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"Pendahuluan. Fistula pankreas masih merupakan komplikasi paling sering setelah pankreatikoduodenektomi yang menyebabkan masa rawat lama dan biaya besar.  Fistula ini terjadi sampai 45%.  Kebocoran anastomosis pankreatikojejunostomi merupakan faktor yang paling penting. Belum ada data tentang faktor pankreas yang dapat memengaruhi fistula pankreas di Jakarta, khususnya RS Cipto Mangunkusumo sehingga dilakukan penelitian ini.

Metode.  Penelitian cross sectional ini dilakukan pada 70 orang penderita yang dilakukan pankreatikoduodenektomi. Data dikumpulkan dari data sekunder rekam medis tahun 2016-2019 berupa tekstur pankreas, diameter duktus pankreatikus, teknik anastomosis pankreatikojejunal, dan penggunaan stent pada pankreatikojejunal sebagai variabel bebas. Fistula pankreas sebagai variabel terikat. Data diuji dengan uji Spearman dikarenakan abnormalitas distribusi data.

Hasil.  Didapatkan 70 subjek. Tidak ada kejadian fistula pankreas sebanyak 21,4% dan ada fistula pankreas sebanyak  78,6%. Diameter duktus pankreatikus tidak melebar sebanyak 78,6% dan melebar sebanyak 21,4%. Tekstur pankreas soft sebanyak 22,9% dan hard sebanyak 77,1%. Penggunaan stent sebanyak 21,4% dan tidak ada penggunaan sebanyak 78,6%. Tipe anastomosis pankreatikojejunal dunking atau invaginasi sebanyak 82,9% dan duck to mucosa sebanyak 17,1%.  Faktor risiko yang bermakna pada analisis bivariat adalah diameter duktus pankreatikus (p=0,007). 

Kesimpulan. Penilaian diameter duktus pankreatikus intraoperatif mempunyai hubungan bermakna dalam memperkirakan kejadian fistula pankreas pascaoperasi pankreatikoduodenektomi.

 

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Introduction. Pancreatic fistula is the most common complication after pancreaticoduodenectomy that cause longer hospital stay and higher cost. It happens 45%. Pancreaticojejunostomy anastomosis leakage is the most important factor. No data about pankreas’ factor that can influence pancreatic fistula in Cipto Mangunkusumo hospital so this study is held.

Method. This cross sectional study was done for 70 patients. Data was collected from medical record in 2016-2019.   The data are pancreatic texture, pancreatic duct diameter, pancreaticojejunal anastomotic technique, and use of  stent in pancreaticojejunal as the independent variables. Pancreatic fistula as the dependent variable.   We analyzed  using Spearman test due to abnormality data distribution.

 

Results. There are 70 subjects enrolled. Subjects with no pancreatic fistula about 21,4% and with pancreatic fistula 78,6%.   No dilated pancreatic duct diameter about 78,6% and dilated about 21,4%. Soft texture pancreas about 22,9% and hard 77,1%. Use of stent about 21,4% and no stent 78,6%. Pancreaticojejunal anastomotic type of dunking or invaginating about 82,9% and duck to mucosa about 17,1%.  The significant risk factor in bivariate analysis is diameter of the pancreatic duct (p=0,007). 

Conclusion. Intraoperative assessment of the pancreatic duct diameter associated significantly in predicting pancreatic fistula after pancreaticoduodenectomy.

 

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"Latar Belakang: Pankreatikoduodenektomi (PD) merupakan prosedur pilihan pada keganasan periampula yang dapat direseksi. Namun, angka kematian pasca operasi untuk PD relatif tinggi. Prediksi kematian dengan sistem penilaian membantu memilih pasien yang memenuhi syarat operasi untuk meminimalkan risiko kematian. Studi ini membandingkan empat sistem penilaian kematian pasca prosedur PD, termasuk skor prognostik Naples (SPN), WHipple-ABACUS (WA), skor Pitt yang dimodifikasi (MSP), dan skor Pitt pada populasi Indonesia.Metode: Kami mengidentifikasi pasien yang menjalani PD karena keganasan periampula di Rumah Sakit Umum Nasional Dr. Cipto Mangunkusumo antara Januari 2010 dan Januari 2022. Kami menilai akurasi, cut-off, sensitivitas, spesifisitas, negative predictive value, positive predictive value, dan area di bawah kurva (AUC). Nilai AUC dari masing-masing sistem penilaian dibandingkan dengan menggunakan uji De-Long. Kami juga menganalisis prediktor kematian.Hasil: Dari 116 pasien yang memenuhi kriteria, angka kematian 29,3%. Rerata usia tahun 51,63 ± 10,22 terdiri dari 75,9% kelompok <60 tahun dan 24,1% 60 tahun, dengan 46,6% laki-laki dan 53,4% perempuan. AUC dari yang tertinggi hingga terendah adalah Pitt Score 0,662 (p 0,006), MPS 0,631 (p 0,027), WA 0,539 (p 0,505), dan SPN 0,495 (p 0,932) dengan tingkat akurasi masing-masing skor adalah skor Pitt 63,79%, MSP 65,52%, WA 50,00%, dan SPN 57,76%.Kesimpulan: Skor Pitt dan MSP memiliki akurasi tertinggi dari semua sistem penilaian dalam penelitian ini. MSP memiliki keuntungan yaitu komponen yang lebih sedikit, sehingga mudah untuk diimplementasikan. MSP dapat menggantikan peran Skor Pitt dalam memprediksi mortalitas pasca-prosedur pankreatikoduodenektomi di Indonesia.

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Background: Pancreaticoduodenectomy (PD) is the procedure of choice in resectable periampullary malignancies. However, the postoperative mortality rate for PD is relatively high. Prediction of mortality with a scoring system helps select patients eligible for surgery to minimize mortality risk. The study compared four post-procedural mortality scoring systems for PD, including Naples prognostic score (NPS), WHipple-ABACUS (WA), modified Pitt score (MPS), and Pitt score in Indonesian population.

Methods: We identified patients who underwent PD due to periampullary malignancy at Dr. Cipto Mangunkusumo National General Hospital between January 2010 and January 2022. We assessed accuracy, cut-off, sensitivity, specificity, negative predictive value, positive predictive value, and area under the curve (AUC). The AUC values of each scoring system were compared using De-Long test. We also analyzed predictors of mortality.

Results: Of the 116 patients who met the criteria, the mortality rate was 29.3%. Mean age years 51.63 ± 10.22 consist of 75.9% group <60 years and 24.1% ≥60 years, with 46.6% male and 53.4% female. The AUC from highest to lowest were Pitt Score 0.662 (p 0.006), MPS 0.631 (p 0.027), WA 0.539 (p 0.505), and NPS 0.495 (p 0.932) with the level of accuracy of each score were Pitt Score 63.79%, MPS 65.52%, WA 50.00%, and NPS 57.76%.

Conclusions: The Pitt and MPS scores have the highest accuracy of all the scoring systems in this study. MPS has the advantage of having fewer components, making it easy to implement. MPS can replace the role of the Pitt Score in predicting post-procedure PD mortality in Indonesia."

"Kami melaporkan hasil 31 pankreatikoduodenektomi dari 141 tumor periampula pada peroide 1994-2002. Di antara kasus, terdapat 16 perempuan; rentang usia 17-68 tahun. Ikterus adalah keluhan tersering, 14 penderita dengan kadar albumin di bawah 3,5 g/dl dan 10 penderita dengan kadar bilirubin lebih dari 10 mg/dl. Telah dilakukan 17 Whipple klasik, 11 pankreatiokoduodenektomi dengan preservasi pilorus dan 3 total pankreatektomi+duodenektomi. Rerata lama operasi 436 menit (290-570). Penderita dikelompokkan dalam 2 periode, antara 1994-1999 dan sesudahnya. Dengan meningkatnya pengalaman, perdarahan intra operatif menurun dari rerata 2000 ml ke 400 ml. Gambaran histopatologi menunjukkan 11 adeno karsinoma kaput pankreas, 11 adeno karsinoma ampula Vater, 4 adeno karsinoma duodenum, 2 kista jinak kaput pankreas dan 3 tumor jinak. Mortalitas operatif terjadi pada 4 penderita dari 12 penderita periode pertama, dan hanya 1 pada 19 penderita sisanya. Komplikasi tersering adalah kebocoran anastomosis ke pankreas yang terjadi pada 14 penderita, dan 4 dari kebocoran tersebut menyebabkan mortalitas operatif. Rentang rawat antara 12 - 47 hari pasca bedah. Sampai akhir laporan ini, 7 penderita hidup tanpa penyakit, dan 4 penderita putus kontak. Rekurensi terjadi pada 13 penderita dari 22 penderita yang terjadi antara 4-24 bulan sesudah operasi, dan 12 penderita meninggal 2-3 minggu kemudian. Tiga penderita meninggal karena sebab yang lain. Kesimpulan: pankreatikoduodenektomi adalah tehnik yang efektif, dan mortalitas operatif dapat diturunkan, khususnya morbidas kebocoran pankreas yang dapat ditangani. (Med J Indones 2004; 13: 166-70).

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We reported our experience on 31 pancreaticoduodenectomy out of 141 periampullary tumors during 1994 until 2002; 16 of them were female, and age average 17-68 years. Jaundice was the most common presenting sign; 14 patients showed plasma albumin lower than 3.5 g/dl, and 10 patients had bilirubin level more than 10 mg/dl. We performed classical Whipple technique in 17, pyloric preserving pancreaticoduodenectomy in 11, and total pancreaticoduodenectomy in 3 patients. The mean of operative time was 436 minutes (290-570 minutes). The patients were grouped into 2 periods, between 1994-1999 and thereafter. With experience, the amount of blood loss has decreased from 2000 ml to 400 ml. Histopathologic results showed adenocarcinoma of the pancreas head in 11, adenocarcinoma of the ampulla of Vater in 11, carcinoma of duodenum in 4, head of pancreas benign cyst in 2, and benign tumor in 3 patients. The surgical mortality was 4 in the first 12 patients, in contrast to only 1 in the last 19 patients. The most serious complication was pancreatic leakage in 14 patients, in 4 of them it was responsible as the cause of death. The length of stay after operation varied between 12 and 47 days. Until the end of this report 7 patients are still alive, and 4 patients lost of contact. Recurrence was detected in 13 out of 22 survivors, occurring between 4 to 24 months after operation and 12 patients died 2-3 months later. Three patients died due to other causes. We conclude that pancreoticoduodenectomy is an effective technique, and the operative mortality is decreasing. Furthermore, morbidity especially from pancreatic leakages can be treated in our hospital. (Med J Indones 2004; 13: 166-70)."

"Latar Belakang: Kanker pankreas merupakan penyakit dengan kesintasan rendah dan kesulitan untuk melakukan diagnosis. Pemeriksaan Computed Tomography (CT)-Scan abdomen dan Ca 19-9 merupakan modalitas yang murah, mudah, dan terjangkau dalam diagnosis kanker pankreas. Endoscopic Ultrasound Fine Needle Aspiration (EUS-FNA) merupakan pemeriksaan baku emas untuk diagnosis kanker pankreas tetapi belum banyak tersedia di fasilitas kesehatan di IndonesiaTujuan: Penelitian ini bertujuan untuk mengetahui kemampuan diagnostik CT-Scan abdomen dan Ca 19-9 dibandingkan dengan EUS-FNA dalam diagnosis kanker pankreas.Metode: Desain studi ini adalah potong lintang dengan melihat rekam medis 62 pasien dengan kecurigaan kanker pankreas di RSCM pada tahun 2015-2019. Diambil pasien-pasien yang memiliki data Ca 19-9 dan CT-Scan abdomen yang kemudian dilakukan EUS-FNA untuk penegakan diagnosis kanker pankreas.Hasil: Sensitivitas dan spesifisitas CT-Scan abdomen masing-masing 76,27% dan 100%, sedangkan Ca 19-9 masing-masing 67,8% dan 33,33%. Nilai duga positif (NDP), nilai duga negatif (NDN), rasio kemungkinan positif (RKP), rasio kemungkinan negatif (RKN), dan akurasi CT-Scan abdomen masing-masing adalah 100%, 17.65%, tidak dapat dinilai, 0,24 , dan 77,42%. Nilai duga positif, NDN, RKP, RKN, dan akurasi untuk Ca 19-9 masing-masing adalah 95.24%, 5%, 1,02, 0,97, dan 66,13%.Kesimpulan: Kombinasi pemeriksaan CT-Scan Abdomen dan Ca 19-9 memiliki sensitivitas yang tinggi untuk kanker pankreas. Computed Tomography abdomen dapat digunakan untuk diagnosis kanker pankreas dengan sensitivitas dan spesifisitas yang baik.

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Introduction: Pancreatic cancer is a disease with low survival rate and difficult to diagnose. Abdominal computed tomography (CT) and Ca 19-9 are diagnostic modalities which are easy, simple, and non-invasive in diagnosis of pancreatic cancer. Endoscopic Ultrasound Fine Needle Aspiration (EUS-FNA) is the gold standard for diagnosis of pancreatic cancer but it is not available in many health care facilities in Indonesia.Purpose: This study aims to know the diagnostic accuracy of abdominal CT and Ca 19-9 compared to EUS-FNA for diagnosis of pancreatic cancer.Methods: The design of this study is cross-sectional by searching medical record of 62 patients with clinical suspicion of pancreatic cancer in Cipto Mangunkusumo hospital from year 2015-2019. Patients who undergo EUS-FNA with clinical suspicion of pancreatic cancer and have abdominal CT and Ca 19-9 data is included.Results: The sensitivity and specificity of abdominal CT are 76.27% and 100%, respectively, and Ca 19-9 are 67.8% and 33.33%, respectively. Positive predictive value, NPV, positive likelihood ratio, negative likelihood ratio, and accuracy of abdominal CT are 100%, 17.65%, unmeasurable, 0.24 , and 77.42%, respectively. Positive predictive value, NPV, positive likelihood ratio, negative likelihood ratio, and accuracy of Ca 19-9 are 95.24%, 5%, 1.02, 0.97, and 66.13%, respectively.Conclusion: The combined sensitivity of abdominal CT and Ca 19-9 has high sensitivity to diagnose pancreatic cancer. Abdominal CT can be used to diagnose pancreatic cancer with good sensitivity and specificity."

"Latar Belakang: Karsinoma pankreas umumnya merupakan adenokarsinoma duktus dari pankreas, karena lebih dari 90% tumor pankreas berasal dari epitel duktus dan memiliki angka mortalitas tinggi. Adenokarsinoma pankreas menyebabkan berbagai gejala akibat obstruksi duktus biliaris dan duktus pankreatikus serta hipermetabolisme terkait perubahan metabolik pada kanker. Tindakan kuratif meliputi pembedahan menyebabkan perubahan anatomi fisiologik saluran cerna dan dapat menimbulkan berbagai komplikasi gastrointestinal yang menyebabkan malnutrisi pada pasien. Perubahan metabolik, gejala penyakit, dan tatalaksana adenokarsinoma pankreas dapat menyebabkan malnutrisi dan kaheksia kanker. Terapi nutrisi perioperatif yang adekuat akan menghasilkan outome bedah yang baik, menurunkan morbiditas dan mortalitas pascabedah, dan meningkatkan kualitas hidup pasien. Metode: Laporan serial kasus ini menguraikan empat kasus adenokarsinoma pankreas, yaitu dua kasus adenokarsinoma papila Vateri, satu kasus adenokarsinoma papila Vateri yang sudah infiltrasi ke duodenum, dan satu kasus adenokarsinoma pankreas dari kaput sampai kauda. Keempat pasien serial kasus tergolong kaheksia kanker. Pembedahan pada keempat kasus disesuaikan dengan lokasi dan metastasis kanker. Terapi nutrisi pada serial kasus ini dilakukan sesuai dengan pedoman terapi nutrisi perioperatif. Seluruh pasien mendapat terapi nutrisi mulai dari masa prabedah hingga pascabedah dengan pemberian energi dan makronutrien ditingkatkan bertahap sesuai dengan kondisi klinis dan toleransi pasien. Suplementasi mikronutrien juga diberikan kepada keempat pasien. Pemantauan pasien meliputi keluhan subjektif, hemodinamik, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan, dan kapasitas fungsional. Hasil: Selama pemantauan di RS, keempat pasien menunjukkan perbaikan klinis, peningkatan toleransi asupan, outcome bedah yang baik, serta perbaikan kapasitas fungsional dan hasil laboratorium. Kesimpulan: Terapi nutrisi perioperatif pada keempat pasien berperan penting dalam menunjang perbaikan klinis, dan outcome bedah, serta mendukung terapi pada kasus kanker pankreas.

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Background: Pancreatic cancer usually refers to ductal adenocarcinomas of the pancreas, since more than 90% of the tumors are ductal epithelium origin and have high mortality rate. Pancreatic adenocarcinoma causes various symptoms resulted from ductal biliary and pancreatic ducts obstruction, along with hypermetabolism related to metabolic alteration in cancer. Curative management involves surgery will make changes in gastrointestinal anatomy and physiology, and cause various gastrointestinal complication that will lead to malnutrition. Metabolic changes, symptoms of the disease and pancreatic adenocarcinoma therapy will cause malnutrition and cancer cachexia. Adequate perioperative nutrition will have good surgery outcome, reduce postoperative morbidity and mortality and increase patients quality of life.

Methods: This serial case report described four cases of pancreatic adenocarcinoma consist of two cases with adenocarcinoma of the papilla of Vater, one case with adenocarcinoma of the papilla of Vater with duodenum infiltration, and one case with pancreatic adenocarcinoma from head to tail. All patients classified as cancer cachexia. Surgery was carried out corresponds to cancer location and metastasis. Nutrition therapy in this serial case report was conducted in accordance to perioperative nutrition therapy guideline. All patients received nutrition support from preoperative to postoperative with gradual increased of energy and macronutrient adjusted to the clinical condition and food tolerance of the patients. Micronutrients supplementation was given to all patients. Monitoring included patients complaints, hemodynamic, food analysis and intake tolerance, laboratory results, anthropometry, fluid balance and functional capacity.

Results: During monitoring in the hospital, all patients showed improve clinical outcomes, increased food intake tolerance, good surgery outcomes, and improved functional capacity, and laboratory results.

Conclusion: Perioperative nutrition therapy in all patients play an important role in supporting clinical outcome improvement, surgery outcomes, and therapy in pancreatic cancer."

"CA 19-9 merefleksikan derajat keparahan adenokarsinoma kaput pankreas ditunjukkan oleh beberapa studi berhasil menemukan korelasi peningkatan CA 19-9 dengan resektabilitas adenokarsinoma kaput pankreas. Penelitian ini bertujuan melakukan evaluasi hubungan dan nilai diagnostik CA 19-9 dalam memprediksi resektabilitas adenokarsinoma kaput pankreas. Penelitian dilakukan secara potong lintang mengambil data dari rekam medis Rumah Sakit dr. Cipto Mangunkusumo tahun 2016–2019. Pasien terdiagnosis adenokarsinoma kaput pankreas secara histopatologis atau pencitraan abdomen, berusia ≤65 tahun, dan memiliki catatan pemeriksaan kadar CA 19-9 diikutsertakan dalam penelitian ini. Selain kadar CA 19-9, peneliti juga menilai factor terkait operabilitas. Tercatat 54 subjek dengan rerata usia 53,78±11,13 tahun. Ditemukan adanya korelasi positif (0,850) dan signifikan antara tingginya kadar CA 19- 9 dengan resektabilitas tumor kaput pankreas. Untuk operabilitas, ditemukan perbedaan bermakna kadar CA 19-9, albumin, dan skor Karnofsky pada kelompok pasien tumor kaput pankreas resectable dan unresectable. Titik potong kadar CA 19-9 tercatat sebesar 140,65 U/mL, dengan sensitivitas sebesar 82,76% (64,23%–94,15%), spesifisitas sebesar 72,00% (50,61%–87,93%), dan AUC sebesar 0,784. CA 19-9 berhubungan secara signifikan dengan resektabilitas tumor kaput pankreas. CA 19-9 memiliki nilai diagnostik yang baik dalam mempredisksi resektabilitas tumor ini.

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This study would like to evaluate the relationship and diagnostic value of CA 19-9 in predicting the resectability of pancreatic head carcinoma. The cross-sectional study took data from the medical records at dr Cipto Mangunkusumo Hospital in 2015–2019. Patients diagnosed with pancreatic head carcinoma based on histopathologic or abdominal imaging, aged ≤75 years, and who had a recorded CA level of 19-9 were enrolled in the study. The investigators also assessed parameters of operability. Of 54 patients with similar characteristics were enrolled, with a mean age of 53.78 ± 11.13 years. It was found that there was a positive (0.850) and significant correlation between high levels of CA 19-9 and unresectable pancreatic head carcinoma. We found significant differences in levels of CA 19-9, albumin, and Karnofsky score in the resectable and unresectable groups of pancreatic head carcinoma. The cut-off point for CA 19-9 levels was 140.65 U / mL, with a sensitivity of 82.76% (64.23%-94.15%), specificity of 72.00% (50.61%-87.93 %), and AUC of 0.784. CA 19-9 was significantly associated with the pancreatic head carcinoma resectability. CA 19-9 has a good diagnostic value in predicting the resectability of these tumors."

"Latar belakang dan objektif: Keberhasilan hemodialisis ditentukan oleh kesuksesan akses vaskular, baik dicapai melalui arteriovenous fistula AVF , arteriovenous graft AVG , atau central venous catether CVC . Dari berbagai pilihan akses vaskular lainnya, AVF adalah akses vaskular hemodialisis yang paling disarankan untuk jangka panjang karena memiliki patensi yang lebih panjang dan tingkat komplikasi yang rendah. Meskipun demikian, AVF memiliki tingkat kegagalan maturasi tinggi, dengan angka sekitar 43-63 . Rumah Sakit Umum Pusat Rujukan Nasional Cipto Mangunkusumo RSCM , rumah sakit tersier terbesar di Indonesia, tidak memiliki data mengenai tingkat patensi AVF. Penelitian ini bertujuan untuk mengetahui tingkat patensi primer AVF di RSCM. Metode: Penelitian kohort retrospektif dilakukan pada seluruh pasien yang menjalani pemasangan AVF di RSCM pada periode Januari 2011 sampai Desember 2013. Hasil: Dari 269 pasien rerata umur 53.1 13.9 , 190 70.6 pasien menjalani pemasangan fistula brakiosefalika, 71 26.4 pasien menjalani pemasangan fistula radiosefalika, dan 7 2.6 pasien menjalani pemasangan fistula jenis lainnya. Tingkat patensi tahun pertama adalah 71.4 . Kesimpulan: Tingkat patensi primer AVF pada pasien end-stage renal disease ESRD memenuhi standar target yang ditentukan oleh pedoman National Kidney Foundation Dialysis Outcomes Quality Initiative NKF/DOQI . Penelitian ini menunjukkan bahwa diameter vena memiliki korelasi yang signifikan dengan tingkat patensi primer AVF. Faktor-faktor lainnya tidak berkaitan dengan patensi primer.

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Background and objectives The success of haemodialysis relies on the success of the vascular access, whether achieved with an arteriovenous fistula AVF , an arteriovenous graft AVG , or a central venous catether CVC . Among other access options, arteriovenous fistula is the preferred long term haeemodialysis vascular access due to longer patency and low complication rate. However, AVF maturation failure rates are high, ranging from 43 to 63 . Cipto Mangunkusumo Hospital, the largest tertiary referral hospital in Indonesia, lacks data on AVF patency rates. This study is aimed to determine the primary patency rates of AVF in Cipto Mangunkusumo Hospital. Methods A single centre retrospective study was performed in all patients who had primary arteriovenous fistulas created at Cipto Mangunkusumo Hospital during the period between January 2011 and December 2013. Results Of 269 patients mean age 53.1 13.9 , 190 70.6 patients underwent brachiocephalic fistula creation, 71 26.4 patients underwent radiocephalic fistula creation, and 7 2.6 patients underwent other fistula types creation during the two year study period. The first year patency rate was 71.4 . Conclusions In this setting, the rate of AVF creation for end stage renal disease patients meets the standard of the target goals set forward by the National Kidney Foundation published updated Dialysis Outcomes Quality Initiative NKF DOQI Guidelines. Our study suggested that venous diameter was significantly correlated with primary patency rates of AVF. Other factors were not associated with primary patency. "

"Latar belakang dan objektif: Keberhasilan hemodialisis ditentukan oleh kesuksesan akses vaskular, baik dicapai melalui arteriovenous fistula AVF , arteriovenous graft AVG , atau central venous catether CVC . Dari berbagai pilihan akses vaskular lainnya, AVF adalah akses vaskular hemodialisis yang paling disarankan untuk jangka panjang karena memiliki patensi yang lebih panjang dan tingkat komplikasi yang rendah. Meskipun demikian, AVF memiliki tingkat kegagalan maturasi tinggi, dengan angka sekitar 43-63 . Rumah Sakit Umum Pusat Rujukan Nasional Cipto Mangunkusumo RSCM , rumah sakit tersier terbesar di Indonesia, tidak memiliki data mengenai tingkat patensi AVF. Penelitian ini bertujuan untuk mengetahui tingkat patensi primer AVF di RSCM. Metode: Penelitian kohort retrospektif dilakukan pada seluruh pasien yang menjalani pemasangan AVF di RSCM pada periode Januari 2011 sampai Desember 2013. Hasil: Dari 269 pasien rerata umur 53.1 13.9 , 190 70.6 pasien menjalani pemasangan fistula brakiosefalika, 71 26.4 pasien menjalani pemasangan fistula radiosefalika, dan 7 2.6 pasien menjalani pemasangan fistula jenis lainnya. Tingkat patensi tahun pertama adalah 71.4 . Kesimpulan: Tingkat patensi primer AVF pada pasien end-stage renal disease ESRD memenuhi standar target yang ditentukan oleh pedoman National Kidney Foundation Dialysis Outcomes Quality Initiative NKF/DOQI . Penelitian ini menunjukkan bahwa diameter vena memiliki korelasi yang signifikan dengan tingkat patensi primer AVF. Faktor-faktor lainnya tidak berkaitan dengan patensi primer.

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Background and objectives The success of haemodialysis relies on the success of the vascular access, whether achieved with an arteriovenous fistula AVF , an arteriovenous graft AVG , or a central venous catether CVC . Among other access options, arteriovenous fistula is the preferred long term haeemodialysis vascular access due to longer patency and low complication rate. However, AVF maturation failure rates are high, ranging from 43 to 63 . Cipto Mangunkusumo Hospital, the largest tertiary referral hospital in Indonesia, lacks data on AVF patency rates. This study is aimed to determine the primary patency rates of AVF in Cipto Mangunkusumo Hospital. Methods A single centre retrospective study was performed in all patients who had primary arteriovenous fistulas created at Cipto Mangunkusumo Hospital during the period between January 2011 and December 2013. Results Of 269 patients mean age 53.1 13.9 , 190 70.6 patients underwent brachiocephalic fistula creation, 71 26.4 patients underwent radiocephalic fistula creation, and 7 2.6 patients underwent other fistula types creation during the two year study period. The first year patency rate was 71.4 . Conclusions In this setting, the rate of AVF creation for end stage renal disease patients meets the standard of the target goals set forward by the National Kidney Foundation published updated Dialysis Outcomes Quality Initiative NKF DOQI Guidelines. Our study suggested that venous diameter was significantly correlated with primary patency rates of AVF. Other factors were not associated with primary patency. "

"[ABSTRAKLatar Belakang : Pada kanker pankreas dapat terjadi obstruksi pada duktus pankreatikus yang menghambat transfer enzim dan bikarbonat ke duodenum yang menyebabkan aktifitas enzim tidak cukup adekuat untuk mempertahankan proses pencernaan secara normal yang disebut sebagai pancreatic exocrine insufficiency (PEI), yang dapat dideteksi dengan pemeriksaan kadar fecal elastase 1.Tujuan : Mengetahui proporsi dan derajat PEI, proporsi steatore pada kanker pankreas, perbedaan kadar fecal elastase 1 antara kanker pankreas yang resectable dan unresectable dan perbedaan rerata kadar fecal elastase 1 berdasarkan stadium kanker pankreas.Metode : Penelitian ini adalah studi potong lintang untuk menentukan perbedaan kadar fecal elastase 1 antara kanker pankreas yang resectable dan unresectable. Penelitian ini dilakukan di Rumah Sakit Cipto Mangunkusumo, beberapa rumah sakit jejaring RSCM, dan RS Wahidin Sudirohusodo Makasar dari bulan November 2014 sampai dengan Mei 2015. Uji statistik yang digunakan untuk menilai perbedaan kadar fecal elastase 1 antara kanker pankreas yang resectable dan unresectable adalah Mann Whitney dan untuk menilai perbedaan rerata kadar fecal elastase 1 berdasarkan stadium kanker pankreas adalah Kruskal Wallis.Hasil : Sebanyak 48 subyek kanker pankreas diikutkan dalam penelitian, dengan kategori resectable sebanyak 19(39,6%) subyek, dan 29(60,4%) subyek yang unresectable. Proporsi pasien kanker pankreas yang mengalami PEI sebanyak 75% (IK 95% 0,63-0,87) dan proporsi pasien kanker pankreas yang memberikan gejala steatore sebanyak 68,8% (IK 95% 0,557-0,819). Tidak ada perbedaan kadar fecal elastase 1 yang bermakna (P=0,738) antara kelompok resectable dan unresectable dengan nilai median pada kelompok resectable adalah 38,0(15-500) μg/g dan pada kelompok unresectable adalah 35,0(15-500) μg/g. Tidak ada perbedaan bermakna (p=0,767) kadar fecal elastase 1 berdasarkan stadium kanker pankreas dengan nilai median(rentang) pada stadium IB 36(15-100) μg/g, stadium IIA 62(15-500) μg/g, stadium III 15(15-500) μg/g, dan stadium IV 36(15-500) μg/g.Kesimpulan : Pada penelitian ini didapatkan proporsi PEI dan steatore yang tinggi pada kanker pankreas. Tidak ditemukan perbedaan bermakna kadar fecal elastase 1 antara kanker pankreas yang resectable dan unresectable. Tidak terdapat perbedaan rerata kadar fecal elastase 1 berdasarkan stadium kanker pankreas.

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ABSTRACTBackground : In the pancreatic cancer can occur obstruction of the pancreatic duct that inhibit the enzyme transfer and bicarbonate into the duodenum which causes the enzyme activity is not quite adequate to maintain normal digestive process referred to as pancreatic exocrine insufficiency (PEI) that can be detected by measurement of fecal elastase 1 level.Objective : Knowing the proportion and the degree of PEI, the steatore proportion in pancreatic cancer, the difference levels of fecal elastase 1 between resectable and unresectable pancreatic cancer and differences between the mean levels of fecal elastase 1 based on the stage of pancreatic cancer.Methods : A cross-sectional study to determine the difference levels of fecal elastase 1 between resectable and unresectable pancreatic cancer. This research was conducted at Cipto Mangunkusumo hospital, some satellite of Cipto Mangunkusumo hospital, and Wahidin Sudirohusodo Makasar hospital at November 2014 until May 2015. The statistical test used to assess differences in the levels of fecal elastase 1 between resectable and unresectable pancreatic cancer is Mann Whitney and to assess the differences between the mean levels of fecal elastase 1 based on staging pancreatic cancer is the Kruskal Wallis.Results : A total of 48 subjects with pancreatic cancer were participated in this study, with resectable category were 19 (39.6%) subjects, and 29 (60.4%) subjects who unresectable. The proportion of patients with pancreatic cancer that experienced PEI are 75% (CI 95% 0.63 - 0.87) and the proportion of patients with pancreatic cancer which provide steatore symptoms are 68.8% (CI 95% 0.557 - 0.819). There is no significant difference levels of fecal elastase 1 (P = 0.738) between the resectable and unresectable where the resectable group median value is 38.0 (15-500) μg / g and in unresectable group was 35.0 (15-500) μg / g. There is no significant difference (p = 0.767) levels of fecal elastase 1 based on the stage of pancreatic cancer with median (range) in stage IB 36 (15-100) pg / g, stage IIA 62 (15-500) pg / g, stage III 15 (15-500) μg / g, and stage IV 36 (15-500) μg / g.Conclusion : This study found a high proportion of PEI and steatore in pancreatic cancer. there is no significant difference fecal elastase 1 levels between the resectable and unresectable pancreatic cancer. There is no significant difference between mean levels of fecal elastase 1 based on the stage of pancreatic cancer., Background : In the pancreatic cancer can occur obstruction of the pancreatic duct that inhibit the enzyme transfer and bicarbonate into the duodenum which causes the enzyme activity is not quite adequate to maintain normal digestive process referred to as pancreatic exocrine insufficiency (PEI) that can be detected by measurement of fecal elastase 1 level.Objective : Knowing the proportion and the degree of PEI, the steatore proportion in pancreatic cancer, the difference levels of fecal elastase 1 between resectable and unresectable pancreatic cancer and differences between the mean levels of fecal elastase 1 based on the stage of pancreatic cancer.Methods : A cross-sectional study to determine the difference levels of fecal elastase 1 between resectable and unresectable pancreatic cancer. This research was conducted at Cipto Mangunkusumo hospital, some satellite of Cipto Mangunkusumo hospital, and Wahidin Sudirohusodo Makasar hospital at November 2014 until May 2015. The statistical test used to assess differences in the levels of fecal elastase 1 between resectable and unresectable pancreatic cancer is Mann Whitney and to assess the differences between the mean levels of fecal elastase 1 based on staging pancreatic cancer is the Kruskal Wallis.Results : A total of 48 subjects with pancreatic cancer were participated in this study, with resectable category were 19 (39.6%) subjects, and 29 (60.4%) subjects who unresectable. The proportion of patients with pancreatic cancer that experienced PEI are 75% (CI 95% 0.63 - 0.87) and the proportion of patients with pancreatic cancer which provide steatore symptoms are 68.8% (CI 95% 0.557 - 0.819). There is no significant difference levels of fecal elastase 1 (P = 0.738) between the resectable and unresectable where the resectable group median value is 38.0 (15-500) μg / g and in unresectable group was 35.0 (15-500) μg / g. There is no significant difference (p = 0.767) levels of fecal elastase 1 based on the stage of pancreatic cancer with median (range) in stage IB 36 (15-100) pg / g, stage IIA 62 (15-500) pg / g, stage III 15 (15-500) μg / g, and stage IV 36 (15-500) μg / g.Conclusion : This study found a high proportion of PEI and steatore in pancreatic cancer. there is no significant difference fecal elastase 1 levels between the resectable and unresectable pancreatic cancer. There is no significant difference between mean levels of fecal elastase 1 based on the stage of pancreatic cancer.]"

"Dewasa ini akses vaskular hemodialisis dan segala permasalahannya masih menjadi penyebab perawatan di rumah sakit dan morbiditas pada pasien gagal ginjal kronik. Dibalik keutamaan dan superioritas penggunaan fistula arteriovenous (AVF) sebagai akses vaskular hemodialisis, kegagalan maturasi merupakan hambatan utama penggunaannya. Penelitian ini bertujuan mengkaji dapatkah bloodflow rate (BFR) yang diukur intraoperatif menggunakan ultrasonografi Doppler memprediksi maturasi AVF. Metode penelitian adalah potong lintang. Hasil didapatkan BFR intraoperatif menggunakan ultrasonografi Doppler sesaat setelah kreasi AVF brakiosefalika dapat memprediksi maturasi dengan nilai titik potong sebesar 245,5 mL/menit, didapatkan nilai sensitifitas sebesar 76,7% , spesifisitas 92,9%, nilai duga positif 95,8% dan nilai duga negatif 65% sehingga dapat menjadi acuan menentukan perlu tidaknya tindakan revisi saat intraoperatif yang pada akhirnya diharapkan dapat menurunkan angka kegagalan maturasi AVF.

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Currently, vaskular access for haemodialysis and its assocoiated problems is the leading cause for hospital admission and morbidity in patients with chronic kidney failure. Arteriovenous fistula (AVF) is the preferred vaskular access for haemodialysis, however its use is impeded by issues of maturation. This cross sectional study aims to evaluate whether bloodflow rate (BFR), measured intraoperatively using Doppler ultrasonography, can predict AVF maturation. The result from this study showed that intraoperative BFR measured using Doppler ultrasonography right after the creation of the brachiocephalic fistula can predict the fistula’s maturation. The intraoperative BFR cut-off value was 245,5 mL/min, with sensititivity of 76,7%, specificity 92,9%, positive predictive value of 95,8% and negative predictive value 65%. Therefore, the intraoperative BFR may be used as a guide to decide whether or not a corrective procedure was needed to repair the brachiocephalic AVF, and consequently, help in reducing the rate of AVF maturation failure.

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