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"ABSTRAKTujuan Untuk mengetahui perbadingan efektivitas dan keamanan antara fakoemulsifikasi torsional dan transversal menggunakan parameter phaco time dan perubahan sel endotel dan ketebalan kornea sentral Metode Penelitian prospektif menggunakan katarak senilis NO 3 4 LOCS III yang dilakukan randomisasi menjadi dua kelompok torsional Ozil IP dan transversal Ellips FX Keluaran primer berupa phaco time sel endotel kornea ketebalan kornea sentral tajam penglihatan terkoreksi pada hari pertama ketujuh dan ke 30 pasca operasi Hasil Penelitian ini menggunakan 61 pasient Karakteristik dasar setara dan dapat dibandingkan Phaco time torsional CDE memiliki nilai kecil hingga hanya 1 3 phaco time transversal EFX Penurunan ECD kelompok torsional 7 9 dan kelompok transversal 8 9 Tidak ada perbedaan bermakna pada perubahan ECD dan CCT antara fakoemulsifikasi torsional dan transversal Simpulan Efektivitas dan keamanan kedua mesin fakoemulsifikasi torsional dan transversal tidak berbeda signifikan.

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ABSTRACT

Purpose To compare the effectivity and safety between torsional and transversal phacoemulsification using intraoperative parameter phaco time and postoperative parameter endothelial cells and central corneal thickness changesMethods This prospective study with senile cataract eyes NO 3 4 LOCS III which randomized to have phacoemulsification using torsional Ozil IP or transversal Ellips FX Primary outcomes were phaco time endothelial cell density ECD central corneal thickness CCT corrected distance visual acuity with 1 7 and 30 days after phacoemulsificationResults The study included 61 patients Baseline characteristic were comparable The phaco time torsional CDE only one third of phaco time transversal EFX The results of the percentage of ECD loss were 7 9 in torsional and 8 9 in transversal No difference in ECD and CCT changes between torsional and transversal statistically Conclusions The effectivity and safety of torsional and transversal phacoemulsification did not differ significantly."

"[ABSTRAKTujuan: Untuk mengevaluasi perbandingan ketebalan kornea dan morfologi sel endotel penderita miopia sedang dengan pemakaian harian lensa kontak lunak hidrogel konvensional (nelfilcon A) terhadap silikon hidrogel (lotrafilcon B) selama 1 bulan.Metode: Penelitian ini merupakan uji klinis tersamar tunggal pada 17 pasien (34 mata) dengan miopia sedang yang dibagi secara acak untuk memakai lensa kontak lunak nelfilcon A atau Lotrafilcon B. Ketebalan kornea sentral (CCT), Coefficient of variation (CV), dan persentase sel heksagonal (6A) diukur menggunakan mikroskop spekuler non-con robo Konan sebelum penelitian (pre-fitting), 1 minggu serta 1 bulan setelah pemakaian lensa kontak lunak. Pasien juga dievaluasi mengenai adanya efek samping subyektif dan komplikasi selama memakai lensa kontak.Hasil: Terdapat 64,7% subyek dengan riwayat pemakaian lensa kontak lunak sebelumnya, dimana 52,9% diantaranya adalah pemakai hidrogel konvensional yang tidak teratur. Setelah evaluasi 1 bulan, tidak didapatkan perbedaan yang bermakna antara pemakai Nelfilcon A dengan Lotrafilcon B dalam hal: ketebalan kornea sentral (p=0,285; uji Mann Whitney), CV (p=0,587; uji t tidak berpasangan), dan 6A (p=0,353; uji t tidak berpasangan). Analisis general linear model terhadap waktu pengukuran mendapatkan perbedaan yang bermakna pada seluru subyek meliputi penurunan CCT (p=0,001) dan CV (p=0,001), serta peningkatan 6A (p=0,022) pada test within subject effect.Simpulan: Tidak terdapat perbedaan CCT, CV, dan 6A yang bermakna secara statistik antara pada pemakaian harian lensa kontak lunak Lotrafilcon B dan Nelficon A. Pasien dengan riwayat penggunaan lensa kontak sebelumnya mendapatkan manfaat dengan pemakaian nelfilcon A dan lotrafilcon B dalam hal perbaikan hipoksia jaringan berupa: penurunan ketebalan kornea dan perbaikan morfologi sel endotel.

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ABSTRACTObjective: To compare corneal thickness and endothelial cell morphology in myopic patients wearing 1 month hydrogel conventional and silicon hydrogel contact lenses in daily wear.Methods: This is a prospective, single blind, randomized study. Seventeen (34 eyes) myopic patients were randomly assigned to wearing either nelfilcon A or lotrafilcon B. Central corneal thickness (CCT), Coefficient of variation (CV), and percentage of six-sided cell (6A) were examined using specular microscope non-con robo Konan. Changes in CCT, CV, and 6A were evaluated before contact lenses fitting as well as 1 week and 1 month after the treatment. Patients were also evaluated for any subjective side effects and complications during the treatment period.Results: There were 64,7% subjects with history of contact lens weares and 52,9% of them was hydrogel wearers. After 1 month daily wear of nelfilcon A and lotrafilcon B, no statistically differences changes in CCT (p=0,285; Mann Whitney test), CV (p=0,587; unpaired t test) dan 6A (p=0,353; unpaired t test). General linear model analysis in follow up evaluation with test of within subject effect revealed decreased CCT(p=0,001) and CV (p=0,001), also increased 6A (p=0,022) in all subjects.Conclusions: There were no statistically difference CCT, CV, and 6A between daily wear of nelfilcon A and lotrafilcon B. Subjects with history of contact lens weares gained advantages in oxygen availability, which is decrease in corneal thickness and improvement of endothelial cell morphology., Objective: To compare corneal thickness and endothelial cell morphology in myopic patients wearing 1 month hydrogel conventional and silicon hydrogel contact lenses in daily wear.Methods: This is a prospective, single blind, randomized study. Seventeen (34 eyes) myopic patients were randomly assigned to wearing either nelfilcon A or lotrafilcon B. Central corneal thickness (CCT), Coefficient of variation (CV), and percentage of six-sided cell (6A) were examined using specular microscope non-con robo Konan. Changes in CCT, CV, and 6A were evaluated before contact lenses fitting as well as 1 week and 1 month after the treatment. Patients were also evaluated for any subjective side effects and complications during the treatment period.Results: There were 64,7% subjects with history of contact lens weares and 52,9% of them was hydrogel wearers. After 1 month daily wear of nelfilcon A and lotrafilcon B, no statistically differences changes in CCT (p=0,285; Mann Whitney test), CV (p=0,587; unpaired t test) dan 6A (p=0,353; unpaired t test). General linear model analysis in follow up evaluation with test of within subject effect revealed decreased CCT(p=0,001) and CV (p=0,001), also increased 6A (p=0,022) in all subjects.Conclusions: There were no statistically difference CCT, CV, and 6A between daily wear of nelfilcon A and lotrafilcon B. Subjects with history of contact lens weares gained advantages in oxygen availability, which is decrease in corneal thickness and improvement of endothelial cell morphology.]"

"Tujuan: mengetahui tingkat efisiensi dan keamanan antara teknologi Ellips FX-Peristaltik dengan Ellips FX-Venturi pada fakoemulsifikasi katarak derajat sedang-keras. Desain: Penelitian ini merupakan uji klinis randomisasi. Metode: sebanyak 48 pasien dilakukan randomisasi untuk dilakukan fakoemulsifikasi. Setiap subjek diukur densitas sel endotel dan ketebalan kornea sentral. Efisiensi dinilai dari effective phaco time EFX . Mesin fakoemulsifikasi yang digunakan adalah Signature Ellips FX. Hasil: Tidak terdapat perbedaan yang signifikan untuk median phaco time, penurunan densitas sel endotel dan peningkatan ketebalan kornea sentral. Tidak terdapat komplikasi pada penelitian ini. Kesimpulan: tidak ada perbedaan efisiensi dan keamanan antara sistem Ellips FX-Peristaltik dengan Ellips FX-Venturi.

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Purpose: To know the level of efficiency and safety of the technology Ellips FX peristaltic with Ellips FX Ventury in phacoemulsification of moderate to hard grade cataract.

Methods: 48 outpatients were eligible selected by RCT at CM hospital in periods of January 2016 ndash June 2016. Impacts of pumps system setting difference were observed by objective measurement of endothelial cell density ECD and central corneal thickness CCT. Efficiency was recorded as effective phaco time EFX. Signature Ellips FX were used as phacoemulsification machine.

Result: The total sample that has been analyzed was 46 patients. There is no significant difference in median phaco time, a decrease in endothelial cell density and an increase in central corneal thickness. There were no complications in this study.

Conclusion: There is no difference between the efficiency and safety of Ellips FX peristaltic with Ellips FX Ventury systemKeywords peristaltic, Ventury, Ellips FX, efficiency and safety"

"Tujuan: membandingkan efektivitas yang dinilai berdasarkan Cumulative Dissipated Energy (CDE), Phaco Time, Best Corrected Visual Acuity (BCVA), dan Keamanan yang diukur berdasarkan Endothelial Cell Density (ECD), Central Corneal Thickness (CCT), dan Balanced Salt Solution. (BSS) volume yang digunakan, dari empat dan enam segmen nukleofraktis dalam teknik fakoemulsifikasi stop and chop untuk katarak sedang-keras. Metode: Uji klinis prospektif yang melibatkan 42 dengan densitas nuklear derajat NO/NC 3-5 berdasarkan Lens Opacities Classification System III (LOCS III), dirandomisasi menjadi dua kelompok nukleofraksis, empat segmen (21 subjek) atau enam segmen (21 subjek). Pengukuran objektif dilakukan pre operatif, 1 hari, 1 minggu, dan 1 bulan pasca operasi yang meliputi ECD, CCT, dan TPDK. Intra- operatif dinilai CDE, phaco time, dan volume BSS yang terpakai.Hasil: terjadi penurunan ECD (5.76 ± 29.08 μm VS 2.33 ± 13.73 μm) dan peningkatan CCT (346.42 ± 154.45 sel/mm2 VS 247.05 ± 160.40 sel/mm2) pada kedua kelompok pada satu bulan pasca operasi. Tidak ada perbedaan yang bermakna pada TPDK satu bulan pasca operasi kedua kelompok (logMAR 0.05 VS 0.04). Parameter intra-operatif dalam kelompok empat segmen (CDE 20.73 ± 6.46, phaco time 78.49 ± 23.63 detik, BSS 59.38 ± 12.04 ml) sebanding dengan kelompok enam segmen (CDE 20.46 ± 5.47, phaco time 78.62 ± 13.80 detik, BSS 58.86 ± 13.32 ml), dan tidak ada perbedaan yang bermakna secara statistik.Simpulan: tidak terdapat perbedaan yang bermakna secara statistik parameter efektivitas dan keamanan antara kelompok nukleofraksis empat segmen dan enam segmen. Namun, pasca operasi nukleofraksis empat segmen mempunyai kecenderungan menimbulkan efek kerusakan endotel lebih banyak dibandingkan nukleofraksis enam segmen.

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Objective: to compare effectiveness, assessed by cumulative dissipated energy (CDE), phaco time, best corrected visual acuity (BCVA), and safety which were observed by endothelial cell density (ECD), central corneal thickness (CCT), and balanced salt solution (BSS) volume used, of four and six segments nucleofractis in stop and chop phacoemulsification technique for moderate-hard cataract.

Methods: This prospective study comprised forty-two subjects with NO/NC 3-5 nuclear density according to the Lens Opacities Classification System III (LOCS III) system. Patients were equally randomized into four segments or six segments nucleofractis group. Stop-and-chop technique were applied in all subjects. The objective measurements of ECD, CCT, and BCVA were performed pre-operative, 1 day, 1 week, and 1 month post-operative. Phaco time, CDE and BSS volume were measured intraoperatively.

Results: The mean ECD were reduced (5.76 ± 29.08 μm VS 2.33 ± 13.73 μm) and CCT increased (346.42 ± 154.45 cells/mm2 VS 247.05 ± 160.40 cells/mm2) in both groups after 1 month follow-up. No statistically difference was found between mean BCVA at 1 month follow-up in both group (logMAR 0.05 VS 0.04). All intraoperative parameters of four segments group (CDE 20.73 ± 6.46, phaco time 78.49 ± 23.63 second, BSS 59.38 ± 12.04 ml) were comparable with six segments group (CDE 20.46 ± 5.47, phaco time 78.62 ± 13.80 second, BSS 58.86 ± 13.32 ml).

Conclusions: No effectiveness and safety difference between four and six segments nucleofractic in stop and chop phacoemulsification technique for moderate - hard cataract. However, our study demonstrates the tendency of higher endothelial cell loss in four segments nucleofractis."

"Tujuan: Mengetahui perubahan sensibilitas kornea akibat perbedaan ciri insisi pada prosedur bedah katarak insisi kecil manual dan fakoemulsifikasi serta pengaruhnya terhadap kuantitas dan kualitas lapisan air mata (LAM).Baban dan Cara: Penelitian ini merupakan penelitian prospektif observasional, dilakukan pada 30 penderita katarak senilis yang akan menjalani tindakan pembedahan insisi kecil manual atau fakoemulsifikasi dengan lensa tanam rigid polymethylmethacrylate secara konsekutif. Tindakan insisi kecil manual dilakukan di Kabupaten Buleleng Bali Utara, sedangkan tindakan fakoemulsfikasi di RSCM Jakarta. Kriteria inklusi adalah subyek yang tidak memiliki riwayal inflamasi pada segmen anterior, operasi atau trauma, bukan pemakai lensa kontak, bukan pemakai obat-obatan yang dapat mengganggu lapisan air mata Pemeriksaan dilakukan sebelum pembedahan, setelah hari pertama, ke-7 dan ke-15. Pemeriksaan meliputi sensibilitas kornea di lima lokasi menggunakan estesiometri Cachet-Bonnet, tear meniscus , Nonivasive break up time (NIBUT) dan pola corakan lipid menggunakan Tearscope plus' , serta uji Schirmer. Keluhan subyektifdicatat menggunakan kuesioner dari Ocular Surface Disease Index (OSDO.Hasil: Sensibilitas menurun dimulai hari pertama setelah pembedahan sampai hari ke-15 pada kelompok fakoemulsifikasi, sedangkan pada kelompok insisi kecil manual ditemukan hanya di hari pertama setelah tindakan pembedahan. Sensibilitas kornea yang menurun ini tidak hanya pada lokasi insisi tetapi juga pada lokasi lainnya terutama pada kelompok fakoemulsifikasi, perbedaan antar kedua kelompok ini signifikan (p<0.05). Penurunan sensibilitas kornea pada kelompok fakoemulsifikasi ini mempengaruhi kuantitas LAM_ Kualitas LAM menurun pada kedua kelompok di hari pertama, dengan penurunan terbesar pada kelompok insisi kecil manual, kualilas LAM ini kembali meningkat mendekati normal sampai hari ke-I5. Keluhan subyektif kelompok fakoemulsifikasi ditemukan meningkat pada hari ke-7 dak ke-15 dan berhubungan dengan produksi air mata.Kesimpulan: Insisi kornea di temporal pada pembedahan katarak fakoernulsifikasi menimbulkan penurunan sensibilitas kornea di lokasi insisi dan lokasi lainnya sampai hari ke-15. Penurunan sensibilitas kornea ini menyebabkan perubahan kuantitas dan kualitas LAM serta menimbulkan subyektif.

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Purpose: To describe corneal sensitivity changes caused by different incision method in manual-small incision cataract surgery (manual-SICS) and phacoemulsification (phaco) and its influence to the tear film quantity and quality.

Material & Methods: A prospective observational study which examined thirthy subjects who planned to underwent cataract surgery with polymelhylmethacrylate intraocular lens concequitively. The manual-SICS group was held in North Bali and phacoemulsification in Jakarta. The inclusion criteria were subject without inflammation of anterior segment, contact lens wearer, history of eye surgery or eye trauma, nerve disorder and drugs which influence the tear film stability. The examination were prior to the surgery, first, seventh and the fifteenth day after surgery, including the five sites of the corneal sensitivity using Cochet-Bonner aesthesiometry, tear meniscus, nonivasive break up time (NIBUT) and lipid pattern using Tearseope plus-m and Schirmer test also were examined. The subjective complains were reviewed based on questionaire by Ocular Surface Disease Index (OSDI).

Results: Corneal sensitivity decreased in phaco group since the first day after surgery until the fifteenth day, while in the manual-SICS group the decreasing only at first day after surgery. Corneal sensitivity decreased not only at the incision site, but also on the other sites of the cornea in phaco group, the difference between two groups was significant (p<0.05). The aquous production decreased in phaco group on the seventh and fifteen days which correlated to the corneal sensitivity. The tear film quality decreased in both groups on the first day and much lower in manual-SICS group, the recovery was shown until the fifteenth day. The increasing subjective complains on phaco group correlated to the changes of the corneal sensitivity.

Conclusion: Temporal-side incision on phacoemulsification caused decreasing corneal sensitivity in the incision site and the other sites up till the 15 day. Decreasing corneal sensitivity caused changes of the tear film quantity and quality, also the complains."

"Tujuan: Evaluasi pengaruh penggunaan cairan irigasi dingin pada fakoemulsifikasi terhadap ketebalan kornea dan jumlah suar bilik mata depan pasca bedah.Tempat: Perjan Rumah Sakit Ciptomangunkusumo dan Jakarta Eye Center, Jakarta. Bahan dan cara: Prospektif, tersamar ganda, randomisasi pada 33 mata katarak senilis gradasi 3-4. Dilakukan fakoemulsifikasi menggunakan BSS® 10°C (n=16) atau BSS® suhu karnar (n=17) dengan prosedur dan terapi pasca bedah yang sama. Pra bedah, pasca bedah hart pertama dan hari ke-7 dilakukan pengukuran ketebalan komea, jumlah suar dan tekanan intraokular, masing-masing dengan OrbscanTM, laser flare-meter Kowa FM-500, dan tonometer non-kontak. Parameter intrabedah; waktu fako efektif (EPT) dan besarnya tenaga ultrasonik(UIS) direkam dalam mesin fako. Subjek yang mengalami komplikasi intrabedah maupun pasca bedah dikeluarkan dari penelitian.Hasil: Prabedah kedua kelompok memiliki karakteristik yang setara pada umur, gradasi katarak, ketebalan kornea, jumlah suar dan TIO. Tidal( terdapat perbedaan bermakna pada E. dan U/S. Fasca bedah hari pertama, ketebalan kornea pada kelompok BSSQ dingin 548,87±48,31}im, pada kelompok BSS® suhu kamar 582,47±35,48p.m (p0,022). Ketebalan kornea hari ke-7 tidak berbeda bermakna. Tidak terdapat perbedaan bermakna jumlah soar sampai tindak lanjut hari ke-7, namun peningkatan jumlah suar pada kelompok BSS® dingin lebih sedikit dan telah mencapai nilai prabedah pada hari ke-7. Hasil pengukuran tekanan intraokular sesuai dengan pengukuran ketebalan kornea.Simpulan: Cairan irigasi dingin dapat mempertahankan fungsi endotel komea dan stabilitas sawar darah akuos, sehingga menghambat penambahan ketebalan kornea dan jumlah suar di bilik mata depan pasca fakoemulsifikasi.

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Purpose: To evaluate the effect of cooled intraocular irrigating solution during phacoemulsification on postoperative central corneal thickness (CCT) and anterior chamber flare (AC flare).

Setting: Cipto Mangunkusumo Hospital and Jakarta Eye Center, Jakarta

Methods: In a prospective, double masked, randomized study, 33 eyes of third and fourth grade density cataract had phacoemulsification with irrigating solutions cooled to approximately 10°C (n=16) or at room temperature (n=17). Surgical procedure and postoperative therapy were otherwise identical in both groups. lntraoperative parameters; effective phaco time (EPT) and ultrasound energy (U/S) were recorded by phaco machine. Postoperative CCT, AC flare and intraocular pressure (IOP) were assessed respectively with Orbscan pachymetry, Kowa FM-500 laser flare-meter and non-contact tonometry on days 1 and 7. Complicated cases were excluded.

Results: Both groups were well matched characteristic in age, cataract density, preoperative CCT, AC flare and IOP. Intraoperative parameters were not different significantly. C.1the first postoperative day, CCT (cooled irrigation 548,87±48,31µm, control 582,47±35,48µm; p0,022) was significantly lower in the group with cooled irrigating solution. There was no significant difference in CCT on the 7th postoperative day. Despite no significant between-group difference in AC flare on any postoperative days, AC flare was lower in the group with cooled irrigating solution. Intraocular pressure measurement was well related to corneal thickness.

Conclusions: Cooled intraocular irrigating solution preserved corneal endothelial function and blood aquas barrier, showed with reducing immediate postoperative CCT and AC flare."

"Pengaruh Prekondisi dan Hipotermia pada Cedera Iskemia-Reperfusi Terhadap Endotel Pembuluh Darah Perifer pada Oryctolagus cuniculusM Febriadi Ismet1 Yefta Moenadjat2 Aria Kekalih3 1Program Studi Ilmu Bedah, Fakultas Kedokteran Universitas Indonesia2Departemen Medik Ilmu Bedah, RSUPN Cipto Mangunkusumo Pendahuluan. Cedera iskemia -reperfusi CI/R merupakan masalah serius yang dihadapi pascahipoksia; menyebabkan kerusakan sel yang letaknya remote organ injury. Intervensi prekondisi iskemia-reperfusi PI/R merupakan fenomena jaringan yang diberikan stimulasi hipoksia berulang sebelum mendapatkan keadaan iskemia lama. Keadaan hipotermia iskemia reperfusi HI/R menyebabkan metabolisme sel menurun termasuk respon sel terhadap iskemia. Penelitian ini bertujuan untuk mengetahui efek intervensi PI/R dan HI/R terhadap perubahan morfologi endotel pembuluh darah dan peningkatan kadar malondialdehyde MDA sebagai respon stress oksidatif pada jaringan endotel a/v femoralis komunis distal obstruksi iskemia dan kontralateral CI/R. Metode: Studi eksperimental yang bersifat deskriptif analitik pada Oryctolagus cuniculus, Pada kelompok CI/R dilakukan ligasi arteri femoralis komunis dalam pembiusan selama empat jam untuk menginduksi iskemia. Pada kelompok PI/R dilakukan dengan ligasi berulang arteri femoralis komunis kanan selama dua menit, dilepaskan tiga menit sebanyak dua siklus, kemudian diligasi selama empat jam. Pada kelompok hipotermia, dilakukan ligasi arteri femoralis komunis selama empat jam yang disertai dengan membungkus ekstremitas bawah kanan dengan es dengan target suhu antara 31-33 C, kemudian pada ketiga intervensi ligasi dibuka dan kelinci dibiarkan beraktivitas selama delapan jam. Setelah itu, dilakukan pengambilan sampel a.v yang berasal dari distal dari ligasi ipsilateral dan kontralateral untuk pemeriksaan histopatologi dan biokimia. Pemeriksaan biokimia dilakukan menggunakan malondialdehid MDA. Hasil: Pada pemeriksaan histomorfologi menunjukan perbedaan bermakna antara skoring kerusakan endotel jaringan a.v. ipsilateral pada ketiga sampel intervensi dibanding kontrol dan nilai sampel intervensi preventif lebih baik daripada sampel CI/R p< 0,05 . Pada sampel a.v kontralateral kelompok PI/R dan HIR tidak memiliki perbedaan bermakna dengan kontrol p> 0,05 . Pada evaluasi kadar MDA ditemukan kadar MDA meningkat pada semua intervensi baik pada CIR, PI/R, dan HI/R yang tidak berbeda bermakna dengan kontrol p> 0,05. Konklusi: Keadaan CI/R menyebabkan disfungsi endotel bukan hanya pada daerah iskemik, namun pada organ yang letaknya berjauhan. Kerusakan endhotelial lining dapat dicegah dengan tindakan PI/R dan HI/R dan peningkatan kadar MDA merupakan respon fisiologis jaringan terhadap iskemia dan cedera reperfusi yang terjadi baik pada CI/R, PI/R, dan HI/R.

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The Effect of Preconditioning and Hypothermia in Ischemia Reperfusion Injury to the Endothelial Cells from Peripheral Blood Vessels in Oryctolagus cuniculusM Febriadi Ismet1 Yefta Moenadjat2 Aria Kekalih31General Surgery Science Study Program, Faculty of Medicine Universitas Indonesia2Department of Surgery, Dr. Cipto Mangunkusumo National General HospitalIntroduction. Ischemia reperfusion injury IRI is a serious problem in the post hypoxia period, which causes remote organ injury. Ischemic preconditioning IPC is a phenomenon where tissues are subjected to repeated hypoxic stimulations to protect against subsequent prolonged period of ischemia. Hypothermia during ischemia reperfusion injury HI decreases metabolism of cells including their response to ischemia. The goal of this study is to investigate the effects of interventions such as IPC and HI on the morphology of endothelial cells in blood vessels and the increased level of malondialdehyde MDA as an oxidative stress response in endothelial tissues of distal common femoral artery and vein obstruction ischemia and its contralateral IRI.

Method: This is a descriptive and analytic experimental study using Oryctolagus cuniculus. In the IRI group, the common femoral artery was ligated during anesthesia for four hours to induce ischemia. In the IPC group, the right common femoral artery was continually ligated for two minutes, which was then released for three minutes for two cycles, and then ligated for four hours. In the hypothermia group, the common femoral artery was ligated for four hours and the right lower extremity was wrapped in ice with the target temperature range between 31 33o C. Then the arteries from the three interventions were unligated and the rabbit was released to observe its activity for eight hours. Next, samples of artery and vein distal from the ligation ipsilateral and its contralateral were obtained for histopathological and biochemical examinations. The biochemical analysis was performed using malondialdehyde MDA.

Results: The histomorphological examination showed significant difference in the injury scores between the endothelial tissues from ipsilateral artery and vein in the three interventional samples compared with control, and the scores for the preventive intervention groups were better than the IRI sample p0.05.

Conclusion: Ischemic reperfusion injury can cause not only endothelial dysfunction in the ischemic area, but also remote organ injury. Endothelial lining injury can be prevented by IPC and HI. The elevated level of MDA is a physiological response of tissue after ischemia reperfusion injury which could be found on IRI, IPC, and HI."

"Panduan resusitasi anak umumnya menganjurkan pemberian cairan dalam jumlah besar. Beberapa penelitian memperlihatkan bahwa penggunaan cairan yang agresif meningkatkan mortalitas. Penelitian pada hewan menunjukkan tekanan vena sentral yang tinggi memicu pelepasan atrial natriuretic peptide ANP , sementara penelitian invitro memperlihatkan ANP meluruhkan glycocalyx endotel vaskular dan meningkatkan permeabilitas endotel. ANP juga memicu vasodilatasi. Hemodilusi berpotensi menurunkan pasokan oksigen tubuh DO2 . Penelitian bertujuan untuk melihat pengaruh resusitasi cairan terhadap kadar ANP serum, peluruhan glycocalyx endotel vaskular, extravascular lung water index ELWI , mean arterial pressure MAP , kadar hemoglobin dan pasokan oksigen. Hewan model renjatan adalah 11 ekor Sus scrofa jantan, usia 6-10 minggu. Renjatan dilakukan dengan metode fixed pressure hemorrhage. Resusitasi pertama dilakukan dengan jumlah cairan sesuai darah yang dikeluarkan resusitasi normovolemik , dilanjutkan dengan 40 mL/kg resusitasi hipervolemik . Pengukuran hemodinamik dilakukan dengan PICCO. Serum ANP dan Syndecan-1, petanda peluruhan glycocalyx, dilakukan dengan teknik ELISA. Hasil penelitian menunjukkan terjadinya peningkatan ANP pasca resusitasi normovolemik p = 0,043 , yang kemudian menurun kembali dalam 30 menit. Peluruhan glycocalyx tidak terjadi. Perbedaan ELWI pada 60 menit pasca resusitasi secara statistik bermakna, dengan perbedaan 0,93 mL/kg 95 IK:0,19 -3,62 . Terdapat korelasi kuat antara SVRI dan CI pasca resusitasi hipervolemik r = -0,587 . Tidak ada perbedaan MAP pasca resusitasi normovolemik dan hipervolemik. Kadar hemoglobin pasca resusitasi hipervolemik lebih rendah daripada pasca resusitasi normovolemik p = 0,009 . Pasokan oksigen tubuh pasca resusitasi hipervolemik lebih tinggi daripada pasca resusitasi normovolemik p = 0,012 . Simpulan: Resusitasi cairan pada renjatan akibat perdarahan tidak mengakibatkan peluruhan glycocalyx endotel vaskular. Peningkatan ELWI amat terbatas. SVRI berkorelasi terbalik dengan CI. Tidak ada perbedaan MAP antara resusitasi normovolemik dan hipervolemik. Resusitasi hipervolemik menyebabkan hemodilusi yang diimbangi dengan peningkatan curah jantung.

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Many pediatric guidelines recommend liberal fluid resuscitation, but recent studies showed that aggressive fluid resuscitation might increase mortality. Animal studies showed that high central venous pressure induced ANP secretion. Invitro studies showed convincing evidence that ANP induced glycocalyx shedding. ANP also induced vasodilatation through cGMP signal transduction pathways. Hemodilution due to a large amount of resuscitation fluid potentially decreasing oxygen delivery.The objectives of this study were investigating the effect of fluid resuscitation, in the animal model, with special concern on serum ANP, glycocalyx shedding indicate by serum Syndecan-1 , changes in extravascular lung water, systemic vascular resirtance and mean arterial pressure, hemoglobin level and oxygen delivery DO2 . The animal models were 11 male domestic pigs, 6 -10 weeks old. The shock was induced with fixed pressure hemorrhage method. Fluid resuscitation was done in 2 phases. On the first attempt, we replaced total numbers of blood that withdrawn normovolemic resuscitation . On the second attempt, we gave 40 mL/kg resuscitation fluids hypervolemic resuscitation . The hemodynamic measurements were done with PICCO. Serum ANP and Syndecan-1 were measure with ELISA method.We found that serum ANP increased after normovolemic resuscitation p = 0.043 and immediately back to base level in 30 minutes. Glycocalyx shedding did not occur. Extravascular lung water index minimally increased. There was a strong correlation between SVRI and CI at hypervolemic resuscitation r = -0.587 . There was no difference in mean arterial pressure between normovolemic and hypervolemic resuscitation. Hemoglobin level after hypervolemic resuscitation was lower than after normovolemic resuscitation p = 0.009 . Oxygen delivery was higher after hypervolemic resuscitation p = 0.012 .Conclusions: Hypervolemic resuscitation in this hemorrhagic shock model did not induce glycocalyx shedding, extravascular lung water index minimally increased. Systemic vascular resistance index negatively correlated to cardiac index. Fluid resuscitation may induce hemodilution, but oxygen delivery can be compensated by increasing cardiac output. "

"Dalam setiap tindakan operasi intra okuler segmen depan seperti operasi katarak, keratoplasti , perbaikan perforasi kornea serta operasi glaukoma , selalu diusahakan mempertahankan kedalaman bilik mata depan. Tujuannya adalah untuk menghindarkan pergeseran yang berlebihan dengan endotel kornea selama operasi, karenahal ini akan menyebabkan kerusakan pada lapisan endotel tersebut.Tujuan penelitian: Menilai daya perlindungan natrium hialuronat 1% dibandingkan dengan metilselulosa 2% pada lapisan endotel kornea terhadap trauma udara."

"Latar Belakang: Hipertensi berkontribusi secara bermakna terhadap morbiditas dan mortalitas kardiovaskular (KV) di dunia. Dua penyebab terpentingnya adalah asupan garam dan disfungsi endotel yang dapat dinilai menggunakan flow-mediated dilatation (FMD). Modifikasi keduanya dapat menurunkan morbiditas dan mortalitas hipertensi. Diet rendah natrium DRN belum diterapkan secara optimal di dunia karena keterbatasan produk garam rendah natrium. Belum ada studi tentang perbandingan efek diet rendah natrium yang bervariasi terhadap perbaikan fungsi endotel yang dinilai melalui FMD pada subjek hipertensi derajat I, khususnya di Indonesia. Metode: Uji klinis ini dilaksanakan di RSJPD Harapan Kita terhadap 52 subjek hipertensi derajat I (26 laki-laki dan 26 perempuan), berusia 25 - 59 tahun, dan berindeks massa tubuh 18,5 - 29,99 kg/m2. Subjek dieksklusi jika berpenyakit atau berfaktor risiko KV, memiliki penyakit liver, kanker, alergi rumput laut, infeksi berat, atau dalam terapi KV, hormonal, steroid, atau terapi herbal rutin. Data primer didapat dari anamnesis dan pemeriksaan fisik. Subjek-subjek dirandomisasi menjadi dua kelompok, yaitu kelompok DRN dengan kadar natrium 21 - 23% dan kelompok DRN dengan kadar natrium 38 - 40%, kedua diet diberikan dalam bentuk kuah. Nilai FMD diukur sebelum intervensi dan 60 menit setelahnya. Hasil: Karakteristik dasar, termasuk diameter arteri brakialis prakompresi dan pascakompresi serta FMD, tidak berbeda bermakna di antara kedua grup. Pada kelompok DRN 38 - 40%, nilai FMD pada menit ke-60 pasca-intervensi menurun dibandingkan nilainya pra-intervensi, tetapi perbedaan tersebut tidak bermakna median [kisaran]: 7,92 [0,00 - 17,50]; p>0,05). Pada kelompok DRN 21 - 23%, nilai FMD pada menit ke-60 pasca-intervensi meningkat dibandingkan nilainya pra-intervensi, tetapi perbedaan tersebut juga tidak bermakna 7,65 [1,36 - 19,51]; p>0,05). Simpulan: Nilai FMD pasca-intervensi tidak berbeda bermakna antarkelompok. Ketidakbermaknaan perbedaan nilai-nilai FMD dalam penelitian ini mungkin disebabkan oleh aspek-aspek internal subjek yang memengaruhi fungsi endotel dan prosedur evaluasi FMD.

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Background: Hypertension contributes significantly to cardiovascular (CV) morbidity and mortality in the world. Two of its most important causes are salt intake and endothelial dysfunction which can be assessed using flow-mediated dilatation (FMD) test. Modification of both may decrease its morbidity and mortality. Low-sodium diet (LSD) has not been optimally implemented in the world due to the limited low-sodiumsalt products. There has been no study regarding the effects of low-sodium salt with various sodium concentrations on FMD of grade-I-hypertension subjects, especially in Indonesia. Methods: This clinical trial was conducted at the NCC Harapan Kita on 52 grade-Ihypertension subjects 26 men, 26 women , aged 25 - 59 years old, with body mass index of 18.5 - 29.99 kg/m2. Subjects were excluded if they had CVD, CV risk factors, liver disease, cancer, seaweed allergy, severe infection, or on routine CV-, hormonal-, steroid, or herbal-therapy. Primary data were collected from anamnesis and physical examinations. We randomly assigned the subjects into two groups, i.e. the group LSD with natrium concentration of 21 - 23% and the group of LSD with natrium concentration of 38-40% . Both diets were given in a soup form. The FMD values were measured before the intervention and 60 minutes after it. Results: Baseline characteristics, including pre-compression and post-compression brachial artery diameter and baseline FMD, were not significantly different between both groups. At group LSD 38 - 40%, FMD value at 60 minutes post-intervention was decreased compared to its baseline value, but the difference was not significant median [range]: 7.92 [0.00 mdash;17.50]; p>0.05). At group LSD 21 - 23%, FMD value at 60 minutes post-intervention was increased compared to its baseline value, but the difference was also not significant 7.65 [1.36 mdash;19.51]; p>0.05). Conclusion: The post-intervention FMD values were not significantly different between both groups. The non-significant differences between FMD values in this study may be due to the subjects' internal aspects influencing endothelial function and FMD evaluation procedure."