E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Histological Description of Meningeal and Periosteal Dural Layers at the Porus of Internal Acoustic Canal in the Vestibular Schwannoma
Full text linkObjective: To study the transformation point of meningeal and periosteal dural at the porus of internal acoustic canal (IAC) in order to verify the different thickness of meningeal and periosteal dura in vestibular schwannomas (VS). Methods: Three IAC cadaver specimens and ten samples of VS patients from porus were obtained and analyzed. Samples were stained by using Masson trichrome technique after cutting in 6 micron of thickness. The samples were then observed under light microscopes to understand the meninges pattern in the IAC. Results: The meningeal dura is becoming thin at the porus and disappears at the meatal portion to form epineurium. However, the periosteal dura is lining continuously to the fundus. In VS, the meningeal dura becomes thick and forms a pseudo-capsule in the middle of meatus, known as perineurium. The residual nerve filament was compressed by the tumor parenchyma. Between the tumor and nerve interface, three or more perineureal layers are seen. The perineurium in the cisternal portion was consistently loose and forms the tumor and arachnoid nerve interface. Almost all the nerve filaments are displaced to the tumor periphery near the pseudocapsule. In contrast, the periosteal dural of VS is becoming thin and disappear nearby the middle of meatal portion. This changing site establishes “meningo-periosteal ring” of VS because of the encircling nearby the porus. Conclusions: In IAC, the meningeal dural becomes thin. The periosteal dura is lining continuously to the fundus. In VS, the meningeal dura becomes thick, joins perineurium and forms pesudocapsule near the porus, but the periosteal dura disappeared. This changing point is called meningo-periosteal ring. Keywords: Meningeal, periosteal, porus, vestibular schwannomasDOI: 10.15850/ijihs.v1n1.10
Scalp Nerve Block pada Kraniotomi Evakuasi Pasien Moderate Head Injury dengan Subdural Hemorrhage dan Intracerebral Hemorrhage Frontotemporoparietal Dekstra Mencegah Stress Response Selama dan Pascabedah
Full text linkInsisi kulit dan kraniotomi selama operasi intrakranial merupakan stimulus berbahaya yang dapat menghasilkan stress response yang menyebabkan peningkatan tekanan intrakranial. Scalp nerve block efektif dalam mengurangi stress response ini, selain itu juga dapat digunakan sebagai analgetik pascabedah. Seorang laki-laki usia 22 tahun dengan moderate head injury, subdural hemorrhage, dan intracerebral hemorrhage at regio fronto-temporo-parietal dextra dilakukan kraniotomi evakuasi dalam combined scalp nerve block - general anesthesia di Rumah Sakit Dr. Hasan Sadikin Bandung pada tanggal 14 Agustus 2012. Setelah dilakukan induksi dan sebelum insisi dilakukan scalp nerve block dengan bupivakain 0,5%. Hemodinamik (tekanan darah dan denyut jantung) setelah insisi kulit dan kraniotomi, serta glukosa darah pascabedah tidak menunjukkan perubahan yang signifikan. Analgetik pascabedah baru diberikan setelah 8 jam sejak dilakukan blok. Hasil ini menunjukkan scalp nerve block menggunakan bupivakain 0,5% mampu menumpulkan stress response dan dapat digunakan sebagai analgetik pascabedah.Kata kunci: Kraniotomi evakuasi, scalp nerve block, stress responseScalp Nerve Block in Craniotomy Evacuation on a Patient with Moderate Head Injury with Subdural Hemorrhage and Right Frontotemporoparietal Intracerebral Hemorrhage Prevents Intra and Post Operative Stress ResponseAbstractSkin incision and craniotomy are recognized as an acute noxious stimulation during intracranial surgery which may result in stress response causing an increase in intracranial pressure. Scalp nerve block may be effective in reducing stress response. It can also be used to provide post-operative analgesia. A twenty two years old male with moderate head injury, subdural hemorrhage, intracerebral hemorrhage at right fronto-temporo-parietal region underwent evacuation craniotomy with combined scalp nerve block and general anesthesia at Dr. Hasan Sadikin Hospital Bandung on August 14th 2012. After induction and before incision of the skin, a scalp nerve block was performed using 0.5% bupivacaine. Hemodynamic (blood pressure and heart rate) changes after incision of the skin and craniotomy were not significant, and so was post-operative blood glucose concentration. Post-operative analgetic was given eight hours after the block. The result demonstrates that scalp nerve block using 0.5% bupivacaine successfully blunts stress response and can be used as post-operative analgesia.Keywords: Craniotomy evacuation, scalp nerve block, stress response DOI: 10.15851/jap.v1n3.19
Perbandingan Granisetron 0,01 mg/KgBb dengan Ondansetron 0,08 Mg/Kg.Bb Untuk Mencegah Mual Muntah Pascaoperasi Dini Mastektomi Radikal Modifikasi
No full textMual muntah pascaoperasi tidak hanya menyebabkan ketidaknyamanan bagi pasien, namun juga menyebabkan terjadinya gangguan keseimbangan elektrolit, regurgitasi dan aspirasi, perdarahan serta lepasnya jahitan pembedahan. Pasien yang mengalami mual muntah pascaoperasi akan membutuhkan perhatian dan pengobatan lebih lanjut yang tentu saja meningkatkan biaya pelayanan medis. Wanita yang menjalani mastektomi dengan disertai pengambilan kelenjar getah bening ketiak mempunyai resiko tinggi terjadinya mual muntah pasca operasi. Banyak anti muntah yang diberikan termasuk diantaranya antihistamin, butyrophenon, dan antagonis reseptor dopamin telah dilaporkan mempunyai efek samping yang tidak diinginkan antara lain sedasi yang berlebihan, hipotensi, mulut kering, dysphoria, halusinasi dan efek ekstrapiramidal. Antagonis reseptor 5 HT3 memberikan kemajuan yang besar sebagai penanganan mual muntah pascaoperasi karena efek sampingnya yang sedikit bila dibandingkan dengan obat-obat anti muntah sebelumnya. Penelitian ini akan membandingkan dua obat antagonis reseptor 5 HT3 yaitu granisetron dengan ondansetron dalam mencegah mual muntah pascaoperasi dini mastektomi radikal modifikasi. Dilakukan penelitian pada 58 pasien ASA I dan II yang dilakukan mastektomi radikal modifikasi dengan anestesi umum. Pengambilan sampel dilakukan dengan menggunakan uji klinis acak terkontrol buta ganda. Sampel dibagi menjadi dua kelompok dengan randomisasi blok. Kelompok G diberikan granisetron 0,01 gr/kg.bb dan kelompok O diberikan ondansetron 0,08 mg/kg.bb. Obat perlakuan diberikan intravena 30 menit sebelum operasi selesai Evaluasi dilakukan pada tekanan darah, denyut jantung, saturasi oksigen dan lama pembedahan. Mual muntah pascaoperasi dinilai segera setelah operasi tiap jam sampai 6 jam pascaoperasi (mual muntah pascaoperasi dini) dengan 4 skala (0-3). Data dianalisis dengan uji-t, uji Chi-square, uji Mann-Whitney, dan uji Exact Fisher pada program SPSS ver.16 Windows. Hasil penelitian menunjukkan terdapat kecenderungan keluhan mual muntah pascaoperasi lebih banyak terjadi pada kelompok O (27,6%) dibandingkan dengan kelompok G (6,9%). Pada analisis statistik yang dilakukan dengan uji Chi-square didapatkan hasil perbedaan yang bermakna (p <0,05). Simpulan pemberian granisetron 0,01 gr/kg.bb intravena lebih baik dibandingkan dengan ondansetron 0,08 mg/kg.bb. intravena dalam dalam menurunkan kejadian mual muntah pascaoperasi dini mastektomi radikal modifikasi.Kata kunci: Mual muntah pascaoperasi dini, granisetron, ondansetron, mastektomi radikal modifikasi Comparison Granisetron 0.01 Mg / Kg.Bb With Ondansetron 0.08 Mg / Kg.Bb To Prevent Early Postoperative Nausea Vomiting Modified Radical MastectomyPostoperative nausea and vomiting not only cause discomfort to the patient, but also lead to electrolyte imbalance, regurgitation and aspiration, bleeding and loss of surgical sutures. Patients who experience postoperative nausea and vomiting will require further attention and treatment which of course increases the cost of medical services. Women who underwent mastectomy with accompanying decision underarm lymph nodes have a high risk of postoperative nausea and vomiting. Many anti-vomiting are given including antihistamines, butyrophenon, and dopamine receptor antagonists have been reported to have undesirable side effects including excessive sedation, hypotension, dry mouth, dysphoria, hallucinations and extrapyramidal effects. 5 HT3 receptor antagonists provide a major advancement for treatment of postoperative nausea and vomiting due to fewer side effects when compared with anti-vomiting medications before. This study will compare the two drugs 5 HT3 receptor antagonist granisetron with ondansetron in preventing postoperative nausea and vomiting modified radical mastectomy early. Conducted research on 58 patients ASA I and II modified radical mastectomy is performed under general anesthesia. Sampling was carried out using double-blind randomized controlled trial. Samples were divided into two groups by block randomization. Group G is given granisetron 0.01 gr / kg.bb and group O is given ondansetron 0.08 mg / kg.bb. Drug treatment is administered intravenously 30 minutes before the surgery ended on a complete evaluation of blood pressure, heart rate, oxygen saturation and length of surgery. Postoperative nausea and vomiting shortly after surgery assessed every hour until 6 hours after surgery (early postoperative nausea and vomiting) to 4 scale (0-3). Data were analyzed by t-test, Chi-square test, Mann-Whitney test and Fisher's Exact test on Windows SPSS ver.16 The results suggest there is a tendency complaints of postoperative nausea and vomiting occurs more frequently in group O (27.6%) compared with group G (6.9%). In the statistical analysis performed with Chi-square test results obtained were significant differences (p <0.05). Conclusion that the provision of granisetron 0.01 mg / kg.bb better than intravenous ondansetron 0.08 mg / kg.bb. intravenously in lowering the incidence of early postoperative nausea and vomiting modified radical mastectomy.Keywords: early postoperative nausea and vomiting, granisetron, ondansetron, modified radical mastectomy DOI: 10.15851/jap.v1n1.15
Laporan Kasus: Penyakit Kawasaki Atipikal
Full text linkPenyakit Kawasaki merupakan penyebab utama kelainan jantung dapatan yang sering ditemukan pada anak. Di Indonesia, penyakit ini masih sangat jarang didiagnosis karena dianggap masih jarang dan belum diketahui secara luas. Dua laporan kasus berikut merupakan laporan kasus anak perempuan dan laki-laki, masing-masing berusia 17 bulan dan 3 tahun. Keduanya datang dengan demam yang persisten lebih dari 5 hari dan hanya memenuhi 3 kriteria klasik penyakit Kawasaki, yakni mata merah dan disertai dengan perubahan mukosa bibir serta ekstremitas. Penderita kemudian didiagnosis sebagai penyakit Kawasaki atipikal. Pada pemeriksaan laboratorium didapatkan peningkatan C-reactive protein dan laju endap darah disertai gambaran ekokardiografi yang normal. Kedua anak diberikan imunoglobulin intravena (IGIV) dengan dosis 2 gram/kgBB dosis tunggal dan aspirin dosis 80 mg/kgBB/hari. Penderita mengalami perbaikan setelah 1 hari mendapat terapi kombinasi tersebut. Disimpulkan bahwa pengobatan dengan kombinasi IGIV dan aspirin memberikan respons yang baik pada penyakit Kawasaki atipikal. [MKB. 2011;43(3):146–52].Kata kunci: Aspirin, imunoglobulin intravena, penyakit Kawasaki atipikal Case Reports: Atypical Kawasaki DiseaseKawasaki disease is the most common cause of acquired heart disease in children. In Indonesia the disease is rare to diagnosed, because of difficulty in diagnosis and not widely known. These were 2 case reports about a girl and a boy age 17 months and 3 years, who came with persistent fever more than 5 days and only fulfilled 3 criteria of Kawasaki disease, which are red eyes, changes in lips, mucose of oral and extremities. They were diagnosed as atypical Kawasaki disease. Laboratory examinations showed an increased of C-reactive protein and erythrocyte sedimentation rate with normal echocardiography. The patients were improved after treated with 2 grams per bodyweight of intravenous immunoglobulin (IVIG) and 80 mg per bodyweight of aspirin. The patients were better after one day combination therapy. In conclusion that atypical Kawasaki disease has good response to combination of IVIG and aspirin. [MKB. 2011;43(3):146–52].Key words: Aspirin, atypical Kawasaki disease, intravenous immunoglobulin DOI: http://dx.doi.org/10.15395/mkb.v43n3.6
Anterior Transpetrosal Untuk Lesi pada Fosa Kranialis Media dan Posterior: Review Literatur dan Diseksi Kadaver
Full text linkReseksi selektif pada bagian anterior piramid os petrosus (segitiga Kawase), dengan terlebih dahulu melakukan kraniotomi pada dinding lateral fosa kranialis media, dapat memberikan lapang pandang bedah yang cukup luas dari parasellar, clivus dan cerebellopontine angle (CPA), tanpa mengorbankan struktur organ pendengaran dalam (internal acoustics organ). Keuntungan utama teknik anterior transpetrosal ini adalah dapat langsung mengakses tumor yang melekat pada klivus melalui rongga kecil yang dibuat pada apeks os petrosus. Pengangkatan tumor dengan perdarahan yang minimal dapat dicapai dengan melakukan koagulasi pada arteri tentorium dan akses langsung ke arah anterior kanalis auditorius internus, juga dapat mengurangi cedera pada nervus fasialis dan vestibulokoklearis. Keuntungan lainnya, yaitu, rendahnya risiko komplikasi perdarahan vena, karena teknik ini tidak mengekspos sinus sigmoid ataupun vena Labbe. [MKB. 2010;42(2):86-91].Kata kunci: Anterior transpetrosal, fosa media dan posterior, diseksi kadaverAnterior Transpetrosal for Lession in Middle and Posterior Fossa: Literature Review and Cadaver DissectionResection of the anterior part of pyramid through the middle fossa craniotomy will give us a surgical field of the parasellar, clivus and cerebellopontine angle without sacrificing the auditory structure. The advantage of the anterior transpetrosal approach is the direct access to tumors that attached to the clivus via a keyhole created on the petrosus apex. Bloodless tumor removal can be achieved by detachment of the tentorial artery and direct access of the anterior internal auditory canal also can minimize the injury of the cranial nerve facialis and vestibulocochlearis. Another advantage is the low risk of venous damages since this approach is not exposing the sigmoid sinus and the vein of Labbe. [MKB. 2010;42(2):86-91].Key words: Anterior transpetrosal, middle and posterior fossa, cadaver dissection DOI: http://dx.doi.org/10.15395/mkb.v42n2.21
TROMBOEMBOLI PARU PADA ANAK
Full text linkTromboemboli paru dapat terjadi akibat adanya obstruksi pembuluh darah paru oleh trombi. Tromboemboli paru jarang didiagnosis dan dilaporkan pada anak, kebanyakan bahkan tidak terdiagnosis sampai setelah dilakukan otopsi. Penyakit yang pada dewasa meningkatkan risiko terjadinya tromboemboli juga berlaku untuk anak dan remaja. Penderita dengan tromboemboli paru biasanya mempunyai penyakit yang mendasari ataupun faktor pencetus, seperti imobilisasi, penggunaan vena sentral, penyakit jantung, trauma, operasi, infeksi, dehidrasi, keganasan, kelainan hematologi, serta kegemukan. Lokasi anatomis trombus vena pada anak berbeda dengan dewasa yaitu pada vena kranialis dan abdominalis, serta seringkali manifestasi klinisnya tidak jelas. Pada anak, tomboemboli paru harus dipertimbangkan pada beberapa keadaan, antara lain dalam mengevaluasi hipertensi paru yang tidak bisa diterangkan penyebabnya, insufisiensi respirasi, dan koagulasi intravaskular diseminata (KID). Pemeriksaan angiografi paru masih merupakan gold-standard untuk mendiagnosis tromboemboli paru dan merupakan pemeriksaan yang invasif. Pemeriksaan non-invasif multidetector helical/spiral computerized tomography scanning yang mempunyai sensitivitas dan spesifisitas tinggi merupakan teknik yang diharapkan dapat menggantikan pemeriksaan angiografi paru. Protokol pengobatan untuk anak masih belum berkembang, tetapi hingga saat ini antikoagulasi merupakan obat yang digunakan untuk mencegah perluasan bekuan dan rekurensi tromboemboli.Kata kunci: Tromboemboli paru, angiografi paru, multidetector helical/spiral computerized tomography scanning, anakPULMONARY THROMBOEMBOLISM IN CHILDRENPulmonary thromboembolism could be happened because of pulmonary vessel obstruction by thrombi. Pulmonary thromboembolism is rarely diagnosed and reported in children, most of them are not diagnosed before autopsy was done. All adult diseases that increase the risk of thromboembolism occur in children and adolescent as well. Patients with pulmonary thromboembolism usually have serious underlying disorders or precipitating factors, such as immobility, central venous catheterization, heart disease, trauma, surgery, infection, dehydration, malignancies, hematologic disorders, and obesity. The anatomic site of venous thrombi in children differs from those in adult, which more likely to involve cranial or abdominal veins, and often asymptomatic. Pulmonary thromboembolism in children should be considered in the evaluation of unexplained pulmonary hypertension, respiratory insufficiency, and disseminated intravascular coagulation. Pulmonary angiography is considered to be the gold-standard for diagnosis of pulmonary thromboembolism, and it is an invasive procedure. Non-invasif procedure multidetector helical/spiral computerized tomography scanning with high sensitivity and specificity is promising technique may replace pulmonary angiography. Although definitive protocols for treatment of pulmonary thromboembolism in children have not been improved yet, but until now anticoagulation drugs is used to prevent clot extension and recurrent thromboembolim.Key words: Pulmonary thromboembolism, pulmonary angiography, multidetector helical/spiral computerized tomography scanning, children DOI: http://dx.doi.org/10.15395/mkb.v41n1.25
NONTHYROIDAL ILLNESS (NTIs)
Full text linkNonthyroidal Illness (NTIs) didefinisikan sebagai keadaan didapatkan fungsi tiroid yang abnormal tanpa ditemukan gangguan pada aksis hipotalamus-hipofise, juga tidak ada gangguan pada kelenjar tiroidnya. NTIs ditemukan pada penderita dengan sakit berat, dan biasanya fungsi tiroid akan membaik sejalan dengan kesembuhan penyakit dasarnya. Macam-macam gangguan fungsi tiroid sangat bervariasi, mulai dari rendahnya kadar triiodotironin serum (T3) dan meningkatnya reverse T3 (rT3). Sejalan dengan beratnya penyakit dasarnya maka sering juga mengakibatkan gangguan pada thyroid-stimulating hormone (TSH), tiroksin (T4), dan free T4 (fT4). NTIs semakin berat terjadi saat kedua hormon T3 dan T4 ditemukan menurun dan secara perlahan-lahan akan meningkat sejalan dengan kesembuhan penyakitnya. Sampai saat ini masih menjadi perdebatan apakah perlu atau tidak diberikan hormon pengganti tiroid. Masih diperlukan studi prospektif dengan jumlah pasien yang besar mengenai penggunaan hormon pengganti ini. Oleh karena itu perlu untuk memahami fisiologi dan patofisiologi NTIs sehingga kita dapat memahami kapan menggunakan hormon pengganti tiroid.Kata kunci: NTIs, fungsi tiroid, hormon pengganti tiroidNONTHYROIDAL ILLNESS (NTIs)Nonthyroidal illness (NTIs) can be described as abnormal findings on thyroid function tests that occur in the setting of a nonthyroidal illness (NTI) without preexisting hypothalamic-pituitary and thyroid gland dysfunction. After recovery from an NTI, these thyroid function test result abnormalities should be completely reversible. Multiple alterations in serum thyroid function test findings have been recognized in patients with a wide variety of NTI without evidence of preexisting thyroid or hypothalamic-pituitary disease. The most prominent alterations are low serum triiodothyronine (T3) and elevated reverse T3 (rT3), leading to the general term low T3 syndrome. Thyroid-stimulating hormone (TSH), thyroxine (T4), and free T4 also are affected in variable degrees based on the severity and duration of the NTI. It cannot diagnosed NTIs only by measure one thyroid hormone. As the severity of the NTI increases, both serum T3 and T4 levels drop and gradually normalize as the patient recovers. It's still be an argument for administration of replacement T3 and T4 hormone in patients with NTIS. However, it is impossible to be certain at this time that it is beneficial to replace hormone, or whether this could be harmful. Only a prospective study will be adequate to prove this point, and probably this would need to involve hundreds of patients. Ongoing studies document the beneficial effects of replacement of other hormones in these acutely and severely ill patients.Key words: NTIs, thyroid function, hormone replacement DOI: http://dx.doi.org/10.15395/mkb.v41n3.24
Optimalisasi Persalinan Non-institusional Untuk Menurunkan Angka Kematian Ibu Era Millenium Development Goals
Full text linkThe Millennium Development Goals (MDGs) adalah delapan target yang harus dicapai pada tahun 2015 sebagai respons terhadap tantangan pembangunan utama dunia. MDGs dalam bidang kesehatan maternal diukur dengan indikator angka kematian ibu (AKI) dan persentase persalinan yang dilakukan oleh penolong persalinan terlatih (skilled birth attendant). Artikel ini membahas kembali program yang sangat baik dan ada di Indonesia namun belum terlaksana dengan sempurna melihat Indonesia merupakan negara dengan AKI tertinggi di Asia Tenggara. AKI nasional memang menunjukkan penurunan dalam beberapa tahun terakhir, tetapi di beberapa daerah masih sangat tinggi, sementara proporsi persalinan yang ditolong oleh penolong persalinan terlatih memang menunjukkan peningkatan tapi dukungan sistem dan keterampilan penolong dianggap masih belum memenuhi harapan. Sebagian besar proses persalinan di Indonesia terjadi di rumah (non-institusional), beberapa faktor yang saling berkaitan dengan karakteristik proses persalinan di Indonesia adalah psikologis, keluarga, dan ekonomi. Upaya menurunkan AKI di Indonesia merupakan gabungan dari penolong persalinan terlatih, asuhan obstetrik emergensi, dan sistem rujukan emergensi. Intervensi di atas tidak harus dilakukan di fasilitas kesehatan, tapi dapat diimplementasikan oleh penolong persalinan terlatih saat persalinan di rumah, harus didukung oleh: lingkungan yang menunjang, rujukan emergensi, dan juga perbaikan akses kontrasepsi. Optimalisasi persalinan non-institusional dengan desa SIAGA dan Gerakan Sayang Ibu (GSI). GSI menggalakkan kesiapan persalinan dan kesiagaan komplikasi dengan “desa SIAGA” yang mempunyai komponen: Sistem Dana, Sistem Transportasi, Sistem Donor Darah, Sistem Pemberitahuan, dan Kemitraan pertolongan persalinan dukun paraji dan bidan. Kata kunci: MDGs, AKI, persalinan non-institusional, desa SIAGA, GSIOptimalization Non-institutional Delivery in Reducing Maternal Mortality Ratios To Achieve Millenium Development GoalsThe Millennium Development Goals are goals that must be achieved in 2015 as a responds to world development challenges. MDGs in maternal healthcare were measured by indicators such as maternal mortality ratios and percentage of births attended by skilled birth attendants (SBA). This article focuses on very good programs inIndonesia but still not being done perfectly because Indonesia's MMR is still the highest among south east asian countries. National MMR is declining over decades, but in several provinces MMR still high. Deliveries by SBA proportion show promising trends although with low system support and skill monitoring support. Most of deliveries were non-institutional, several aspects known to play important roles were psychological, families, and economics aspects. Efforts on lowering maternal mortality in Indonesia actually are combinations between SBA, emergency obstetric care, and emergency referral system. Interventions can be done by SBA at home whileworking, with an adequate support from community system, emergency referral system, and improvement of contraception access. Non-institutional delivery optimalization with des SIAGA and GSI (Safe Motherhood Activities) which had 5 components; Funding System, Transportation System, Blood Donor System, Information System, and partnership in midwives and traditional birth attendant (TBA). Key words: MDGs, MMR, non-institutional deliveries, desa SIAGA, GSI DOI: http://dx.doi.org/10.15395/mkb.v41n4.25