospital
admission and morbidity.Maturation failure is impeded by issues of maturation. The result from
this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate
measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict
AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV
with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week
679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure
was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF
maturation failure.
;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.
Vascular access for hemodialysis its associated problems is the leading cause for hospital
admission and morbidity.Maturation failure is impeded by issues of maturation. The result from
this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate
measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict
AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV
with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week
679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure
was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF
maturation failure.
;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.
Vascular access for hemodialysis its associated problems is the leading cause for hospital
admission and morbidity.Maturation failure is impeded by issues of maturation. The result from
this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate
measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict
AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV
with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week
679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure
was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF
maturation failure.
;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.
Vascular access for hemodialysis its associated problems is the leading cause for hospital
admission and morbidity.Maturation failure is impeded by issues of maturation. The result from
this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate
measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict
AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV
with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week
679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure
was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF
maturation failure.
;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.
Vascular access for hemodialysis its associated problems is the leading cause for hospital
admission and morbidity.Maturation failure is impeded by issues of maturation. The result from
this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate
measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict
AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV
with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week
679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure
was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF
maturation failure.
"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Faisal Ali Ahmad Kler
Evaluasi spektrum gelombang USG Doppler dan kaitannya dengan Ankle Brachial Index (ABI) dan faktor-faktor risiko pada pasien Peripheral Arterial Disease (PAD) = The evaluation of Doppler Ultrasonography spectral waveform and its relationship with Ankle Brachial Index (ABI) value and risk factors in Peripheral Artery Disease (PAD) paitents
"[ABSTRAK
Salah satu komplikasi dari Peripheral Arterial Disease (PAD) adalah kerusakan tungkai bawah hingga tidak
dapat digunakan untuk beraktifitas. PAD disebabkan oleh gangguan vaskular yang menyebabkan atherosklerotik
pada vaskular di bagian distal. Suatu penelitian kohort di Swedia menyatakan bahwa penyembuhan primer, laju
amputasi dan mortalitas pada pasien PAD berhubungan dengan derajat insufisiensi vaskular. Dengan demikian perlu dilakukan penelitian untuk mengetahui karakteristik vaskular pada kasus PAD secara kuantitatif maupun kualitatif serta hubungannya dengan nilai Ankle Brachial Index (ABI) dan gambaran gelombang Doppler Ultrasonography(DUS). Metode penelitian menggunakan studi potong lintang. Hasil penelitian didapatkan
pasien PAD dengan nilai ABI rata-rata 0,7 dengan gambaran gelombang DUS yang berubah dari trifasik
menjadi non-tirfasik dominan pada arteri infrapopliteal. ABI di bawah 0.9 menunjukkan perubahan pada gelombang DUS dari arteri femoralis hingga a.dorsalis pedis dengan nilai p <0.05. Faktor-faktor risiko yang paling tampak adalah usia di atas 45 tahun yang menunjukkan peningkatan risiko PAD. Selain itu hubungan
ABI dan faktor ?faktor risiko menunjukkan bahwa hiperlipidemia dan diabetes melitus menunjukkan hubungan signifikan dengan p<0,05. Sedang pada hubungan DUS dan faktor-faktor risiko hanya usia >45 tahun yang
tampak secara statistik signifikan meski secara klinis faktor-faktor risiko yang lain menunjukkan jumlah
persentase yang diatas 50%. Disimpulkan bahwa dengan mengetahui nilai ABI dapat ditentukan derajat
keparahan PAD dan juga dengan mengetahui gelombang DUS saja maka dapat diketahui oklusi di tingkat segmen arteri yang mana.Selain itu, usia di atas 45 tahun, hiperlipidemia dan juga diabetes melitus merupakan faktor risiko yang penting untuk terjadinya atherosklerosis dan penyumbatan pada distal arteri. Penggunaan DUS untuk menentukan tingkat penyumbatan sangat informatif dalam hal penggambran gelombang, aman dan murah sehingga dapat menetukan tindakan selanjutnya.ABSTRACT One of the complications of Peripheral Arterial Disease (PAD) is the damage that can be made to the lower
extremities causing difficulties to perform any activities with it. PAD is caused by vascular insufficiency known as atherosclerotic of the distal vascular. A cohort research in Sweden described that the primary recovery, amount of amputation and mortaltiy of PAD patients is related to the degree of vascular insufficiency. As for which, a research should be made to endorsed the knowhow of the vascular characteristics on PAD patients
quantitatively and qualitatively in accordance to ABI value and DUS spectral waveform. Methods used is cross
sectional. The result was, PAD patients had mean ABI value of 0.7 with changes of DUS spectral waveform
from triphasic to non-triphasic dominantly seen in infrapopliteal arteries. ABI less than 0.9 has a significant value towards changes in the spectral waveform from the femoral artery to the dorsal pedis artery. The risk factors such as age above 45 years old shows a significant relationship with the increase in PAD risk (p <0.05). Besides that, p <0.05 was also seen in hyperlipidemia and diabetes mellitus patients with PAD. As for the
relation between DUS and the risk factors, age above 45 years old was seen significant statistically eventhough
clinically all risk factors showed a percentage above 50%. It is concluded that by knowing the ABI value, the
degree of severity of PAD can be acknowledge and by knowing the waveform of DUS only one can know the
level of occlusion in an arterial segment. Besides that, age above 45 years, hyperlipidemia and diabetes mellitus are the important risk factors that causes atherosclerosis and occlusion in distal arteries. The usage of DUS to evaluate the level of occlusion is very informative showing images, it?s safe, low cost and can indicate towards future intervention. ;One of the complications of Peripheral Arterial Disease (PAD) is the damage that can be made to the lower
extremities causing difficulties to perform any activities with it. PAD is caused by vascular insufficiency known as atherosclerotic of the distal vascular. A cohort research in Sweden described that the primary recovery, amount of amputation and mortaltiy of PAD patients is related to the degree of vascular insufficiency. As for which, a research should be made to endorsed the knowhow of the vascular characteristics on PAD patients
quantitatively and qualitatively in accordance to ABI value and DUS spectral waveform. Methods used is cross
sectional. The result was, PAD patients had mean ABI value of 0.7 with changes of DUS spectral waveform
from triphasic to non-triphasic dominantly seen in infrapopliteal arteries. ABI less than 0.9 has a significant value towards changes in the spectral waveform from the femoral artery to the dorsal pedis artery. The risk factors such as age above 45 years old shows a significant relationship with the increase in PAD risk (p <0.05). Besides that, p <0.05 was also seen in hyperlipidemia and diabetes mellitus patients with PAD. As for the
relation between DUS and the risk factors, age above 45 years old was seen significant statistically eventhough
clinically all risk factors showed a percentage above 50%. It is concluded that by knowing the ABI value, the
degree of severity of PAD can be acknowledge and by knowing the waveform of DUS only one can know the
level of occlusion in an arterial segment. Besides that, age above 45 years, hyperlipidemia and diabetes mellitus are the important risk factors that causes atherosclerosis and occlusion in distal arteries. The usage of DUS to evaluate the level of occlusion is very informative showing images, it?s safe, low cost and can indicate towards future intervention. , One of the complications of Peripheral Arterial Disease (PAD) is the damage that can be made to the lower
extremities causing difficulties to perform any activities with it. PAD is caused by vascular insufficiency known as atherosclerotic of the distal vascular. A cohort research in Sweden described that the primary recovery, amount of amputation and mortaltiy of PAD patients is related to the degree of vascular insufficiency. As for which, a research should be made to endorsed the knowhow of the vascular characteristics on PAD patients
quantitatively and qualitatively in accordance to ABI value and DUS spectral waveform. Methods used is cross
sectional. The result was, PAD patients had mean ABI value of 0.7 with changes of DUS spectral waveform
from triphasic to non-triphasic dominantly seen in infrapopliteal arteries. ABI less than 0.9 has a significant value towards changes in the spectral waveform from the femoral artery to the dorsal pedis artery. The risk factors such as age above 45 years old shows a significant relationship with the increase in PAD risk (p <0.05). Besides that, p <0.05 was also seen in hyperlipidemia and diabetes mellitus patients with PAD. As for the
relation between DUS and the risk factors, age above 45 years old was seen significant statistically eventhough
clinically all risk factors showed a percentage above 50%. It is concluded that by knowing the ABI value, the
degree of severity of PAD can be acknowledge and by knowing the waveform of DUS only one can know the
level of occlusion in an arterial segment. Besides that, age above 45 years, hyperlipidemia and diabetes mellitus are the important risk factors that causes atherosclerosis and occlusion in distal arteries. The usage of DUS to evaluate the level of occlusion is very informative showing images, it’s safe, low cost and can indicate towards future intervention. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Novrizal Saiful Basri
Komplikasi infeksi pemasangan kateter lumen ganda sebagai akses hemodialisis = Infection as complication of double lumen catheter as hemodialysis access
"ABSTRAK
Pendahuluan. Salah satu komplikasi tersering dari pemasangan kateter lumen ganda adalah infeksi aliran darah. Tujuan penelitian ini adalah mengetahui angka komplikasi infeksi pada kateter lumen ganda dan faktor yang berhubungan.Metode. Dilakukan studi potong lintang analitik yang melibatkan semua subjek berusia ge;18 tahun yang telah menjalani tindakan pemasangan kateter lumen ganda untuk hemodialisis tahun 2015 di RSCM. Variabel yang dinilai adalah infeksi aliran darah, usia, jenis kelamin, diabetes melitus, riwayat kateter, riwayat infeksi, lokasi, dan lama pemakaian, untuk selanjutnya dilakukan uji statistik. Hasil statistik akan bermakna bila nilai p ABSTRACT
Introduction. One of the most common complication in vascular access was bacteremia or bloodstream infection. The purpose of this study was to know the infection rate in dialysis double lumen catheter DLC and its relating factors.Method. This was a cross sectional analytical study that was carried out by enrolling all ge 18 year old subjects who had underwent surgical insertion of double lumen catheter for hemodialysis in 2015 at Cipto Mangunkusumo Hospital. Variables of bloodstream infection, age, gender, diabetes mellitus, history of previous DLC infection, history of catheter related bacteremia, site of insertion and duration were subjected to statistical analysis. Significance was achieved if p value "
Fakultas Kedokteran Universitas Indonesia, 2017
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UI - Tugas Akhir  Universitas Indonesia Library
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Sari Febriana
Hubungan prokalsitonin dan faktor-faktor lain dengan amputasi ekstremitas bawah pada kaki diabetik terinfeksi di IGD RSCM pada Januari 2013-Juni 2016 = Relations procalcitonin and other factors with lower extremity amputation in infected diabetic foot in the emergency room rscm in January 2013-June 2016
"ABSTRAK
Latar Belakang. Kaki diabetik terinfeksi masih menjadi permasalahan serius bagi penderitanya dan kerapkali berujung pada amputasi ekstremitas bawah. Penentuan agresifitas tindakan diperlukan untuk mencegah perburukan kondisi pasien. Prokalsitonin sebagai salah satu penanda infeksi sensitif diharapkan dapat membantu untuk mendiagnosis lebih awal sehingga manajemen yang diterapkan lebih tepat. Penelitian ini bertujuan untuk mengetahui hubungan prokalsitonin terhadap risiko terjadinya amputasi ekstremitas bawah. Metode. Dilakukan studi analitik komparatif dengan desain cross-sectional yang dilakukan di Divisi Bedah Vaskular dan Endovaskular Departemen Ilmu Bedah FKUI-RSCM periode Januari 2013-Juni 2016 pada semua pasien kaki diabetik terinfeksi yang datang ke IGD RSCM yang tidak disertai infeksi pneumonia, malaria, trauma berat, luka bakar, autoimun, dan karsinoma tiroid medula. Subjek dikelompokkan menjadi amputasi dan tidak, kemudian dilakukan analisis untuk melihat hubungan nilai prokalsitonin terhadap terjadinya amputasi ekstremitas bawah. Sumber data diambil dari rekam medik data sekunder . Dilakukan uji statistik dengan kemaknaan p ABSTRACT
Background. Diabetic foot infection remains a serious problem for the patient and often lead to lower limb amputation. Determination of aggressive action is needed to prevent the worsening of the patient 39 s condition. Procalcitonin as a sensitive marker of infection is expected to help to diagnose early so that management implemented more precise. This study aims to determine the relationship of procalcitonin on the risk of lower limb amputation. Method. Comparative analytic study with cross sectional design conducted at the Vascular and Endovascular Divison Department of Surgery Faculty of Medicine Universitas Indonesia Cipto Mangunkusumo Hospital from January 2013 to June 2016 in all patients with diabetic foot infection who come to the ER RSCM without pneumonia, malaria, severe trauma, burns, autoimmune, and medullary thyroid carcinoma. Subject are grouped into amputation and not amputation, then do analysis to find correlation values of procalcitonin on the occurence of the lower limb amputation. Data are extracted from medical records secondary data and performed statistical tests with significance p "
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
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UI - Tugas Akhir  Universitas Indonesia Library
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Budhi Arifin Noor
Analisis Faktor-Faktor yang Memengaruhi Angka Amputasi Mayor dan Mortalitas Pasien Kaki Diabetik dengan Chronic Limb Threatening Ischemia Satu Tahun setelah Tindakan Revaskularisasi di Rumah Sakit Dr. Cipto Mangunkusumo = Analysis of Factors Affecting Major Amputation and Mortality of Diabetic Foot Patients with Critical Limb Threatening Ischemia One Year After Revascularization at Cipto Mangunkusumo Hospital
"Latar belakang: Chronic limb threatening ischemia (CLTI) merupakan bentuk terparah peripheral arterial disease. Pasien kaki diabetik dengan CLTI memiliki risiko amputasi mayor dan mortalitas paska revaskularisasi dan dipengaruhi beberapa faktor seperti usia lanjut, gagal ginjal kronik, komorbid penyakit jantung dan hipertensi. Indonesia belum memiliki data amputasi mayor dan mortalitas kaki diabetik dengan CLTI setelah revaskularisasi dan faktor-faktor yang berpengaruh. Penelitian ini bertujuan mengetahui angka amputasi mayor dan mortalitas satu tahun pasca revaskularisasi beserta faktor-faktor yang memengaruhi di Rumah Sakit Cipto Mangunkusumo (RSCM).
Metode: Kohort retrospektif pasien kaki diabetik dengan CLTI setelah revaskularisasi di RSCM Januari 2010 – Desember 2020. Pengambilan data rekam medis. Luaran utama amputasi mayor dan mortalitas satu tahun setelah revaskularisasi. Dilakukan analisis bivariat dengan uji Kai Kuadrat, jika persyaratan tidak terpenuhi maka menggunakan Fischer-exact, variabel bermakna diuji lebih lanjut dengan regresi logistik.
Hasil: Penelitian melibatkan 150 subjek. Amputasi mayor dan mortalitas satu tahun setelah revaskularisasi sebesar 27,3% dan 24,7%. Tidak didapatkan hubungan yang bermakna antara faktor-faktor yang diteliti dengan amputasi mayor dan mortalitas satu tahun.
Kesimpulan: Didapatkan angka amputasi mayor dan mortalitas 1 tahun pasca revaskularisasi. Usia lanjut, gagal ginjal kronik, komorbid penyakit jantung dan hipertensi bukan merupakan faktor yang memengaruhi angka amputasi dan mortalitas satu tahun.
Background: Chronic limb threatening ischemia (CLTI) is the most severe form of peripheral arterial disease. Diabetic foot patients with CLTI have major amputation and mortality risk after revascularization and affected by factors such as elderly, chronic kidney disease (CKD), cardiac morbidity and hypertension. In Indonesia there are no data regarding diabetic foot major amputation and mortality with CLTI after revacularization and influencing factors. Study aims to determine one year major amputation and mortality and factors that can affect diabetic foot pastients with CLTI after revascularization.
Methods: Retrospective cohort study on diabetic foot patients with CLTI undergoing revascularization at Cipto Mangunkusumo National Hospital from January 2010 to December 2020. The primary outcome was one-year major amputation and mortality after revascularization. Factors included were age, CKD, cardiac comorbidity and hypertension. We conducted bivariate analysis using Chi Square or Fisher-exact test. Variables were further tested using multivariate test.
Result: 150 subjects were enrolled. One-year major amputation and mortality was 27.3% and 24.7%. There are not significant correlations between factors with major amputation and mortality.
Conclusion: Major amputation and mortality rate one year after revascularization at RSCM are gained. Elderly, CKD, cardiac comorbidity and hypertension are not factors affecting one-year major amputation and mortality."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
UI - Tugas Akhir  Universitas Indonesia Library
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Donie Firdhianto
Faktor yang berhubungan dengan keberhasilan terapi endovaskular dengan plain old ballon angioplasty untuk kasus stenosis vena sentral pada pasien hemodialisys = Factor associated with the success of endovascular therapy with post-old plain ballon angioplasty for central venous stenosis case in hemodialisys patients.
"Stenosis atau oklusi vena sentral merupakan komplikasi serius pada pasien hemodialisis yang secara signifikan menurunkan kwalitas hemodialisis yang efektif patensi semua komponen akses vascular dialisis, termasuk arteri beserta cabangnya, AV anastomosis, vena perifer, dan vena sentral, sangat penting untuk penyediaan dialisis yang konsisten, kuat, nyaman, dan tidak rumit. Etiologi utama  stenosis vena sentral (SVS) sebagian besar adalah sekunder akibat penempatan kateter dialisis yang sementara ataupun menetap pada vena subclavia, vena  jugular internal, dan vena femoralis. Terapi endovascular standar stenosis vena sentral adalah angioplasty dengan balon konvensional.
Analisis deskriptif dilakukan untuk menilai karakteristik serta sebaran data masing-masing variabel yang kemudian disajikan dalam bentuk tabuler atau grafik. Data kategorik disajikan dalam bentuk persentase dan dilakukan uji statistik dengan Chi-square atauFisher (univariat dan bivariat). Data yang akan dibandingkan adalah keberhasilan setelah tindakan Endo Vaskular dibandingkan antara riwayat pemasangan kateter vena sentral di vena subclavia dan vena jugularis interna, dengan tipe kateter, onset gejala, dan durasi pemasangan kateter sebagai variabel perancu.
Dari hasil analisis data di temukan faktor-faktor bermakna yang berhubungan dengan keberhasilan tindakan Endo Vaskular pada pasien stenosis vena sentraldengan POBA (p>0.005) adalah ; onset gejalaklinis (<3 bulan), durasipemasangankateter (<2,5 bulan), riwayat pemasangan kateter sebelumnya (baru 1 kali), Initial stenosis (kurangdari 80), serta diameter POBA (> 10 mm). Diperlukan SOP untuk pemasangan KVS yang sesuai standar KADOQi untuk mengurangi resiko kejadian SVS.
Diperlukan strategi screening yg lebih baik untuk mendeteksi  kasusSVS. Perlu edukasi kepada tenaga medis dan pasien mengenai durasi pemasangan KDL akut. Mengoptimalkan akses vaskuler permanen AVF sebagai Akses vaskular idaman penderita GGK yg menjalani HD.Perlu perhatian yang lebih dari pemerintah atau pihak penjamin kesehatan, karena keterbatasan biaya yang membuat tindakan Endo Vaskuler pada kasus SVS menjadi kurang optimal, terutama pada kasus re-Intervensi dan inisial stenosis yg berat (>80%).
Central venous stenosis or occlusion is a serious complication in hemodialysis patients that significantly decreases effective hemodialysis quality The patency of all components of dialysis vascular access, including arteries and branches, AV anastomosis, peripheral veins and central veins, is essential for the provision of consistent, adequate dialysis, comfortable, and not complicated. The main etiologies of central venous stenosis (SVS) are mostly secondary to temporary or persistent dialysis / chemoteraphycatheter placement in the subclavian vein, internal jugular vein, and femoral vein. Standard endovascular therapy of central venous stenosis is angioplasty with conventional balloons.
Descriptive analysis is done to assess the characteristics and distribution of data for each variable which is then presented in tabular or graphical form. Categorical data is presented in the form of a percentage and statistical tests are performed by Chi-square or Fisheries (univariate and bivariate). Data to be compared is the success after endovascular action compared between the history of central venous catheter placement in the subclavian vein and internal jugular vein, with, catheter type, symptom onset, and duration of catheter placement as confounding variables.
The results of data analysis found significant factors related to the success of endovascular action in patients with central venous stenosis with POBA (p> 0.005) are; onset of clinical symptoms (<3 months), duration of catheter placement (<2.5 months), history of catheter placement (only 1 time), initial stenosis (less than 80), and diameter of POBA (> 10 mm).
According with KADOQi standards is needed to reduce the risk of SVS events. A better screening strategy is needed to detect SVS cases. Need education to medical staff and patients regarding the duration of the installation of acute KDL. Optimizing AVF permanent vascular access as ideal vascular access for people with CRF who undergo HD. More attention is needed from the government or health guarantor, because of the limited costs that make endovascular actions in SVS cases less optimal, especially in cases of re-intervention and severe initial stenosis (> 80%)."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
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UI - Tugas Akhir  Universitas Indonesia Library
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Willy Muljono
Korelasi spektral USG doppler tungkai dengan skor pedis berat pada ulkus kaki diabetik = Correlation between doppler leg ultrasound and severe pedis score on diabetic foot ulcers
"Latar belakang: Ulkus Kaki diabetik atau Diabetic Foot Ulcer merupakan salah satu komplikasi yang berat, karena sering kali ulkus kaki diabetik berakhir dengan amputasi kecacatan dan kematian. USG Doppler merupakan modalitas yang mudah tersedia dan non invasif untuk evaluasi arteri ekstremitas inferior dan dapat mendeteksi tingkat keparahan gangguan aliran darah atau Penyakit Arteri Perifer (PAP) dengan sensitivitas 42,8% dan spesifisitas 97,5%. WHO merekomendasikan klasifikasi Perfusion, Extent/Size, Depth/Tissue Loss, Infection, Sensation (PEDIS) sebagai sarana penegakan diagnosis dan membantu menentukan tatalaksana kaki diabetik. Penelitian ini dilakukan untuk melihat korelasi skor PEDIS dalam menilai gangguan aliran arteri tungkai berdasarkan spektral USG Doppler pada penderita ulkus kaki diabetik di RS Cipto Mangunkusumo Jakarta. Subjek dan Metode: Subjek penelitian adalah pasien ulkus kaki diabetes yang dirawat di Divisi Bedah Vaskular dan Endovaskular FKUI-RS Cipto Mangunkusumo Jakarta dan memenuhi kriteria inklusi dan eksklusi. Penelitian ini dilakukan dengan perhitungan menggunakan sensitivitas estimasi sebesar 80%, error absolut (d=5%), prevalensi estimasi 51,8% maka besar sampel minimal adalah 76. Setelah itu diperoleh data berupa skor PEDIS dan hasil spektral USG pada arteri femoralis, arteri poplitea, arteri dorsalis pedis dan arteri tibialis posterior. Penelitian ini mengumpulkan 81 orang subjek dengan 52 orang (64%) jenis kelamin laki-laki, 29 orang (36%) perempuan dan rata-rata usia 59,8+10,5 tahun. Profil gula darah sewaktu subjek median 265 mg/dl dengan kisaran antara 105-571 mg/dl. Pada tabel 3 dalam menentukan Cut Off skor PEDIS menggunakan kurva ROC (Receiver Operating Characteristic), didapatkan Cut Off arteri poplitea >10, sedangkan arteri dorsalis pedis dan arteri tibialis posterior >8.
Main topics: Diabetic Foot Ulcer or Diabetic Foot Ulcer is one form that is severe, because often diabetic foot ulcers end with disability amputation and death. Doppler ultrasound is an easily available and unlimited modality for lower limb risk and can detect the severity of arterial disease or peripheral arterial sensitivity (PAP) with a sensitivity of 42.8% and specificity of 97.5%. WHO that performs Data Perfusion, Area/Size, Depth/Tissue Loss, Infection, Sensation (PEDIS) as a means of enforcing the diagnosis and helps determine the management of diabetic foot. This study was conducted to look at the PEDIS score in assessing the disturbance of limb arterial flow based on Doppler ultrasound in patients with diabetic foot ulcer at Cipto Mangunkusumo Hospital, Jakarta. Subjects were patients with diabetic foot ulcers performed in the Division of Vascular and Endovascular Surgery of the Faculty of Medicine-Cipto Mangunkusumo Hospital Jakarta and fulfilled the inclusion and exclusion criteria. This research was conducted by calculating using an estimation sensitivity of 80%, absolute error (d = 5%), the largest prevalence of 51.8%, then the minimum sample size was 76. After that data was obtained in the form of PEDIS scores and spectral results of ultrasound in the femoral artery, arteries poplitea, dorsalis pedis artery and posterior tibial artery. This study collected 81 subjects with 52 people (64%) male gender, 29 people (36%) women and an average of 59.8 + 10.5 years. The blood sugar profile was median 265 mg/dl with a range of 105-571 mg/dl. In table 3 in determining the PEDIS score Cut-Off using the Receiver Operating Characteristic curve, obtained Cut-ff popliteal artery> 10, while the dorsalis pedis artery and posterior tibial artery> 8."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
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UI - Tugas Akhir  Universitas Indonesia Library
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Hippocrates Kam
Hubungan kejadian renal artery stenosis terhadap derajat lower peripheral arterial disease berdasarkan ANGIO Score di RSUPN Cipto Mangunkusumo = Relation of incidence of renal artery stenosis in lower peripheral arterial disease based on ANGIO score in Cipto Mangunkusumo Hospital
"ABSTRAK
Penyebab PAD yang paling sering adalah atherosclerosis. PAD berhubungan dengan penyakit atherosklerosis lain seperti renal artery stenosis (RAS). Angka harapan hidup menurun pada pasien yang mengalami RAS, terutama yag stenosisnya diatas 60% namun belum sampai ke tahap gagal ginjal kronik. Dengan penatalaksanaan yang holistik diharapkan angka harapan hidup pasien semakin meningkat.
Tujuan: Untuk mengetahui prevalensi RAS pada pasien PAD serta melihat hubungan antara Angio Score, riwayat hipertensi dan diabetes melitus terhadap derajat RAS yang terjadi.
Metode: Desain yang digunakan adalah desain potong lintang. Penelitian ini dilakukan di RSUPN Dr. Cipto Mangunkusumo selama periode Februari hingga Mei 2019. Penelitian dilakukan di RSUPN Dr. Cipto Mangunkusumo dengan diagnosis lower extremity PAD dan dari pemeriksaan CT Angiografi didapatkan stenosis pada pembuluh darah tungkai, serta tampak arteri renalis pada pemeriksaan CTA yang dilakukan pada pasien tersebut. Pengambilan sampel dilakukan dengan metode total sampling.
Hasil: sampel terbanyak berjenis kelamin wanita (50,8%) sedangkan pria sebanyak 32 orang (49,2%). Sebanyak 90,8% pasien yang diteliti menderita diabetes sedangkan 61,5% dari sampel menderita hipertensi. RAS derajat 1 merupakan yang terbanyak ditemukan. Tidak ada hubungan ANGIO Score terhadap usia, jenis kelamin dan diabetes mellitus, namun ada terhadap hipertensi. Terdapat hubungan antara RAS dengan usia dan hipertensi, namun tidak terdapat hubungan terhadap diabetes mellitus dan jenis kelamin. ANGIO Score dan RAS terdapat hubungan yang bermakna (p<0,001).
Simpulan: Perbandingan ANGIO Score berdasarkan derajat stenosis mendapatkan hasil uji Kruskall Wallis mendapatkan nilai p<0,001 dan dilanjutkan dengan uji Mann Whitney mendapatkan bahwa perbedaan sudah terjadi saat perbandingan derajat stenosis 0 dengan derajat 1 dan seterusnya (p<0,001). Semakin tinggi nilai ANGIO Score (cut off pada score 9), angka spesifitas semakin tinggi.
ABSTRACT
Background: The most common cause of PAD is atherosclerosis. PAD is associated with other atherosclerosis diseases such as renal artery stenosis (RAS). Life expectancy decreases in patients who experience RAS, especially those with stenosis above 60% but have not yet reached the stage of chronic renal failure. With holistic management, it is expected that the patient's life expectancy will increase.
Objective: To determine the prevalence of RAS in PAD patients and to see the relationship between Angio Score, history of hypertension and diabetes mellitus to the degree of RAS that occurred.
Method: The design used is a cross-sectional design. This research was conducted at RSUPN Dr. Cipto Mangunkusumo during the period February to May 2019. The study was conducted at RSUPN Dr. Cipto Mangunkusumo with a diagnosis of lower extremity PAD, which obtained an ABI score of <0.9, severe ischemia until both unilateral and bilateral limb necrosis and CT angiography examination found stenosis in the leg veins, and the appearance of the renal artery on CTA examination performed on patients that is. Sampling is done by the total sampling method.
Results: the most samples were female (50.8%) while men were 32 (49.2%). As many as 90.8% of patients studied had diabetes while 61.5% of the samples suffered from hypertension. 1st degree RAS is the most found. There is no relationship between ANGIO Score with age, gender and diabetes mellitus, but there is a hypertension. There is a relationship between RAS and age and hypertension, but there is no relationship to diabetes mellitus and gender. ANGIO Score and RAS have a significant relationship (p <0.001).
Conclusion: The comparison of ANGIO Score based on the degree of stenosis obtained the results of the Kruskall Wallis test obtained a p value of <0.001 and continued with the Mann Whitney test found that the difference had occurred when the ratio of stenosis degrees was 0 with degrees 1 and so on (p <0.001). The higher the ANGIO score (cut off at score 9), the higher the specificity."
Depok: Fakultas Kedokteran Universitas Indonesia, 2019
T55567
UI - Tesis Membership  Universitas Indonesia Library
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Hendra Wibowo
Pengaruh Latihan Isometrik Terhadap Perubahan Diameter, Peak Systolic Velocity, Intima Media Thickness dan Volume flow Arteri Radialis dan Vena Cephalica Pada Pasien Gagal Ginjal Kronis Sebelum Tindakan Pembuatan Fistula Radiocephalica = Effect of Isometric Exercise on Changes in Vascular Diameter, Peak Systolic Velocity, Intima Media Thickness and Volume flow of Radial Artery and Cephalic Vein in Patients with Chronic Renal Failure Before Radiocephalic AV Fistula Making Procedure
"Penyakit Ginjal Kronik (PGK) merupakan kelainan struktur atau fungsi ginjal yang mengalami penurunan selama 3 bulan yang mengalami peningkatan prevalensi kasus. Peningkatan prevalensi kejadian PGK juga akan meningkatkan kebutuhan hemodialisis dan penggunaan arteriovenous fistula (AVF). Maturasi dan keberhasilan AVF dipengaruhi oleh faktor pasien dan struktur vaskular. Latihan isometrik dilaporkan dapat meningkatkan diameter vena, arteri, dan peak systolic velocity (PSV). Tujuan penelitian ini untuk melihat pengaruh latihan isometrik pre operatif terhadap diameter vena cephalica, diameter arteri radialis, PSV, intimal medial thickening (IMT), dan volume flow arteri radialis. Desain penelitian adalah eksperimental pre and post-test study, dilakukan di RSUPN Cipto Mangunkusumo. Penelitian dilaksanakan follow up pasien selama 8 minggu latihan isometri. Total subjek penelitian sebanyak 38 orang. Usia median subjek penelitian yaitu 56 tahun dengan rentang usia 20 sampai 71 tahun. Terdapat perbedaan yang signifikan antara diameter vena (p=0,003), PSV (p=0,032), dan volume flow (p=0,030) subjek penelitian pre dan post latihan isometrik. Terdapat perbedaan signifikan antara perubahan diameter vena terhadap komorbid diabetes melitus. Tidak terdapat perbedaan bermakna antara perubahan diameter vena, PSV, dan volume flow paska latihan ismoetrik terhadap kelompok usia, komorbid, dan jenis kelamin (p>0,005). Penggunaan latihan isometrik dapat meningkatkan perubahan diameter vena, PSV dan volume flow pada pasien sebelum pembuatan AVF radiocephalica. Tidak terdapat perubahan signifikan diameter vena pasca latihan isometrik pada penderita diabetes melitus.
Chronic Kidney Disease (CKD) is a disorder of kidney structure or function that has decreased over 3 months and has an increased prevalence of cases. The increasing prevalence of CKD will also increase the need for hemodialysis and the use of arteriovenous fistula (AVF). AVF maturation and success are influenced by patient factors and vascular structure. Isometric exercise is reported to increase the diameter of veins, arteries, and peak systolic velocity (PSV). Objective: Analyzing the effect of preoperative isometric exercise on the diameter of veins, arteries, PSV, intimal medial thickening (IMT), and volume flow. The research design was an experimental pre and post-test study, conducted at Cipto Mangunkusumo Center National Hospital. The study was conducted to follow up patients for 8 weeks of isometric exercise. The total study subjects were 38 people, with the highest prevalence being men, and comorbid hypertension. The median age of the research subjects was 56 years with an age range of 20 to 71 years. There were significant differences between venous diameter (p=0.003), PSV (p=0.032), and volume flow (p=0.030) in pre and post isometric training subjects. There was significant difference between cephalic vein diameter to diabetes mellitus group. There was no significant difference between changes in radial artery diameter, PSV, IMT, and post-isometric exercise volume flow for the age, comorbid, and sex groups (p>0.005). The use of isometric exercises can increase changes in venous diameter, PSV and volume flow in patients before the making of radiocephalic AVF. There was no significant change in venous diameter after isometric exercise in patient with diabetes mellitus.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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Hendri
Tingkat Kesembuhan Ulkus Kaki Diabetik dengan Penyakit Arteri Perifer yang Dilakukan Revaskularisasi dan yang Tidak Dilakukan Revaskularisasi di RSUPN Cipto Mangunkusumo, Jakarta = Healing Rate Comparison of Revascularized and Non-revascularized Diabetic Foot Ulcers with Peripheral Arterial Disease
"Latar Belakang: Tindakan revaskularisasi menjadi hal yang penting dalam penyembuhan ulkus kaki diabetikum dengan penyakit arteri perifer, karena berperan dalam merestorasi fungsi perfusi jaringan tungkai. Selain itu, beberapa studi juga melaporkan bahwa tindakan ini juga dapat mengurangi risiko komplikasi kardiovaskular. Namun, belum ada penelitian di Indonesia yang secara ekslusif membahas efektivitas revaskularisasi pada pasien ulkus kaki diabetik dengan penyakit arteri perifer. Tujuan penelitian ini adalah membandingkan tingkat kesembuhan ulkus kaki diabetik dengan penyakit arteri perifer terhadap pasien yang dilakukan revaskularisasi maupun yang tidak dilakukan revaskularisasi.
Metode: Penelitian ini berlangsung dari Januari hingga Mei 2023, di RSUPN Cipto Mangunkusumo, dengan desain kohort retrospektif.
Hasil: Jumlah sampel pada masing-masing tindakan adalah 23 pasien. Tingkat kesembuhan pasien ulkus kaki diabetik dengan penyakit arteri perifer yang mendapatkan tindakan revaskularisasi adalah 78,3% (18 pasien), sementara yang tidak mendapatkan tindakan revaskularisasi 26,1% (6 pasien). Pasien yang menjalani tindakan revaskularisasi memiliki peluang 14,944 (1,102–202,692) kali lebih tinggi untuk mengalami kesembuhan luka dibandingkan pasien ulkus kaki diabetik dengan penyakit arteri perifer yang tidak mendapatkan tindakan revaskularisasi (p < 0,01). Setelah mengontrol faktor perancu, tindakan revaskularisasi tetap ditemukan berpengaruh terhadap kesembuhan pasien dengan WIfI stadium 2-3 memiliki peluang 11,926 (1,438–98,883) untuk mengalami penyembuhan luka dibandingkan pasien dengan WIfI stadium 4.
Kesimpulan: Tingkat kesembuhan pasien revaskularisasi lebih tinggi dibandingkan non-revaskularisasi. Selain itu, keparahan luka berdasarkan WIfI juga berpengaruh pada kesembuhan luka pasien.
Background: Revascularization is important in the healing of diabetic foot ulcers with peripheral arterial disease, because it plays a role in restoring the perfusion function of the leg tissues. In addition, several studies also report that this action can also reduce the risk of cardiovascular complications. However, there is no study in Indonesia that exclusively discusses the effectiveness of revascularization in diabetic foot ulcer patients with peripheral arterial disease. This study aims to compare the healing rates of diabetic foot ulcers with peripheral arterial disease in patients who underwent revascularization and those who did not undergo revascularization.
Methods: This study was conducted from January to May 2023, at Cipto Mangunkusumo General Hospital, with a retrospective cohort design.
Results: The number of samples in each group was 23 patients. The healing rate for diabetic foot ulcer patients with peripheral arterial disease who received revascularization was 78.3% (18 patients), while those who did not receive revascularization was 26.1% (6 patients). Patients who underwent revascularization had a 14.944 (1.102–202.692) times higher chance of getting their wound healed than patients with diabetic foot ulcers with peripheral arterial disease who did not receive revascularization (p <0.01). After controlling for confounding factors, revascularization was still found to have an effect on healing. Patients with WIfI stage 2-3 had a 11,926 (1,438–98,883) chance of experiencing wound healing compared to patients with stage 4 WIfI.
Conclusion: The wound healing rate for revascularized patients is higher than non-revascularized patients. In addition, the severity of the wound based on WIfI score also affects the patient's wound healing.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tesis Membership  Universitas Indonesia Library
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