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Siregar, Bintang Abadi
Abstrak :
Keberhasilan penanganan pasien-pasien emergensi ke rumah sakit berkaitan erat dengan "waktu penanganan" yaitu waktu antara kedatangan pasien dengan waktu tindakan yang seharusnya dilakukan, dalam hal ini tindakan pembedahan. Makin lama waktu respon penanganan akan meningkatkan morbiditas dan mortalitas yang akan dialami pasien tersebut di Unit Gawat Darurat Rumah Sakit dr. Cipto Mangunkusumo (UGD RSCM) yang khusus menangani pasien-pasien gawat darurat/emergensi telah ditetapkan stiatu indikator kinerja sebagai acuan keberhasilan penanganan yaitu dengan dibedakannya kasus Sangat Gawat Darurat (SGD) dan kasus Gawat Darurat (GD). Kasus Sangat Gawat Darurat adalah kondisi pasien yang rnembutuhkan tindakan pembedahan secepatnya karena adanya ancaman kehilangan nyawa. Hal ini dihubungkan dengan adanya gangguan jalan nafas, kemampuan bernafas atau gangguan sirkulasi. Sedangkan kasus Gawat Darurat adalah kondisi pasien yang memerlukan tindakan pembedahan dalam waktu 8 jam pertama (misalnya : hernia strangulata, apendisitis, trauma pembuluh darah, trombosis pembuluh darah). Dalam hal keterlambatan penanganan akan meningkatkan morbiditas yang pada akhirnya akan meningkatkan mortalitas. Sejak saat kedatangan di UGD, pasien pada umumnya harus melewati beberapa pemeriksaan, diantaranya anamnesa, pemeriksaan fisik, pemeriksaan penunjang, tindakan-tindakan prabedah. Selain itu juga dilakukan konsultasi antar departemen jika diperlukan dan persetujuan pasien atau keluarganya atas tindakan pembedahan yang akan dilakukan. Bila pasien yang datang disebabkan trauma akan dilakukan Primary Survey dengan segala penanganannya dan dilanjutkan dengan Secoudary survey. Tujuan penelitian ini adalah untuk mengetahui lamanya waktu penanganan prabedah pada pasien-pasien kasus SGD dan GD UGD RSCM yang akan dilakukan pembedahan beserta faktor-faktor 1 alasan yang mempengaruhinya. Parameter yang digunakan adalah waktu yang dilalui pasien sejak kedatangan sampai dilakukan tindakan bedah dikaitkan dengan waktu yang diperlukan untuk pemeriksaan-pemeriksaan dan tindakan-tindakan prabedah lainnya (persiapan prabedah).
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2006
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UI - Tesis Membership  Universitas Indonesia Library
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Djony Edward Tjandra
Abstrak :
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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Novinda Herwirastri
Abstrak :
Pendahuluan: Chronic Limb Threatening Ischemia (CLTI) adalah stadium lanjut penyakit arteri perifer (PAD). The society for Vascular Surgery Lower Extremity Guidelines Committee menciptakan sistem klasifikasi yang lebih komprehensif untuk stratifikasi risiko amputasi pada pasien di seluruh spektrum CLTI. Sistem ini didasarkan pada nilai objektif Wound (W), Ischemia (I) dan Foot Infection (fI) untuk menghitung stadium klinis tungkai terancam dari 1 hingga 4 yang telah divalidasi dalam beberapa penelitian untuk dapat sangat memprediksi risiko amputasi ekstremitas mayor dalam satu tahun. Berbagai pedoman profesional saat ini merekomendasikan terapi statin untuk semua individu dengan PAD. Temuan para peneliti tentang hubungan yang kuat dan bergantung pada intensitas antara terapi statin dan amputasi serta mortalitas di antara individu dengan insiden PAD adalah hal yang penting secara klinis, baik untuk pasien maupun dokter yang merawat mereka. Namun demikian, protokol pemberian statin masih bervariasi di Indonesia. Penelitian ini bertujuan untuk mengetahui peran konsumsi statin pada pasien CLTI dengan berbagai skor WIfI terhadap amputasi mayor yang diamati hingga satu tahun di Rumah Sakit Cipto Mangunkusumo (RSCM) berdasarkan skor CLTI. Metode: Dilakukan studi kohort retrospektif dari data pasien yang didiagnosis CLTI di RSCM pada tahun 2010-2019. Subjek dibagi menjadi grup statin dan non statin. Dilakukan Uji bivariat dengan chi-square untuk melihat bagaimana pengaruh pemberian statin, komorbid dan skor WIFI pada subjek CLTI terhadap amputasi mayor. Kemudian dilakukan analisis stratifikasi untuk melihat pengaruh statin pada subjek CLTI dengan berbagai spektrum. Dilakukan pula analisis bagaimana kecendrungan statin bekerja jika diberikan pada pasien dengan berbagai jumlah komorbid. Uji multivariat dilakukan menggunakan regresi logistik menghadirkan nilai p dengan adjusted relative risk (RR).Hasil: Mayoritas pasien adalah laki-laki (59,5%). Sebanyak 83,2% subjek penelitian menderita diabetes melitus, 70,5% subjek mengalami hipertensi, 47,7% subjek mengalami gagal ginjal kronis, dan 26,4% subjek menderita penyakit jantung. Selain itu, hampir setengah dari total subjek penelitian memiliki skor WIfI yang parah (45,5%). Subjek yang diberi statin berpeluang menjalani amputasi mayor sebesar 0,562 kali dibandingkan subjek yang tidak diberikan statin (95% CI 0,407 - 0,777). Dengan kata lain, pemberian statin mampu mencegah amputasi mayor pada pasien CLTI. Namun hal tersebut hanya dapat diterapkan pada subjek CLTI dengan skor WifI yang rendah, karena semakin tinggi skor WifI pasien memiliki faktor komorbid yang lebih banyak (p <0,05; 95% CI 0,008 - 0,783). Amputasi mayor pada subjek CLTI secara statistik signifikan dengan diabetes komorbid (p = 0,001), penyakit jantung (p <0,001), skor WIfI (p = 0,001) dan penggunaan statin (p <0,001). Simpulan: Penelitian ini menunjukkan bahwa pemberian statin dapat mencegah kejadian amputasi mayor pada pasien CLTI dengan skor WIfI rendah meskipun terdapat faktor komorbid. ......Background : Chronic limb threatening ischemia (CLTI) is an advanced stage of peripheral artery disease (PAD). The society for Vascular Surgery Lower Extremity Guidelines Committee created a more comprehensive threatened limb classification system intended to stratify amputation risk in patients across the spectrum of CLTI. The system is based on objective grades Wound (W), Ischemia (I) and Foot Infection (FI) to calculate a threatened limb clinical stage from 1 to 4 has been validated in multiple studies to be highly predictive of 1-year major limb amputation risk. Current professional society guidelines recommend statin therapy for all individuals with PAD. The investigators’ finding of a strong and intensity-dependent association between statin therapy and both amputation and mortality among individuals with incident PAD is of considerable clinical importance, both to patients and the physicians who care for them. Yet, there is no study available for this and statin protocol vary in our country. This study aims on revealing the role of statin consumption prior to major amputation on CLTI patients in Cipto Mangunkusumo based on CLTI score. Methods: We performed retrospective cohort study from a database of CLTI patients diagnosed at Cipto Mangunkusumo Hospital in 2010-2019. Subjects were divided into statin and nonstatin groups. A bivariate test with chi-square was performed to see how the effect of statin, comorbid and WIFI scores on CLTI subjects on major amputations. Then a stratification analysis was performed to see the effect of statins on CLTI subjects with various spectra. An analysis of how the statin likelihood of working when given to subjects with varying amounts of comorbidities was also conducted. Multivariate tests was performed used logistic regression presenting p values ​​with adjusted relative risk (RR). We performed cohort retrospective analysis study from a database of CLTI patients diagnosed at Cipto Mangunkusumo Hospital in 2010- 2019. Subjects were divided into 2 groups, the CLTI patients with statin and without statin based on their database. We also analyse comorbid factors (diabetes mellitus, hypertension, chronic renal failure and heart disesase) related to CLTI and WIfI score to major amputation incidence Results: Majority of the patients were male (59.5%). A total of 83.2% of study subjects suffered from diabetes mellitus, 70.5% of subjects had hypertension, 47.7% of subjects had chronic kidney failure, and 26.4% of subjects had heart disease. In addition, almost half of the total study subjects had a severe WIfI score (45.5%). Subjects who were given statins had a chance to undergo major amputation by 0.562 times compared to subjects who were not given statins (95% CI 0.407 - 0.777). In other words, statin administration was able to prevent major amputation in CLTI patients. However, it only can be applied to CLTI subjects with low WifI score, as higher WifI score patients have more comorbid factors (p <0,05; 95%CI 0,008 – 0,783). Major amputation in CLTI subjects was statistically significant with comorbid diabetes (p = 0.001), heart disease (p <0.001), WIfI score (p = 0.001) and statin use (p <0.001).
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Whiko Irwan Destanto
Abstrak :
ABSTRAK
Latar belakang Tindakan ablasi endovenous untuk varises tungkai di Indonesia mulai dikerjakan tahun 2010 EVLT dikerjakan di RSCM tahun 2013 dan MOCA dikerjakan di RSUP Fatmawati tahun 2014 Belum ada evaluasi terhadap rekanalisasi pasca tindakan MOCA dan EVLT di Indonesia Metode Studi ini merupakan penelitian deskriptif analitik dengan desain cross sectional Subjek pasca MOCA atau EVLT dengan rentang waktu 3 18 bulan pasca tindakan diwawancara dan dilakukan pemeriksaan USG vaskular pada tungkai yang dioperasi untuk menilai rekanalisasi Data sekunder praoperasi diambil dari rekam medis Dicari karakteristik klinis subjek membandingkan kecenderungan rekanalisasi pasca tindakan MOCA dan EVLT dicari hubungan antara karakteristik klinis subjek dengan kejadian rekanalisasi Data diolah dengan SPSS ver 20 0 Hasil Didapatkan 43 sampel tungkai terdiri dari 24 tungkai pasca MOCA dan 19 tungkai pasca EVLT Karakteristik subjek MOCA terbanyak usia 7 mm 13 19 tungkai Pada MOCA rekanalisasi total didapatkan 2 24 dan partial 8 24 tungkai sedangkan pada EVLT rekanalisasi total 1 19 dan partial 3 19 tungkai Hubungan antara karakteristik klinis subjek dengan kejadian rekanalisasi p 0 05 Kesimpulan Kecenderungan rekanalisasi MOCA lebih tinggi dibandingkan EVLT Tidak ada hubungan bermakna antara karakteristik klinis subjek dengan kejadian rekanalisasi secara statistik namun diameter terbesar VSM 7 mm sebelum operasi secara proporsional lebih tinggi MOCA 3 4 tungkai dibandingkan EVLT 3 13 tungkai ABSTRACT
Background Endovenous ablation for varicose vein of the limb in Indonesia has been done since 2010 EVLT has been done in RSCM since 2013 and MOCA in RSUP Fatmawati in 2014 There has not any evaluation been done for recanalization post MOCA and EVLT procedure in Indonesia Method This study was descriptive analytic with cross sectional design Subjects post MOCA or EVLT with time span 3 18 months post procedure are interviewed and USG vascular examination is done on operated limb in order to evaluate the recanalization Secondary data pre surgery are taken from medical records Clinical characteristics of the subjects are seek comparing possibility of recanalization post MOCA and EVLT procedure in order to see the correlation between clinical characteristics of subjects and recanalization Data is treated using SPSS ver 20 0Results Forty three samples were collected consists of 24 extremities post MOCA samples and 19 extremities post EVLT samples Most subjects on MOCA group were 7mm were 13 19 extremities On MOCA group total recanalization were 2 24 extremities and partial were 8 24 extremities EVLT group total recanalization were 1 19 extremities and partial were 3 19 extremities Relationship between subjects clinical characteristics with recanalization event p 0 05 Conclusion Recanalization tendency in MOCA is higher compared to EVLT There is no statistically significant assosiation between clinical characteristic of the subjects and recanalization but the highest diameter VSM 7 mm pre surgery proportionally is higher in MOCA 3 4 extremities compared to EVLT 3 13 extremities ;Background Endovenous ablation for varicose vein of the limb in Indonesia has been done since 2010 EVLT has been done in RSCM since 2013 and MOCA in RSUP Fatmawati in 2014 There has not any evaluation been done for recanalization post MOCA and EVLT procedure in Indonesia Method This study was descriptive analytic with cross sectional design Subjects post MOCA or EVLT with time span 3 18 months post procedure are interviewed and USG vascular examination is done on operated limb in order to evaluate the recanalization Secondary data pre surgery are taken from medical records Clinical characteristics of the subjects are seek comparing possibility of recanalization post MOCA and EVLT procedure in order to see the correlation between clinical characteristics of subjects and recanalization Data is treated using SPSS ver 20 0Results Forty three samples were collected consists of 24 extremities post MOCA samples and 19 extremities post EVLT samples Most subjects on MOCA group were 7mm were 13 19 extremities On MOCA group total recanalization were 2 24 extremities and partial were 8 24 extremities EVLT group total recanalization were 1 19 extremities and partial were 3 19 extremities Relationship between subjects clinical characteristics with recanalization event p 0 05 Conclusion Recanalization tendency in MOCA is higher compared to EVLT There is no statistically significant assosiation between clinical characteristic of the subjects and recanalization but the highest diameter VSM 7 mm pre surgery proportionally is higher in MOCA 3 4 extremities compared to EVLT 3 13 extremities ;Background Endovenous ablation for varicose vein of the limb in Indonesia has been done since 2010 EVLT has been done in RSCM since 2013 and MOCA in RSUP Fatmawati in 2014 There has not any evaluation been done for recanalization post MOCA and EVLT procedure in Indonesia Method This study was descriptive analytic with cross sectional design Subjects post MOCA or EVLT with time span 3 18 months post procedure are interviewed and USG vascular examination is done on operated limb in order to evaluate the recanalization Secondary data pre surgery are taken from medical records Clinical characteristics of the subjects are seek comparing possibility of recanalization post MOCA and EVLT procedure in order to see the correlation between clinical characteristics of subjects and recanalization Data is treated using SPSS ver 20 0Results Forty three samples were collected consists of 24 extremities post MOCA samples and 19 extremities post EVLT samples Most subjects on MOCA group were 7mm were 13 19 extremities On MOCA group total recanalization were 2 24 extremities and partial were 8 24 extremities EVLT group total recanalization were 1 19 extremities and partial were 3 19 extremities Relationship between subjects clinical characteristics with recanalization event p 0 05 Conclusion Recanalization tendency in MOCA is higher compared to EVLT There is no statistically significant assosiation between clinical characteristic of the subjects and recanalization but the highest diameter VSM 7 mm pre surgery proportionally is higher in MOCA 3 4 extremities compared to EVLT 3 13 extremities
Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Andrio Wishnu Prabowo
Abstrak :
Latar belakang: Insufisiensi vena kronis IVK derajat berat atau C5-C6 membutuhkan penatalaksanaan yang lebih kompleks dan membawa dampak morbiditas yang lebih berat akibat lamanya waktu pengobatan dan angka kekambuhan yang tinggi. Tata laksana definitif IVK C5-C6 telah mengalami pergeseran dari terapi non operatif terapi kompresi dan medikamentosa menjadi terapi operatif dengan teknik non invasif seperti ablasi endovena. Penelitian ini bertujuan untuk melakukan evaluasi terhadap jenis terapi yang diberikan baik terapi definitif maupun terapi perawatan luka dengan keluaran berupa angka rekurensi dan lama rawat. Metode penelitian: Studi potong lintang analitik dilakukan dengan mengambil total sampel 54 pasien IVK C5-C6 yang datang ke RSCM pada periode Januari 2014-Desember 2015. Pasien IVK yang disertai dengan insufisiensi arteri, insufisiensi vena dalam, dan kelainan kulit akibat penyakit kulit primer, keganasan, trauma dieksklusi. Analisis statistik diolah dengan SPSS 21 for windows, untuk menilai keluaran dari terapi definitif berupa angka kekambuhan dan lama rawat. Hasil penelitian: Angka kekambuhan pasien IVK C5-C6 dengan terapi operatif lebih rendah dibandingkan dengan terapi non operatif yakni 7,1 berbanding 30,8 dalam follow up selama 2 tahun dengan nilai p 0,02 dan OR 0,17 95 IK 0,03-0,91. Lama perawatan rerata pasien IVK C5-C6 pada kelompok terapi operatif selama 10,6 hari dan kelompok non operatif selama 14,8 hari. Kesimpulan: Angka kekambuhan pasien IVK C5-C6 yang memperoleh terapi definitif operatif lebih rendah dari yang hanya memperoleh terapi non operatif dalam evaluasi selama 1-2 tahun
Background: Severe degree C5-C6 of chronic venous insufficiency CVI require complex management and bring severe morbidity due to long duration of treatment and high recurrence rate. This leads to high treatment costs and interfered quality of patients life. Management of CVI C5-C6 in developed countries has changed from non operative therapy to operative therapy with non-invasive technique, i.e. endovascular treatment. In Indonesia CVI patient characteristics differ from developed countries, where the majority of patients come at advanced stage or C5-C6. This study aims to evaluate the management of CVI C5-C6, both definitive therapy and also wound care techniques, to afford an appropriate treatment in accordance with the characteristics of the patients in Indonesia. Method: a cross sectional analytic study carried out by taking the total sample of 54 patients who came with CVI C5-C6 to Cipto Mangunkusumo Hospital in the period of January 2014-December 2015. Those accompanied by arterial insufficiency, deep venous insufficiency, and skin disorders due to primary skin disease, malignancy, trauma were excluded. Statistical analysis is processed with SPSS 21 for windows, to assess the outcome of the definitive therapy in the form of recurrence rates and length of stay. Results: Recurrence rate of CVI C5-C6 patients with operative therapy is lower than non-operative therapy which is 7.1 versus 30,8 in 2-year follow-up with p-value of 0.02 and OR 0.17 95 CI 0, 03-.91. The mean treatment duration CVI C5-C6 patients in the operative therapy group is 10.6 days and non-operative group is 14.8 days Conclusions: recurrence rate of CVI C5-C6 patients who obtain definitive operative therapy was lower than non-operative therapy group in the evaluation for 1-2 years.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Ahmadi Alwi
Abstrak :
Latar Belakang: Akses vaskular sebagai jalur kehidupan pasien gagal ginjal kronik yang menjalani hemodialisis dapat mengalami disfungsi. Stenosis merupakan salah satu penyebab disfungsi akses vaskular yang dapat menurunkan kualitas hemodialisis. Terapi endovaskular seperti angioplasty adalah salah satu solusi efektif untuk mengatasi masalah ini, tetapi tindakan ini memerlukan biaya yang cukup tinggi. Penelitian ini bertujuan untuk mengidentifikasi faktor-faktor yang mempengaruhi keberhasilan tindakan single balloon angioplasty, yang merupakan alternatif dari tindakan angioplasty standar, pada penderita stenosis vena sentral. Metode: Penelitian ini merupakan studi kohort retrospektif analitik yang menilai faktor-faktor yang berpengaruh terhadap keberhasilan tindakan single balloon angioplasty di RSCM, RS Hermina Bekasi, RSUP Fatmawati dan RSUD Tangerang pada periode Januari 2018 sampai Desember 2020. Analisis dilakukan untuk mengidentifikasi hubungan lokasi stenosis, riwayat pemasangan kateter vena sentral, panjang lesi dan stenosis awal dengan keberhasilan tindakan single balloon angioplasty berdasarkan stenosis residual dan adekuasi hemodialisis pascatindakan. Hasil: Terdapat 109 pasien yang diinklusi dalam penelitian ini, dengan rerata usia 55,17±11,51 tahun. Dari jumlah tersebut, 58 subjek (53,2%) adalah laki-laki; 96 subjek (88,1%) memiliki komorbid hipertensi dan 38 subjek (34,9%) menderita komorbid diabetes. Pasien dengan panjang lesi >2 cm memiliki proporsi keberhasilan sebesar 21,1%, lebih rendah dibandingkan kelompok panjang lesi ≤2 cm (78,9%) (p<0,001). Derajat stenosis inisial >80% juga lebih banyak ditemukan memiliki stenosis residual ≥30% (p<0,001). Pasien dengan panjang stenosis ≤2 cm memiliki peluang keberhasilan 5,089 kali (IK 95%, 2,103–12,31) lebih tinggi dibandingkan pasien dengan panjang stenosis >2 cm. Pasien dengan derajat stenosis 50–80% memiliki peluang keberhasilan 31,62 kali (IK 95%, 7,00–142,83) lebih tinggi dibandingkan pasien dengan derajat stenosis inisial >80%. Patensi vena sentral pada 3 bulan pertama didapatkan pada 59 pasien (54,1%) dan berkurang menjadi 28,4% pada bulan ke-6 dan 9,2% pada bulan ke-12. Kesimpulan: Terdapat hubungan antara panjang lesi dan derajat stenosis inisial dengan keberhasilan tindakan single balloon angioplasty ......Background: Vascular access is the lifeline of a hemodialysis patient. Hemodialysis vascular access dysfunction is a major cause of morbidity and mortality in the hemodialysis population. Venous stenosis may result in access dysfunction, which impairs dialysis quality. Endovascular intervention such as angioplasty is an effective solution to treat this condition; however, the cost of this procedure is unacceptably high for most patients.  This study aims to identify factors affecting the success of single balloon angioplasty, which is a modification of standard angioplasty technique, for patients with central venous stenosis. Methods: This is a retrospective analytic cohort study identifying factors affecting the success rate of single balloon angioplasty procedure in dr. Ciptomangunkusumo, Hermina Bekasi, Fatmawati, and Tangerang General Regional hospitals from January 2018 to December 2020. Statistical analysis was conducted to identify the correlation between stenosis location, previous history of central venous catheter placement, lesion length, and initial stenosis with the success rate of single balloon angioplasty according to residual stenosis and hemodialysis adequacy postoperatively. Results: There were 109 patients included in this study, with an average age of 55.17±11.51 years. Of the 109 subjects, 58 (53.2%) were men; 96 subjects (88.1%) suffered from chronic hypertension, while 38 were diabetics. Patients with lesion length of >2 cm had a 21.1% lower success rate compared with those with lesion length of ≤2 cm (78.9%) (p<0.001). Patients with an initial stenosis of >80% was more likely to have residual stenosis of ≥30% (p<0,001). Patients with stenosis length of ≤2 cm had a 5.089-times (95% CI, 2.103–12.31) higher success rate compared with those with stenosis length of >2 cm. Patients with a degree of stenosis 50–80% had a 31.62-times (95% CI, 7.00–142.83) higher success rate compared with patients with an initial stenosis of >80%. Central venous was patent in 59 patients (54.1%) in the first 3 month and decreased to 28.4% and 9.2% in the 6th and 12th month, respectively. Conclusion: Lesion length and the degree of initial stenosis were significantly correlated with the success rate of single balloon angioplasty.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
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Marethania Maheranny
Abstrak :
ABSTRAK
Latar belakangModalitas akses vaskular yang sering digunakan untuk melakukan tindakan hemodialisis HD regular pada anak dengan gagal ginjal adalah tunneled double lumen catheter TDLC , yang telah meningkat penggunaannya dari 60 pada tahun 2011 menjadi 78 pada tahun 2014 di Indonesia. Angka kejadian sumbatan yang disebabkan trombosis adalah sekitar 50 . Kondisi tersebut dapat terjadi dalam waktu 24 jam pertama setelah pemasangan TDLC, dan biasanya berkembang dalam waktu 2 minggu, kemudian menyebabkan early catheter dysfunction. Alteplase rT-pa merupakan salah satu pilihan trombolitik untuk disfungsi TDLC, di samping heparin, streptokinase, dan urokinase. pemasangan kateter vena sentral, dan biasanya berkembang dalam waktu 2 minggu.Subjek dan Metode : Studi kasus kontrol dengan subyek penelitian anak berusia 0-18 tahun dan mengalami penyakit ginjal kronik PGK stadium 4-5 yang menjalani HD regular di RSCM. Analisis statistik dengan uji statistik Mann-Whitney, Chi-square, Fisher rsquo;s exact, regresi linear, dan Receiver Operating Characteristic ROC . Pengujian dilakukan dengan menggunakan piranti lunak SPSS version 20 for Windows.Hasil : Selama periode Januari 2016 sampai November 2017 terdapat 111 subyek yang memenuhi kriteria; 65 subyek 58,6 laki laki dan 46 subyek 41,1 perempuan. Analisis bivariat menunjukkan masing-masing kadar albumin
ABSTRACT
BackgroundThe frequent vascular access modality used to perform regular hemodialysis HD actions in children with renal failure is a tunneled double lumen catheter TDLC , which has increased its use from 60 in 2011 to 78 by 2014 in Indonesia. Problems common to the TDLC are blockage and infection. The incidence of blockage caused by thrombosis is about 50 . The condition can occur within the first 24 hours after the installation of TDLC, and usually develops within 2 weeks, then causes early catheter dysfunction. Alteplase rT pa is one of the thrombolytic options for TDLC dysfunction, in addition to heparin, streptokinase, and urokinase. central venous catheter insertion, and usually develops within 2 weeks.MethodA case control study with children aged 0 18 years old and chronic kidney disease PGK stage 4 5 who underwent regular HD at RSCM. Statistical analysis with Mann Whitney statistical test, Chi square, Fisher 39 s exact, linear regression, and Receiver Operating Characteristic ROC . The test was performed using SPSS version 20 for Windows softwareResultDuring the period January 2016 to November 2017 there were 111 subjects meeting the criteria 65 subjects 58.6 male and 46 female subjects 41.1 . Bivariate analysis showed that each albumin
Depok: 2017
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Sinaga, Amsal Pebruanto
Abstrak :
Latar Belakang: Aortoiliac disease adalah varian dari PAD yang lesi obstruktifnya terdapat di aorta infrarenal, arteri iliaka komunis, arteri iliakan interna, arteri iliaka eksterna, atau kombinasi di antaranya. Diagnosis PAD pada aortoiliac disease dapat dilakukan secara klinis, dengan menilai gejala klinis sesuai klasifikasi Rutherford maupun Fontaine. Jumlah klasifikasinya pada level aorta abdominalis hingga pedis kemudian dibagi 3 segmen sesuai dengan letak anatomi kemudian dapat dihitung menggunakan nilai Lower Leg Arterial Calcium (LLAC) score.Metode: Penelitian ini menggunakan desain cross sectional yang menggunakan data dari rekam medis CT angiography secara restrospektif di RSCM dan beberapa RS Pendidikan jejaringan dari bulan Januari 2019 – Juni 2022. Jumlah sampel sebanyak 20 subjek per kelompok dan dana di analisis menggunakan SPSS versi 25 for Mac. Hasil: Dari 56 subjek penelitian dengan aortoiliac disease, terdapat 20 subjek yang dilakukan operasi bedah bypass terbuka dan 36 subjek yang dilakukan operasi endovaskular. Secara statistik, tidak terdapat perbedaan LLAC score yang bermakna antara pasien aortoiliac disease yang dilakukan operasi bedah terbuka dengan yang dilakukan operasi endovaskular (p>0,05) dan tidak terdapat hubungan antara nilai range LLAC score dengan pilihan tindakan revaskularisasi dengan nilai p=0,601. Kesimpulan: Semua nilai LLAC score pada aortoiliac disease adalah kategori severe. Selain itu, tidak ada perbedaan yang bermakna antara nilai LLAC score dengan tindakan revaskularisasi bedah terbuka dan endovaskular serta tidak ada perbedaan bermakna antara nilai LLAC score kategori severe terhadap tindakan revaskularisasi bedah terbuka dan endovaskular. ......Background: Aortoiliac disease is a variant of PAD in which obstructive lesions are found in the infrarenal aorta, common iliac artery, internal iliac artery, external iliac artery, or a combination of them. The diagnosis of PAD in aortoiliac disease can be done clinically, by assessing clinical symptoms according to Rutherford's and Fontaine's classifications. The number of classifications at the level of the abdominal aorta to the pedis is then divided into 3 segments according to the anatomical location and can then be calculated using the Lower Leg Arterial Calcium (LLAC) score.Method: This study used a cross-sectional design that used data from CT angiography medical records retrospectively at RSCM and several networked Education Hospitals from January 2019 – June 2022. The number of samples was 20 subjects per group and the funds were analyzed using SPSS version 25 for Mac.Results: A total of 56 study subjects with aortoiliac disease, 20 subjects underwent open bypass surgery and 36 subjects underwent endovascular surgery. Statistically, there was no significant difference in LLAC scores between patients with aortoiliac disease who underwent open surgery and those who underwent endovascular surgery (p>0.05) and there was no relationship between the LLAC score range and the choice of revascularization with a value of p=0.601.Conclusion: All LLAC scores for aortoiliac disease are in the severe category. In addition, there was no significant difference between the LLAC score and open and endovascular revascularization procedures and there was no significant difference between the LLAC score in the severe category for open and endovascular revascularization procedures.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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Irwan Mulyantara
Abstrak :
Tesis ini membahas mengenai performa skor V-POSSUM sebagai prediktor mortalitas 30 hari pasca tindakan EVAR TEVAR pada pasien AAA dan TAA di RSUPN Cipto Mangunkusumo.Penelitian ini merupakan studi kohort retrospektif menggunakan data dari rekam medis. Data yang diambil sesuai variabel yang terdapat dalam sistem skoring dalam bentuk kategorik lalu diolah secara statistik untuk menguji validitas skor V-POSSUM. Hasil penelitian melibatkan 85 pasien yang memenuhi syarat penerimaan penelitian. Dari pengolahan data statistik diketahui bahwa skor fisiologis, risiko morbiditas, dan risiko mortalitas dapat digunakan sebagai model untuk memprediksi luaran kematian karena memiliki performa akurasi dan diskriminasi yang baik, sedangkan skor kepelikan operasi tidak dapat digunakan karena secara statistik tidak menunjukkan hal yang sama. Nilai P hasil perhitungan 'Goodnes of Fit Model' skor fisiologis, risiko morbiditas, risiko mortalitas masing-masing adalah 0.00, sedangkan skor kepelikan operasi 0.18 (>0.05). 'Area Under the Curve' (AUC) masing-masing adalah 94%, 93%, 93%, dengan titik potong masing-masing berada di angka 31, 68.8, dan 10.6. Sebagai kesimpulan adalah bahwa skor V-POSSUM memiliki akurasi dan diskriminasi yang baik bukan hanya pada skor risiko mortalitasnya saja, namun pada skor fisiologis dan skor risiko morbiditasnya. ...... This thesis discusses the performance of V-POSSUM score as a predictor of 30 days mortality after EVAR TEVAR in AAA and TAA patients at Cipto Mangunkusumo Hospital. This study is a retrospective cohort method using data from medical records. Data taken according to the variables contained in the scoring system in categorical form then processed statistically to test the validity of the V-POSSUM score. The results of the study involved 85 patients who met the research acceptance requirements. From the processing of statistical data it is known that physiological scores, morbidity risk, and mortality risk can be used as a model to predict the outcome of death because it has good performance in accuracy and discrimination, while the severity score of surgery cannot be used because it does not show the same result statistically. The P value calculated by the Goodnes of Fit Model physiological score, the morbidity risk, the mortality risk of each was 0.00, while the severity score of the operation was 0.18 (> 0.05). Area Under the Curve (AUC) are 94%, 93%, 93%, respectively, with points 31, 68.8 and 10.6. The conclusion is that the V-POSSUM score has good accuracy and discrimination not only on the mortality risk score, but also on the physiological score and the morbidity risk score.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
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Haidir Bima
Abstrak :
ABSTRAK
Aterosklerosis adalah penyakit sistemik, Peripheral artery disease PAD dan Carotid artery stenosis CS secara luas mencakup penyakit vaskular yang keduanya dikenal sebagai manifestasi spesifik aterosklerosis. Mengingat etiologi umum aterosklerosis perifer yang bisa terjadi di lokasi vaskular yang berbeda, keberadaan penyakit di satu tempat meningkatkan frekuensi penyakit simptomatik dan asimtomatik di tempat lain. Karena keduanya memiliki penyebab yang sama, maka terdapat hipotesis bahwa keduanya berkorelasi satu sama lain. Tujuan penelitian adalah untuk mengetahui faktor-faktor risiko yang berhubungan dengan Carotid artery stenosis CS pada pasien lower extremityPeripheral artery disease PAD berat serta mengetahui prevalensi Carotid artery stenosis CS dan ketebalan Intimal media thicknes IMT pada pasien dengan penyakit lower extremity Peripheral artery disease PAD berat. Penelitian ini dilakukan di RSUPN Cipto Mangunkusumo selama Februari-Mei 2018. Penelitian ini bersifat prospektif, data diambil dari data sekunder berdasarkan anamnesis dan hasil laboratorium sedangkan derajat stenosis dan intimal media thickness dilakukan carotid duplex ultrasound DUS dengan United imaging ultrasound menggunakan probe 8,5 Mhz. Data dikumpulkan, direvisi, dikodekan dan dimasukkan ke paket statistik untuk ilmu sosial SPSS versi 20 dan yang berikut ini dilakukan : Data kualitatif disajikan sebagai jumlah dan persentase sementara data kuantitatif disajikan sebagai rata-rata, standar deviasi, rentang median dan interkuartil. Kurva karakteristik operasi penerima digunakan untuk menilai titik potong terbaik dengan sensitivitas, spesifisitas, nilai prediksi positif dan nilai prediktif negatif. Interval kepercayaan ditetapkan 95 dan margin kesalahan ditetapkan hingga 5 sehingga p-value dianggap signifikan sebagai P> 0,05. Hasil penelitiandidapatkan 50 subjek dengan rentang umur antara 49-80 tahun 63,8 8,8 tahun , dimana yang berjenis kelamin laki-laki sebanyak 31 62 , dan perempuan sebanyak 19 38 . Didapatkan korelasi antara hiperkolesterol dan riwayat merokok dengan derajat Carotid Stenosis dengan nilai ABSTRACT
Atherosclerosis is a systemic disease, Peripheral arterial disease PAD and Carotid artery stenosis CS widely include vascular disease bothh known as specific manifestation of atheroscleroris. Given the common etiology of peripheral atherosclerosis that can occur in different vascular sites, the presence of disease in one place increases the frequency of symptomatic and asymptomatic disease elsewhere. Since both have the same cause, there is a hypothesis that the two are correlated with each other. The objective of the study were to investigate the risk factor associated with Carotid artery stenosis CS in patients with severe lower extremity Peripheral arterial disease PAD and to know the prevalence of Carotid artery stenosis CS and degree of Intimal media thickness IMT in patients with severe lower extremity Peripheral arterial disease PAD . This research was conducted at Cipto Mangunkusumo General Hospital during February-May 2018. This is prospective research, the data was taken from secondary data based on hystory taking and laboratory result while the degree of stenosis and intimal media thickness is carotid duplex ultrasound DUS with United imaging ultrasound, using linier probe 8,5 Mhz. Data are collected, revised, encoded and fed into statistical package for social-science SPSS version 20, and the following are performed : Qualitative data are presented as quantities and percentages while quantitative data are presented as mean, standart deviation, median and interquartile range. The reciever operating characteristic curve is use to asses the best ctoff point with sensitivity, specificity, positive predictive value and negative predictive value. The confidence interval is set 95 and the margin error is set to 5 so p-value is considered significant as p
2018
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