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Farahniar Hamidiana
"ABSTRAK
Latar belakang. Status volume intravaskular hipovolemia atau hipervolemia dapat meningkatkan angka morbiditas dan mortalitas. Baku emas penilaian status volume intravaskular adalah pemeriksaan immunoassay, sifatnya invasif, sulit dan lama sehingga para klinisi mencari teknik yang tidak invasif, mudah dan singkat. Pemeriksaan diameter vena kava inferior IVC dan vascular pedicle width VPW merupakan teknik noninvasif yang mulai dipakai untuk menilai status volume intravaskular. Keuntungan VPW adalah dapat dilakukan pada rumah sakit yang tidak memiliki USG. Uji kesesuaian IVC dan VPW dalam menilai status volume intravaskular hanya pernah dilakukan pada pasien dengan ventilasi mekanik. Penelitian ini bertujuan untuk mengetahui kesesuaian hasil penilaian status volume intravaskular antara teknik ultrasonografi diameter IVC dengan teknik radiografi dada VPW pada pasien napas spontan. Metode. Penelitian ini merupakan uji klinis observasional analitik potong lintang untuk mengetahui kesesuaian hasil penilaian status volume intravaskular pasien di ruang resusitasi IGD antara IVC dengan VPW pada bulan Mei 2018. Didapatkan 40 subjek yang memenuhi kritera penerimaan dan bersedia menandatangani informed consent penelitian. 40 subjek diukur VPW-nya dari hasil radiografi dada oleh sejawat Radiologi di IGD lalu dinilai diameter IVC maksimal, minimal dan reratanya serta collapsibility index-nya oleh peserta PPDS Anestesiologi dan Terapi Intensif. Terdapat 1 subjek yang dikelurkan karena nilai VPW tidak dapat diukur. Analisis data menggunakan analisis Kappa. Hasil. Nilai median diameter IVC 1,1 cm dengan nilai minimum 0,46 cm dan maksimum 3 cm. Nilai median collapsibility index 33 dengan nilai minimum 10,2 dan maksimum 100 . Nilai median VPW 5,7 cm dengan nilai minimum 3,5 cm dan maksimum 10,8 cm. Didapatkan hasil tidak adanya kesesuaian antara diameter rerata IVC dengan VPW koefisien Kappa -0,085 . Tidak terdapat kesesuaian antara diameter maksimal IVC dengan VPW koefisien Kappa -0,123 . Tidak terdapat kesesuaian juga antara collapsibility index dengan VPW koefisien Kappa 0,069 Simpulan. Penilaian status volume intravaskular teknik ultrasonografi diameter IVC tidak sesuai dengan teknik radiografi dada VPW. Kata Kunci: status volume intravaskular; kesesuaian; IVC; VPW ABSTRACT
Background. Intravascular volume status hypovolemia or hypervolemia can both increase morbidity and mortality. The gold standard for assessing intravascular volume is immunoassay measurement. It is an invasive measurement, difficult and requires time before a final evaluation is complete. So there is a significant need for a rapid, noninvasive and easy technique to determines volume status. Inferior vena cava IVC and vascular pedicle width VPW are noninvasive and easy technique to measure intravascular volume status. VPW can be done without USG. Compatibility between IVC and VPW had only been done in patient with mechanical ventilation. This study was conducted to see compatibility between IVC diameter and VPW for assessing intravascular volume status in spontaneous patient. Methods. This was a cross sectional analytic study in the emergency room to see compatibility between IVC diameter and VPW for assessing intravascular volume status in spontaneous patient during May 2018. There were 40 subjects who fulfilled inclusion criteria and agreed to sign informed consent. VPW of 40 subjects were assessed by the radiologist then the maximum, minimum, mean diameter and collapsibility index of the IVC were assessed by anesthesiologist resident in the emergency room. There was 1 drop out subject due to VPW can not be measured. We use Kappa analysis for this study.. Results. Median of IVC diameter for this study was 1,1 cm, with minimum diameter was 0,46 cm and maximum was 3 cm. Median of collapsibility index was 33 , with minimum value was 10,2 and maximum was 100 . Median of VPW was 5,7 cm, with minimum outcome was 3,5 cm and maximum was 10,8 cm. We found that there was no compatibility between IVC mean diameter and VPW Kappa coefficent was -0,085 . There was also no compatibility between IVC maximum diameter and VPW Kappa coefficient -0,123 . WE also found there was no compatibility between collapsibility index of IVC and VPW Kappa coefficient 0,069 Conclusion. Assessment intravascular volume status by ultrasonography technique of IVC diameter was not compatible with radiographic technique of VPW. Keywords: intravascular volume status; compatibility; IVC; VPW."
2018
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UI - Tugas Akhir  Universitas Indonesia Library
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Rommy Zunera
"[ABSTRAK
Latar Belakang : pengukuran VPW dari modalitas foto toraks merupakan
pemeriksaan yang non invasif, cepat dan mudah untuk memprediksi kondisi
hipervolemia. Namun belum terdapat konsensus nilai rerata VPW yang dipakai
secara global, sehingga penggunaan nilai rerata VPW dari penelitian sebelumnya
terhadap populasi diluar populasi penelitian tersebut mungkin tidak relavan. Di
Indonesia khususnya di Rumah Sakit Cipto Mangunkusumo belum terdapat data
dasar nilai rerata VPW.
Tujuan Penelitian: Mengetahui rerata nilai VPW dewasa normal Indonesia
Desain Penelitian: Retrospektif potong lintang
Metode: Pengukuran jarak antara tepi terluar arteri subklavia kiri dengan tepi
terluar vena kava superior yang melewati bronkus utama kanan (VPW),
pengukuran rasio VPW terhadap diameter jantung terluas dan rasio VPW terhadap
diameter terluas rongga toraks. Pengukuran dilakukan pada radiografi toraks PA
dari 104 subyek normal yang terdiri dari 52 laki-laki dan 52 perempuan, dihitung
rerata dan standar deviasi. Pengukuran serupa juga dilakukan pada topogram CT
scan toraks (radiografi toraks AP supine) dan CT scan toraks dari 103 subyek
yang terdiri dari 51 laki-laki dan 52 perempuan.
Hasil: Pada pemeriksaan toraks PA didapatkan rerata VPW 48,0 mm ± 5,5 mm,
rerata VPCR 40,3% ± 4,6 %, dan rerata VPTR 17,2% ± 1,7%. Pada pemeriksaan
topogram CT scan didapatkan rerata VPW 50,3 mm ± 6,2 mm, rerata VPTR 45%
± 5,1%, dan rerata VPTR 19,8% ± 2,5%. Rerata VPW pada CT scan toraks 50,4 ±
6,1 mm. Pengukuran pada foto toraks AP sekitar 10 % lebih besar dibandingkan
pada foto toraks PA, dan pengukuranVPW pada foto toraks terbukti memiliki
akurasi yang tinggi.
Kesimpulan: Rerata VPW pada pemeriksaan foto toraks PA tegak dewasa normal
Indonesia adalah 48 ± 5,5 mm, ternyata tidak berbeda bermakna dengan rerata
VPW pada populasi barat ( 48 ± 5mm). Rerata VPCR pada foto toraks PA
adalah 40,3 % ± 4,6 % dan VPTR adalah 17,2 % ± 1,7 %.

ABSTRACT
Background: Vascular pedicle width (VPW) is the distance, from a perpendicular
line at the takeoff point of the left subclavian artery off the aorta to the point at
which the superior vena cava. Measurement of VPW on chest x-ray is relatively
non-invasive, fast and easy technique as hypervolemia predictor, but no
wordwide consensus has been proposed.
Objective: to investigate mean vascular pedicle witdh of Indonesian adult
Study design: Retrospective cross sectional
Methods : VPW is the distance, measure in millimeters, from a perpendicular line
at the takeoff point of the left subclavian artery to the point at which the superior
vena cava crosses the right main bronchus, than calculate VPW ratio to a widest
horizontal diameter of cardiac dan thoracic wall.
Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CT
scan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5
mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scan
topogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, and
mean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1
mm. Measurements on the AP chest x-ray about 10% greater than in the PA
chest x-ray, and measurement of VPW on conventional chest x-ray aproved to
have high accuracy.
Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5
mm, no significant different between westerns population ( 48 ± 5mm).;Background: Vascular pedicle width (VPW) is the distance, from a perpendicular
line at the takeoff point of the left subclavian artery off the aorta to the point at
which the superior vena cava. Measurement of VPW on chest x-ray is relatively
non-invasive, fast and easy technique as hypervolemia predictor, but no
wordwide consensus has been proposed.
Objective: to investigate mean vascular pedicle witdh of Indonesian adult
Study design: Retrospective cross sectional
Methods : VPW is the distance, measure in millimeters, from a perpendicular line
at the takeoff point of the left subclavian artery to the point at which the superior
vena cava crosses the right main bronchus, than calculate VPW ratio to a widest
horizontal diameter of cardiac dan thoracic wall.
Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CT
scan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5
mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scan
topogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, and
mean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1
mm. Measurements on the AP chest x-ray about 10% greater than in the PA
chest x-ray, and measurement of VPW on conventional chest x-ray aproved to
have high accuracy.
Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5
mm, no significant different between westerns population ( 48 ± 5mm).;Background: Vascular pedicle width (VPW) is the distance, from a perpendicular
line at the takeoff point of the left subclavian artery off the aorta to the point at
which the superior vena cava. Measurement of VPW on chest x-ray is relatively
non-invasive, fast and easy technique as hypervolemia predictor, but no
wordwide consensus has been proposed.
Objective: to investigate mean vascular pedicle witdh of Indonesian adult
Study design: Retrospective cross sectional
Methods : VPW is the distance, measure in millimeters, from a perpendicular line
at the takeoff point of the left subclavian artery to the point at which the superior
vena cava crosses the right main bronchus, than calculate VPW ratio to a widest
horizontal diameter of cardiac dan thoracic wall.
Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CT
scan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5
mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scan
topogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, and
mean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1
mm. Measurements on the AP chest x-ray about 10% greater than in the PA
chest x-ray, and measurement of VPW on conventional chest x-ray aproved to
have high accuracy.
Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5
mm, no significant different between westerns population ( 48 ± 5mm)., Background: Vascular pedicle width (VPW) is the distance, from a perpendicular
line at the takeoff point of the left subclavian artery off the aorta to the point at
which the superior vena cava. Measurement of VPW on chest x-ray is relatively
non-invasive, fast and easy technique as hypervolemia predictor, but no
wordwide consensus has been proposed.
Objective: to investigate mean vascular pedicle witdh of Indonesian adult
Study design: Retrospective cross sectional
Methods : VPW is the distance, measure in millimeters, from a perpendicular line
at the takeoff point of the left subclavian artery to the point at which the superior
vena cava crosses the right main bronchus, than calculate VPW ratio to a widest
horizontal diameter of cardiac dan thoracic wall.
Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CT
scan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5
mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scan
topogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, and
mean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1
mm. Measurements on the AP chest x-ray about 10% greater than in the PA
chest x-ray, and measurement of VPW on conventional chest x-ray aproved to
have high accuracy.
Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5
mm, no significant different between westerns population ( 48 ± 5mm).]"
2015
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UI - Tesis Membership  Universitas Indonesia Library
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Endy Jutamulia
"Latar Belakang : Syok sepsis merupakan kondisi mengancam nyawa dengan beban morbiditas dan mortalitas tinggi terutama di Asia Tenggara. Perencanaan resusitasi cairan yang optimal pada pasien sepsis membutuhkan panduan status hemodinamik tubuh, namun pengukuran Central Venous Pressure (CVP) yang saat ini paling umum digunakan merupakan tindakan invasif dengan segala kekurangannya. Sejumlah penelitian sebelumnya mengajukan pemeriksaan ultrasonografi vena cava inferior (USG IVC) sebagai metode alternatif estimasi status hemodinamik tubuh, namun dengan hasil yang bervariasi. Diskrepansi hasil penelitian sebelumnya dan kurangnya data penelitian pada populasi syok sepsis di Indonesia menunjukkan perlunya ada penelitian lebih lanjut. Tujuan : Penelitian ini bertujuan untuk mengetahui korelasi antara parameter USG IVC berupa diameter, Collapsibility Index (CI), dan velositas maksimal (maxV) terhadap nilai CVP. Metode : Desain penelitian merupakan studi korelasi dengan teknik potong lintang. Data primer didapatkan dari hasil pemeriksaan USG IVC dan CVP menggunakan manometer manual dari sampel pasien syok sepsis yang dirawat di RSUPN Cipto Mangunkusumo dengan waktu penelitian Juli hingga Oktober 2020. Pengukuran diameter, CI, dan maxV dari IVC diambil di regio subxiphoid, dilakukan sendiri oleh peneliti dengan supervisi langsung dari spesialis radiologi konsultan abdomen. Hasil : Didapatkan 27 sampel USG IVC tanpa perbedaan proporsi yang bermakna antar subyek berdasarkan umur dan jenis kelaminnya. Didapatkan korelasi positif sedang antara diameter dengan nilai CVP (r = 0,459, p = 0,016), korelasi negatif sedang antara CI dengan nilai CVP (r = - 0,571, p = 0,002), dan tidak ada korelasi yang bermakna secara statistik antara maxV dengan nilai CVP (r = 0,074, p = 0,715). Kesimpulan : Korelasi bermakna antara diameter dan CI IVC terhadap nilai CVP menunjukkan bahwa pemeriksaan USG IVC dapat digunakan sebagai metode pemeriksaan alternatif non-invasif untuk estimasi nilai CVP dalam perencanaan penatalaksanaan pasien syok sepsis.

Background : Septic shock is one of life-threatening condition with high morbidity and mortality rate, especially in the South East Asia. Optimal fluid resuscitation planning requires adequate portrayal of hemodynamic status, but the most often used indicator, Central Venous Pressure (CVP), is an invasive procedure with all its drawbacks. Several studies has been done worldwide to propose Inferior Vena Cava Ultrasonography (IVC USG) as an alternative method to estimate hemodynamic status, to varying degree of success. These discrepancies from previous studies, and the lack of data for septic shock population in Indonesia suggests the need for further study.
Objective : This study aims to determine the correlation strength between IVC USG parameters such as diameter, Collapsibility Index (CI), and maximum velocity (maxV) with CVP. Method : The study design is cross-sectional correlation study. Primary data was acquired from IVC USG examination results and CVP values was acquired by manual measurement from septic shock patients in Cipto Mangunkusumo National Central General Hospital (RSUPN CM) from July until October 2020. Measurements of diameter, CI, and maxV were done in the subxiphoid region under direct supervision from abdominal consultant radiologist. Result: In total, 27 samples of IVC USG were acquired without statistically significant difference of proportion across age and gender. Moderate positive correlation were found between diameter and CVP (r = 0,459, p = 0,016). Moderate negative correlation were found between CI and CVP (r = - 0,571, p = 0,002). No statistically significant correlation were found between maxV and CVP (r = 0,074, p = 0,715). Conclusion : Significant correlation between IVC diameter and CI with CVP values implies that IVC USG is an acceptable non-invasive alternative method to estimate CVP values in accordance to septic shock therapy planning.
"
Depok: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Achmad Fachri
"ABSTRAK
Latar belakang dan tujuan: Modalitas radiografi toraks merupakan pemeriksaan
rutin dan tersedia di hampir setiap rumah sakit. Pengukuran secara kuantitatif
berupa vascular pedicle width (VPW), cardiothoracic ratio (CTR) maupun
vascular pedicle-thoracic ratio (VPTR) melalui radiografi toraks dapat membantu
dalam membedakan jenis edema paru dengan mengetahui titik potong rerata
VPTR berdasarkan kombinasi VPW dan CTR.
Metode: Penelitian dilakukan retrospektif dengan descriptive cross sectional pada
100 pasien dengan klinis edema paru yang telah melakukan radiografi toraks di
ICU Rumah Sakit CiptoMangunkusumo (RSCM) dalam rentang waktu Januari
2013 ? Desember 2015. Subjek dibagi menjadi edema kardiogenik dan non
kardiogenik berdasarkan kombinasi pengukuran VPW dan CTR. Kemudian
dilakukan pengukuran VPTR dan ditentukan titik potong rerata VPTR, sensitivitas
dan spesifisitas berdasarkan kombinasi VPW dan CTR dalam membedakan edema
paru.
Hasil: Dari total 100 subjek penelitian di ICU RSCM dengan metode Receiver
Operating Curve (ROC) didapatkan titik potong VPTR sebesar 25,1% dengan
sentivitas 90,5% dan spesifisitas 86,1% dalam membedakan edema paru
kardiogenik dan non kardiogenik. Selain itu diperoleh juga proporsi edema paru
kardiogenik sebesar 21%, sedangkan edema paru non kardiogenik sebesar 79%.
Kesimpulan: Titik potong VPTR berdasarkan kombinasi VPW dan CTR memiliki
sensitivitas dan spesifisitas yang cukup tinggi dalam membedakan edema paru
kardiogenik dan non kardiogenik.

ABSTRACT
Background and purpose: Pulmonary edema in critically ill patient were
challenging in intensive care unit (ICU). Radiography of thorax is routine
examination and widely available in almost every hospital. Measurement
quantitatively of vascular pedicle width (VPW), cardiothoracic ratio (CTR) and
vascular pedicle-thoracic ratio in thorax radiography can help in differentiating
the type of pulmonary edema through the cut off of VPTR based on combination
VPW and CTR.
Methods: Descriptive cross sectional restrospective in 100 patients with clinically
pulmonary edema which have examined by thorax radiography at ICU RSCM in
January 2013 to Desember 2015. Subject divided to cardiogenic and non
cardiogenic pulmonary edema based on combination VPW and CTR. Then,
VPTR were measured and the cut off of VPTR determined based on combination
VPW and CTR in differentiaiting pulmonary edema.
Results: From total 100 subject study at ICU RSCM using Receiver Operating
Curve (ROC) metode, the cut off of VPTR is 25,1% with sensitivity 90,5% and
specificity 86,1% in differentiating cardiogenic and non cardiogenic pulmonary
edema. Beside that, the prevalence of cardiogenik pulmonary edema is 21% and
non cardiogenic pulmonary edema is 79%.
Conclusion : The cut off of VPTR based on combination VPW and CTR have
significant sensitivity and specificity in differentiating cardiogenic and non
cardiogenic pulmonary edema."
2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Kazuhiko Sakamoto
"ABSTRACT
The prognosis of hepatocellular carcinoma (HCC) patients with tumor thrombus (TT) in the inferior vena cava (IVC) or right atrium (RA) is extremely poor. We reviewed the recent surgical treatments and outcomes of this form of advanced HCC. TT is classified into three types according to its anatomic location relative to the heart: the inferior hepatic type (type I), where the TT is in the IVC below the diaphragm; the superior hepatic type (type II), where the TT is in the IVC above the diaphragm, but still outside the RA; and the intracardiac type (type III), where the TT is above the diaphragm and has entered the RA. Type I can be treated relatively easily by standard radical hepatectomy. For type II, the intrathoracic IVC is approached via the abdominal cavity and an incision in the diaphragm with total hepatic vascular exclusion (THVE). For type III, hepatectomy plus thrombectomy is generally performed under cardiopulmonary bypass. If the TT is only just inside the RA, THVE can be performed by mobilizing the liver caudally. The median overall survival of HCC patients with TT in the IVC or RA, who undergo curative resection, is 19.0-30.8 months. As postoperative recurrence is likely to develop, even after curative surgery, effective postoperative adjuvant chemotherapy is required."
Tokyo: Springer, 2018
617 SUT 48:9 (2018)
Artikel Jurnal  Universitas Indonesia Library
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Simatupang, Satria Mula Habonaran
"Latar belakang. Risiko Venous Thromboembolism (VTE) yang terkait dengan keganasan adalah 4,1 kali lipat lebih besar dibandingkan dengan pasien tanpa keganasan. Pasien keganasan memiliki risiko perdarahan yang lebih besar dengan terapi antikoagulan yang umum digunakan. Inferior Vena Cava Filter (IVCF) telah direkomendasikan sebagai alternatif yang kontroversial.
Tujuan. Untuk menemukan bukti ilmiah tertinggi dalam keamanan, manfaat, dan dampak klinis IVCF untuk mengelola VTE terkait keganasan.
Metode. Sesuai dengan pedoman PRISMA, pada situs berbasis data Cochrane, PubMed, dan ClinicalKey dicari menggunakan kata kunci ("Inferior Vena Cava Filter" or "IVCF") and (“Anticoagulant”) and ("Cancer" or "Malignancy") and ("Venous Thromboembolism" or "VTE" or "Pulmonary Embolism" or "Deep Vein Thrombosis") and ("Safety" or "Benefit" or "Complication" or "Recurrence" or "Survival Rate" or "Mortality"). Artikel-artikel ini ditinjau dan dinilai.
Hasil. Ada 10 artikel yang ditinjau (1.191 partisipan). Komplikasi IVCF yang ditemukan: migrasi filter (0,9%), trombosis vena cava (3,7%), PE berulang (2,8%); fraktur filter (0,9%); dan penetrasi IVCF (0,9%). Tidak ada kematian yang ditemukan pada pasien karena komplikasi karena penyisipan filter (LOE 2). Penyisipan IVCF dapat mengurangi tingkat PE tetapi dengan peningkatan jumlah DVT (DVT: dengan filter vs tanpa filter: 35,7% vs 27,5%; HR 1,52; CI95 % 1,02–2,27; p = 0,042; PE: 6,2% vs. 15,1 %; HR 0,37; 95% CI 0,17–0,79; p = 0,008). Enam studi tidak menemukan peningkatan yang signifikan secara statistik dalam mortalitas terkait PE.
Kesimpulan. IVCF aman dan bermanfaat untuk pengelolaan VTE terkait keganasan, terutama pada pasien dengan kontraindikasi antikoagulan (LOE 2, 3 dan 4).

Background. The risk of venous thromboembolism (VTE) associated with malignancy is 4.1-fold greater compared to patients without malignancy. Malignancy patient have greater risk of bleeding with the commonly used anticoagulant therapy. Inferior Vena Cava Filter (IVCF) have been recommended as an controversial alternative.
Objective. To find the highest evidence in the safety, benefit, and clinical outcome of the IVCF for managing VTE associated with malignancy.
Method. Aligning with PRISMA guidelines, online databases Cochrane, PubMed, ScienceDirect and ClinicalKey were searched using keywords ("Inferior Vena Cava Filter" or "IVCF") and (“Anticoagulant”) and ("Cancer" or "Malignancy") and ("Venous Thromboembolism" or "VTE" or "Pulmonary Embolism" or "Deep Vein Thrombosis") and ("Safety" or "Benefit" or "Complication" or "Recurrence" or "Survival Rate" or "Mortality"). These articles were reviewed and appraised.
Results. There were 10 articles reviewed (1,191 participants). Complication of IVCF found: filter migration (0.9%), vena cava thrombosis (3.7%), recurrent PE (2.8%); filter fracture (0.9%); and IVCF penetration (0.9%). No mortality was found in patients due to complications due to filter insertion (LOE 2). IVCF insertion can reduce PE rates but with an increase in the number of DVT (DVT: with filter vs without filters: 35.7% vs 27.5%; HR 1.52; CI95 % 1.02–2.27; p = 0.042 ; PE: 6.2% vs. 15.1%; HR 0.37; 95% CI 0.17–0.79; p = 0.008). Six studies found no statistically significant increase in PE-related mortality.
Conclusion. IVCF is safe and beneficial for the management of malignancy-associated VTE, especially in patients with contraindications to anticoagulants (LOE 2, 3 and 4).
"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
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UI - Tugas Akhir  Universitas Indonesia Library
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Hendra Wibowo
"Penyakit Ginjal Kronik (PGK) merupakan kelainan struktur atau fungsi ginjal yang mengalami penurunan selama 3 bulan yang mengalami peningkatan prevalensi kasus. Peningkatan prevalensi kejadian PGK juga akan meningkatkan kebutuhan hemodialisis dan penggunaan arteriovenous fistula (AVF). Maturasi dan keberhasilan AVF dipengaruhi oleh faktor pasien dan struktur vaskular. Latihan isometrik dilaporkan dapat meningkatkan diameter vena, arteri, dan peak systolic velocity (PSV). Tujuan penelitian ini untuk melihat pengaruh latihan isometrik pre operatif terhadap diameter vena cephalica, diameter arteri radialis, PSV, intimal medial thickening (IMT), dan volume flow arteri radialis. Desain penelitian adalah eksperimental pre and post-test study, dilakukan di RSUPN Cipto Mangunkusumo. Penelitian dilaksanakan follow up pasien selama 8 minggu latihan isometri. Total subjek penelitian sebanyak 38 orang. Usia median subjek penelitian yaitu 56 tahun dengan rentang usia 20 sampai 71 tahun. Terdapat perbedaan yang signifikan antara diameter vena (p=0,003), PSV (p=0,032), dan volume flow (p=0,030) subjek penelitian pre dan post latihan isometrik. Terdapat perbedaan signifikan antara perubahan diameter vena terhadap komorbid diabetes melitus. Tidak terdapat perbedaan bermakna antara perubahan diameter vena, PSV, dan volume flow paska latihan ismoetrik terhadap kelompok usia, komorbid, dan jenis kelamin (p>0,005). Penggunaan latihan isometrik dapat meningkatkan perubahan diameter vena, PSV dan volume flow pada pasien sebelum pembuatan AVF radiocephalica. Tidak terdapat perubahan signifikan diameter vena pasca latihan isometrik pada penderita diabetes melitus.

Chronic Kidney Disease (CKD) is a disorder of kidney structure or function that has decreased over 3 months and has an increased prevalence of cases. The increasing prevalence of CKD will also increase the need for hemodialysis and the use of arteriovenous fistula (AVF). AVF maturation and success are influenced by patient factors and vascular structure. Isometric exercise is reported to increase the diameter of veins, arteries, and peak systolic velocity (PSV). Objective: Analyzing the effect of preoperative isometric exercise on the diameter of veins, arteries, PSV, intimal medial thickening (IMT), and volume flow. The research design was an experimental pre and post-test study, conducted at Cipto Mangunkusumo Center National Hospital. The study was conducted to follow up patients for 8 weeks of isometric exercise. The total study subjects were 38 people, with the highest prevalence being men, and comorbid hypertension. The median age of the research subjects was 56 years with an age range of 20 to 71 years. There were significant differences between venous diameter (p=0.003), PSV (p=0.032), and volume flow (p=0.030) in pre and post isometric training subjects. There was significant difference between cephalic vein diameter to diabetes mellitus group. There was no significant difference between changes in radial artery diameter, PSV, IMT, and post-isometric exercise volume flow for the age, comorbid, and sex groups (p>0.005). The use of isometric exercises can increase changes in venous diameter, PSV and volume flow in patients before the making of radiocephalic AVF. There was no significant change in venous diameter after isometric exercise in patient with diabetes mellitus.
"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Rizky Priambodo Wisnubaroto
"Pendahuluan: Instrumentasi posterior mengharuskan dipertahankannya fiksasi stabil sekrup pedikel di tulang belakang untuk mencapai fusi. Hal ini dapat menjadi sulit terutama pada kondisi tertentu, misalnya pada penurunan densitas masa tulang pedikel. Teknik insersi sekrup dengan lintasan kortikal diharapkan menambah antarmuka sekrup dan tulang dengan meningkatkan engagement antara sekrup dengan korteks tulang. Lintasan sekrup dari arah kortikal infero-superior serta kortikal supero-inferior diharapkan memiliki keunggulan kekuatan cabut (pullout strength) dibandingkan dengan lintasan konvensional dalam mengatasi masalah ini. Penelitian ini bertujuan untuk mendapatkan profil biomekanik awal lintasan kortikal dan perbedaan pull out strength lintasan konvensional (Weinstein, 1992), kortikal infero-superior (Santoni, 2009), dan kortikal supero-inferior.
Metode: Sampel dari lumbal (L1-L5) babi Yorkshire (n=30) dilakukan pengukuran morfometri dan dibagi secara acak. Sampel dilakukan pengeboran dan sekrup dimasukkan ke dalam tulang dengan tiga lintasan: konvensional, kortikal infero-superior, dan kortikal supero-inferior. Arah lintasan diperiksa kembali dengan sinar-x. Dilakukan penarikan sekrup dengan arah sesuai aksis insersi sekrup dengan kecepatan translasi 5mm/menit. Hasil dicatat dengan satuan Newton (N).
Hasil: Didapatkan rata-rata nilai uji tarik pada kelompok konvensional, infero-superior, dan supero-inferior masing-masing 491,72 (187.23) N, 822,16 (295.73) N, dan 644,14 (201.97) N. Lintasan kortikal infero-superior dan kortikal supero-inferior masing-masing mendapatkan nilai 67% dan 30% lebih tinggi dibandingkan dengan lintasan konvensional. Hasil uji ANOVA satu arah dan uji post-hoc Tukey menunjukkan perbedaan signifikan antara lintasan kortikal infero-superior dengan konvensional (p<0.01).
Kesimpulan: Lintasan sekrup dalam tulang lumbal dapat memengaruhi nilai pullout sekrup. Keterlibatan tulang kortikal pada lintasan insersi sekrup baru ini bisa meningkatkan nilai pullout sekrup pedikel. Secara statistik pullout strength lintasan kortikal infero-superior dan kortikal supero-inferior tidak ada perbedaan. Studi ini menunjukkan nilai pullout yang lebih tinggi sebesar 30% dari lintasan yang disarankan peneliti dibandingkan dengan lintasan konvensional, walaupun tidak ada perbedaan signifikan secara statistik.

Introduction: Posterior instrumentation is aimed to achieve spinal fusion which is helped by maintaining a stable pedicle screw insertion within the pedicle. This presents a challenge especially in conditions with low bone quality. Pedicle screw insertion with cortical bone trajectory is designed to add interface between the screw and the bone through engagement between pedicles and the cortex when compared to conventional pedicle screw insertion. Pedicle screw insertion trajectory from cortical infero-superior and the proposed cortical supero-inferior should obtain better pull out performance when compared with conventional pedicle trajectory. We aim to evaluate the pull out strength differences between conventional (Weinstein, 1992) pedicle screw trajectory, cortical infero-superior (Santoni, 2009), and a proposed cortical supero-inferior trajectory.
Methods: Samples from Yorkshire porcine lumbar spine (L1-L5) (n=30) were relieved of soft tissue attachments and dried. Morphometric measurements were conducted and the samples were randomly assigned to three groups. The screws were inserted into the vertebrae by drilling with the three trajectories: conventional, cortical infero-superior, and cortical supero-inferior. The trajectory of the screws were examined using x-rays. Pull-out tests were conducted by applying uniaxial traction in line with the screw trajectory with a translational speed of 5mm/minutes. The results of the pull-out are measured in Newton (N).
Results: We obtained a mean value of pullout force in conventional trajectory 491,72 (187.2) N, cortical infero-superior 822,16 (295.73) N, and cortical supero-inferior 644,14 (201.97) N. Cortical infero-superior trajectory and cortical supero-inferior trajectory attained 67% and 30% higher pullout mean respectively. Using one-way ANOVA and a post-hoc Tukey test revealed a significant difference between cortical infero-superior and conventional trajectory (p<0.01). Differing pull out strengths between cortical infero-superior and supero-inferior trajectory showed no statistical significance. Our study showed a 30% higher pull-out strength in our proposed trajectory compared with conventional trajectory although not statistically significant.
Conclusion: The trajectory of the screws within the lumbar spine seemed to have an impact in pullout strength. Cortical bone engagement using the novel trajectories may increase screw pullout strength of pedicle screws.
"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Rizky Priambodo Wisnubaroto
"Instrumentasi posterior mengharuskan dipertahankannya fiksasi stabil sekrup pedikel di tulang belakang untuk mencapai fusi. Hal ini dapat menjadi sulit terutama pada kondisi tertentu, misalnya pada penurunan densitas masa tulang pedikel. Teknik insersi sekrup dengan lintasan kortikal diharapkan menambah antarmuka sekrup dan tulang dengan meningkatkan engagement antara sekrup dengan korteks tulang. Lintasan sekrup dari arah kortikal infero-superior serta kortikal supero-inferior diharapkan memiliki keunggulan kekuatan cabut (pullout strength) dibandingkan dengan lintasan konvensional dalam mengatasi masalah ini. Penelitian ini bertujuan untuk mendapatkan profil biomekanik awal lintasan kortikal dan perbedaan pull out strength lintasan konvensional (Weinstein, 1992), kortikal infero-superior (Santoni, 2009), dan kortikal supero-inferior. Metode: Sampel dari lumbal (L1-L5) babi Yorkshire (n=30) dilakukan pengukuran morfometri dan dibagi secara acak. Sampel dilakukan pengeboran dan sekrup dimasukkan ke dalam tulang dengan tiga lintasan: konvensional, kortikal infero-superior, dan kortikal supero-inferior. Arah lintasan diperiksa kembali dengan sinar-x. Dilakukan penarikan sekrup dengan arah sesuai aksis insersi sekrup dengan kecepatan translasi 5mm/menit. Hasil dicatat dengan satuan Newton (N). Hasil: Didapatkan rata-rata nilai uji tarik pada kelompok konvensional, infero-superior, dan supero-inferior masing-masing 491,72 (187.23) N, 822,16 (295.73) N, dan 644,14 (201.97) N. Lintasan kortikal infero-superior dan kortikal supero-inferior masing-masing mendapatkan nilai 67% dan 30% lebih tinggi dibandingkan dengan lintasan konvensional. Hasil uji ANOVA satu arah dan uji post-hoc Tukey menunjukkan perbedaan signifikan antara lintasan kortikal infero-superior dengan konvensional (p<0.01). Kesimpulan: Lintasan sekrup dalam tulang lumbal dapat memengaruhi nilai pullout sekrup. Keterlibatan tulang kortikal pada lintasan insersi sekrup baru ini bisa meningkatkan nilai pullout sekrup pedikel. Secara statistik pullout strength lintasan kortikal infero-superior dan kortikal supero-inferior tidak ada perbedaan. Studi ini menunjukkan nilai pullout yang lebih tinggi sebesar 30% dari lintasan yang disarankan peneliti dibandingkan dengan lintasan konvensional, walaupun tidak ada perbedaan signifikan secara statistik.

Introduction: Posterior instrumentation is aimed to achieve spinal fusion which is helped by maintaining a stable pedicle screw insertion within the pedicle. This presents a challenge especially in conditions with low bone quality. Pedicle screw insertion with cortical bone trajectory is designed to add interface between the screw and the bone through engagement between pedicles and the cortex when compared to conventional pedicle screw insertion. Pedicle screw insertion trajectory from cortical infero-superior and the proposed cortical supero-inferior should obtain better pull out performance when compared with conventional pedicle trajectory. We aim to evaluate the pull out strength differences between conventional (Weinstein, 1992) pedicle screw trajectory, cortical infero-superior (Santoni, 2009), and a proposed cortical supero-inferior trajectory. Methods: Samples from Yorkshire porcine lumbar spine (L1-L5) (n=30) were relieved of soft tissue attachments and dried. Morphometric measurements were conducted and the samples were randomly assigned to three groups. The screws were inserted into the vertebrae by drilling with the three trajectories: conventional, cortical infero-superior, and cortical supero-inferior. The trajectory of the screws were examined using x-rays. Pull-out tests were conducted by applying uniaxial traction in line with the screw trajectory with a translational speed of 5mm/minutes. The results of the pull-out are measured in Newton (N). Results: We obtained a mean value of pullout force in conventional trajectory 491,72 (187.2) N, cortical infero-superior 822,16 (295.73) N, and cortical supero-inferior 644,14 (201.97) N. Cortical infero-superior trajectory and cortical supero-inferior trajectory attained 67% and 30% higher pullout mean respectively. Using one-way ANOVA and a post-hoc Tukey test revealed a significant difference between cortical infero-superior and conventional trajectory (p<0.01). Differing pull out strengths between cortical infero-superior and supero-inferior trajectory showed no statistical significance. Our study showed a 30% higher pull-out strength in our proposed trajectory compared with conventional trajectory although not statistically significant. Conclusion: The trajectory of the screws within the lumbar spine seemed to have an impact in pullout strength. Cortical bone engagement using the novel trajectories may increase screw pullout strength of pedicle screws."
Depok: Fakultas Kedokteran Universitas Indonesia, 2019
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
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Luki Sumaratih
"Latar Belakang. Selama ini pemberian oksigen dengan nasal kanul, sungkup hidung dan wajah merupakan tatalaksana pertama untuk gagal nafas hipoksemia. Alat high flow nasal cannula (HFNC) merupakan alternatif terapi oksigen yang lebih baik dari nasal kanul, karena dapat mengalirkan oksigen hingga 60 L/menit, FiO2 21% hingga 100% yang dilengkapi penghangat serta pelembab udara. Alat tersebut dapat menurunkan kerja otot- otot pernafasan dengan mekanisme menurunkan tekanan jalan nafas positif dan tahanan jalan nafas, meningkatkan oksigenasi, serta menghilangkan ruang rugi nasofaring. Penelitian ini bertujuan membandingkan HFNC dengan terapi oksigen konvensional (TOK) terhadap profil hemodinamik dan mikrosirkulasi pada pasien pascabedah.
Metodologi. Penelitian ini merupakan uji acak terkendali yang dilakukan di RSUPN Cipto Mangunkusumo bulan Februari hingga Juli 2019. Sebanyak 40 subjek terbagi ke dalam dua kelompok yaitu kelompok HFNC (n=20) dan kelompok terapi oksigen konvensional (TOK) (n=20). Pengambilan data dilakukan pada menit ke-0, 30, 60, jam ke-3 dan ke-24 setelah prosedur ekstubasi. Pengambilan data dilakukan menggunakan kateter vena sentral yang tertera di monitor, pengambilan darah dari kateter vena sentral, serta pengukuran hemodinamik dengan ICON® dari Ospyka. Uji kemaknaan dilakukan dengan uji-t tidak berpasangan dan generalize estimating equation (GEE) dengan SPSS versi 23.
Hasil. Hasil uji kemaknaan menunjukkan tidak didapatkan perbedaan bermakna antara kelompok HFNC dengan kelompok TOK untuk seluruh luaran hemodinamik (p>0,05). Terdapat perbedaan bermakna untuk luaran kadar laktat pada uji GEE dengan perbedaan rerata sekitar 0,78 mmol/L (nilai p=0,049), namun secara klinis tidak berbeda bermakna. Hal ini disebabkan tidak ada subyek kami yang mengalami hipoksemia maupun gangguan hemodinamik perioperatif.
Kesimpulan. Penggunaan alat HFNC tidak lebih baik dibandingkan nasal kanul pada pasien pascabedah laparotomi abdomen atas di ICU.

Background. Conventional oxygen therapy (COT) with nasal cannula, simple mask or face mask remains as the first line therapy for hypoxemic respiratory failure. High flow nasal cannula (HFNC) serves as an alternative oxygen therapy which can deliver oxygen at the flow up to 60 L/min and FiO2 ranging from 21% to 100% via warm and humid air based on human's physiology. This device can decrease the workload of respiratory muscles by reducing positive airway pressure and airway resistances, improving oxygenation and washing out airways' dead space. This research was conducted to study the comparison between HFNC and COT on hemodynamic profile and microcirculation in post-upper abdominal patients.
Methods. This was an open label randomized controlled trial (RCT) at National Cipto Mangunkusumo between February to July 2019. Forty patients were recruited and divided into HFNC group (n=20) and COT group (n=20). Hemodynamic parameters were recorded using the bedside monitor (heart rate, respiratory rate, and mean arterial pressure) as well as the electrical cardiometry using ICON® measurements (stroke volume index, cardiac index and systemic vascular resistance index); laboratory parameters were ScvO2 and lactate serum collected via central venous catheter. Data were collected at 0, 30 minutes, 60 minutes, 3 hours and 24 hours after extubation. Statistic analysis were conducted using independent sample T-test and generating estimating equations (GEE) with SPSS 23.
Results. All analysis showed no statistically significant difference between HFNC and COT group for all hemodynamic parameters (p>0.05). There was a significant mean difference for 0.78 mmol/L of serum lactate level according to GEE analysis in HFNC group (p=0.049), whereas this difference is not clinically significant. This results are caused by relatively stable subjects condition without the occurrence of perioperative hypoxemia or hemodynamic disturbances.
Conclusion. In post-upper abdominal surgery patients, HFNC is not superior compared to COT on improving hemodynamic and microcirculation outcomes.
"
Depok: Fakultas Kedokteran Universitas Indonesia, 2019
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
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