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Abstrak :
Latar Belakang: COVID-19 merupakan penyakit infeksi yang menjadi sebuah pandemi global dalam waktu singkat. Radiologi memegang peranan penting menggunakan modalitas radiografi toraks untuk identifikasi COVID-19 dengan melihat gambaran ground glass opacity (GGO) dan konsolidasi. Melakukan interpretasi radiografi toraks dengan benar masih menjadi tantangan dimana akurasi tertinggi dipegang oleh dokter spesialis radiologi divisi toraks. LUNIT INSIGHT CXR merupakan salah satu sistem artificial intelligence (AI) yang dikembangkan untuk meningkatkan efisiensi dan akurasi pembacaan radiografi toraks. Hingga saat ini berlum ada sistem AI lain di RSUPN Cipto Mangunkusumo yang dapat menginterpretasi radiografi toraks. Penelitian ini bertujuan untuk mengevaluasi manfaat sistem AI LUNIT INSIGHT CXR dalam membantu dokter radiologi mendeteksi GGO dan konsolidasi yang merupakan gambaran radiografi toraks paling sering pada pasien COVID-19. Metode: Studi ini merupakan studi retrospektif menggunakan gambaran radiografi toraks pasien tersangka COVID-19. Radiografi toraks diinterpretasi oleh dokter radiologi umum tanpa dan dengan bantuan sistem AI dibandingkan dengan interpretasi dokter radiologi divisi toraks menggunakan variabel ada atau tidaknya lesi, interpretasi GGO, interpretasi konsolidasi serta interpretasi berdasarkan lokasi lapangan paru yang terlibat. Hasil: Kelainan paling banyak ditemukan adalah GGO dengan lokasi di lapangan bawah kedua paru baik oleh dokter radiologi umum dan dokter radiologi divisi toraks. Ditemukan konkordans penilaian GGO yang rendah (< 0,8) sedangkan penilaian konsolidasi ditemukan konkorans baik (> 0,8). Berdasarkan lokasi ditemukan konkordans terendah di lapangan tengah paru kanan (0,773) pada kelompok dengan bantuan sistem AI. Konkordans pada lokasi lain ditemukan baik (> 0,8). Tidak ditemukan perbedaan signifikan pada konkordans antara tanpa dan dengan bantuan sistem AI. Simpulan: Dalam studi ini tidak ditemukan perbedaan kesesuaian penilaian GGO maupun konsolidasi pada radiografi toraks antara dokter radiologi tanpa dan dengan bantuan sistem AI LUNIT INSIGHT CXR ......Background: COVID-19 is an infectious disease that quickly became a global pandemic. Radiology holds an important role in COVID-19 early detection using chest radiograph by evaluating ground glass opacity (GGO) and consolidation. Correctly interpreting chest radiograph is still a challenge where chest division radiologists holds the highest accuracy. LUNIT INSIGHT CXR is an artificial intelligence (AI) system that created to increase efficiency and accuracy in interpreting chest radiograph. Until now there are no other AI system in Cipto Mangunkusumo National General Hospital that can interpret chest radiograph. This study aims to evaluate the benefit of LUNIT INSIGHT CXR AI system to help radiologists detect GGO and consolidation, the most common findings in COVID-19 patients. Method: This study is a retrospective study using chest radiograph image of suspected COVID-19 patients. Chest radiograph will be interpreted by general radiologist with and without AI system’s aid, compared with interpretation by chest division radiologist using presence of lesion, GGO interpretation, consolidation interpretation and location of the lesion as variables. Result: Most common findings are GGO with lower lung as the most common location by all interpreter. Concordance of GGO interpretation is low (< 0,8) whereas concordance of consolidation interpretation is good (> 0,8). Based on location, the lowest concordance is on the mid right lung (0,773) in the group with AI system’s aid. Concordance in other locations are good (> 0,8). There is no significant difference of concordance between with and without AI system groups. Conclusion: There are no difference in concordance of GGO and consolidation interpretation in chest radiograph between radiologists with and without LUNIT INSIGHT CXR system’s aid.

Abstrak :
Latar Belakang : Pneumotoraks merupakan kasus kegawat daruratan yang harus ditatalaksana segera. Penilaian berbagai penyakit paru dan faktor-faktor penyebab secara tepat sangat penting diketahui sebagai panduan dalam kerjasama antardisiplin ilmu dan untuk meningkatkan penatalaksanaan pneumotoraks secara menyeluruh. Faktor risiko yang mempengaruhi kesintasan pasien pneumotoraks adalah usia dan infeksi HIV, namun data di Indonesia masih belum ada. Tujuan : Untuk mengetahui karakteristik pasien pneumotoraks dan faktor-faktor yang mempengaruhi kesintasannya selama perawatan di RSCM. Metode : Penelitian desain kohort retrospektif, dilakukan terhadap pasien pneumotoraks yang dirawat inap di RSCM pada kurun waktu Januari 2000 sampai Desember 2011. Kesintasan kumulatif selama 8 hari perawatan dan faktor yang mempengaruhi dianalisis secara bivariat dengan metode Kaplan Meier dan uji Log-rank serta analisis multivariat dengan Cox proportional hazard regression model untuk menghitung hazard ratio (HR) dan interval kepercayaan 95%. Hasil : Seratus empat pasien pneumotoraks yang memenuhi kriteria penelitian ditemukan lebih banyak pada laki-laki 78(73,1%) dengan rerata usia 39,7(simpang baku[SB],16,2) tahun. Keluhan respirasi terbanyak berupa sesak napas 103(99%) dan kelainan pada pemeriksaan fisik hipersonor 101(97,1%). Foto polos toraks menunjukkan hiperlusen avaskular 95(91,4%). Faktor penyebab kejadian yang didapatkan adalah merokok 43(41,3%), pneumonia 42(40,3%), tuberkulosis 37(35,5%), trauma dada 13(12,5%), kejadian iatrogenik 6(5,7%), keganasan paru 6(5,7%), PPOK 5(4,8%), asma bronkiale 5(4,8%) dan artritis reumatoid 1(1%). Jenis pneumotoraks terbanyak adalah pneumotoraks spontan sekunder 49(47,1%). Tatalaksana sebagian besar dengan pemasangan WSD 98(94,2%). Keluaran pasien pneumotoraks hidup 69(66,3%), meninggal 35(33,7%). Penyebab kematian terbanyak pada pasien pneumotoraks saat perawatan adalah gagal napas 16(45,8%). Faktor-faktor yang memperburuk kesintasan pasien pneumotoraks adalah trauma dada (HR=3,49 (IK 95% 1,52;8,04)) dan tuberkulosis paru (HR=3,33 (IK 95% 1,39;7,99)). Kesimpulan : Adanya tuberkulosis paru dan trauma dada memperburuk kesintasan pasien pneumotoraks selama perawatan di RSCM. ...... Background : Pneumothorax is an emergency case should be managed immediately. Assessment of lung diseases and the factors that cause pneumothorax is very important to know the proper guidelines in cooperation an interdisciplinary medical science and to improve the overall management of pneumothorax. Risk factors affecting the survival rate of pneumothorax patients are age and HIV infection, but there is no data in Indonesia. Objective : The purpose of this study was to determine the characteristics of pneumothorax patients and factors affecting survival during hospitalization in RSCM. Methods : Retrospective cohort study design conducted on pneumothorax patients who were admitted in RSCM in the period January 2000 to December 2011. Cumulative survival rate for 8 days of hospitalization and the factors affecting analyzed by bivariate with Kaplan Meier method and log-rank test and multivariate analysis by cox proportional hazard regression model to calculate hazard ratio (HR) and 95% confidence intervals. Results : A total of 104 pneumothorax patients were reviewed. Their mean age was 39.7 years (SD ± 16.2 years) with a male to female ratio of 3:1. Commonest symtoms was shortness of breath 103(99%) and abnormalities on physical examination was hypersonor 101(97.1%). Plain chest X-ray showed hyperlucent avascular 95(91.4%). Etiologic factors for the incidence of secondary pneumothorax were smoking 43(41.3%), pneumonia 42(40.3%), tuberculosis 37(35.5%), chest trauma 13(12.5%), iatrogenic 6(5.7%), lung malignancy 6(5.7%), COPD 5(4.8%), asthma 5(4.8%) and rheumatoid arthritis 1(1%). Commonest type of pneumothorax was secondary spontaneous pneumothorax 49(47.1%). Most of pneumothorax patients were successfully managed by chest thoracoscopy 98(94.2%). Outcome of pneumothorax patients were live 69(66.3%), died 35(33.7%). Causes of death in pneumothorax patients was respiratory failure 16(45.8%). Factors that worsen the survival rate of pneumothorax patients were chest trauma (HR = 3.49 (95% CI 1.52 to 8.04)) and pulmonary tuberculosis (HR = 3.33 (95% CI 1.39 to 7.99 )). Conclusions : Factors that worsen the survival rate of pneumothorax patients were pulmonary tuberculosis and chest trauma that hospitalized in RSCM.

Abstrak :
Latar belakang : penegakkan diagnosis TB paru pada pasien HIV dapat dilakukan berdasarkan pemeriksaan mikrobiologis dan klinis. Rekomendasi WHO 2007, memperbolehkan penegakan diagnosis berdasarkan hasil pemeriksaan klinis dengan dan tanpa melalui pemeriksaan mikrobiologis. Penelitian ini bertujuan mendapatkan perbedaan karakteristik gambaran radiografi toraks pasien HIV dengan TB paru yang didiagnosis berdasarkan pemeriksaan mikrobiologis dan klinis. Metode : Penelitian ini adalah comparative cross sectional study. Subyek penelitian diambil secara consecutive dan dipilih berdasarkan catatan hasil pemeriksaan BTA sputum, kultur, Genexpert®, CD4+, dan radiografi toraks. Subyek penelitian dikelompokkan menjadi mikrobiologis dan klinis. Dilakukan pembacaan ulang radiografi toraks. Hasil : gambaran radiografi toraks dengan frekuensi terbanyak pada kelompok diagnosis mikrobiologis adalah infiltrat/konsolidasi, fibroinfiltrat, limfadenopati, kavitas dan kalsifikasi. Sisanya efusi pleura, milier, fibrosis, bronkiektasis, pneumotoraks dan normal. Pada kelompok diagnosis klinis, gambaran radiografi toraks dengan frekuensi terbanyak adalah infiltrat/konsolidasi, kavitas, limfadenopati, fibroinfiltrat dan sisanya kalsifikasi, efusi pleura, milier, fibrosis, bronkiektasis, dan normal. Terdapat perbedaan bermakna karakteristik gambaran radiografi toraks fibroinfiltrat pada kelompok diagnosis mikrobiologis dan klinis. Frekuensi fibroinfiltrat terbanyak adalah di kelompok mikrobiologis dengan sebaran lokasi tersering di lapangan atas paru. Kesimpulan : Terdapat perbedaan bermakna karakteristik gambaran radiografi toraks fibroinfiltrat pada kelompok diagnosis mikrobiologis dan klinis dengan lokasi tersering di lapangan atas paru.

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Background : To diagnose Pulmonary Tuberculosis in HIV patient can be done based on microbiology examination and clinically. WHO 2007 recommendation, allowing diagnosis based on clinical examination with and without microbiological examination. This study aims to obtain the different characteristics of chest radiographs of HIV patients with pulmonary TB were diagnosed based on clinical and microbiological examination. Methods : This study is a comparative cross-sectional study. Subjects were taken consecutively and selected based on the results of sputum smear examination, culture, Genexpert®, CD4+, and chest x-ray. The study subjects were grouped into microbiological and clinical. Then we do expertise review. Results : The most chest x-ray finding in the microbiological group is infiltrates/ consolidation. Following by fibroinfiltrat, lymphadenopathy, cavities and calcification. The rest are pleural effusion, miliary, fibrosis, bronchiectasis, pneumothorax and normal . In the group of clinical diagnosis, the highest frequency chest x-ray finding is infiltrates/ consolidation. Following by cavities, lymphadenopathy, fibroinfiltrat and the rest are calcification, pleural effusion, miliary, fibrosis, bronchiectasis and normal. There is significant differences of fibroinfiltrat on microbiological and clinical diagnosis groups. The highest frequency of fibroinfiltrat is in the microbiological group with the most common sites in the upper of the lung field. Conclusions : There is significant differences of fibroinfiltrat on microbiological and clinical diagnosis groups with the most common sites in the upper lung field.

Abstrak :
Koinfeksi HIV dan tuberkulosis masih merupakan ancaman kesehatan global saat ini. Diperkirakan sebanyak 1.4 juta kasus tuberculosis pada pasien HIV (+) dilaporkan pada tahun 2007. HIV merupakan risiko terbesar untuk tuberculosis, risiko berkembang menjdai TB laten 20 kali lipat. Tuberkulosis penyebab utama kematian pada pasien HIV.Pengobatan tuberculosis paru pada pasien HIV harus dimulai sesegera mungkin saat diagnosis ditegakkan, inisiasi dari pengobatan berkorelasi dengan menurunnya mortalitas dan risiko penularan infeksi tuberculosis. Tujuan dari penelitian ini adalah menilai perubahan radiografi toraks pada pasien HIV dengan tuberculosis selama pemberian obat anti tuberkulosis (OAT) di rumah sakit Cipto Mangunkusumo. Semua pasien yang menjalani pemeriksaan radiografi toraks proyeksi AP atau PA sebelum pengobatan, setelah 2 bulan dan 6 bulan setelah pengobatan diberikan dan juga bulan ke 9 dan 12 apabila pengobatan dilanjutkan. Kemudian perubahan scoring lesi radiografi toraks diamati dan dievaluasi. Hasil penelitian adalah statistic deskriptif menggambarkan perubahan scoring lesi radiogafi toraks sebelum dan 2 bulan serta setelah pengobatan 2 bulan dan 6 bulan setelah terapi diberikan. Perubahn yang terlihat pada radiografi toraks membaik 33 pasien (60%), menetap 9 pasien (16.4%) dan memburuk 13 pasien (23.6%). Perubahan lain pada bulan ke-2 dan ke-6 adalah; membaik 43 pasien (78.2%), menetap 6 pasien (10.9%) dan memburuk 6 pasien (10.9%). Kemungkinan kecurigaan kasus imune reconstitution inflammatory syndrome (IRIS) terdapat pada 3 pasien (5.45%). Perubahan skoring lesi pada bulan ke-2 dan ke-6 dianalisa dengan menggunakan Friedman Rank test dengan nilai confidence interval CI 95% ( p = 0.000). Kesimpulan : Perubahan skoring lesi pada radiografi toraks pasien HIV dengan tuberkulosis paru lebih terlihat membaik setelah 6 bulan sejak diberikan obat anti tuberkulosis. Radiografi toraks masih merupakan modalitas bermakna dalam mengevaluasi perubahan lesi pada pasien HIV dan tuberculosis paru. ......HIV and tuberculosis coinfection are major global health threats recently. It was estimated1.4 milionnew tuberculosis cases in patient with HIV- positive were reported in 2007. HIVconfers the greatest risk for tuberculosis, increasing the risk of latentTB reactivation 20-fold.Tuberculosis is a leading cause of death among patients with HIV.The initiation treatment of lung tuberculosis in HIV patients beginsmust be started as early as possible at the time when diagnose is made, the initiation treatment of tuberculosis correlated with decreasing mortality and risk of transmission tuberculosis infection. The aim of this research is to observe changes of chest radiography in HIV patients with tuberculosis during administration of anti tuberculous therapy at CiptoMangunkusumo hospital. All of patients have taken chest radiography with PA or AP projection before the treatment begin and after 2 and 6 months therapy was given and also after 9 and 12 months if therapy continued, than the changes scoring lesion of chest radiography finding is observed and examined. Descriptive statistic is provided as scoring lesion changes of chest radiography devided into changes chest radiography before and 2 month after anti tuberculous therapy was given and changes at 2 months to 6 months therapy was given. In group before and 2 months therapy, the changes was seen in chest radiography; better in 33 patients (60%), stationary condition in 9 patients (16.4%) and worse 13 patients (23.6%). Another changes in 2 and 6 months therapy was seen; better in 43 patients (78.2%), stationary condition in 6 patients (10.9%) and worse 6 patients (10.9%). Imune reconstitution inflammatory syndrome was suspected in 3 patients (5.45%). The changes of scoring lesion in 2 and 6 months therapy was examined used Friedman Rank test with confidence interval CI 95% ( p = 0.000).

Abstrak :
[ABSTRAK
Latar Belakang : pengukuran VPW dari modalitas foto toraks merupakan pemeriksaan yang non invasif, cepat dan mudah untuk memprediksi kondisi hipervolemia. Namun belum terdapat konsensus nilai rerata VPW yang dipakai secara global, sehingga penggunaan nilai rerata VPW dari penelitian sebelumnya terhadap populasi diluar populasi penelitian tersebut mungkin tidak relavan. Di Indonesia khususnya di Rumah Sakit Cipto Mangunkusumo belum terdapat data dasar nilai rerata VPW.

Tujuan Penelitian: Mengetahui rerata nilai VPW dewasa normal Indonesia

Desain Penelitian: Retrospektif potong lintang

Metode: Pengukuran jarak antara tepi terluar arteri subklavia kiri dengan tepi terluar vena kava superior yang melewati bronkus utama kanan (VPW), pengukuran rasio VPW terhadap diameter jantung terluas dan rasio VPW terhadap diameter terluas rongga toraks. Pengukuran dilakukan pada radiografi toraks PA dari 104 subyek normal yang terdiri dari 52 laki-laki dan 52 perempuan, dihitung rerata dan standar deviasi. Pengukuran serupa juga dilakukan pada topogram CT scan toraks (radiografi toraks AP supine) dan CT scan toraks dari 103 subyek yang 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 pemeriksaan topogram 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 dibandingkan pada foto toraks PA, dan pengukuranVPW pada foto toraks terbukti memiliki akurasi yang tinggi.

Kesimpulan: Rerata VPW pada pemeriksaan foto toraks PA tegak dewasa normal Indonesia adalah 48 ± 5,5 mm, ternyata tidak berbeda bermakna dengan rerata VPW pada populasi barat ( 48 ± 5mm). Rerata VPCR pada foto toraks PA adalah 40,3 % ± 4,6 % dan VPTR adalah 17,2 % ± 1,7 %.

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ABSTRACT
Background: Vascular pedicle width (VPW) is the distance, from a perpendicular line at the takeoff point of the left subclavian artery off the aorta to the point at which the superior vena cava. Measurement of VPW on chest x-ray is relatively non-invasive, fast and easy technique as hypervolemia predictor, but no wordwide consensus has been proposed.

Objective: to investigate mean vascular pedicle witdh of Indonesian adult

Study design: Retrospective cross sectional

Methods : VPW is the distance, measure in millimeters, from a perpendicular line at the takeoff point of the left subclavian artery to the point at which the superior vena cava crosses the right main bronchus, than calculate VPW ratio to a widest horizontal diameter of cardiac dan thoracic wall.

Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CT scan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5 mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scan topogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, and mean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1 mm. Measurements on the AP chest x-ray about 10% greater than in the PA chest x-ray, and measurement of VPW on conventional chest x-ray aproved to have high accuracy.

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

Abstrak :
ABSTRAK
Latar belakang dan tujuan: Modalitas radiografi toraks merupakan pemeriksaan rutin dan tersedia di hampir setiap rumah sakit. Pengukuran secara kuantitatif berupa vascular pedicle width (VPW), cardiothoracic ratio (CTR) maupun vascular pedicle-thoracic ratio (VPTR) melalui radiografi toraks dapat membantu dalam membedakan jenis edema paru dengan mengetahui titik potong rerata VPTR berdasarkan kombinasi VPW dan CTR. Metode: Penelitian dilakukan retrospektif dengan descriptive cross sectional pada 100 pasien dengan klinis edema paru yang telah melakukan radiografi toraks di ICU Rumah Sakit CiptoMangunkusumo (RSCM) dalam rentang waktu Januari 2013 ? Desember 2015. Subjek dibagi menjadi edema kardiogenik dan non kardiogenik berdasarkan kombinasi pengukuran VPW dan CTR. Kemudian dilakukan pengukuran VPTR dan ditentukan titik potong rerata VPTR, sensitivitas dan spesifisitas berdasarkan kombinasi VPW dan CTR dalam membedakan edema paru. Hasil: Dari total 100 subjek penelitian di ICU RSCM dengan metode Receiver Operating Curve (ROC) didapatkan titik potong VPTR sebesar 25,1% dengan sentivitas 90,5% dan spesifisitas 86,1% dalam membedakan edema paru kardiogenik dan non kardiogenik. Selain itu diperoleh juga proporsi edema paru kardiogenik sebesar 21%, sedangkan edema paru non kardiogenik sebesar 79%. Kesimpulan: Titik potong VPTR berdasarkan kombinasi VPW dan CTR memiliki sensitivitas dan spesifisitas yang cukup tinggi dalam membedakan edema paru kardiogenik dan non kardiogenik.

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ABSTRACT
Background and purpose: Pulmonary edema in critically ill patient were challenging in intensive care unit (ICU). Radiography of thorax is routine examination and widely available in almost every hospital. Measurement quantitatively of vascular pedicle width (VPW), cardiothoracic ratio (CTR) and vascular pedicle-thoracic ratio in thorax radiography can help in differentiating the type of pulmonary edema through the cut off of VPTR based on combination VPW and CTR. Methods: Descriptive cross sectional restrospective in 100 patients with clinically pulmonary edema which have examined by thorax radiography at ICU RSCM in January 2013 to Desember 2015. Subject divided to cardiogenic and non cardiogenic pulmonary edema based on combination VPW and CTR. Then, VPTR were measured and the cut off of VPTR determined based on combination VPW and CTR in differentiaiting pulmonary edema. Results: From total 100 subject study at ICU RSCM using Receiver Operating Curve (ROC) metode, the cut off of VPTR is 25,1% with sensitivity 90,5% and specificity 86,1% in differentiating cardiogenic and non cardiogenic pulmonary edema. Beside that, the prevalence of cardiogenik pulmonary edema is 21% and non cardiogenic pulmonary edema is 79%. Conclusion : The cut off of VPTR based on combination VPW and CTR have significant sensitivity and specificity in differentiating cardiogenic and non cardiogenic pulmonary edema.

Abstrak :
Pendahuluan: Estimasi usia dan jenis kelamin yang akurat memiliki peran penting dalam upaya identifikasi individu yang tidak dikenal terutama pada kasus-kasus forensik, baik pada individu yang masih hidup maupun sudah meninggal. Tulang belakang segmen dada dan iga merupakan tulang yang tidak banyak diteliti dalam penentuan usia dan jenis kelamin, namun tulang-tulang tersebut sering ditemukan pada saat pemeriksaan identifikasi dilakukan. Metodologi: Penelitian ini merupakan penelitian observasional deskriptif dan analitik dengan desain potong lintang menggunakan 300 sampel radiografi toraks dari pasien rawat jalan RSUPN Dr. Cipto Mangunkusumo Jakarta, terdiri dari 150 laki-laki dan 150 perempuan dengan rentang usia antara 18 hingga 65 tahun. Pengukuran dilakukan pada tulang belakang segmen dada ke-1 hingga ke-12 dan tulang iga ke-2 hingga ke-7. Penelitian ini disetujui oleh komite etik Fakultas Kedokteran Universitas Indonesia. Hasil: Pada penelitian ini didapatkan korelasi yang lemah dan sangat lemah pada tulang belakang segmen dada yang signifikan (p<0,05) dan korelasi yang sangat lemah namun tidak signifikan (p>0,05) pada tulang iga terhadap estimasi usia kronologis. Terdapat hubungan yang signifikan antara ukuran lebar, tinggi, diagonal pada seluruh tulang belakang segmen dada dan semua iga yang diperiksa, dimana 14 parameter yang bermakna pada tulang belakang segmen dada ke-2, ke-3 dan ke-8; tulang iga ke-2, ke-3, dan ke-7; serta Y total secara bersama-sama memberikan nilai akurasi 70,7% terhadap estimasi jenis kelamin. Kesimpulan: Radiografi toraks untuk menilai tulang belakang segmen dada dan iga-iga merupakan metode yang sangat berguna untuk upaya identifikasi usia dan jenis kelamin. Namun, penelitian lebih lanjut tetap diperlukan untuk mendapatkan estimasi yang lebih akurat.

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Introduction: Accurate age and sex determination holds important role in determining the identity of unknown individuals in forensic science for both living and remains. Vertebrae are one of the least studied bones for chronologica age and sex identification; however, eventhough its presence at a death scene is the most common of all. Methodology: This research was an observational descriptive and analytic study using cross-sectional research design with 300 chest radiograph as its sample in Dr. Cipto Mangunkusumo Hospital, with 150 males and 150 females taken for T1-T12 thoracic vertebras and second-seventh ribs. All the procedures for this study were approved by the ethical committee of Faculty of Medicine, Universitas Indonesia. Results: In this study, weak and very weak significant correlation was calculated from thoracic vertebras calculation and very weak correlation but no significant of ribs related to chronological age. There were significant correlation between width, height, and diagonal size in all thoracic vertebras and all ribs, which have 14 significant parameters of 2nd, 3rd and 8th thoracic vertebras; 2nd, 3rd and 7th ribs; and total height of thoracic vertebras with an accuracy value of 70.7% for sex determination. Conclusion: Chest radiograph of thoracic vertebrae and ribs is a useful method for sex and chronological age identification of unknown bodies; however, further studies are still needed to develop examinations with higher accuracy.

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Tujuan: Menentukan hubungan obesitas dengan proporsi ukuran tumor, keterlibatan KGB aksila dan derajat histopatologi pada pasien kanker payudara stadium I – IIIA di RSUPNCM, serta membantu meningkatkan kualitas tatalaksana bagi klinisi. Metode: Analisa menggunakan data sekunder pada pasien kanker payudara stadium I – III A. Dikatan obesitas bila indeks massa tubuh ≥ 25 kg/m2 dan non obesitas < 25 kg/m2. Hasil ukuran tumor dikelompokkan menjadi < 2 cm, 2-5 cm dan > 5 cm berdasarkan sistem staging TNM AJCC. Ukuran tumor diperoleh melalui pencitraan ultrasonografi payudara yang tersimpan pada sistem PACS. Keterlibatan KGB aksila serta derajat histopatologi diperoleh dari hasil ekspertise patologi anatomi. Hasil: Jumlah subyek penelitian sebanyak 52 pasien kanker payudara stadium I– IIIA tahun 2012 - 2014 di RSUPNCM terdiri dari 26 pasien obesitas dan 26 pasien non obesitas. Tidak ada hubungan yang bermakna antara ukuran tumor berdasarkan staging dengan obesitas (P= 0,795 (uji chi square)). Tidak terdapat hubungan yang bermakna antara obesitas dengan derajat histopatologi (P=0,610, (uji mutlak fisher)). Tidak terdapat hubungan yang bermakna antara obesitas dan keterlibatan KGB aksila (P =0,404 (uji chi square)). Median ukuran tumor pada pasien obesitas 2,95 cm dan pasien non obesitas 2,73 cm. Dari 26 pasien obesitas, 25 diantaranya memiliki derajat tinggi. Dari 26 pasien non obesitas, 14 memiliki keterlibatan KGB aksila. Kesimpulan: Pasien kanker payudara yang obesitas tidak berhubungan dengan besarnya ukuran tumor, keterlibatan KGB aksila dan derajat histopatologi yang tinggi. Namun terdapat kecenderungan pasien kanker payudara yang obesitas memiliki ukuran tumor yang lebih besar dan tingginya derajat histopatologi. Sedangkan keterlibatan KGB aksila lebih cenderung pada pasien yang non obesitas.

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ABSTRACT
Objective: Determine the relationship of obesity with tumor size proportion, axillary lymph node involvement and histopathological grading in breast cancer patients stage I-IIIA in Cipto Mangunkusomo hospital and to help improvement the quality of management by clinician. Methods: Analysis using secondary data of breast cancer patient stage I-IIIA. Obesity grouped if body mass index ≥ 25 kg/m2 and non obese < 25 kg/m2. The results of tumor size are grouped into 0-2 cm, 2-5 cm and > 5 cm based on the AJCC TNM staging system. Tumor size obtained through breast ultrasound imaging from PACS system. Axillary lymph node involvement and histopathological grading obtained from the anatomical pathology expertise. Results: The study subjects are 52 patients with stage I-IIIA breast cancer in 2012-2014 in Cipto Mangunkusumo consisted of 26 obese and 26 non-obese patients. There is no significant relationship between tumor size based on staging with obesity (P = 0.795 (chi square test)). There was no significant relationship between obesity and grading histopathology (P = 0.610, (absolute test fisher)). There was no significant relationship between obesity and the involvement of axillary lymph nodes (P = 0.404 (chi square test)). The median tumor size of 2.95 cm in obese patients and 2,73 cm in non-obese patients. From 26 obese patients, 25 of them had a high grading histopathology. From 26 non-obese patients, 14 of them had involvement of axillary lymph nodes. Conclusion: Breast cancer patients who are obese are not related to the larger tumor size , involvement of axillary lymph nodes and a high grading of histopathology. However, there is a tendency that breast cancer patients who are obese had larger tumor size and high grading of histopathology. Where as the involvement of axillary lymph nodes are more likely in non-obese patients., Objective: Determine the relationship of obesity with tumor size proportion, axillary lymph node involvement and histopathological grading in breast cancer patients stage I-IIIA in Cipto Mangunkusomo hospital and to help improvement the quality of management by clinician. Methods: Analysis using secondary data of breast cancer patient stage I-IIIA. Obesity grouped if body mass index ≥ 25 kg/m2 and non obese < 25 kg/m2. The results of tumor size are grouped into 0-2 cm, 2-5 cm and > 5 cm based on the AJCC TNM staging system. Tumor size obtained through breast ultrasound imaging from PACS system. Axillary lymph node involvement and histopathological grading obtained from the anatomical pathology expertise. Results: The study subjects are 52 patients with stage I-IIIA breast cancer in 2012-2014 in Cipto Mangunkusumo consisted of 26 obese and 26 non-obese patients. There is no significant relationship between tumor size based on staging with obesity (P = 0.795 (chi square test)). There was no significant relationship between obesity and grading histopathology (P = 0.610, (absolute test fisher)). There was no significant relationship between obesity and the involvement of axillary lymph nodes (P = 0.404 (chi square test)). The median tumor size of 2.95 cm in obese patients and 2,73 cm in non-obese patients. From 26 obese patients, 25 of them had a high grading histopathology. From 26 non-obese patients, 14 of them had involvement of axillary lymph nodes. Conclusion: Breast cancer patients who are obese are not related to the larger tumor size , involvement of axillary lymph nodes and a high grading of histopathology. However, there is a tendency that breast cancer patients who are obese had larger tumor size and high grading of histopathology. Where as the involvement of axillary lymph nodes are more likely in non-obese patients.]

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Kerusakan target organ tersering pada hipertensi adalah left ventricular hypertrophy LVH dan mikroalbuminuria Radiografi toraks merupakan pemeriksaan non invasif untuk mengevaluasi LVH terutama proyeksi lateral dengan Hoffman Rigler sign. Penelitian bertujuan mengetahui hubungan antara LVH berdasarkan modalitas radiografi toraks dengan mikroalbuminuria pada pasien hipertensi. Sampel merupakan pasien hipertensi yang telah diberikan terapi dan dilakukan radiografi toraks PA dan lateral. Dari 66 pasien hipertensi 19 28 8 dengan mikroalbuminuria positif. Dari 35 pasien hipertensi dengan LVH 12 34 3 dengan mikroalbuminuria positif. Pada penelitian ini radiografi toraks PA dan lateral dapat digunakan untuk menilai tanda LVH.

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Common target organ damage in hypertension is left ventricular hypertrophy LVH and microalbuminuria Chest x ray is a non invasive examination to evaluate LVH especially lateral projection with Hoffman Rigler sign methode. The research aims to investigate the relationship between LVH based modalities PA and lateral chest x ray with microalbuminuria in hypertensive patients. Samples taken were hypertensive patients who have been given therapy and do PA and lateral chest x ray Of 66 hypertensive patients 19 28 8 with positive microalbuminuria Of 35 hypertensive patients with LVH 12 34 3 with positive microalbuminuria In this study PA and lateral chest x ray can be used to assess the sign of LVH.

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Pembedahan abdomen atas berkaitan disfungsi diafragma. Disfungsi diafragma merupakan penyebab PPC (postoperative pulmonary complication). Terapi oksigen konvensional (TOK) merupakan terapi standar pada pasien pasca pembedahan abdomen atas. Terapi HFNC (high-flow nasal cannula) memiliki berbagai mekanisme yang berbeda dengan TOK dan dipikirkan dapat membantu fungsi diafragma pascapembedahan abdomen atas. Studi ini bertujuan untuk membandingkan kemampuan HFNC terhadap TOK dalam mempertahankan fungsi diafragma pascapembedahan abdomen atas. Studi ini dilakukan di RSUPN Dr. Cipto Mangunkusumo dari November 2018 – September 2019. Tujuh puluh satu pasien dibagi secara acak menjadi dua kelompok: kelompok TOK dan HFNC. Enam puluh enam pasien mendapat intervensi setelah ekstubasi di ICU (intensive care unit). Seluruh subjek dilakukan pencatatan nilai DTF (diaphragm thickening fraction) menggunakan ultrasonografi, ΔTIV (perubahan tidal impedance variance), ΔEELI-G dan ΔEELI-ROI (perubahan end expiratory lung impedance global dan region of interest) menggunakan EIT (electrical impedance tomography), PaO2 dan PaCO2 (tekanan parsial oksigen dan karbon dioksida arteri) secara berkala pada dua seri. Efek samping dan keluhan yang muncul dicatat dan ditatalaksana. Total 66 subjek disertakan dalam bivariat menggunakan t-test dan mann whitney, sedangkan analisis tren menggunakan general linear model atau generalized estimating equation. Durasi ventilasi mekanik di ICU, persentase prediksi mortalitas dan skor P-POSSUM antara kedua kelompok berbeda signifikan (p=0,003; 0,001; dan 0,019, secara berurutan). Tidak ada perbedaan tren yang ditemukan antarkelompok pada seri pertama parameter DTF, ΔTIV, ΔEELI-G, ΔEELI-ROI dan PaCO2 (p=0,951; 0,100; 0,935; 0,446; dan 0,705, secara berurutan) maupun pada seri kedua (p=0,556; 0,091; 0,429; 0,423; dan 0,687, secara berurutan). Tren PaO2 pada seri pertama dan kedua berbeda sangat signifikan (p<0,001) karena protokol pengaturan fraksi oksigen yang lebih tinggi pada kelompok TOK. Penggunaan HFNC tidak lebih baik daripada TOK dalam membantu mempertahankan fungsi diafragma pascapembedahan abdomen atas. ...... Upper abdominal surgery is related to diaphragmatic dysfunction. Diaphragmatic dysfunction is the main factors causing postoperative pulmonary complication (PPC). Conventional oxygen therapy (TOK) in the form of nasal cannula, is a standard therapy in post upper abdominal surgery patients. High-flow nasal cannula (HFNC) therapy has a variety of mechanisms that differ from TOK and is thought to be able to maintain diaphragm function in post upper abdominal surgery patients. This study aims to compare the ability of HFNC vs TOK in maintaining diaphragm function for post upper abdominal surgery patients. This study was conducted at RSUPN dr. Cipto Mangunkusumo from November 2018 - September 2019. Seventy-one patients were randomly divided into two groups: TOK and HFNC groups. Sixty-six patients received intervention after extubation in the intensive care unit (ICU). This given data were all collected periodically in 2 series; diaphragm thickening fraction (DTF) values using ultrasonography, changes in tidal impedance variance (ΔTIV), changes in global end expiratory lung impedance and region of interest (ΔEELI-G and ΔEELI-ROI) using electrical impedance tomography, arterial oxygen and carbon dioxide partial pressure (PaO2 and PaCO2). Side effects and complaints that arise were collected and managed. A total of 66 subjects were included in the bivariate using t-test and mann whitney test, while trends were analyzed by general linear models or generalized estimating equations. The baseline characteristics of mechanical ventilation duration in the ICU, the predicted mortality rate and P-POSSUM score between the two groups were significantly different (p = 0.003; 0.001; and 0.019, respectively). No trend differences were found between groups in the first series of DTF, ΔTIV, ΔEELI-G, ΔEELI-ROI and PaCO2 parameters (p = 0.951; 0.100; 0.935; 0.446; and 0.705, respectively) and in the second series (p = 0.556, 0.091, 0.429, 0.423 and 0.687, respectively). The PaO2 trends in the first and second series differed very significantly (p<0.001) due to the higher oxygen fraction regulation protocol in the COT group. The use of HFNC is no better than COT in maintaining diaphragm function for post upper abdominal surgery patients.