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"Latar BelakangAdenoma hipofisis merupakan jenis tumor hipofisis yang paling umum, yang menyebabkan efek massa dan ketidakseimbangan hormon. Gejala seperti gangguan ketajaman penglihatan (VA), cacat lapang pandang (VFD), dan sakit kepala mendorong pasien untuk mencari pertolongan medis. Penelitian ini bertujuan untuk menganalisis karakteristik, gejala, dan hasil akhir pasien adenoma hipofisis yang dirawat di Rumah Sakit Rujukan Nasional Cipto Mangunkusumo (RSCM) dari tahun 2018-2022, dengan fokus pada gejala penglihatan dan sakit kepala sebelum dan sesudah perawatan.MetodePenelitian observasional retrospektif dan potong lintang, ini meninjau catatan medis pasien adenoma hipofisis dari tahun 2018-2022 di RSCM. Awalnya, 241 pasien diidentifikasi, setelah menerapkan kriteria eksklusi untuk hasil patologi yang inkonklusif dan rekam medis tidak lengkap, berkurang menjadi 161 pasien. Data tentang demografi, karakteristik tumor, intervensi, dan keluhan utama dikumpulkan, dengan fokus pada gangguan penglihatan dan pola sakit kepala.HasilRata-rata usia pasien adalah 46,2 tahun, dengan sedikit dominasi perempuan (54,6%). Adenoma non-fungsional (NFA) mencakup 86,9% kasus, sedangkan prolaktinoma merupakan adenoma fungsional yang paling umum. Makroadenoma terdapat pada 96,9% pasien. Intervensi yang paling umum adalah operasi transsphenoidal. Gangguan lapang pandang (42,2%) dan sakit kepala merupakan gejala yang sering muncul. Pascaoperasi, sakit kepala berkurang secara signifikan, dengan perbaikan yang terlihat pada ketajaman penglihatan dan defek lapang pandang pada kunjungan tindak lanjut.KesimpulanSakit kepala dan gangguan penglihatan merupakan gejala yang paling umum pada pasien adenoma hipofisis di RSCM (2018-2022). Meskipun temuan tersebut menggarisbawahi pentingnya pemeriksaan diagnostik yang komprehensif, penelitian ini dibatasi desain retrospektif dan dokumentasi pasien yang tidak konsisten.

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Background

Pituitary adenomas are the most common type of pituitary tumors, leading to mass effects and hormonal imbalances. Symptoms such as visual acuity (VA) disturbances, visual field defects (VFDs), and headaches prompt patients to seek medical attention. This study aims to analyze the characteristics, symptoms, and outcomes of pituitary adenoma patients treated at Cipto Mangunkusumo National Referral Hospital (RSCM) from 2018 to 2022, focusing on visual and headache symptoms pre- and post-treatment.

Methods

This retrospective, cross-sectional, observational study reviewed the medical records of pituitary adenoma patients from 2018 to 2022. Initially, 241 patients were identified, but after applying exclusion criteria for inconclusive pathology and incomplete records, 161 patients were included. Data on demographics, tumor characteristics, interventions, and chief complaints were collected, concentrating on visual disturbances and headache patterns.

Results

The average age of patients was 46.2 years, with a slight female predominance (54.6%). Non-functioning adenomas (NFA) accounted for 86.9% of cases, while prolactinomas were the most common functioning adenomas. Macroadenomas were present in 96.9% of patients. The most common intervention was transsphenoidal surgery. Visual field disturbances (42.2%) and headaches were the frequent presenting symptoms. Postoperatively, headaches decreased, with improvements noted in both visual acuity and field defects at follow-up visits.

Conclusion

Headaches and visual impairments were the most common symptoms in pituitary adenoma patients at RSCM (2018-2022). Although the findings underscore the importance of comprehensive diagnostic workups, the study's limitations include its retrospective design and inconsistent documentation. Future research should aim to standardize data collection for improved clinical management."

"Latar Belakang: Adenoma hipofisis adalah kumpulan dari berbagai jenis tumor yang ditemukan di kelenjar hipofisis, yang dapat menyebabkan kompresi nervus optikus, sehingga menyebabkan penurunan tajam penglihatan dan lapang penglihatan akibat efek penekanan massa tumor. Tindakan operasi transfenoid pada adenoma hipofisis bertujuan untuk menegakkan diagnosis dan dekompresi massa tumor dengan harapan memperbaiki atau mempertahankan fungsi nervus optikus. Tujuan: Menilai luaran fungsi penglihatan (tajam penglihatan dan lapang penglihatan) pada pasien adenoma hipofisis serta faktor-faktor yang mempengaruhi luaran tersebut. Metode: Penelitian potong lintang terhadap pasien-pasien adenoma hipofisis yang telah dioperasi transfenoid dari tahun 2012-2014. Fungsi penglihatan pasien (visus, visual impairment scale, dan lapang penglihatan) sebelum dan sesudah operasi transfenoid diambil dari rekam medik pasien. Hasil: Sebanyak delapan sampel (57,1%) mengalami perbaikan dan enam pasien (42,9%) tidak mengalami perbaikan nilai visual impairment scale (VIS). Sebanyak delapan sampel (57,1%) mengalami perbaikan dan sebanyak enam pasien (42,9%) tidak mengalami perbaikan visus. Setelah dilakukan tindakan pembedahan untuk mengangkat adenoma hipofisis dengan pendekatan transfenoid, sebagian besar pasien (57,1%) mengalami perbaikan fungsi penglihatan baik dengan metode pemeriksaan visus maupun VIS. Usia, jenis kelamin, waktu onset sampai berobat, waktu berobat sampai operasi, waktu onset sampai operasi, atau volume operasi tidak berhubungan dengan luaran fungsi penglihatan pasien. Kesimpulan: Operasi transfenoid pada adenoma hipofisis dapat memberikan perbaikan fungsi penglihatan pada sebagian besar pasien adenoma hipofisis.

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Background: Pituitary adenoma is a collection of various type tumors found in the pituitary gland, which can lead to compression of the optic nerve, causing a decrease in visual acuity and field of vision due to the suppressive effect of the tumor mass. Transphenoidal surgery on pituitary adenoma aims to diagnose and decompression of the tumor mass in order to improve or preserve optic nerve function.

Purpose: Evaluate the visual function outcomes (visual acuity and field of vision) in patients with pituitary adenoma and the factors that influence these outcomes.

Method: A cross-sectional study on patients who had transphenoidal surgery of pituitary adenoma from 2012 - 2014. The patient’s visual functions (visual acuity, visual impairment scale, and field of vision) were evaluated before and after transphenoidal surgery. The data were taken from the patient’s medical record.

Result: A total of eight patients (57.1%) showed improvement and six patients (42.9%) didn’t show improvement of visual impairment scale (VIS). A total of eight pstients (57.1%) showed improvement, and as many as six patients (42.9%) did not show vision improvement. After transphenoidal surgery, most patients (57.1%) had improved their visual functions not only by Snellen chart visual acuity test, but also by VIS score. Age, gender, time of onset to treatment, treatment time until surgery, time of onset to surgery, tumor volume before surgery were not related to the patient's visual function outcomes.

Conclusion: Transphenoidal surgery of pituitary adenoma can provide visual function improvement in most patients with pituitary adenoma."

"Latar Belakang : Adenoma hipofisis merupakan tumor intrakranial yang berasal dari jaringan hipofisis anterior. Manifestasi klinis yang ditimbulkan terkait dengan pendesakan massa dan gangguan sekresi hormon. Salah satu gangguan hormonal yang ditimbulkan adalah hipotiroidisme sekunder. Hipotiroidisme sekunder terkait dengan penurunan kualitas hidup serta peningkatan risiko kardiovaskular. Tujuan : Penelitian ini bertujuan untuk mengetahui proporsi hipotiroidisme sekunder dan gambaran klinis pasien adenoma hipofisis. Metode : Penelitian ini adalah studi potong lintang. Data diambil dari rekam medis pasien di Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta dalam kurun waktu tahun 2007-2012. Data demografis pasien (usia, jenis kelamin), karakteristik klinis, jenis adenoma, data radiologis, serta hasil pemeriksaan hormon (T4 bebas dan TSH) dievaluasi pada peneltian ini. Hasil : Selama kurun waktu 2007-2012 terdapat 63 pasien adenoma hipofisis di RSCM. Sebanyak 45 pasien memiliki data yang lengkap dan diikutsertakan sebagai subyek pada penelitian ini. Sebagian besar subyek adalah wanita (62,2%). Keluhan utama subyek adalah gangguan penglihatan (55,6%). Gejala atau tanda yang sering ditemukan adalah sakit kepala (86,7%), gangguan penglihatan (77,8%). Pada subyek wanita manifestasi yang pertama kali muncul adalah gangguan penglihatan dan gangguan fungsi seksual (39,3% dan 32,1%). Usia gejala pertama kali muncul lebih muda pada kelompok adenoma fungsional dibandingkan non fungsional (32,9 vs. 40,6). Hampir seluruh kasus yang ditemukan adalah makroadenoma (97,8%). Proporsi subyek yang mengalami hipotiroidisme sekunder adalah 40%. Subyek dengan hipotiroidisme sekunder lebih banyak mengeluhkan gangguan penglihatan dan gangguan ereksi. Simpulan : Gangguan penglihatan adalah keluhan utama yang sering ditemukan. Pada subyek wanita, keluhan gangguan fungsi seksual bersama dengan gangguan penglihatan adalah manifestasi yang pertama kali muncul. Proporsi hipotiroidisme sekunder pada penelitian ini adalah 40,0 %. Subyek dengan hipotiroidisme sekunder lebih banyak mengeluhkan gangguan penglihatan, gangguan ereksi.

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Background : Pituitary adenoma is intracranial neoplasm that arise from anterior pituitary tissue. Clinical manifestations are caused by mass effect and hormonal secretion disorder. One of the hormonal disorder is secondary hypothyroidism. Secondary hypothyroidism is related with increased cardiovascular morbidity and decreased quality of life.

Objectives: This study described the proportion of secondary hypothyroidism and and clinical features of pituitary adenoma patients.

Methods: This study was a cross sectional study. Data were collected from medical record in Cipto Mangunkusumo Hospital, from 2007 to 2012. Demographic data (age, gender), clinical characteristic, radiological result, adenoma type, and hormonal evaluation (free T4 and TSH) were evaluated.

Result : During 2007-2012 there were 63 patients with pituitary adenoma in Cipto Mangunkusumo Hospital.There were 43 patientswho fulfilled the study criteria. Majority of patients were female (62,2%). Visual disturbance was the most common presenting symptom (55,6%). Headache and visual disturbance were symptoms that commonly found, respectively (86,7% and 77,8%). Female subjects suffered visual disturbance and sexual dysfunction as their first occured symptoms, 39,3% and 32,1% respectively. Age at first symptom was younger in the subjects with functional adenoma compared non functional (32,9 vs. 40,6). Almost all cases were macroadenoma (97,8%). Secondary Hypothyroidism proportionin this study was 40 %. Subjects with secondary hypothyroidism had higher frequencies of visual distrubance and erectile dysfunction.

Summary : Visual disturbance is most common presenting symptom. Female subjects tend to had visual disturbance and sexual dysfunction as their first symptom. Secondary Hypothyroidism proportion in this study was 40 %. Subjects with secondary hypothyroidism had larger tumor diameter. Visual disturbance and erectile dysfunction commonly found in subjects with secondary hypothyroidism."

"Berdasarkan pengalaman Departemen Bedah Saraf Fakultas Kedokteran Universitas Indonesia – Rumah Sakit Cipto Mangunkusumo (FKUI-RSCM), pasien datang berobat dengan durasi keluhan yang beragam untuk suatu diagnosis adenoma hipofisis. Sebagai rumah sakit pusat rujukan nasional, semua pasien adenoma hipofisis yang datang ke institusi kami merupakan pasien rujukan dari dokter spesialis mata, spesialis saraf, maupun dokter spesialis bedah saraf dari institusi lain. Adenoma hipofisis dapat menyebabkan keluhan visus, lapang pandang, dan keluhan-keluhan lain yang diakibatkan oleh gangguan hormonal. Beberapa penelitian telah menyatakan hubungan antara durasi keluhan dengan luaran klinis dengan hasil yang signifikan. Pada penelitian ini akan dicari hubungan antara durasi, yang dihitung mulai dari awal keluhan sampai dilakukan tindakan operasi, dengan luaran visus dan lapang pandang pada pasien adenoma hipofisis yang dilakukan operasi dengan pendekatan transnasal transfenoid. Penelitian ini merupakan penelitian restrospektif pada pasien adenoma hipofisis yang dilakukan tindakan operasi dengan pendekatan transnasal transfenoid antara tahun 2015-2017. Seluruh operasi dilakukan oleh spesialis bedah saraf di RSCM. Semua pasien pada penelitian ini mengalami penurunan visus dan penyempitan lapang pandang. Durasi antara onset sampai dengan dilakukan tindakan operasi dihitung dalam satuan bulan. Dilakukan pemeriksaan visus dan lapang pandang 1 hari sebelum operasi dan dalam 1 sampai 2 bulan pasca operasi. Penelitian ini juga menghitung volume tumor, presentase tumor yang diambil, dan perluasan tumor, tetapi tidak dapat dilakukan uji statistik karena dibutuhkan jumlah sampel yang lebih banyak. Tujuh puluh satu pasien dengan keluhan penurunan visus dan penyempitan lapang pandang dengan median usia 42 tahun (20-77 tahun). Terdapat 36 pasien berjenis kelamin laki-laki dan 35 pasien perempuan. Median durasi mulai dari onset sampai dilakukan tindakan operasi untuk keluhan penurunan visus dan penyempitan lapang pandang adalah sama yaitu 12 bulan (1-108 bulan). Tedapat perbaikan visus pasca operasi pada 50 pasien (40,5%), dengan median durasi onset sampai dilakukan tindakan operasi adalah 11 bulan (p=0,58). Pada pasien keluhan penyempitan lapang pandang didapatkan perbaikan klinis pada 48 pasien (67.6%), dengan median durasi onset sampai dilakukan tindakan adalah 12 bulan (p=0.01). Dari penelitian ini dapat ditarik kesimpulan bahwa terdapat hubungan bermakna secara statistik antara durasi onset sampai dilakukan tindakan operasi dengan luaran klinis lapang pandang. Perbaikan lapang pandang didapatkan pada pasien yang memiliki durasi onset sampai dilakukan tindakan operasi sampai dengan 12 bulan.

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Based on the experience of the Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital (FMUI-Cipto Mangunkusumo Hospital), patients came seeking treatment with varying duration of complaints for a diagnosis of pituitary adenoma. As a national referral center hospital, all pituitary adenoma patients who came to our institution were referred from ophthalmologists, neurologists, and neurosurgeons from other institutions. Pituitary adenomas can cause decrease of visual acuity (VA), narrowing visual field (VF), and other complaints caused by hormonal disorders.¹ Several studies have showed that the duration of complaints were related significantly with clinical outcomes.^2,3,4,5,6

In this study, we investigated the relationship between duration, which is calculated from the time of symptoms first appeared to the time of surgery, and outcome (visual field and visual acuity) in pituitary adenoma patients who underwent surgery via transnasal-transsphenoidal approach.

This study used retrospective design on pituitary adenoma patients who was performed surgery via transnasal-transsphenoidal approach between 2015-2017. All surgeries were performed by neurosurgeons at RSCM. All patients in this study experienced decreased VA and narrowing of the VF. The duration between symptoms’ onset and surgery was calculated in months. VA and VF examinations were performed 1 day before surgery and within 1 to 2 months postoperatively. This study also calculated the volume of tumor, the percentage of tumor removal, and the extent of tumor, but statistical tests cannot be carried out on these parameters because more samples are needed.

There were 71 patients with decreased visual acuity and narrowed visual field, consisted of 36 male and 35 female patients, with a median age of 42 years (20-77 years). The median length of duration of onset for both symptoms is the same, which was 12 months (1-108 months).

Fifty patients (40.5%) had improved VA postoperatively, with median duration of onset was 11 months (p = 0.58). Clinical improvement in VF was experienced in 48 patients (67.6%), in which the median duration of onset was 12 months (p = 0.01)

There was a statistically significant relationship between the duration of onset and the VF outcomes. Improvements in the VF were found in patients who underwent surgery up to 12 months after the time of onset."

"Latar BelakangHemodialisa membutuhkan suatu akses vaskuler yang fungsional dan adekuat untuk mendapatkan hasil terbaik, bagi Negara berkembang seperti Indonesia tingginya biaya perawatan dan tenaga ahli masih merupakan hal yang harus ditanggapi serius oleh semua pihak. NKF-KDOQI menetapkan tiga Tujuan utama suatu unit hemodialisa antara lain meningkatkan pemakaian AV Fistula, Mengurangi pemakaian kateter hingga 10% dan Deteksi dini dari disfungsi akses vaskuler. Hingga saat ini belum ada gambaran akses vaskular yang terdapat di unit hemodialisa RSUPN Ciptomangunkusumo sehingga dapat dibandingkan dengan guideline, dan diharapkan mendapat masukan untuk pelayanan terbaik bagi pasien. MetodePenelitian ini berupa deskriptif retrospektif, Populasi penelitian adalah pasien gagal ginjal kronikyang menjalani hemodialisa dengan akses vaskuler fistula AV dan kateter vena sentral di RumahSakit Cipto Mangunkusumo pada bulan Mei – Desember 2012. Data dari rekam medis penderitadiketahui mengenai tanggal hemodialisa pertama kali, tanggal pembuatan akses vaskuler pertamakali, jenis akses vaskuler yang digunakan pertama kali serta konversi yang mengikutinya, sertalokasi akses vaskuler tersebut.HasilDidapatkan 234 data pasien yang aktif menjalani hemodialisa di unit hemodialisa RSUPNCiptomangunkusumno Jakarta dari bulan Mei – juni 2012, terdiri dari 146 laki laki dan 88perempuan , rerata umur 49.04 tahun dengan rentang umur 11 tahun sampai 78 tahun. Diantarapasien tersebut , 122 (52.1%) pasien dengan AV fistula, dan pasien yang membuat AV Fistulasebelum hemodialisa pertama hanya pada 7 pasien (1.2%) 1 pasien menggunakan graft PTFE,dengan lokasi tersering untuk AV Fistula adalah Radiocephalica sebanyak 29.4%, 48 pasienmenggunakan central venous catheter, dimana 28 pasien dengan longterm catheter (12%) dansisanya dengan shortterm catheter (8.5%). Direct Puncture digunakan oleh pasien sebagai carayang dipakai pertama kali melakukan hemodialisa, sebanyak 49.6%. dari keseluruhan pasienyang pernah menjalani pemasangan AV fistula mengalami primary failure sebanyak 10.65%, dansecondary failure sebanyak 7.37%.KesimpulanMasalah pada suatu unit hemodialisa tidaklah sederhana dan untuk mencapai suatu hasil yangterbaik diperlukan kerjasama dari sebuah tim multidisiplin vaskular akses yang terdiri dari ahliginjal hipertensi, ahli bedah vaskular, ahli radiologi, dan perawat dialisa. Dengan seorangkoordinator yang berdedikasi tinggi yang selalu memperbaharui data base pasien dan updateterbaru dari perkembangan akses vaskuler.

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Background

A vascular access that mantained to be functioning and adequate is a must to achieve the best

result in haemodialysis procedure. For a developing country like Indonesia, a high cost and

expertise in vascular access maintenance reluctantly a serious issues. NKF-KDOQI has

established three primary goals for a haemodialysis unit to achieve, to increase the placement of

native fistulas as vascular access at initiation of hemodialysis procedure until 65 %, to discourage

catheter insertion until 10% and early detection of vascular access dysfunction. Recently at Cipto

Mangunkusumo hospital, there are no profile of vascular access in haemodialysis unit to figure

out the condition and compare with guideline.

Method

This is a descriptive retrospective study with a CRF (Chronic Renal Failure) patients that undergo

hemodialysis with natve fistula and catheter as their vascular access in Cipto Mangunkusumo

hospital from May to December 2012. Data collected from medical record included dates when

initiates their hemodialysis procedure, diagnose of CRF, creation of fistula or other vascular

access, and complication that has occurred.

Results

From 234 patients that undergo hemodialysis procedure from May to December 2012, there werre

146 male and 81 female, with median age of 49.04 years old and distance within 11 – 78 years

old. Among these patients 122(52%) with fistula an 1 patient with graft but only 7 patients (1.2%)

that use native fistula to initiate their hemodialysis procedure. The most location for fistula were

on left radiocephalic in 29.4% of patients, 48 patients use catheter for their vascular access that

ionclude 12% long term and 8.5 % long term catheter. There were 49.6% patients with direct

venous puncture to initiate their hemodialysis. From all fistulas that created there were 10.65%

primary failure and 7.37% secondary failure.

Conclusion

Problems in hemodialysis unit is not as simple as that, and to achieve the best result require the

concerted effort of multivariariate vascular access team that consist nephrologist, vascular

surgeon, radiologist, and nurse with a chief coordinator that updating vascular access patients

database and its development"

"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."

"ABSTRAKLatar Belakang. Gangguan otonom merupakan gejala yang cukup sering dialamioleh pasien Parkinson. Gangguan ini sudah dapat ditemukan sejak awal stadiumpenyakit. Gangguan otonom meliputi gangguan gastrointestinal, urologi,kardiovaskular, seksual dan termoregulasi. Untuk mendeteksi gangguan otonomdapat digunakan kuesioner SCOPA-AUT (Scale for Outcomes in Parkinson’sDisease for Autonomic Symptoms). Tujuan dari penelitian ini adalah untukmengetahui gambaran gangguan otonom pada pasien Parkinson di PoliklinikSaraf RSUPN Cipto Mangunkusumo dan RSUPN Fatmawati.Metode. Penelitian dilakukan dengan menggunakan desain potong lintang.Pengumpulan data dilakukan pada bulan April hingga Juni 2012.Hasil. Sebanyak 54 subyek penelitian yang terdiri dari 33 (61,1%) pria dan 21(38,9 %) wanita diikutsertakan dalam penelitian ini. Pasien Parkinson padapenelitian ini berusia antara 45-79 tahun. Sebagian besar pasien memiliki durasisakit kurang dari 5 tahun (63%), stadium Hoehn & Yahr 1-2 (63%) dan memakaiterapi kombinasi levodopa dengan agonis dopamin (79,6%). Gangguan otonomdidapatkan pada seluruh subyek penelitian. Gangguan otonom yang paling seringdialami pasien Parkinson adalah masalah urologi berupa nokturia (79,6%) danurinary frequency (57,3%), serta masalah gastrointestinal yaitu sialorea (51,9%)dan mengejan kuat saat buang air besar (50%) Tidak ada pasien yang mengalamiinkontinensia feses atau jatuh pingsan.Kesimpulan. Seluruh pasien Parkinson pada penelitian ini mengalami gangguanotonom. Telah diketahui proporsi gangguan otonom pada pasien Parkinson diPoliklinik Saraf RSUPN Cipto Mangunkusumo dan RSUPN Fatmawati.

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ABSTRACTBackground. Autonomic symptoms are quite often reported by Parkinson’sdisease patients. These symptomps are found already in early stage of disease.Autonomic symptomps comprise gastrointestinal, urinary, cardiovascular, sexualand thermoregulation symptomps. SCOPA-AUT (Scale for Outcomes inParkinson’s Disease for Autonomic Symptoms) questionnaire can detectautonomic dysfunctions. The purpose of this study is to obtain profile ofautonomic symptomps in Parkinson’s disease patients in neurology clinic inRSUPN Cipto Mangunkusumo and RSUPN Fatmawati.Methods: a cross sectional study was conducted between April and June 2012Results: A total of 54 patients, i.e. 33 (61,1%) man and 21 (38,9 %) woman, wererecruited in this study. The age of patients was between 45 and 79 years. Mostpatients have illness duration less than 5 years (63%), Hoehn & Yahr stage 1-2(63%) and use combination therapy (levodopa with dopamine agonist) (79,6%).Autonomic symptoms are complained by all patients. Most frequent autonomicsymptomps reported by Parkinson’s disease patients are nocturia (79,6%), urinaryfrequency (57,3%), sialorea (51,9%) and strain hard when pass stools (50%).There are no patients who complained involuntary loss of stools or fainted.Conclusion. All Parkinson’s disease patients in this study reported autonomicsymtomps. Autonomic symptomps profile has been known in Parkinson’s diseasepatients in neurology clinic in RSUPN Cipto Mangunkusumo and RSUPNFatmawati"

"[ABSTRAKPendahuluan : Glioma adalah jenis tumor yang paling umum dari neoplasma intraserebralprimer. Tumor ganas primer sistem saraf pusat (SSP) mencapai sekitar 2% dari semua kankerdan high grade glioma adalah jenis yang paling banyak ditemukan. High grade gliomamenyebabkan tingkat morbiditas dan mortalitas yang tinggi. Saat ini belum ada data yangmenggambarkan profil pasien glioma yang menjalani radioterapi di Indonesia.Metode penelitian : Penelitian ini merupakan penelitian retrospektif deskriptif analitikterhadap 121 pasien glioma yang mendapat radiasi di departemen Radioterapi RSUPN Dr.Cipto mangunkusumo dari Januari 2009 sampai Januari 2014. Data diperoleh dari catatanmedisdan hasil penelusuran melalui telepon terhadap pasien atau keluarganya. Respon tumordianalisa terhadap 22 pasien yang mempunyai CT scan atau MRI pre dan post radiasi denganmenggunakan kriteria RECIST.Hasil : Sebagian besar pasien adalah laki-laki (53,7%), dengan usia rata-rata 45 tahun.Histopatologi yang paling banyak ditemukan adalah astrositoma. Prosedur bedah yang palingbanyak ditemukan pada penelitian ini adalah craniotomi removal tumor (70%). Teknik 3DCRT paling banyak digunakan yaitu pada 77,7% pasien. Nimotuzumab sebagai antibodimonoklonal digunakan pada 9% pasien. Respon parsial ditemukan 59,1%. Analisis kesintasanhidup tiga tahun dari seratus sebelas pasien yang memenuhi kriteria didapatkan angkakesintasan yaitu 46,15%. Analisis kaplan meyer menunjukkan overall treatment timemerupakan faktor prognostik untuk kesintasan hidup (p = 0,016).Kesimpulan : Teknik operasi terbanyak pada pasien glioma yang menjalani radiasi didepartemen radioterapi RSUPN DR. Cipto Mangunkusumo adalah kraniotomi removal tumor(70,9%). Teknik 3D CRT adalah teknik radiasi yang paling banyak digunakan. Responparsial ditemukan 59,1%. Kesintasan hidup tiga tahun pasien glioma yaitu 46,2% dan overalltreatment time merupakan faktor prognostik yang bermakna untuk kesintasan hidup

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ABSTRACTIntroduction : Glioma is the most common type of primary intracerebral neoplasms. Highgrade glioma being the most frekuent type found (70,9%) causes a high morbidity andmortality rate. There is currently no data describing the profile management of patientsundergoing radiotherapy glioma in Indonesia.Methods : This study Retrospective analytic descriptive study of 121 glioma patients fromjanuari 2009 until december 2014. The data was obtained from medical records and indivualcontact via telephone. Tumor response was evaluated in 22 patients with pre and postirradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECISTcriteria.Results : Most of our patients were male (53,7%), with median age 45 years old.Astrocytoma was the most histopathological type found. 70.9% of Patients who receivedradiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3DConformal technique was used in 81.0% of patients. Seventy nine point three had a two graydose perfraction. Provision of chemotherapy in patients undergoing radiation still only at7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The medianoverall treatment time was 45 days and delay treatment time 38 days. Fifty nine point onepercent of partial respon was found. Local recurrences were found throughout the follow-upof 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factorfor overal survival rate (p=0,016).Conclusions : : Almost seventy one percent of glioma patients who received radiotherapyhad craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty ninepoint one percent of partial respon founded. Three years overall survival was 46,2% andoverall treatment time was found as a factor that significantly affects overall survivalprognosis.;Introduction : Glioma is the most common type of primary intracerebral neoplasms. Highgrade glioma being the most frekuent type found (70,9%) causes a high morbidity andmortality rate. There is currently no data describing the profile management of patientsundergoing radiotherapy glioma in Indonesia.Methods : This study Retrospective analytic descriptive study of 121 glioma patients fromjanuari 2009 until december 2014. The data was obtained from medical records and indivualcontact via telephone. Tumor response was evaluated in 22 patients with pre and postirradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECISTcriteria.Results : Most of our patients were male (53,7%), with median age 45 years old.Astrocytoma was the most histopathological type found. 70.9% of Patients who receivedradiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3DConformal technique was used in 81.0% of patients. Seventy nine point three had a two graydose perfraction. Provision of chemotherapy in patients undergoing radiation still only at7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The medianoverall treatment time was 45 days and delay treatment time 38 days. Fifty nine point onepercent of partial respon was found. Local recurrences were found throughout the follow-upof 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factorfor overal survival rate (p=0,016).Conclusions : : Almost seventy one percent of glioma patients who received radiotherapyhad craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty ninepoint one percent of partial respon founded. Three years overall survival was 46,2% andoverall treatment time was found as a factor that significantly affects overall survivalprognosis.;Introduction : Glioma is the most common type of primary intracerebral neoplasms. Highgrade glioma being the most frekuent type found (70,9%) causes a high morbidity andmortality rate. There is currently no data describing the profile management of patientsundergoing radiotherapy glioma in Indonesia.Methods : This study Retrospective analytic descriptive study of 121 glioma patients fromjanuari 2009 until december 2014. The data was obtained from medical records and indivualcontact via telephone. Tumor response was evaluated in 22 patients with pre and postirradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECISTcriteria.Results : Most of our patients were male (53,7%), with median age 45 years old.Astrocytoma was the most histopathological type found. 70.9% of Patients who receivedradiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3DConformal technique was used in 81.0% of patients. Seventy nine point three had a two graydose perfraction. Provision of chemotherapy in patients undergoing radiation still only at7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The medianoverall treatment time was 45 days and delay treatment time 38 days. Fifty nine point onepercent of partial respon was found. Local recurrences were found throughout the follow-upof 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factorfor overal survival rate (p=0,016).Conclusions : : Almost seventy one percent of glioma patients who received radiotherapyhad craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty ninepoint one percent of partial respon founded. Three years overall survival was 46,2% andoverall treatment time was found as a factor that significantly affects overall survivalprognosis., Introduction : Glioma is the most common type of primary intracerebral neoplasms. Highgrade glioma being the most frekuent type found (70,9%) causes a high morbidity andmortality rate. There is currently no data describing the profile management of patientsundergoing radiotherapy glioma in Indonesia.Methods : This study Retrospective analytic descriptive study of 121 glioma patients fromjanuari 2009 until december 2014. The data was obtained from medical records and indivualcontact via telephone. Tumor response was evaluated in 22 patients with pre and postirradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECISTcriteria.Results : Most of our patients were male (53,7%), with median age 45 years old.Astrocytoma was the most histopathological type found. 70.9% of Patients who receivedradiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3DConformal technique was used in 81.0% of patients. Seventy nine point three had a two graydose perfraction. Provision of chemotherapy in patients undergoing radiation still only at7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The medianoverall treatment time was 45 days and delay treatment time 38 days. Fifty nine point onepercent of partial respon was found. Local recurrences were found throughout the follow-upof 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factorfor overal survival rate (p=0,016).Conclusions : : Almost seventy one percent of glioma patients who received radiotherapyhad craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty ninepoint one percent of partial respon founded. Three years overall survival was 46,2% andoverall treatment time was found as a factor that significantly affects overall survivalprognosis.]"

"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."

"Tumor odontogenik merupakan jenis tumor yang sering terjadi di regio kepala leher terutama di rongga mulut. Badan Kesehatan Dunia WHO telah membuat klasifikasi yang baru terhadap jenis tumor odontogenik. Kejadian tumor odontogenik di Indonesia dipengaruhi oleh banyak hal di antaranya kondisi demografi, sosioekonomi dan keadaan klinis masing-masing individu. Penelitian mengenai tumor odontogenik masih sangat sedikit dilakukan di Indonesia sehingga penelitian ini bertujuan untuk mengetahui frekuensi dan distribusi tumor odontogenik di Indonesia periode 2012-2015. Analisis dilakukan pada 118 rekam medik pasin tumor odontogenik. Frekuensi dan distribusi dilihat berdasarkan umur, jenis kelamin, lokasi, pekerjaan, pendidikan, diagnosis tumor, jenis perawatan, spesialisi, gambaran histopatologis, lama rawat inap dan tingkat rekurensi. Mayoritas pasien berusia 31-40 tahun 26,27. Tumor odontogenik ditemukan lebih banyak pada laki-laki dengan rasio 1.03:1. Tingkat pendidikan paling banyak adalah tamat SMA, 35 pasien 29,67. Mayoritas pasien tidak bekerja sebanyak 26 pasien 22,03. Ameloblastoma merupakan jenis tumor paling banyak yaitu 101 kasus 85,60. Tumor odontogenik paling banyak ditemukan di rahang bawah sebanyak 102 kasus 86,44. Penanganan tumor paling banyak dilakukan oleh spesialis bedah mulut sebanyak 91 kasus 77,12. Rata-rata lama rawat inap pasien adalah 9,87 7,60 hari. Terjadi 15 kasus rekurensi pada jenis tumor ameloblastoma.

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Odontogenic tumor is a common tumor in the head and neck regio especially oral cavity. World Health Organization WHO in 2005 currently reclassify the classification of tumor odontogenic. The incidence of the odontogenic tumor in Indonesia were depends on demographic conditions, socio economic and clinical condition of the patients. The research about odontogenic in Indonesia are currently limited so this research are conducted to see the frequency and distribution of odontogenic tumor in Dr. Cipto Mangunkusumo General Hospital from 2012 2015. 118 medical records was analyzed. Frequency and distribution analyzed concerning age, gender, location of tumor, educational level, occupation, diagnosis, treatment, specialization, histopatologic type, length of stay, and reccurent rate. Most of the patients were 31 40 years old in age 26,27. Odontogenic tumor mostly happen in man with ratio 1.03 1. The educational level of the patients mostly are graduated high school student 29,67 and mostly are not work 22,03. Ameloblastoma is the most common odontogenic tumor 85,60. Mandible is the common site of the odontogenic tumor 86,44. The treatment of the odontogenic tumor mostly done by the oral and maxillofacial surgeon 77,12. Mean of patient length of stay were 9,87 7,60 days. "