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"Latar Belakang: Acute Limb Ischemia (ALI) merupakan kondisi yang mengancam fungsi tungkai hingga keberlangsungan hidup seseorang. Corona Virus Disease of 2019 (COVID-19), telah menjadi pandemi sejak diumumkan oleh World Health Orgazination (WHO) pada Maret 2020, berdampak dalam penundaan diagnosis dan penanganan penyakit termasuk penyakit non COVID-19. Trombosis merupakan salah satu etiologi ALI diketahui meningkat kejadiannya sebagai komplikasi COVID-19. Namun, studi terkait karakteristik pasien ALI terkait pandemi COVID-19 tidak banyak dilakukan, terutama di Indonesia. Metode: Studi kohort retrospektif karakteristik pasien ALI di Rumah Sakit Cipto Mangunkusumo, Jakarta pada tahun 2018-2022. Seluruh pasien kemudian dibagi menjadi kelompok sebelum pandemi dan selama pandemi dengan batas Maret 2023. Keluaran yang dianalisis adalah keberhasilan revaskularisasi, re-intervensi, dan mortalitas saat perawatan. Analisis data menggunakan SPSS for Mac versi 25 secara bivariat dan multivariat. Hasil: Sebanyak 81 pasien menjadi subjek penelitian terdiri dari 28 (34,6%) pasien pada periode sebelum pandemi dan 53 (65,4%) pasien pada periode selama pandemi COVID-19. Pada periode selama pandemi COVID-19 didapatkan bahwa lebih banyak pasien rujukan (p = 0,001). Terdapat perbedaan bermakna antara kedua periode pandemi terhadap keberhasilan revaskularisasi (p = 0,013) tapi tidak pada keluaran re-intervensi dan mortalitas saat perawatan. Pada periode selama pandemi COVID-19, didapatkan 13 pasien yang memiliki riwayat/terkonfirmasi COVID-19 dengan keluaran yang secara deskriptif sebanding. Pada analisis multivariat, penggunaan fluoroskopi dan trombektomi memengaruhi keluaran keberhasilan revaskularisasi; klasifikasi Rutherford memengaruhi keluaran re-intervensi; dislipidemia, penyakit jantung, dan fluoroskopi memengaruhi keluaran mortalitas saat perawatan. Kesimpulan: Terdapat perbedaan keluaran tatalaksana pasien ALI sebelum dan selama pandemi COVID-19 pada keluaran keberhasilan revaskularisasi. Terdapat beberapa faktor yang memengaruhi keluaran pasien ALI sebelum dan selama pandemi COVID-19

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Background: Acute Limb Ischemia (ALI) is a condition that threatens limb function and the survival of a patient. Corona Virus Disease of 2019 (COVID-19), has become a pandemic since it was announced by the World Health Organization (WHO) on March 2020, causing delays in the diagnosis and treatment of diseases including non-COVID-19 diseases. Thrombosis is one of the etiologies of ALI known to increase its incidence as a complication of COVID-19. However, there are not many studies regarding the characteristics of ALI patients related to the COVID-19 pandemic, especially in Indonesia. Methods: A retrospective cohort study of the characteristics of ALI patients at Cipto Mangunkusumo Hospital, Jakarta in 2018-2022. All patients were then divided into groups before the pandemic and during the pandemic with a deadline of March 2023. The outcomes analyzed were revascularization success, re-intervention, and mortality during treatment. Data analysis used SPSS for Mac version 25 in bivariate and multivariate ways. Results: A total of 81 patients were the subjects of the study consisting of 28 (34.6%) patients in the pre-pandemic period and 53 (65.4%) patients in the period during the COVID-19 pandemic. During the period during the COVID-19 pandemic, it was found that there were more referral patients (p = 0.001). There was a significant difference between the two pandemic periods on revascularization success (p = 0.013) but not on re-intervention outcomes and on-hospital mortality. During the period during the COVID-19 pandemic, there were 13 patients who had a history/confirmed COVID-19 with outcomes that were descriptively comparable. In multivariate analysis, the use of fluoroscopy and thrombectomy influenced the outcome of successful revascularization; Rutherford's classification influenced re-intervention outcomes; dyslipidemia, heart disease, and fluoroscopy affect the outcome of in-hospital mortality. Conclusion: There are differences in the outcome of the management of ALI patients before and during the COVID-19 pandemic in the outcome of revascularization success. There are several factors that influence patient outcomes for ALI before and during the COVID-19 pandemic."

"ABSTRAKPendahuluanAcute limb ischemia (ALI) adalah kondisi serius yang ditandai dengan penurunanyang cepat dan mendadak dari perfusi tungkai. 1 Di Amerika Serikat insiden Acute legischemia diperkirakan terjadi 14 per 100.000 penduduk per tahun, sedangkan Acutearm ischemia seperlimanya. Penyebab utama dari Acute limb ischemia ini lebih dari90 % adalah thromboemboli. 2 Acute limb ischemia merupakan salah satu tantanganterberat, penilaian awal dan assestment penting, karena kesalahan diagnosis dapatmengakibatkan amputasi pada pasien atau bahkan kematian.MetodeJenis penelitian ini adalah deskriptif retrospektif. Dilakukan di Rumah Sakit CiptoMangunkusumo (RSCM), dengan mengumpulkan data rekam medis pada pasienpasiendengan ALI di divisi Vaskuler dan Endovaskuler periode 1 Januari 2009 – 31Desember 2011. Kriteria inklusi meliputi semua pasien ALI yang sudah didiagnosissecara pasti dan dilakukan tindakan operasi. Kriteria eksklusi meliputi pasien ALIyang tidak memiliki data rekam medis lengkap.HasilDari 32 kasus ALI yang dirawat di Divisi Vaskuler dan Endovaskuler, didapatkan 22kasus (69 %) laki-laki dan 10 kasus (31 %) perempuan. Usia terbanyak padakelompok umur 40 – 60 tahun sebanyak 17 kasus (53 %). Untuk penyebab ALI yangpaling sering yaitu thrombus sebanyak 19 pasien (59 %). Faktor resiko yang palingsering adalah pasien dengan atherosklerosis sebanyak 18 pasien. Sebanyak 16 pasien(50 %) datang ke RS sudah masuk dalam klasifikasi III ALI. Sebanyak 26 pasien (81%) terkena pada ekstremitas bawah dan sebanyak 6 pasien (19 %) terkena padaekstremitas atas. Dari data didapatkan 3 pasien yang meninggal.KesimpulanManajemen terhadap ALI tetap menjadi tantangan, karena melibatkan salah satujalur keputusan yang paling kompleks dalam operasi vaskuler. Pasien dengan kondisiAcute limb ischemia, sebaiknya dirujuk ke pusat vaskular tanpa di tunda-tunda.

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ABSTRACTBackgroundAcute limb ischemia (ALI) is a serious condition characterized by rapid and suddenlimb perfusion. In the United States the incidence of acute leg ischemia is thought tobe 14 per 100,000 population per year, while one-fifth of acute arm ischemia. Themain cause of acute limb ischemia is more than 90% are thromboemboli. Acute limbischemia is one of the toughest challenges, initial assessment important, becausemisdiagnosis can lead to amputation or even death in patients.MethodThe study was a retrospective descriptive. The study was conducted in CiptoMangunkusumo Hospital (RSCM), by collecting data from medical records ofpatients with ALI in Vascular and Endovascular Surgery division from 1st January2009 through 31st December 2011. Inclusion criteria include all ALI patients alreadydiagnosed with certainty and performed surgery. Exclusion criteria include patientswith ALI who did not have complete medical records.ResultOf the 32 cases of ALI, 22 cases were found in men and 10 cases were found inwomen. Age of majority in the age group 40-60 years 17 cases. For the most frequentcause of ALI is thrombus were 19 patients. The most frequent risk factors were asmany as 18 patients with atherosclerotic patients. A total of 16 patients came to thehospital already in the classification III of ALI. A total of 26 patients affected thelower extremities and 6 patients affected the upper extremities. Three patients died.ConclusionManagement of the ALI remains a challenge, as it involves one of the most complexdecisions pathways in vascular surgery. Patients with acute limb ischemia conditions,should be referred to a vascular center without delay delay."

"Pendahuluan: Chronic Limb Threatening Ischemia (CLTI) adalah stadium lanjut penyakit arteri perifer (PAD). The society for Vascular Surgery Lower Extremity Guidelines Committee menciptakan sistem klasifikasi yang lebih komprehensif untuk stratifikasi risiko amputasi pada pasien di seluruh spektrum CLTI. Sistem ini didasarkan pada nilai objektif Wound (W), Ischemia (I) dan Foot Infection (fI) untuk menghitung stadium klinis tungkai terancam dari 1 hingga 4 yang telah divalidasi dalam beberapa penelitian untuk dapat sangat memprediksi risiko amputasi ekstremitas mayor dalam satu tahun. Berbagai pedoman profesional saat ini merekomendasikan terapi statin untuk semua individu dengan PAD. Temuan para peneliti tentang hubungan yang kuat dan bergantung pada intensitas antara terapi statin dan amputasi serta mortalitas di antara individu dengan insiden PAD adalah hal yang penting secara klinis, baik untuk pasien maupun dokter yang merawat mereka. Namun demikian, protokol pemberian statin masih bervariasi di Indonesia. Penelitian ini bertujuan untuk mengetahui peran konsumsi statin pada pasien CLTI dengan berbagai skor WIfI terhadap amputasi mayor yang diamati hingga satu tahun di Rumah Sakit Cipto Mangunkusumo (RSCM) berdasarkan skor CLTI. Metode: Dilakukan studi kohort retrospektif dari data pasien yang didiagnosis CLTI di RSCM pada tahun 2010-2019. Subjek dibagi menjadi grup statin dan non statin. Dilakukan Uji bivariat dengan chi-square untuk melihat bagaimana pengaruh pemberian statin, komorbid dan skor WIFI pada subjek CLTI terhadap amputasi mayor. Kemudian dilakukan analisis stratifikasi untuk melihat pengaruh statin pada subjek CLTI dengan berbagai spektrum. Dilakukan pula analisis bagaimana kecendrungan statin bekerja jika diberikan pada pasien dengan berbagai jumlah komorbid. Uji multivariat dilakukan menggunakan regresi logistik menghadirkan nilai p dengan adjusted relative risk (RR).Hasil: Mayoritas pasien adalah laki-laki (59,5%). Sebanyak 83,2% subjek penelitian menderita diabetes melitus, 70,5% subjek mengalami hipertensi, 47,7% subjek mengalami gagal ginjal kronis, dan 26,4% subjek menderita penyakit jantung. Selain itu, hampir setengah dari total subjek penelitian memiliki skor WIfI yang parah (45,5%). Subjek yang diberi statin berpeluang menjalani amputasi mayor sebesar 0,562 kali dibandingkan subjek yang tidak diberikan statin (95% CI 0,407 - 0,777). Dengan kata lain, pemberian statin mampu mencegah amputasi mayor pada pasien CLTI. Namun hal tersebut hanya dapat diterapkan pada subjek CLTI dengan skor WifI yang rendah, karena semakin tinggi skor WifI pasien memiliki faktor komorbid yang lebih banyak (p <0,05; 95% CI 0,008 - 0,783). Amputasi mayor pada subjek CLTI secara statistik signifikan dengan diabetes komorbid (p = 0,001), penyakit jantung (p <0,001), skor WIfI (p = 0,001) dan penggunaan statin (p <0,001). Simpulan: Penelitian ini menunjukkan bahwa pemberian statin dapat mencegah kejadian amputasi mayor pada pasien CLTI dengan skor WIfI rendah meskipun terdapat faktor komorbid.

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Background : Chronic limb threatening ischemia (CLTI) is an advanced stage of peripheral artery disease (PAD). The society for Vascular Surgery Lower Extremity Guidelines Committee created a more comprehensive threatened limb classification system intended to stratify amputation risk in patients across the spectrum of CLTI. The system is based on objective grades Wound (W), Ischemia (I) and Foot Infection (FI) to calculate a threatened limb clinical stage from 1 to 4 has been validated in multiple studies to be highly predictive of 1-year major limb amputation risk. Current professional society guidelines recommend statin therapy for all individuals with PAD. The investigators’ finding of a strong and intensity-dependent association between statin therapy and both amputation and mortality among individuals with incident PAD is of considerable clinical importance, both to patients and the physicians who care for them. Yet, there is no study available for this and statin protocol vary in our country. This study aims on revealing the role of statin consumption prior to major amputation on CLTI patients in Cipto Mangunkusumo based on CLTI score. Methods: We performed retrospective cohort study from a database of CLTI patients diagnosed at Cipto Mangunkusumo Hospital in 2010-2019. Subjects were divided into statin and nonstatin groups. A bivariate test with chi-square was performed to see how the effect of statin, comorbid and WIFI scores on CLTI subjects on major amputations. Then a stratification analysis was performed to see the effect of statins on CLTI subjects with various spectra. An analysis of how the statin likelihood of working when given to subjects with varying amounts of comorbidities was also conducted. Multivariate tests was performed used logistic regression presenting p values ​​with adjusted relative risk (RR). We performed cohort retrospective analysis study from a database of CLTI patients diagnosed at Cipto Mangunkusumo Hospital in 2010- 2019. Subjects were divided into 2 groups, the CLTI patients with statin and without statin based on their database. We also analyse comorbid factors (diabetes mellitus, hypertension, chronic renal failure and heart disesase) related to CLTI and WIfI score to major amputation incidence Results: Majority of the patients were male (59.5%). A total of 83.2% of study subjects suffered from diabetes mellitus, 70.5% of subjects had hypertension, 47.7% of subjects had chronic kidney failure, and 26.4% of subjects had heart disease. In addition, almost half of the total study subjects had a severe WIfI score (45.5%). Subjects who were given statins had a chance to undergo major amputation by 0.562 times compared to subjects who were not given statins (95% CI 0.407 - 0.777). In other words, statin administration was able to prevent major amputation in CLTI patients. However, it only can be applied to CLTI subjects with low WifI score, as higher WifI score patients have more comorbid factors (p <0,05; 95%CI 0,008 – 0,783). Major amputation in CLTI subjects was statistically significant with comorbid diabetes (p = 0.001), heart disease (p <0.001), WIfI score (p = 0.001) and statin use (p <0.001)."

"Studi ini mengidentifikasi faktor-faktor yang berhubungan dengan kejadian amputasi mayor pada pasien Acute Limb Ischemia (ALI) klasifikasi Rutherford IIb dan seberapa besar pengaruhnya. Penelitian ini berdesain kuantitatif dengan desain kohort retrospektif terhadap semua pasien RSCM pada tahun 2014-2019 dengan diagnosis ALI Rutherford IIb. Data demografi dan faktor risiko, dianalisa untuk mendapatkan korelasinya dengan tindakan amputasi mayor. Pada penelitian ini,  insiden amputasi mayor pada total subjek adalah 39,2%. Rata-rata subjek berusia 60 tahun, dengan insiden komorbiditas diabetes mellitus 32,4%, gangguan ginjal kronik 19,6%, hipertensi 41,2%, dan penyakit jantung koroner 39,2%. Hasil analisis menunjukkan hipertensi meningkatkan risiko amputasi mayor 27,4 kali, riwayat penyakit jantung koroner meningkatkan risiko 10,7 kali, dan diabetes mellitus meningkatkan risiko 9,8 kali, semua secara signifikan. Merokok ditemukan sebagai faktor risiko tidak langsung terhadap kejadian amputasi mayor.Kata kunci: Acute limb ischemia, Amputasi mayor, Rutherford IIb

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This study identifies the factors associated with major amputation in patients with Acute Limb Ischemia (ALI) Rutherford Stage IIb and how much they affect it. This is a quantitative study with retrospective cohort design for all patients with ALI in Rutherford IIb stage in 2014-2019. Demographics and risk factors were all analyzed in order to find the correlation with the incidence of major amputation. In this study, the incident of major amputation on the overall subject was 39.2%. The mean age for the subjects was 60 years old, and the comorbidity incidence of diabetes is 32.4%, chronic kidney disease is 19.6%, hypertension is 41.2%, and coronary heart disease is 39.2%. The result of the analysis shows that hypertension increases the risk of major amputation in patients with ALI in Rutherford IIb stage by 27.4 times, while coronary heart disease does by 10.7 times and diabetes does by 9.8 times, all statistically significant. Smoking is also found as an indirect risk factor to the incident of major amputation.Key words: Acute limb ischemia, Major amputation, Rutherford IIb"

"A number of investigations reported that hyperhomocysteinemia (hHcy) is a risk factor for vascular diseases. Some casecontrol studies find that total homocysteine (tHcy) level is higher among stroke ischemic patients. if hHcy in stroke ischemic patients is due to genetic defect, their children may inherit that. And if the causes are nutritional deficiencies or lifestyle determinants, their children may have that also. So, it may be expected that hHcy is more prevalent among the children of stroke ischemic patients. The role of Hcy in vascular disease has been investigated in many studies. One of vascular phenotypes observed in hHcy is endothelial dysfunction, manifested by decreased bioavailability of endothelium derived nitric oxide (NO). Hypertension, hypercholesterolemia, diabetes mellitus, and smoking can also decrease NO released from endothelial cells. The aim of this study was to find proportion of hHcy, and the pattern of NO level among the children of stroke ischemic patients. In addition, we examined the relationship between plasma tHcy, hypertension, LDL-cholesterol, and HbAlc 'with NO production, by measuring nitrate-nitrite (NOx) level, as its metabolites. This cross sectional study includes 86 childrenof stroke ischemic patients, who fulfilled study criteria. The proportion of hHcy is in the range of 11,6 } 6,9%. The NOx level of 40 subjects which are randomly selected from the 86 subjects, have the median of 80,99 µM (42,9 - 226,8 1.M). There is no significant relationship between plasma tHcy with NOx level (r = 0,220, p = 0,086). There is no significant relationship between systolic, and diastolic blood pressure, LDL-cholesterol, HbAlc, and history of hypertension with plasma NOx level (r = 0.073 ; p = 0.327, r = 0,220, p = 0,086, r = -0,207 ; p = 0,100, r = 0,261 ; p = 0,052 dan r = 0,119, p = 0,233). The NOx level of subjects .with hHcy, history of hypertension, elevated systolic, diastolic blood pressure, and high LDL-cholesterol level tends to be higher than the subjects with Hcy level < 15 µM, Without hypertension history, normotensive, and subjects with normal LDL-cholesterol level."

"Latar Belakang: Giant Cell Tumor (GCT) adalah tumor yang sering mengenai individu berusia 20-45 tahun. Penatalaksanaan GCT radius distal adalah untuk menghilangkan massa tumor sepenuhnya dan mempertahankan pergelangan tangan. Beberapa metode rekonstruksi dapat dilakukan seperti arthrodesis total, Free Vascularized Fibular Graft (FVFG) atau Non-Vascularized Fibular Graft (NVFG), dengan prosedur rekonstruksi terutama melibatkan artroplasti atau arthrodesis pergelangan tangan parsial. Penelitian ini disusun untuk mengetahui perbandingan luaran fungsional pasien rekonstruksi GCT radius distal menggunakan teknik FVFG, NVFG, dan arthrodesis. Metode: Penelitian ini merupakan penelitian analitik dengan desain studi potong lintang yang menilai keluaran. post operasi dan tidak pada subjek tidak terdapat perlakuan khusus pada pasien. Pengambilan data akan dilakukan di RSUPN Cipto Mangunkusumo, Jakara, dan dilaksanakan pada bulan Juli 2020 – Juli 2021. Populasi target pada penelitian ini yaitu pasien yang telah didiagnosis dengan GCT tulang distal radius dan telah dilakukan operasi penyelamatan ekstrimitas beserta prosedur rekonstruksi berupa NVFG atau FVFG atau arthrodesis. Hasil : Terdapat 21 pasien GCT radius distal di RSCM pada penelitian ini yang termasuk kriteria inklusi dan di ikutkan dalam proses analisis data. Jumlah subjek laki-laki adalah 12 orang dan perempuan 9 orang (rasio 4:3). Golongan usia yang paling banyak adalah 21-30 tahun (33,3%). Tidak didapatkan hubungan yang bermakna di antara ketiga prosedur tersebut dengan luaran fungsional pasien (p = 0,49). Namun apabila dilihat dari rerata skor MSTS yang terbaik adalah metode FVFG dengan skor 24,4. Rerata FVFG lebih baik bila dibandingkan dengan arthrodesis 23,2 dan NVFG 23,18. Kesimpulan: Tidak terdapat perbedaan luaran fungsional dari tatalaksana operasi penyelamatan ekstremitas pada pasien dengan GCT tulang distal radius yang dilakukan prosedur NVFG, FVFG, dan arthrodesis.

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Background: Giant Cell Tumor (GCT) is a tumor that often affects individuals aged 20- 45 years. Management of the distal radius GCT is to completely remove the tumor mass and preserve the wrist. Several reconstruction methods can be performed such as total arthrodesis, Free Vascularized Fibular Graft (FVFG) or Non-Vascularized Fibular Graft (NVFG), with the reconstructive procedure primarily involving arthroplasty or partial wrist arthrodesis. This study was structured to compare the functional outcomes of patients with distal radius GCT reconstruction using FVFG, NVFG, and arthrodesis techniques. Method: This study is an analytic study with a cross-sectional design that assesses outcomes. postoperatively and not on the subject there is no special treatment for the patient. Data collection will be carried out at Cipto Mangunkusumo General Hospital, Jakarta, and will be held in July 2020 – July 2021. The target population in this study are patients who have been diagnosed with GCT of the distal radius and have undergone extremity rescue surgery along with reconstruction procedures in the form of NVFG or FVFG or arthrodesis. Result: There were 21 distal radius GCT patients at the RSCM in this study which included the inclusion criteria and were included in the data analysis process. The number of male subjects was 12 people and 9 female subjects (4:3). The most common age group is 21-30 years (33.3%). There was no significant relationship between the three procedures and the patient's functional outcome (p = 0.49). However, when viewed from the average MSTS score, the best is the FVFG method with a score of 24.4. The mean FVFG was better when compared to arthrodesis 23.2 and NVFG 23.18. Conclusion: There was no difference in the functional outcome of limb salvage surgical management in patients with GCT of the distal radius who underwent NVFG, FVFG, and arthrodesis procedures."

"[ABSTRAKPendahuluan Osteosarkoma adalah tumor ganas tulang paling sering ditemukan di RS Cipto Mangunkusumo (RSCM). Penatalaksanaan osteosarkoma dengan limb-salvage surgery (LSS) makin berkembang disamping tindakan amputasi. Penelitian ini bertujuan untuk mengetahui perbandingan luaran hasil LSS dan amputasi pada pasien osteosarkoma di RSCM.Metode Studi ini menggunakan desain kohort retrospektif pada pasien osteosarkoma periode tahun 1995-2014 di RSCM. Dilakukan evaluasi angka kesintasan, rekurensi lokal, metastasis, komplikasi, skor fungsional menurut Musculoskeletal Tumor Society Scoring system (MSTS) pada pasien yang dilakukan LSS dan amputasi. Metode Kaplan-Meier digunakan untuk mendeskripsikan kesintasan, sintasan bebas rekurensi lokal antara LSS dan amputasi. Hubungan karakteristik pasien dianalisis dengan uji log rank. Uji Kai kuadrat, Eksak Fischer dan Mann-Whitney U digunakan untuk menganalisis hubungan antara skor MSTS dan karakteristik pasien, angka rekurensi, metastasis serta komplikasi. Untuk melihat pengaruh katakteristik terhadap sintasan dilakukan analisis regresi Cox dan uji Wald serta analisis multivariat backward stepwise.Temuan Penelitian dan Diskusi Kesintasan 5 tahun pasien osteosarkoma 14,6%. Kesintasan 5 tahun LSS 34,8%, kesintasan 5 tahun amputasi 15,9%. Kesintasan bebas rekurensi lokal 5 tahun untuk LSS 96,2% dan untuk amputasi 86,5%. Kesintasan dipengaruhi metastasis, tipe operasi dan ukuran tumor. Metastasis merupakan faktor paling berpengaruh berdasarkan analisis multivariat. Metastasis terbanyak ditemukan di paru. Gejala awal dan staging Enneking mempengaruhi metastasis (p=0,02 dan 0,007). Infeksi adalah komplikasi tersering. Tipe biopsi FNAB memberi komplikasi yang paling sedikit. LSS memberi skor fungsional yang lebih tinggi (83,3%) daripada amputasi (61,7%). Pasien dengan rekurensi lokal cenderung mempunyai skor fungsional buruk (p=0,023).Kesimpulan Kesintasan paling tinggi pada pasien osteosarkoma RSCM yang dilakukan LSS. Luaran fungsional dengan skor MSTS baik (83,3%) didapatkan pada pasien yang dilakukan LSS dan bebas rekurensi lokal. Skor MSTS buruk dijumpai pada pasien amputasi dengan rekurensi lokal, komplikasi dan metastasis.

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ABSTRACTIntroduction Osteosarcoma is the most common malignant bone tumor seen in Cipto Mangunkusumo Hospital (CMH). Treatment for osteosarcoma includes limb-salvage surgery (LSS), and it is increasingly more frequently performed compared to amputation. This study aims to analyze the outcome of LSS compared to amputation for osteosarcoma patients in CMH.Methods This is a retrospective cohort study to review osteosarcoma patients during 1995-2014 period in CMH. Analysis was performed on survival rate, local recurrence, metastasis, complication, and functional score according to Musculoskeletal Tumor Scoring System (MSTS) for patients underwent LSS or amputation. Kaplan-Meier method was used to determine survival rate, and disease-free survival rate between LSS and amputation. Log-rank analysis was used to determine relationship between patients characteristic. Chi-Square, Exact-Fischer, and Mann-Whitney U tests were used to analyze the correlation between MSTS score and patient characteristics, rate of recurrence, metastasis, and complication. To determine the influence of patient characteristics to survival, Cox regression analysis, Wald Test and backward stepwise multivariate analysis were performed.Results and discussion 5-year survival rate osteosarcoma patients was 14.6%, 5-year survival rate for LSS was 34.8% compared to 15.9% for amputation. Disease-free survival for LSS was 96,2%, while amputation was 86,5%. Survival were influenced by metastasis, type of surgical intervention, and tumor size. According to multivariate analysis, survival was most influenced by metastasis. Metastasis were found predominantly in lungs. Initial symptoms and Enneking stage were correlated to metastasis (p=0.02 and 0.007, respectively). Infection was the most common complication. FNAB gave the least complication compared to other types of biopsy. LSS gave the highest functional score (83.3%) compared to amputation (61.7%). Patients with local recurrence tend to have poor functional score (p=0.023).Conclusion The highest survival rate for osteosarcoma patients in CMH was found on patients who underwent LSS. Good functional outcome according to MSTS score (83.3%) were found on patients who underwent LSS and free of local recurrence. Poor MSTS score were seen on patients undergone amputation, patients who had had local recurrence, complication and metastasis, Introduction Osteosarcoma is the most common malignant bone tumor seen in Cipto Mangunkusumo Hospital (CMH). Treatment for osteosarcoma includes limb-salvage surgery (LSS), and it is increasingly more frequently performed compared to amputation. This study aims to analyze the outcome of LSS compared to amputation for osteosarcoma patients in CMH.Methods This is a retrospective cohort study to review osteosarcoma patients during 1995-2014 period in CMH. Analysis was performed on survival rate, local recurrence, metastasis, complication, and functional score according to Musculoskeletal Tumor Scoring System (MSTS) for patients underwent LSS or amputation. Kaplan-Meier method was used to determine survival rate, and disease-free survival rate between LSS and amputation. Log-rank analysis was used to determine relationship between patients characteristic. Chi-Square, Exact-Fischer, and Mann-Whitney U tests were used to analyze the correlation between MSTS score and patient characteristics, rate of recurrence, metastasis, and complication. To determine the influence of patient characteristics to survival, Cox regression analysis, Wald Test and backward stepwise multivariate analysis were performed.Results and discussion 5-year survival rate osteosarcoma patients was 14.6%, 5-year survival rate for LSS was 34.8% compared to 15.9% for amputation. Disease-free survival for LSS was 96,2%, while amputation was 86,5%. Survival were influenced by metastasis, type of surgical intervention, and tumor size. According to multivariate analysis, survival was most influenced by metastasis. Metastasis were found predominantly in lungs. Initial symptoms and Enneking stage were correlated to metastasis (p=0.02 and 0.007, respectively). Infection was the most common complication. FNAB gave the least complication compared to other types of biopsy. LSS gave the highest functional score (83.3%) compared to amputation (61.7%). Patients with local recurrence tend to have poor functional score (p=0.023).Conclusion The highest survival rate for osteosarcoma patients in CMH was found on patients who underwent LSS. Good functional outcome according to MSTS score (83.3%) were found on patients who underwent LSS and free of local recurrence. Poor MSTS score were seen on patients undergone amputation, patients who had had local recurrence, complication and metastasis]"

"Latar Belakang: Stroke iskemia merupakan disfungsi neurologik area tertentu atau menyeluruh akibat gangguan aliran darah ke otak yang dapat menyebabkan kerusakan jaringan. Berbagai faktor risiko yang tidak dapat dimodifikasi dan dapat dimodifikasi seperti usia, jenis kelamin, riwayat keluarga, hipertensi, diabetes melitus, obesitas berperan menyebabkan pembentukan aterosklerosis, iskemia serebral selanjutnya menyebabkan stroke iskemia. Stroke iskemia dan sejumlah penyulit akan menimbulkan defisit neurologi yang menyebabkan malnutrisi, dehidrasi, keluaran yang buruk dan kualitas hidup menurun. Terapi medik gizi klinis berperan memberi nutrisi optimal, membatasai natrium, mengontrol glukosa darah dan memperhatikan volume cairan yang diberikan sehingga status nutrisi tetap terjaga, memperbaiki keluaran, dan mencegah rekurensi. Metode: Serial kasus ini memaparkan empat kasus stroke iskemia pada pasien perempuan dan laki-laki dengan rentang usia 53 ndash;66 tahun, dengan penyulit seperti disfagia, perdarahan GIT dan pneumonia, disertai komorbiditas yaitu DM tipe 2, hipertensi, dan chronic kidney disease,. Keempat pasien membutuhkan dukungan nutrisi akibat komplikasi stroke iskemia yaitu disfagia dengan risiko terjadinya malnutrisi, dehidrasi dan ketidakseimbangan elektrolit. Satu pasien dengan berat badan normal, 1 pasien BB lebih, dan 2 pasien obes I. Masalah nutrisi yang dihadapi keempat pasien ini adalah asupan makro dan mikronutrien yang tidak optimal, jalur pemberian nutrisi, kebutuhan nutrisi yang tidak terpenuhi selama sakit, anemia, hiperglikemia, dislipidemia, gangguan fungsi ginjal dan keseimbangan cairan. Terapi medik gizi klinik diberikan sesuai rekomendasi stroke iskemia dan disesuaikan dengan komorbidnya. Pemantauan pasien meliputi keadaan umum, hemodinamik, analisis dan toleransi asupan, monitoring terhadap kadar glukosa darah, fungsi ginjal, keseimbangan cairan, elektrolit dan kapasitas fungsional. Hasil :Ketiga pasien pada serial kasus menunjukkan perbaikan klinis, berupa tekanan darah terkontrol, kadar glukosa darah terkontrol, dan kapasitas fungsional yang membaik. Satu pasien meninggal pada hari perawatan ke-35 akibat sepsis. Kesimpulan:Terapi medik gizi klinik yang optimal dapat memperbaiki kondisi klinis pada pasien stroke iskemia dengan DM tipe 2 dan penyulitnya.

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Background: Ischemic stroke is a partial or comprehensive neurological disfunction caused by cerebral blood flow disturbance as basis of tissue damages. A diversity of non modified and modified risk factors such as age, sex, family history, hypertension, diabetes mellitus, and obesity act as underlying causes to atherosclerosis, ischemia cerebral, that lead to ischemic stroke. Ischemic stroke with accompanying comorbidity will inflict neurological deficit causing malnutrition, dehydration, bad outcome and the diminution quality of life. The role of nutritional medical therapy is pivotal for optimal nutritional support, sodium intake restriction, and glycemic control with the goal to maintain nutrition status, improve outcome and prevent recurrence.

Methods: The case series describes four ischemic stroke cases with complications such as dysphagia, gastrointestinal bleeding, and pneumonia, and aggravated by DM type II, hypertension, and chronic kidney disease comorbidity, in males and females aged 53 ndash 66 years old. Due to risk of malnutrition, dehydration and electrolyte imbalance caused by dysphagia, nutrition support was required by all patients to treat this ischemic stroke complication. One patient was normoweight, while three other cases included one overweight and two obese I patients. The nutritional problems faced by these four patients laid on the non optimal macro and micro nutrient intake, route of nutrient intake, nutrition composition imbalance during ill period, anaemia, hyperglycaemia, dyslipidemia, decrease of renal function, and fluid imbalance. Nutritional medical therapy was given according to recommendations for ischemic stroke and adjusted with its comorbidity. Patients rsquo monitoring was done including their general condition, hemodynamic, intake analysis and tolerance, monitoring in blood glucose, kidney function, fluid balance, electrolyte and functional capacity.

Result: Three patients in the case series showed positive changes in clinical conditions, shown by improvement in blood pressure, blood glucose, and functional capacity. One patient died on the 35th treatment day due of sepsis.

Conclusion: Optimal nutritional medical therapy plays important role in improving clinical conditions of ischemic stroke patient with DM type 2 and other complications."

"Latar belakang: Pentoksifilin belum memberikan hasil yang konsisten pada pasien stroke iskemik akut sehingga pada penelitian ini dipakai suatu penanda spesifik untuk melihat efektifitas terapi yaitu adanya hiperviskositas darah. Metode: Penelitian ini merupakan penelitian uji klinis acak tersamar tunggal. Pasien stroke iskemik akut onset kurang dari 72 jam yang mengalami hiperviskositas darah diacak menjadi kelompok perlakuan n=22 dan kontrol n=22 . Terapi standar stroke akut diberikan pada semua subyek. Kelompok perlakuan mendapat terapi tambahan berupa pentoksifilin 1.200mg/hari intravena selama lima hari dan dilanjutkan dosis oral 2x400mg per hari selama 23 hari setelahnya. Pemeriksaan viskositas darah dan interleukin-6 dilakukan pada hari pertama dan ketujuh perawatan. Luaran klinis dinilai dengan menggunakan national institute of health stroke scale NIHSS , modified rankin score mRS dan indeks barthel pada hari ketujuh dan juga pada hari ke-30. Hasil: Kadar viskositas darah seluruh subyek mengalami penurunan pada hari ketujuh dan ketiga puluh. Pada kelompok perlakuan, rerata penurunan viskositas darah memiliki perbedaan bermakna pada subyek dengan faktor risiko merokok dan dislipidemia. Tidak didapatkan penurunan kadar interleukin-6 pada kedua kelompok. Kelompok perlakuan memiliki perbaikan defisit neurologis sebesar 32 risiko relatif [RR]1,00; 95 interval kepercayaan [IK] 0,421-3,556; p = 1,00 . Disabilitas dan kemandirian fungsional yang baik didapatkan pada 67 kelompok perlakuan RR 1,026; 95 IK 0,656-1,605; p = 0,9 . Pada kelompok perlakuan, luaran klinis berbeda bermakna pada subyek yang memiliki sakit jantung dan diabetes melitus. Kesimpulan: Setelah pemberian pentoksifilin didapatkan penurunan kadar viskositas dan perbaikan luaran klinis. Studi lanjutan dibutuhkan dengan kriteria yang lebih spesifik dan jumlah sampel yang lebih besar.

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Background: The role of pentoxifylline in acute ischemic stroke lacks objective markers of its efficacy. Therefore, we used blood viscosity to determine the efficacy of pentoxifylline.

Method: This was a randomized single blind, controlled trial. Acute ischemic stroke patients with blood hyperviscosity within 3 day onset were randomly allocated to the study n 22 or control n 22 group. All subjects received a standard treatment for acute ischemic stroke. The study group was administered with intravenous pentoxifylline 1,200 mg day for five consecutive days and continued with oral 800 mg in two divided doses for next twenty three days. Blood viscosity and interleukin 6 IL 6 were evaluated at the first and seventh day. Clinical outcomes were measured using the National Institutes of Health Stroke Scale NIHSS, modified Rankin Scale mRS, and barthel index BI at the seventh and thirtieth day.

Result: The level of blood viscosity of all subjects tends to be decreased on the seventh and thirtieth day. In study group, the decrement of blood viscosity was significant for smoking and dyslipidemic subject. There was no decrement of the IL 6 on both group. The improvement of NIHSS in study group was 32 relative risk RR 1,00 95 CI 0,421 3,556 p 1,00 . At 1 month follow up, 67 of study group had a good functional outcome RR 1,026 95 CI 0,656 1,605 p 0,9 and the good functional outcome was statistically significant for diabetes mellitus and heart disease subject.

Conclusion The decrement of blood viscosity and the improvement of clinical outcome were seen after pentoxifylline administration. "

"Pendahuluan: Iskemia tungkai kritis (ITK) merupakan penyakit vaskular yang memiliki risiko mortalitas dan amputasi yang tinggi. Insidens dari penyakit arteri perifer (PAP) khususnya ITK di Amerika mencapai 500-1000 kasus per 1 juta orang setiap tahunnya. Intervensi endovaskular (EVI) merupakan salah satu metode terapi ITK yang menjadi pilihan utama karena secara signifikan menurunkan risiko amputasi dan meningkatkan limb salvage. Penatalaksanaan menggunakan EVI terbagi menjadi balloon angioplasty dan stent angioplasty. Penelitian ini bertujuan untuk mengetahui efektivitas dari metode EVI dalam pemyembuhan luka akibat ITK.Metode: Dilakukan studi cross sectional dengan 90 subjek ITK yang menjalani intervensi endovaskular berupa balloon angioplasty dan stent angioplasty di Rumah Sakit dr. Cipto Mangunkusumo dari Januari 2013 hingga Juli 2017. Lama penyembuhan luka diantara kedua metode dianalisis menggunakan uji T tidak berpasangan dengan nilai p<0,05 dianggap bermakna secara statistik. Data yang diambil berupa metode EVI, lama penyembuhan luka, dan data karakteristik subjek (usia, riwayat amputasi, IMT, riwayat merokok, DM, lokasi pembuluh darah, dan profil darah).Hasil: Persebaran data lama perawatan pada kelompok balloon angioplasty dan stent angioplasty menunjukan hasil yang normal dengan rerata 84,8 ± 2,423 hari dan 59,93 ± 2,423 hari dengan perbedaan rerata 25 hari. Perbedaan rerata antara kedua faktor bermakna secara statistik (p<0,05). Kejadian amputasi pada kelompok balloon angioplasty dan stent angioplasty adalah 22 dan 16 kejadian dengan perbedaan yang tidak bermakna secara statistik (p<0,05).Kesimpulan: Metode stent angioplasty lebih baik dibandingkan metode balloon angioplasty dalam hal lama penyembuhan luka pada pasien ITK.

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Introduction: Critical limb ischemia (CLI) is a vascular disease that has a significant amputation and mortality risk with diabetes mellitus, the most significant risk factor in CLI, is very common among Indonesian. Endovascular intervention (EVI) is preferred in treating CLI because it is non invasive and effective. Balloon angioplasty and stent angioplasty are the most common method of EVI in Indonesia. This study aims to compare the effectiveness of balloon angioplasty and stent angioplasty on wound healing in CLI.

Method: A cross sectional study enrolled 90 subjects of CLI who underwent endovascular intervention using balloon angioplasty and stent angioplasty from January 2013 to July 2017 in dr. Cipto Mangunkusumo General Hospital, Jakarta. The wound healing period between balloon angioplasty and stent angioplasty were analyzed using unpaired T-test with p<0,05 considered as statistically significant. Data of intervention method, wound healing period, and subjects characteristic data (age, amputation, BMI, smoking habit, DM, occlusion site, and blood profile) were obtained.

Result: The wound healing period in balloon angioplasty and stent angioplasty distributed normally. Mean value of wound healing period in balloon angioplasty and stent angioplasty is 84,8 ± 2,423 and 59,93 ± 2,423 days with mean difference of 25 days. The difference of wound healing period in both group is statically significant (p<0,05). The amputation event in balloon angioplasty and stent angioplasty is 22 and 16 event with no difference statistically.

Conclusion: Stent angioplasty is better method than balloon angioplasty for wound healing in patients with CLI."