28 research outputs found
Outcome management of Fournier’s gangrene cases at tertiary hospital: 7 Years experience
Get PDFObjective: This study aims to describe the condition of Fournier’s gangrene in Dr. Soetomo General Hospital from January 2014 to December 2020. Material and methods: This study used a retrospective analytic design, by taking data through medical records at Dr. Soetomo General Hospital from January 2014 to December 2020. This study used total sampling with recorded data: age, gender, length of stay, outcome, location, comorbidities, causes, management, culture results, and Fournier’s gangrene severity index (FGSI) score. Result: Of the 135 subjects collected, it was found that 55.56% were individuals over 50 years of age. About 91.11% were male patients, with some sites being in the scrotum 50.37%. Only 25.19% of patients had no comorbids, while the rest had a history of CKD, hypertension, diabetes, or a combination of these diseases. Bacterial cultures obtained were mostly caused by the Enterobacteriaceae bacteria group (32.59%). Of the subjects we studied who experienced mortality, it was found that all were from the group with FGSI >9. Conclusion: From the results of our descriptive study, at a glance, it appears that there is a tendency for the incidence of Fournier’s gangrene in the elderly and individuals with comorbidities. And the mortality rate increases with a high FGSI value. So that FGSI could be used as a predictor of mortality in patients with FG
Makna dan fungsi upacara Piodalan Umat Hindu di Pura Jala Siddhi Amerta Juanda Sidoarjo
Get PDFUpacara Piodalan atau Odalan adalah sebuah ritual upacara keagamaan Hindu yang dikenal sebagai peringatan hari lahirnya atau hari ulang tahun sebuah Pura. Bagi umat Hindu Jala Siddhi Amerta Juanda Sidoarjo, upacara Piodalan ini merupakan upacara yang diadakan setiap enam bulan sekali atau 210 hari sekali, dalam artian upacara untuk menyampaikan rasa terima kasih atau rasa syukur atas anugerah yang berlimpah dari Hyang Widhi Wasa. Penelitian ini bertujuan untuk mengetahui makna dan fungsi prosesi upacara Piodalan bagi umat Hindu di Pura Jala Siddhi Amerta. Penelitian ini menggunakan pendekatan kualitatif, yakni peneliti melakukan penelitian lapangan menggunakan metode pengumpulan data melalui observasi, wawancara secara langsung kepada narasumber dan dokumentasi. Dalam penelitian ini peneliti menganalisis data dengan menggunakan teori kebudayaan dan agama serta teori fungsi ritual menurut Victor Witer Turner, dimana dalam teori ini menjelaskan fungsi ritual dibagi menjadi empat fungsi sosial, menurutnya ritual tidak hanya sebagai kewajiban saja melainkan sebagai simbol dari apa yang sebenarnya terjadi dalam masyarakat. Hasil dari penelitian ini adalah bahwa prosesi pelaksanaan upacara Piodalan dilakukan dengan mempersiapkan perlengkapan atau alat-alat upacara, membersihkan Pura serta merangkai sesaji atau banten berupa korban, khususnya rangkaian korban (bunga, daun kelapa, biji beras, dan air suci). Barulah upacara Piodalan bisa dilaksanakan dengan berkumpulnya pengurus rumah tangga Jala Siddhi Amerta, warga kompleks TNI-AL dan para umat Hindu Sidoarjo maupun Surabaya berkumpul di Mandala Utama Pura dimulai dengan melakukan sembahyang Tri Sandya sampai rangkaian upacara berakhir. Makna yang terkandung dalam upacara Piodalan bagi umat Hindu di Pura Jala Siddhi Amerta adalah sebagai wujud rasa terima kasih atau Bhakti syukur umat kepada Hyang Widhi Wasa. Selain itu makna bagi generasi muda sebagai sarana untuk belajar berorganisasi di lingkungan masyarakat dan belajar merangkai banten sendiri. Sedangkan fungsi yang terkandung dalam upacara Piodalan bagi umat Hindu Jala Siddhi Amerta adalah untuk membebaskan diri seseorang dari ikatan dosa dan membebaskan diri dari ikatan karma
Endoscopic combined intrarenal surgery for successful removal of an encrusted ureteral stent and multiple renal stones in solitary kidney:A case report
Get PDFIntroduction and importance: Several endoscopic procedures have been performed to clear stones in the kidney. A potential technique called endoscopic combined intrarenal surgery (ECIRS) is a practical option for treating complex kidney stones. Hereby, we report a neglected double j (DJ) stent and recurrent multiple kidney stones treated by ECIRS. Case presentation: A 56-year-old female complained of right flank pain one week ago, which worsened within one day before hospital admission. She underwent DJ stent insertion one year ago because of residual stones after right percutaneous nephrolitothomy (PCNL) but was lost to follow-up. There was a history of left nephrectomy, leaving the patient with only a right kidney. A x-ray kidney ureter bladder (KUB) evaluation showed multiple irregular radiopaque shadows. A computed tomography (CT) scan detected numerous stones in the right kidney. The patient underwent ECIRS to remove the DJ stent and clear multiple stones in the right kidney. Following the surgery, the patient was discharged from the hospital on the fourth postoperative day with no complications and residual stone. Clinical discussions: ECIRS is a technique that combines a simultaneous antero-retrograde approach to the kidney and aims to resolve nephrolithiasis in one step and with one access. The ECIRS procedure could be considered in cases of complex multiple stone nephrolithiasis. ECIRS could widen the operative vision, thus helping to clear difficult kidney stones. Conclusions: The ECIRS technique could provide successful and safe management of recurrent multiple kidney stones and encrusted, neglected DJ stents in a solitary kidney patient.</p
Evaluating prognostic indicators for in-Hospital mortality in Fournier's gangrene:A 7-year study in a tertiary Hospital
Get PDFBackground: Fournier's Gangrene Scoring Index (FGSI), Simplified FGSI (SFGSI), Uludag FGSI (UFGSI), Laboratory Risk Indicator for Necrotizing (LRINEC), Neutrophil-Lymphocyte ratio (NLR), and Platelet-lymphocyte ratio (PLR) have been devised to assess the risk of mortality in Fournier's Gangrene (FG) patients. However, the effectiveness of these indicators in predicting mortality at the time of admission remains uncertain. The aim of this study is to assess the prognostic efficacy of FG’s various indicators on in-hospital mortality. Methods: This study analyzed 123 patients from Dr. Soetomo General Hospital’s emergency department in Indonesia from 2014 to 2020. Data included demographics, wound cultures, and parameters like FGSI, UFGSI, SFGSI, NLR, PLR, and LRINEC. In-hospital mortality status was also recorded. The data was subjected to comparative, sensitivity, specificity and regression analyses. Results: In our study of 123 patients, the median age was 52, with a mortality rate of 17.9%. The majority of patients were male (91.1%) and the most common location was scrotal (54.5%). Non-survivors had a shorter median stay (6.5 days) compared to survivors (14 days). Diabetes was the most prevalent comorbidity (61.8%). The highest sensitivity and specificity were found in FGSI and UFGSI indicators. Multivariate logistic regression identified LoS and FGSI as independent predictors of mortality. Conclusions: FGSI and UFGSI, upon admission, demonstrated the highest sensitivity and specificity, with hospital stay duration and FGSI as key mortality determinants.</p
Management of high-grade pediatric renal trauma in tertiary referral hospital in Indonesia:A case series and literature review
Get PDFIntroduction and importance: Genitourinary tract injuries constitute 10 % of all traumas, with renal injuries being common in pediatric cases due to reduced perirenal fat and abdominal wall muscle development. However, very few reports of pediatric renal trauma in Indonesia have been reported. In this case series, We present a case series of high-grade renal injury and review the literature on pediatric renal trauma in Indonesia. Case presentation: We present four cases with renal trauma as the subjects of this case study. The 13-year-old boy, who was the initial patient, complained of hematuria and abdominal pain after falling from a tree. The second patient, the 13-year-old boy, presented with left lower back pain and hematuria after being elbowed in the left waist. The third patient, a 14-year-old boy, had been in a motorcycle accident and got grade 5 renal injury according to AAST classification. The final case involved a 4-year-old boy who experienced recurrent hematuria caused by a pseudoaneurysm following blunt renal trauma. Discussion: Trauma is the leading cause of morbidity and mortality in children, with approximately 3 % of children assessed in pediatric hospital trauma departments having had trauma. With appropriate management according to guidelines, mortality can be avoided. Conclusion: The case series highlights the significance of treating pediatric renal trauma patients individually according to their hemodynamic state and degree of impairment.</p
Management of Fournier's gangrene in a newborn:A rare case report and literature review
Get PDFIntroduction: Fournier's gangrene (FG) in neonates is less common than in adults, but this case can lead to a poor prognosis. FG is a disease of the genital, perianal, and perineal areas characterized by necrotizing infections. Here, we report a case of a 24-day-old male infant diagnosed with Fournier's gangrene involving the scrotum. Case presentation: The patient presented with scrotal swelling, fever, erythema, and insect bites on the penile tip that had gradually extended to the proximal area and bilateral scrotum. On physical examination, indurated grayish and blackish-brown scrotal skin with sharp distinction from the surrounding normal skin, erythema, purulence, ulceration, and necrotic tissue were observed. Abdominal X-ray and scrotal ultrasonography revealed gaseous distension of the scrotal region, free fluid on bilateral testes, and enlargement of bilateral testicles. Immediate surgical debridement, along with broad-spectrum antibiotics, was initiated, and a microbiological culture identified the presence of Pseudomonas aeruginosa. The patient demonstrated the completed healing of the surgical wound after thirty days of surgical intervention. Discussion: Fournier's gangrene in neonates is a sporadic case. Our patient presented with multiple predisposing factors, including insect bites and poor hygiene, underscoring the need for heightened clinical suspicion in vulnerable populations. Prompt recognition and intervention are critical, given the rapid progression of FG. Conclusion: This case underscores the importance of timely diagnosis and early initiation of surgical and medical interventions in neonatal Fournier's gangrene, particularly in cases involving the scrotum.</p
Management of neglected urethral stone and Fournier's gangrene as its complication:A case report
Get PDFIntroduction and importance: Fournier's gangrene (FG) is a rare necrotizing fasciitis, and it's a urological emergency. Another disease that can cause FG is urethral stones. This case report is prepared to discuss the management of neglected urethral stones and Fournier's Gangrene, as well as its complications. Case presentation: A 49-year-old male presented to the emergency room (ER) referred from the public health centre with a swollen and infected scrotum 2 weeks ago. It was worsened 1 day before hospital admission, accompanied by the discharge of pus from the scrotum. The patient also complained presence of intermittent fever, nausea, and vomiting. There was a history of straining when urinating. Physical examination showed a lump at the penis and crepitation at the scrotum. Radiological examination of the kidney ureter and bladder (KUB) x-ray and urethrography showed the presence of gangrenous gas at the scrotum. In this case, we perform open cystostomy, debridement necrotomy, and removal of urethral stone. Clinical discussion: Management of neglected urethral stones and Fournier's Gangrene cases needs to be done immediately to prevent poor outcomes. Necrotomy debridement management is performed immediately as a source of infection. Open cystostomy as a urinary diversion is performed so that urine does not pass through the urethra and the healing process of the urethra can be maximized. Conclusion: Controlling the source of infection and urinary diversion is important in cases where neglected urethral stones and Fournier's gangrene are found.</p
Massive subcutaneous abscess:A case report of management and source control
Get PDFIntroduction and importance: Postoperative peritoneal infection, a common complication, remains prevalent despite surgical advancements. Acute abdomen necessitates rapid treatment, often presenting with abdominal pain and systemic inflammation. Bladder injuries, potentially leading to sepsis, require immediate surgical intervention. Case presentation: We report a case of a 60-year-old man who came with the main complaint of feeling full in his stomach for 7 days, accompanied by non-radiating right lower abdominal pain since one day before hospital admission and a lethargy condition. There are complaints of seepage from the stitch marks on the right stomach, such as yellow urine. Laboratory and physical examination showed the patient in sepsis condition. CT Cystography showed a defect of 0.4 cm on the bladder dome, the contrast leakage into extraperitoneal and intraperitoneal, and tunneling to the right abdominal subcutaneous. The patient underwent subcutaneous abscess, bladder repair, and cystostomy. One month after surgery, the patient had normal micturition. Clinical discussion: Acute abdominal pain is one sign of emergency surgery. It can be caused by infection, inflammation, vascular occlusion, or obstruction. Physical and laboratory examination of the patient showed a sepsis condition. CT Cystography showed the presence of bladder rupture and subcutaneous abscess. The only management is surgical exploration for infection source control. Conclusions: This case underscores the importance of prompt diagnosis and comprehensive management, involving surgical intervention and targeted antibiotics, for sepsis-related complications post-TURP and bladder repair, necessitating a multidisciplinary approach for optimal outcomes and complication prevention.</p
Massive hydropyonephrosis on pediatric patient:A case report of management and source control
Get PDFIntroduction and importance: Dilation and stretching of the collecting system of the kidney due to obstruction of urine flow is called hydronephrosis. This case may be accompanied by the presence of pus known as pyonephrosis. This case report reporting massive pyonephrosis in pediatrics related to management and source of control. Case presentation: A 10-year-old boy came in with the main complaints of high fever, decreased appetite, vomiting, and nausea. The examination showed left severe hydronephrosis (+) with a size of 14.59 × 6.9 × 9.2 cm. The patient underwent percutaneous nephrostomy (PCN) and showed pus production. From the antegrade pyelography (APG) during PCN, it was stenosis of the left ureteropelvic junction (UPJ). Empirical antibiotics were administered, followed by albumin transfusion. Antibiotics were changed on day 3 post-PCN when urine culture results showed Staphylococcus aureus. After successful improvement of the general condition and minimal pus production from PCN, the patient had a Double J Stent (DJ) and pyeloplasty on the left UPJ. The patient was discharged on day 4 after the left pyeloplasty. Clinical discussion: Management of UPJ Stenosis with massive hydronephrosis complications can be done in two stages with the first stage being the diversion of pus from the kidney, then followed by pyeloplasty management. Management is continued with nephrostomy or ureteral stent placement for urine diversion. Management of bacterial infections is adjusted according to culture results. Conclusion: Management of hydronephrosis with pyonephrosis as complications can be be carried out in two stages, pus diversion, then followed by the pyeloplasty.</p
The relationship between income, health insurance, and employment status as prognostic indicators of bladder cancer:A survival analysis
Get PDFBackground: Bladder Cancer (BC) is one of Summary the health problems. Socioeconomic status (SES) may correlate with patient treatment, possibly impacting patient prognosis. This study aimed to determine the relationship between income, health insurance, and employment status as prognostic indicators of BC.Methods: A retrospective observational study for patients diagnosed with BC in a hospital during the 5-year period between January 2019 and December 2023. Kaplan-Meier test analysis was used to generate overall survival curves stratified by income, employment status, and health insurance. Multivariate Cox proportional-hazards regression was used to identify factors associated with worse overall survival.Results: The results of the analysis on 219 patients showed no difference in patient survival based on income (p > 0.05), while employment status and health insurance showed significant difference in patient survival (p < 0.05). Moreover, there were 99 (45.2%) patients died, with the average patient being 58 years old and dominant in male patients.Conclusions: Prevention of poor outcomes in patients needs to pay attention to certain characteristics, particularly for the low-economic patients without appropriate national health insurance coverage.</p
