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Latar Belakang

Brain Arteriovenous Malformation (BAVM) merupakan salah satu anomali vaskular pada otak yang dapat menyebabkan berbagai komplikasi. Baku emas untuk mendeteksi BAVM adalah dengan digital subtraction angiography (DSA), namun modalitas ini tidak tersedia secara luas di Indonesia. Penelitian ini disusun untuk memberikan gambaran profil karakteristik klinis dan temuan dari DSA, CT-Angiography (CTA), dan MR-Angiography (MRA) dalam sesuai penilaian Grade Spezler-Martin.

Metode

Data rekam medis dan hasil pencitraan kasus BAVM dengan DSA disertai atau tidak pemeriksaan MRA atau CTA didapat dari Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo (RSCM) pada periode 2018-2022. Kasus yang memenuhi kriteria inklusi dan eksklusi disertakan penelitian deskriptif obserasional ini.

Hasil

Terdapat total 37 subjek pada penelitian ini. Kasus BAVM didominasi oleh laki-laki (62,2%) dan lebih banyak pada pasien dewasa berusia >18 tahun (75,7%). Hampir seluruh pasien menggunakan jaminan kesehatan BPJS (94,6%) dan asal rujukan terbanyak adalah dari Jabodetabek (54,1%). Gejala terbanyak pada pasien adalah nyeri kepala 59,4%), diikuti dengan kesadaran terganggu (37,8%) dan kejang (35,1%). Temuan DSA tidak berbeda jauh dengan temuan MRA dan CTA. Hampir seluruh pasien memiliki feeding artery [DSA (97,3%); CTA dan MRA (100%)], mayoritas terdapat lokasi eloquent [DSA (67,6%); MRA (71,4%); CTA (80%)], berukuran sedang (3-6 cm) [DSA (59,5%); MRA (71,4%); CTA (40%)], dan memiliki drainase vena superficial [DSA (59,5%); MRA (71,4%); CTA (40%)]. Presentase grade SM terbanyak adalah grade III (31,6%), diikuti oleh grade IV (28,9%) dan grade II (21,1%).

Kesimpulan

Pengetahuan akan profil karakteristik klinis dan profil temuan pencitraan dapat memberikan pengetahuan lebih untuk membantu dokter menunjang diagnosis BAVM.

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Background

Brain Arteriovenous Malformation (BAVM) is a vascular anomaly in the brain that can cause various complications. The gold standard for detecting BAVM is digital subtraction angiography (DSA), but this modality is not widely available in Indonesia. This study was designed to provide an overview of the profile of clinical characteristics and findings from DSA, CT-Angiography (CTA), and MR-Angiography (MRA) in accordance with the Spezler-Martin Grade assessment.

Method

Medical record data and imaging results of BAVM cases with DSA accompanied/not by MRA or CTA examination were obtained from the Department of Neurosurgery, RSUPN Dr. Cipto Mangunkusumo (RSCM) in the 2018-2022 period. Cases that met the inclusion and exclusion criteria were included in this observational descriptive study.

Results

There was a total of 37 subjects in this study. BAVM cases are dominated by men (62.2%) and are more common in adult patients aged >18 years (75.7%). Almost all patients use BPJS health insurance (94.6%) and the highest number of referrals is from Jabodetabek (54.1%). The most common symptom in patients was headache, 59.4%), followed by impaired consciousness (37.8%) and seizures (35.1%). DSA findings do not differ much from MRA and CTA findings. Almost all patients had a feeding artery [DSA (97.3%); CTA and MRA (100%)], the majority had eloquent locations [DSA (67.6%); MRA (71.4%); CTA (80%)], medium-sized (3-6 cm) [DSA (59.5%); MRA (71.4%); CTA  (40%)], and had superficial venous drainage [DSA (59.5%); MRA (71.4%); CTAs (40%)].  The highest percentage of SM grade was grade III (31.6%), followed by grade IV (28.9%) and grade II (21.1%).

Conclusion

Knowledge of the profile of clinical characteristics and profile of imaging findings can  provide more knowledge to help doctors support the diagnosis of BAVM.

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"Pendahuluan: Arteriovenous malformation (AVM) serebral adalah kelainan vaskular di otak yang sering menyebabkan perdarahan intraserebral dan kejang, dengan prevalensi 10-18 per 100.000 orang pada populasi dewasa. Modalitas terapi meliputi observasi, reseksi bedah, bedah radiasi stereotaktik, dan embolisasi endovaskular. Studi ini bertujuan untuk mengevaluasi luaran klinis dan radiologis pasien AVM serebral setelah Gamma Knife Radiosurgery (GKRS) di RSUPN dr. Cipto Mangunkusumo (RSCM).

Metode: Studi observasional kohort-retrospektif dilakukan pada pasien AVM serebral yang menjalani GKRS di RSCM antara 2018 dan 2022. Evaluasi klinis dan radiologis dilakukan pada 6 bulan, 1 tahun, 2 tahun, dan 3 tahun pasca tindakan. Pengambilan sampel menggunakan metode consecutive sampling berdasarkan kriteria inklusi dan eksklusi.

Hasil: Dari 41 pasien yang memenuhi kriteria inklusi dan ekslusi, usia rerata pasien adalah 25,76 tahun dengan mayoritas laki-laki (63,45), gejala klinis yang paling umum adalah nyeri kepala dan kejang. Rata-rata tingkat obliterasi AVM setelah 1 tahun pasca-GKRS adalah 71,69%, meningkat menjadi 87,21% setelah 2 tahun, dan mencapai 91,07% setelah 3 tahun. Dalam evaluasi satu tahun pasca-GKRS, seluruh 41 pasien mengalami resolusi nyeri kepala. Sedangkan, dari 15 pasien yang mengalami kejang sebelum GKRS, hanya 2 pasien yang masih mengalami kejang dalam evaluasi 1 tahun setelah GKRS. Terdapat korelasi kuat antara tingkat obliterasi dan ukuran nidus <3cm (r=0.39) dan ukuran 3-6 cm (r=0.83). Selain itu, peningkatan tingkat obliterasi memiliki korelasi terhadap Spetzler-Martin (SM) Grade yang lebih rendah (p=0,001).

Pembahasan: Penelitian ini menunjukkan tingkat obliterasi yang tinggi pada pasien AVM serebral pasca-GKRS, terutama pada kelompok SM grade rendah dan ukuran nidus yang kecil. Meskipun demikian, perdarahan tetap merupakan risiko selama periode evaluasi pasca GKRS, terutama pada pasien dengan SM grade tinggi. Faktor seperti embolisasi sebelum GKRS tidak mempengaruhi tingkat obliterasi secara signifikan, sementara hubungan antara tingkat obliterasi dengan perbaikan klinis, seperti penurunan nyeri kepala, ditemukan bermakna.

Kesimpulan: Sebagai kesimpulan, ukuran nidus yang lebih kecil mempunyai korelasi signifikan dalam memprediksi obliterasi AVM serebral pasca GKRS. Meskipun GKRS dapat menjadi pilihan utama pada pasien dengan SM grade rendah dan ukuran nidus kecil, risiko perdarahan perlu dipertimbangkan selama pemantauan pasca tindakan. Perbaikan klinis, khususnya dalam mengurangi nyeri kepala, berkorelasi positif dengan tingkat obliterasi AVM setelah GKRS.

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Introduction: Brain arteriovenous malformation (AVM) is a vascular disorder in the brain often associated with intracerebral hemorrhage and seizures, with a prevalence of 10-18 per 100,000 adults. Treatment modalities include observation, surgical resection, stereotactic radiosurgery, and endovascular embolization. This study aimed to evaluate the clinical and radiological outcomes of cerebral AVM patients after Gamma Knife Radiosurgery (GKRS) at Dr. Cipto Mangunkusumo National General Hospital (RSCM).

Methods: A retrospective cohort observational study was conducted on brain AVM patients who underwent GKRS at RSCM between 2018 and 2022. Clinical and radiological evaluations were performed at 6 months, 1 year, 2 years, and 3 years post-procedure. Sampling was conducted using consecutive sampling based on inclusion and exclusion criteria.

Results: Of the 41 patients meeting the inclusion and exclusion criteria, the mean age was 25.76 years with a predominance of males (63.45%). The most common clinical symptoms were headache and seizures. The average AVM obliteration rate after 1 year post-GKRS was 71.69%, increasing to 87.21% after 2 years, and reaching 91.07% after 3 years. At the one-year evaluation post-GKRS, all 41 patients experienced resolution of headaches. Among the 15 patients with pre-GKRS seizures, only 2 patients still experienced seizures at the 1-year evaluation post-GKRS. There was a strong correlation between obliteration rate and nidus size <3 cm (r=0.39) and size 3-6 cm (r=0.83). Furthermore, increased obliteration rates correlated with lower Spetzler-Martin (SM) Grade (p=0.001).

Discussion: This study demonstrates high obliteration rates in brain AVM patients after GKRS, particularly in the low SM grade and small nidus size groups. However, hemorrhage remains a risk during the post-GKRS evaluation period, especially in patients with high SM grades. Factors such as pre-GKRS embolization did not significantly affect obliteration rates, while a significant association between obliteration rate and clinical improvement, such as reduction in headaches, was found.

Conclusion: In conclusion, smaller nidus size significantly predicts brain AVM obliteration post-GKRS. Although GKRS may be the primary choice for patients with low SM grade and small nidus size, the risk of hemorrhage needs consideration during post-procedural monitoring. Clinical improvements, particularly in reducing headaches, positively correlate with AVM obliteration rates after GKRS."

"Latar Belakang: malformasi arteri-vena (MAV) adalah struktur abnormal yang menyebabkan fistula antara arteri dan vena tanpa perantara kapiler. MAV serebral memiliki risiko ruptur yang tinggi, dimana keadaan ruptur dapat menyebabkan kondisi katastrofik bagi pasien. Terdapat berbagai modalitas penatalaksanaan dalam manajemen MAV, seperti reseksi, embolisasi endovaskular, pembedahan stereotaktik, atau kombinasi tindakan-tindakan tersebut. Penelitian mengenai MAV sudah banyak dilakukan di luar negeri, namun masih sedikit dilakukan di Indonesia.Tujuan: memperoleh data profil klinis, manajemen, luaran, dan gambaran pembiayaan pasien MAV serebral di RSUPN Dr. Cipto Mangunkusumo, serta memperoleh hubungan antara variabel tersebut.Metode: penelitian ini merupakan penelitian observasional deskriptif dengan memperoleh data dari rekam medis pasien sejak tahun 2012 hingga 2021.Hasil: sebanyak 128 tindakan dilakukan pada pasien MAV serebral di RSCM. Jenis tindakan terbanyak adalah DSA diagnostik, disusul dengan GKRS dan embolisasi. Pada tindakan embolisasi,  luaran klinis yang memiliki perbedaan signifikan atara pra dan pasca operasi adalah kejang, nyeri kepala, dan penurunan kesadaran. Pada tindakan GKRS, luaran klinis yang memiliki perbedaan signifikan pra dan pasca operasi adalah kejang, nyeri kepala, mual muntah, penurunan kesadaran, hemiparesis, dan hemihipestesia. Median persentase obliterasi GKRS adalah 51,86%. Data tindakan reseksi tidak dianalisis karena jumlah sampel tidak mencukupi. Biaya tindakan paling tinggi adalah tindakan GKRS, dengan rerata pembiayaan tindakan sebesar Rp. 134.878.643,00.Kesimpulan: dibandingkan dengan embolisasi dan reseksi, tindakan GKRS menunjukkan luaran klinis yang lebih baik dengan nilai median obliterasi 51,86%, namun merupakan tindakan dengan pembiayaan paling tinggi dan tidak ditanggung oleh asuransi negara.

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Backgrounds: Arteriovenous malformation (AVM) is an abnormal structure that causes fistulas between arteries and veins without capillary intermediaries. Cerebral AVM has a high risk of rupture, where the state of rupture can cause catastrophic conditions for the patient. There are various treatment modalities in the management of AVM, such as resection, endovascular embolization, stereotactic surgery, or a combination of the treatments above. Many researches on AVM have been carried out abroad, but little has been done in Indonesia.

Objective: to obtain data on clinical profiles, management, outcomes, and costs of cerebral AVM patients at Dr. Cipto Mangunkusumo, and to obtain the relationship between the variables.

Method: this study is a descriptive observational study by extracting data from patient medical records from 2012 to 2021.

Results: a total of 128 procedures were performed on cerebral AVM patients at RSCM. The most common type of procedure was diagnostic DSA, followed by GKRS and embolization. In the embolization procedure, the clinical outcomes that had a significant difference between pre and post-procedure were seizures, headache, and decreased consciousness. In the GKRS procedure, the clinical outcomes that had significant differences before and after the procedure were seizures, headache, nausea and vomiting, decreased consciousness, hemiparesis, and hemihypesthesia. The median percentage of GKRS obliteration was 51.86%. Resection data were not analyzed because the number of samples was insufficient. The highest cost of procedure is GKRS, with an average cost of action of Rp. 134,878,643.00.

Conclusion: compared to embolization and resection, the GKRS procedure showed a better clinical outcome with a median obliteration value of 51.86%, but it was the procedure with the highest cost and was not covered by national health coverage."

"Latar Belakang: Beberapa penelitian telah membuktikan faktor-faktor yang berpengaruh pada maturasi fistula arteriovenosa, namun pengaruh profil lipid(LDL,HDL, Trigliserida, Kolesterol total) belum terlalu jelas.Tujuan: Untuk mengetahui pengaruh profil lipid pada maturasi fistula arteriovenosapada pasien penyakit ginjal tahap akhir dengan komorbid diabetes mellitus tipe 2.Metode: Desain yang digunakan adalah desain potong lintang. Penelitian inimengambil data sekunder dari penelitian dr. Dedy Pratama, SpBSubVE yangmelakukan penelitian di RSUPN Dr. Cipto Mangunkusumo, RS Hermina Bekasi Barat,dan RS Hermina Depok pada pasien penyakit gagal ginjal tahap akhir dengan diabetesmellitus tipe 2 dan dilakukan operasi fistula arteriovenosa brachiocefalica.Hasil: Total sampel 67, sampel terbanyak berjenis kelamin laki-laki 34 (50,7%)sedangkan perempuan sebanyak 33 (49,3%). Sebanyak 47 (70,1%) matur, sedangkanyang tidak matur 20 (29,9%). Didapatkan nilai rerata LDL pada sampel matur FAV110,13(32,786) dan tidak matur 135,6(39,317) P=0,008. Didapatkan diameter arteribrachialis pre operasi 4,25 mm(0,68) pada kelompok matur, 3,85(0,69) pada tidak maturP=0,029. Volume aliran pasca operasi 568,48(44,9-1451) pada kelompok matur,347,12(43,1-1295) pada kelompok tidak matur dengan P=0,031. Usia, hipertensi,merokok, gula darah sewaktu, indeks massa tubuh, trigliserida, HDL, kolesterol total,volume aliran pre operasi, IMT feeding artery, PSV feeding artery per dan pascaoperasi tidak berpengaruh pada maturasi.Simpulan: Nilai LDL lebih tinggi dari 119,5 mg/dL dapat menurunkan angka maturasiFAV pada pasien PGTA dengan DM tipe 2. Sedangkan kolesterol total, HDL, dantrigliserida pada penelitian ini tidak berpengaruh pada maturasi FAV.

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Background: Several studies have shown the factors that influence the maturation of

arteriovenous fistulas, but the effect of the lipid profile (LDL, HDL, triglycerides, total

cholesterol) is not clear.

Objective: To determine the effect of lipid profiles on the maturation of arteriovenous

fistulas in end-stage renal disease patients with comorbid type 2 diabetes mellitus.

Method: The design used is a cross-sectional design. This study took secondary data

from the research of dr. Dedy Pratama, SpBSubVE who conducted research at RSUPN

Dr. Cipto Mangunkusumo, West Bekasi Hermina Hospital, and Hermina Depok

Hospital in patients with end-stage renal failure with type 2 diabetes mellitus and

undergoing surgery for fistula arteriovenosa brachiocefalica.

Results: The total sample was 67, the largest sample was male 34 (50.7%), while the

female was 33 (49.3%). A total of 47 (70.1%) were mature, while 20 (29.9%) were not

mature. The average value of LDL in the mature FAV sample was 110.13 (32.786) and

the immature sample was 135.6 (39.317) P = 0.008. The preoperative brachial artery

diameter was 4.25 mm (0.68) in the mature group, 3.85 (0.69) in the immature P =

0.029. Postoperative flow volume was 568.48 (44.9-1451) in the mature group, 347.12

(43.1-1295) in the immature group with P = 0.031. Age, hypertension, smoking,

temporary blood sugar, body mass index, triglycerides, HDL, total cholesterol,

preoperative flow volume, BMI of artery feeding, PSV feeding arteries per and

postoperatively had no effect on maturation.

Conclusion: LDL values higher than 119.5 mg/dL can reduce the maturation rate of

AVF in ESRD patients with type 2 diabetes. Meanwhile, total cholesterol, HDL, and

triglycerides in this study had no effect on FAV maturation."

"Latar Belakang: Penyakit Ginjal Kronik (PGK) dan Penyakit Ginjal Tahap Akhir (PGTA) merupakan penyebab utama morbiditas dan mortalitas pada 10% populasi dunia penderita PGK. Terapi yang tersering dipilih adalah hemodialisis dengan pembuatan fistula arteriovenosa (FAV). Akan tetapi, angka kegagalan FAV relatif tinggi akibat feeding artery dan draining vein inadekuat. Teknik dilatasi angioplasty balon (PBA) merupakan salah satu cara mengatasi kegagalan FAV. Penelitian unutk mengetahui lama ketahanan / patency rate dengan dan tanpa PBA belum banyak dilakukan.Tujuan: Menganalisis perbandingan patency rate dan jumlah patency failure pada pasien FAV dengan dan tanpa PBA.Metode: Desain penelitian adalah survival analysis pada kohort prospektif, dilakukan di RSUPN Cipto Mangunkusumo, RSUPN Fatmawati, dan RSUD Kabupaten Tangerang. Penelitian dilaksanakan pada bulan Januari 2020 – Maret 2022.Hasil: Total subyek 60 orang, sebanyak 29 subyek dengan PBA, 31 tanpa PBA. Terdapat perbedaan signifikan antara kedua kelompok dari segi diameter vena dan volume flow vena pasca operasi (p<0,01). Uji log-rank menunjukkan ada beda signifikan patency failure dengan nilai p 0,028, pada kelompok tanpa PBA (35,5%; rerata patency rate 56,3 minggu) dibandingkan dengan kelompok dengan PBA (10,3%; rerata patency rate 104,4 minggu). Median durasi menunjukkan sebanyak 50% dari kelompok tanpa PBA mengalami patency failure pada minggu ke-59,3, sedangkan hingga akhir pengamatan pada kelompok dengan PBA yang mengalami patency failure tidak sampai 50%.Simpulan: Penggunaan teknik PBA dapat menurunkan kejadian patency failure dan mempertahankan patensi dalam jangka waktu lebih lama pada pasien dengan FAV.

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Background: Chronic kidney disease (CKD) and end stage renal disease (ESRD) are the main causes of morbidity and mortality in 10% of the world's population with CKD. The most commonly chosen therapy is hemodialysis with the creation of an arteriovenous fistula (AVF). However, the FAV failure rate is relatively high due to inadequate feeding artery and draining vein. Primary balloon angioplasty (PBA) dilatation technique is a way to mitigate FAV failure. There have not been many studies to determine the patency rate with and without PBA.

Objective: To analyze the comparison of the patency rate and the number of patency failures in AVF patients with and without PBA.

Methods: The study design was a survival analysis in a prospective cohort, conducted at Cipto Mangunkusumo General Hospital, Fatmawati Hospital, and Tangerang District Hospital. The research was conducted in January 2020 – March 2022.

Results: There were 60 subject as a total, 29 subjects with, 31 without PBA. There were a significant difference between the two groups in terms of venous diameter and postoperative venous flow volume (p<0.01). The log-rank test showed a significant difference in patency failure in the group without PBA (35.5%; mean patency rate 56.3 weeks) compared to the group with PBA (10.3%; mean patency rate 104.4 week), p-value=0.028,. The median duration showed that 50% of the group without PBA experienced patency failure at week 59.3, while until the end of the observation, the group with PBA experienced patency failure of less than 50%.

Conclusion: The use of PBA technique can reduce the incidence of patency failure and maintain patency in the longer term in patients with AVF."

"Pendahuluan: Penelitian ini adalah penelitian pendahuluan untuk mengetahui pengaruh tekanan darah sistolik dan diastolik terhadap maturasi arteriovenous fistula (AVF) pada pasien gagal ginjal kronis stadium akhir dengan diabetes melitus tipe 2, sehingga nantinya dapat dijadikan pertimbangan dalam pembuatan akses AVF di divisi Bedah Vaskular RSCM.Metode: Penelitian ini dilakukan dengan desain historical cohort di Divisi Vaskular Departemen Ilmu Bedah FKUI-RSCM, Jakarta. Dengan dilakukan consecutive sampling, semua penderita penyakit ginjal kronik stadium akhir dengan diabetes melitus tipe 2 yang direncanakan untuk hemodialisis dengan akses vaskular AVF brakiosefalika.Hasil: Didapatkan 64 subjek gagal ginjal kronik dengan diabetes melitus tipe 2 menjalani prosedur pemasangan akses brakiosefalika. Sebanyak 75% yang matur dari keseluruhan subjek yang diikutsertakan. Rerata tekanan sistolik pra bedah antar kedua kelompok menunjukan angka maksimal berada di 165,15 mmHg dan minimum 123.19 mmHg pada kelompok matur dan angka maksimal berada di 164,65 mmHg dan minimum 125,26 mmHg pada kelompok tidak matur dengan nilai p = 0,922. Rerata tekanan diastolik prabedah antar kedua kelompok dimana angka maksimal berada di 93,04 mmHg dan minimum 72,6 mmHg pada kelompok matur dan angka maksimal berada di 90,34 mmHg dan minimum 75,78 mmHg pada kelompok tidak matur. Sehingga secara statistik tidak memberi kemaknaan (p = 0,982).Kesimpulan: Tekanan darah sistolik-diastolik pra bedah tidak memiliki kemaknaan terhadap maturitas AVF brakiosefalika pada penderita penyakit ginjal kronik stadium akhir dengan dibetes melitus tipe 2.Kata Kunci: tekanan darah sistolik-diastolik, maturitas AV fistula, brakiosefalika, diabetes melitus.

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Introduction: This study is a preliminary study to see the effect of systolic and diastolic blood pressure on arteriovenous fistula maturation (AVF) in end-stage chronic renal failure patients with type 2 diabetes melitus, in the future this study can be considered as reference in making AVF access in the Vascular Surgery division of RSCM.

Methods: This study was conducted with a historical cohort design at the Division of Vascular Surgery Department of the Faculty of medicine University Indonesia- Cipto Mangunkusumo Hospital, Jakarta. We are using consecutive sampling, all patients with end-stage chronic kidney disease with type 2 diabetes melitus that have planned for hemodialysis with brachiocephalic AVF vascular access.

Result: There were 64 subjects with chronic renal failure with type 2 diabetes melitus undergoing brachiocephalic access insertion procedures. There are 75% of mature subjects were enrolled. The mean preoperative systolic pressure between the two groups showed the maximum number was 165.15 mmHg and minimum was 123.19 mmHg for the mature group, and we also found the maximum number is 164.65 mmHg and the minimum 125.26 mmHg for the immature group with P value 0.922 (P=0.922). The mean preoperative diastolic pressure between the two groups, where the maximum number was 93.04 mmHg and the minimum 72.6 mmHg for the mature group and the maximum number is 90.34 mmHg and the minimum 75.78 mmHg for the immature group. The result was statistically not significant with P value 0.982 (P=0.9820). Conclusion: Preoperative systolic-diastolic blood pressure has no significance meaning on the maturity of the brachiocephalic AVF in patients with end-stage chronic kidney disease with type 2 diabetes melitus.

Keywords: Systolic-diastolic blood pressure, AV fistula maturity, brachiocephalica, end-stage chronic kidney disease, diabetes melitus."

"Latar Belakang: Malformasi vaskular terjadi pada 1-1.5% populasi, dengan 40-60% kasus anomali terjadi pada regio kepala dan leher karena anatomi vaskularnya yang kompleks. USG Doppler merupakan modalitas diagnostik pertama untuk menangani pasien dengan malformasi vaskular karena biayanya yang rendah, merupakan produk teknologi non-radiasi, serta kemampuannya untuk mengidentifikasi ciri-ciri aliran lesi. Studi ini ditujukan untuk menilai kesesuaian antara temuan klinis dengan temuan ultrasonografi pada pasien dengan malformasi venolimfatik, vena, dan limfatik. Metode: Desain studi ini adalah potong lintang, dengan meggunakan data sekunder di Rumah Sakit Cipto Mangunkusumo dari Januari 2017 hingga Desember 2022. Didapatkan sebanyak 64 subyek dengan kriteria inklusi berupa tersedianya data lengkap berupa kulit kebiruan dan kompresibel pada temuan klinis serta aliran dan kompresibel pada temuan USG Doppler. Analisis data menggunakan perhitungan Kappa Cohen. Hasil: Pada analisis kesesuaian antara temuan klinis warna kulit kebiruan dan komponen low-flow pada USG Doppler didapatkan besar nilai Kappa kesesuaian kuat (K = 0.664) yang bermakna (p = 0.000). Pada analisis kesesuaian temuan klinis kompresibel pada klini s dan kompresiebel pada USG didapatkan hasil measure of agreement Kappa kesesuaian sangat kuat (K = 1.000) yang bermakna (p = 0.000). Simpulan: Terdapat kesesuaian kuat yang bermakna antara temuan klinis berupa warna kulit kebiruan dengan komponen vena dan temuan klinis berupa tidak ada perubahan warna kulit dengan komponen limfatik pada malformasi venolimfatik. Terdapat kesesuaian sangat kuat yang bermakna antara ada tidaknya tanda kompresibel pada temuan klinis dengan ada tidaknya tanda kompresibel pada temuan USG pada malformasi venolimfatik.

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Background: Vascular malformations occur in 1-1.5% of the population, with 40-60% of cases of anomaly occurring in the head and neck region due to their complex vascular anatomy. Doppler ultrasound is the first diagnostic modality for treating patients with vascular malformations due to its low cost, non-radiation technology, and ability to identify flow characteristics of the lesion. This study aimed to assess the concordance between clinical findings and ultrasound findings in patients with venolymphatic, venous, and lymphatic malformations.

Methods: The design of this study was cross-sectional, using secondary data at Cipto Mangunkusumo Hospital from January 2017 to December 2022. A total of 64 subjects were selected with inclusion criteria in the form of the availability of complete data in the form of bluish and compressible sign on clinical findings as well as flow and compressibility sign on Doppler ultrasound findings. Data were analyzed using Kappa Cohen.

Results: In the concordance analysis between the clinical findings of bluish skin color and the low-flow component on Doppler ultrasound, a strong concordance Kappa value (K = 0.664) was found, which was significant (p = 0.000). In the concordance analysis of compressibility sign on clinical findings and compressibility on ultrasound findings, the Kappa measure of agreement yielded a very strong suitability (K = 1,000) which was significant (p = 0,000).

Conclusion: There is a strong significant agreement between the clinical findings of a bluish skin color with a venous component and clinical findings of no change in skin color with a lymphatic component in venolymphatic malformations. There was a very strong significant concordance between compressibility signs on clinical findings and compressibility signs on ultrasound findings in venolymphatic malformations."

"Latar Belakang Kelainan bawaan bertanggung jawab atas 11,3% kematian bayi di dunia. Di negara-negara berpenghasilan rendah dan menengah, neural tube defect merupakan jenis kelainan bawaan yang berperan penting dalam kecacatan dan kematian neonatus, yaitu sekitar 17% hingga 70% dari seluruh kematian akibat kelainan bawaan. Penelitian ini bertujuan untuk mengetahui profil karakteristik klinis dan tata laksana anak dengan neural tube defect di Departemen Bedah Saraf FKUI-RSCM pada tahun 2018–2022. Metode Desain penelitian ini adalah deskriptif observasional dengan metode penelitian potong lintang. Hasil Jenis kelamin yang paling banyak ditemukan adalah perempuan (51,7%). Jaminan kesehatan yang paling banyak digunakan adalah BPJS (94,8%) dengan rujukan paling banyak berasal dari fasilitas kesehatan di wilayah Jabodetabek (65,5%). Jenis NTD yang paling banyak ditemukan adalah myelomeningocele (25,9%), lipomyelomeningocele (24,1%), dan encephalocele occipital (20,7%). Faktor risiko maternal yang teridentifikasi adalah usia maternal > 35 tahun (12,1%). Proporsi ibu yang rutin mengonsumsi vitamin hamil sejak prekonsepsi sangat rendah (1,7%). Riwayat infeksi saat hamil ditemukan pada sebagian kecil kasus (3,4%) sedangkan riwayat kontak ibu dengan unggas atau hewan peliharaan cukup banyak ditemukan (22,4%). Waktu tahu hamil paling banyak saat usia kehamilan < 5 minggu (55,2%). Riwayat keluarga dengan NTD, riwayat diabetes pregestasional, dan riwayat konsumsi obat antiepilepsi maternal tidak ditemukan. Jenis operasi yang paling banyak dilakukan adalah rekonstruksi tutup defek. Sebagian besar operasi untuk NTD bersifat elektif (89,7%). Kesimpulan Jenis NTD yang paling banyak ditemukan adalah myelomeningocele, lipomyelomeningocele, dan encephalocele occipital dengan jenis operasi tersering berupa rekonstruksi tutup defek.

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Introduction Birth defects are responsible for 11.3% of infant deaths worldwide. In low- and middle-income countries, neural tube defect are a type of birth defect that plays an important role in neonatal disability and death, accounting for around 17% to 70% of all deaths due to birth defect. This study aims to determine the clinical and therapeutic profile of children with neural tube defects in the Department of Neurosurgery at Cipto Mangunkusumo Hospital, Indonesia, period 2018–2022. Method The design used in this research is descriptive observational with cross-sectional research method. Results The most common gender found was female (51.7%). The most widely used health insurance was BPJS (94.8%) with most referrals coming from health facilities in the Jabodetabek area (65.5%). The most common types of NTD were myelomeningocele (25.9%), lipomyelomeningocele (24.1%), and occipital encephalocele (20.7%). The maternal risk factor identified was maternal age > 35 years (12.1%). The proportion of mothers who regularly take pregnancy vitamins since preconception was very low (1.7%). A history of infection during pregnancy was found in a small number of cases (3.4%) while a history of maternal contact with poultry or pets was quite common (22.4%). The most common time the mothers knew that they’re pregnant was when the gestational age was < 5 weeks (55.2%). Family history of NTDs, history of pregestational diabetes, and history of maternal antiepileptic drug consumption were not found. The most common type of surgery performed was repair of the defect. Most operations for NTDs were elective (89.7%). Conclusion The most common types of NTD found were myelomeningocele, lipomyelomeningocele, and occipital encephalocele while the type of surgery most frequently performed was repair of the defect."

"Introduction: Steal syndrome is one of the most feared complications in maintaining arteriovenous fistula (AVF) for hemodialysis. The incidence of steal syndrome in worldwide is estimated to be 0.5-5%. There are various non-invasive examinations to assess the degree of stealing, one of which is the digital brachial index (DBI). In this study, subjects with brachiocephalic AVF were assessed by the hand ischemic questionnaire (HIQ) to assess the manifestations of steal syndrome complained by the patient, which are the sensation of cold, pain, the decrease in sensation and strength, and cramps. The literature about the correlation of DBI with other assessment is still limited. Method: The subjects of this study were all patients undergoing hemodialysis with upper arm AVF at Cipto Mangunkusumo Hospital in the period May – June 2019. Patients will be asked about various symptoms of stealing syndrome, the severity, and also frequency, according to HIQ. The scores were then calculated, followed by scores of DBI measurements using a plethysmograph. The DBI values that considered to be meaningful as stealing syndrome were <0.6. The correlation between the two parameters was then analyzed. Results: From demographic data, characteristics of patients with native AVF by sex were 37 (46.2%) men and 43 (53.8%) women with an average age of 53 years. The minimum value of the HIQ score was 0, and the maximum value was 70, with a median value of 3. The correlation test between the total value of the HIQ questionnaire score and the DBI value found a significant correlation (r = -0.0798, p <0.001). A diagnostic tests was performed between HIQ scores using a cut-off value ≥50 with a DBI value <0.6 as a reference. It was obtained a sensitivity value of 15.3% and a specificity value of 100%, with a diagnostic accuracy of 58.75%. Conclusion: There was a good correlation between HIQ and DBI in patients undergoing hemodialysis using upper arm native AVF. The use of HIQ as a screening tool in native upper arm AVF patients is less recommended, but its use for patients who are suggestive of stealing syndrome has good specificity results."

"Tujuan: Menganalisis ekspresi gen manganese superoxide dismutase (MnSOD) pada jaringan jantung, otak dan darah tikus yang diinduksi hipoksia sistemik.Desain: penelitian eksperimental in vivo dengan menggunakan hewan coba.Metode: Sampe! penelitizm ini adalah 25 ekor tikus jantan strain Sprague Dawley (Rarms novergicus L), yang dibagi menjadi 5 kelompok: kelompok I tikus tanpa perlakuan hipoksia sebagai kontrol, kelompok II, III, IV dan V adalah kelompok tikus dengan perlakuan hipoksia 10% O2 selama 1, 7, 14 dan 21 hari. Setelah perlakuan tikus dimaiikan, kemudian darah, otak dan jantung tikus diambil untuk diperiksa tingkat ekspresi mRNA dengan menggunakan real time RT PCR dengan pewamaan SYBR green, serta diukur aktivitas spesifik MnSOD dengan menggunakan kit RanSOD® dengan ditambahkan NaCN untuk menghambat aktivitas CuZn SOD.Hasil: Pada hipoksia awa] (1 hari) ekspresi relatif mRNA MnSOD dan aktivitas spesifik MnSOD menunjukkan penurunan di darah dan jantung, sedangkan pada otak tidak te1jadi penurunan. Hal ini menunjukkan bahwa dalam keadaan hipoksia sistemik perlindungan antioksidan pada otak terjadi lebih awal dibandingkan jantung dan darah. Pada hipoksia awal di jantung dan darah, mulai terjadi peningkatan ROS sehingga aktivitas spesink MnSOD menurun, namun belum dapat menstimulasi peningkatan eksprsi mRNA-nya_ Pada hipoksia I-I4 hari baik ekspresi mRNA maupun aktivitas spesiiik MnSOD pada ketiga jaringan tersebut mengalami peningkatan sejalan dengan lamanya hipoksia. Pada hipoksia lanjut (21 hari) terjadi korelasi negatif antara ekspresi relatif mRNA dngan aktivitas spesiiik MnSOD di jantung dan darah. Hal ini mnmgkin disebabkan karena produksi ROS yang sangat masif, sehingga ekspresi MRNA terus ditingkatkan namun stres oksidatif belum dapat diatasi, sedangkan pada otak fenomena tersebut tidak terjadi. Hal ini diduga karena peningkatan ROS pada hipoksia lanjut masih dapat diatasi dengan aktivitas enzim MnSOD yang tersedia tanpa harus meningkatkan ekspresi mRNA-nya. Hasil ini menunjukkan bahwa otak cenderung lebih dilindungi dalam keadaan hipoksia sistemik dibandingkan janrung dan darah. Hasil analisis uji korelasi Pearson menunjukkan bahwa perubahan ekspresi relatif MRNA dan aktivitas spesifik MnSOD pada induksi hipoksia sistemik pada darah sejalan dengan perubahannya pada jantung dan otak.Kesimpulan: Setiap jaringan mempunyai pola ekspresi gen MnSOD dan aktivitas MnSOD yang berbeda-beda pada kondisi hipoksia. Terdapat perbedaan regulasi ekspresi gen MnSOD antara hipoksia sistemik awal dan lanjut. Pengukuran ekspresi MnSOD (mRNA dan aktivitas spesifik) pada darah dapat sekaligus menggambarkan ekspresi tersebut pada jantung dan otak.

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Background: The aim of this study is to determine the gene expression of manganese supenoxide dismutase (MnSOD) in rat?s heart, brain and blood induced by systemic hypoxia.

Design: This study is an in vivo experimental study.

Method: This study was conducted on 25 male Sprague Dawley rats (Rattus no1°e:~_gicn.s~ L) which were divided into 5 groups and subjected to systemic hypoxia by placing them in hypoxic chamber supplied by 10% O3 for O, l, 7. I4, 2.1 days. respectively. Rats were sacrified after treatment, and the blood. heart and brain were used for measurement of relative mRNA level ofMnSOD with real time RT PCR and measurement of spesitic activity of MnSOD enzyme using RanSOD® kit.

Result: Determination of gene expression of MnSOD (relative mRNA expression and specific activity) in rat blood and heart cells under early hypoxic induction (1 day) resulted in the lower levels compared to the level in control group. After l day of hypoxic induction the gene expression level was then increased and again decreased under very late hypoxic condition (21 days) compared to the control. This suggests that the blood and heart cells at early hypoxia have not enough time to provide more MnSOD enzyme through gene expression to eliminate the sudden accumulation of ROS. In contrast to the results in heart and blood cells. the gene expression of MnSOD in brain cells were demonstrated to be increased since early systemic hypoxia (day I) up to day l4_ and tends to decrease under late hypoxic condition (day 21) although the level still slightly higher compared to the level in control group. Under late hypoxic condition (21 days). the capacity of1VlnSOD to eliminate the accumulated ROS has been saturated as found in brain cells, or even reduced to the lower level than in normal condition as found in blood and heart cells. This study could demonstrate that brain cells have different pattern of gene expression of MnSOD compared to blood and heart cells during several time points of hypoxic induction, particularly at early stage. It should also be considered that the levels of gene expression of MnSOD in each tissue were distinct although measured under the same condition. Analysis of Pearson correlation test shows that pattern of gene expression ot`MnSOD in blood cells is appropriate with the pattern in heart and brain cells under hypoxic condition.

Conclusion: Every tissue has the different pattern of gene expression of MnSOD (relative mRNA expression and specific activity) under hypoxic condition There is different regulation of MnSOD gene expression at early and late hypoxia Analysis gene expression of MnSOD in blood cells could represent the analysis of gene expression of MnSOD in heart and brain cells under hypoxia condition."