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Abstrak :
Tujuan : Mengetahui gambaran atheroskierosis arteri karotis komunis dan arteri ekstremitas bawah (femoralis komunis) pada pasien stroke iskemik dengan USG Color Doppler dan pengaruh faktor-faktor resiko terhadap terjadinya atheroskierosis (plak). BAHAN DAN METODE Penelitian "cross sectional", dimulai dari bulan November 2004 sampai dengan April 2005. Penelitian pada 32 pasien stroke iskemik (berdasarkan klinis&CT Scan), menggunakan CDU, transduser 10 MHz. Dilakukan pemeriksaan CDU arteri karotis dan ekstremitas bawah (kanan-kiri) untuk melihat adanya penebalan intima-media, plak, dan pola aliran darah. Faktor-faktor resiko stroke (usia, jenis kelamin, DM, merokok, hiperkoleslerol, riwayat jantung dan stroke) pada pasien dicatat. Hasil dianalisa olch peneliti dan spesialis radiologi. HASIL Rata-rata diameter lumen arteri karotis komunis kanan dan kid adalah 0,89 dan 0,85 cm. Rata-rata diameter lumen arteri femoralis komunis adalah 0,90 dan 0,90 cm. Faktor resiko terbesar penyebab stroke adalah hipertensi (84,4%), disusul riwayat stroke (53,1%), diabetes militus (50,1%), merokok (46,9%), hiperkolesterol (31,3%), jantung (18,8%). Jumlah temuan penebalan intima-media pada arteri karotis dan femoralis komunis hampir sama. Tetapi temuan plak arteri femoralis komunis lebih sering dibandingkan pada arteri karotis komunis, dan pada uji Mc Nemar terdapat hubungan bermakna bahwa plak di arteri femoralis komunis lebih awal dibandingkan pada arteri karotis komunis. Lokasi plak tersering berada di biffurcatio. Pada penelitian ini tidak didapatkan stenosis bermakna, sehingga nilai PI dan RI masih dalam batas normal. Faktor resiko penyebab timbulnya plak tersering adalah hiperkolesterol, disusul DM, jantung, stroke, merokok. Semakin banyak Faktor resiko, maka sernakin besar kemungkinan terdapat plak di arteri karotis komunis dan terutama di arteri femoralis komunis. KESIMPULAN Temuan plak di arteri femoralis komunis lebih awal dan lebih sering terjadi dibandingkan di arteri karotis komunis, yang diduga sering mcnyebabkan pelepasan thrombus penyebab stroke iskemik

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Purpose To asses atherosclerosis of common carotid artery and common femoral artery in patient with ischemic stroke, and risk factor that influence formation of atherosclerosis (plaque). MATERIALS AND METHODS Study cross sectional; begin from November 2004 to April 2005. Examinations of 32 patients ischemic stroke (based on clinical and CT Scan) use CDU, transducer 10 MHz. CDU carotid and femoral artery right-left was done to evaluated Intima-Media Thickness (IMT) and plaque. Risk factors of stroke (age, sex, diabetes, smoking, hipercholesterol, history of CAD and CVD); in patients being recorded. Reviewed by observer, radiologist. RESULT The mean lumen of diameter right and left command carotid artery is 0,89 and 0.85 cm. The mean of lumen diameter right and left command femoral artery is 0,90 and 0,90 cm. The most frequence risk factor causing ischemic stroke is hipert'nsi (84,4%), then follow history of CVD (53,1%), diabetes (50,1%), smooking (46,9%), hipercholesterol (31,3%), and CAD (18,8%). Amount of Intima-Media Thickness in carotid artery, as common as femoral artery. But plaque in common femoral artery more frequency than in common carotid artery, and with Mc Nemar test there is association that plaque finding in common femoral artery earlier than common carotid artery. Plaque location more frequent in biffurcatio. The most frequency risk factors causing plaque is hipercholesterol, then follow diabetes, CAD, stroke, smoking. Too much risk factor in ischemic stroke, too much plaque finding in common carotid artery and common femoral artery. CONCLUSION Plaque finding in common femoral artery more frequency and earlier than in common carotid artery that suspected release thrombus cause of ischemic stroke.

Abstrak :
[Penyakit Arteri Perifer (PAP) merupakan sumbatan aliran darah arteri selain koroner dan intrakranial. PAP dihasilkan dari proses atherosklerosis, emboli, trombus, dan inflamasi yang mengarah ke stenosis arteri. PAP asimptomatik menempati 3-10% populasi dunia, dan meningkat hingga 15-20% pada 70 tahun ke atas. Divisi kami mencatat 18,1-24,7% pasien kaki diabetik dengan PAP mengalami amputasi pada kurun waktu 3 tahun terakhir. Evaluasi ultrasonografi Doppler pada arteri utama ekstremitas bawah diharapkan mampu mendeteksi secara dini apakah pasien akan diamputasi atau tidak baik mayor maupun minor. Metode yang diambil adalah analitik komparatif kategorik independen dengan disain penelitian kohort retrospektif. Selama Januari 2010 hingga Desember 2011 didapatkan 24 pasien yang masuk kriteria inklusi. Arteri yang diperiksa a.femoralis, a.poplitea, a.tibialis posterior, dan a.dorsalis pedis dengan tampilan spektral mulai dari monofasik, bifasik, atau trifasik terutama dengan pelebaran spektral. Ultrasonografi salah satu modalitas ?operator dependent?, untuk mengurangi bias, peneliti menggunakan operator ultrasonografi adalah peneliti sendiri, trainee atau konsultan divisi kami. Hasil didapatkan spektral bifasik hingga monofasik pada a.femoralis 25,0%, a.poplitea 58,3%, a.tibialis posterior 41,6%, a.dorsalis pedis 45,8%, angka amputasi mayor dan minor masing-masing 4%. Perhitungan statistik didapatkan untuk a.femoralis p=0,054 (95% CI), a.poplitea p=0,006 (95% CI), a.tibialis posterior p=0,010 (95% CI), dan a.dorsalis pedis p=0,021 (95% CI). Secara statistik, prediksi amputasi dapat bermakna pada ultrasonografi Doppler pada a.poplitea, a.tibialis posterior, dan a.dorsalis pedis. Dapat ditarik kesimpulan pemeriksaan ultrasonografi Doppler penting dilakukan pada setiap pasien PAP untuk mengevaluasi secara khusus keadaan empat arteri utama ekstremitas bawah pasien dan untuk prediktor amputasi ...... Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss.;BACKGROUND Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss.;BACKGROUND Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss.;BACKGROUND Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss.;BACKGROUND Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss.;BACKGROUND Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss., BACKGROUND Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss.]

Abstrak :
Latar belakang: Hemodialisis merupakan salah satu tatalaksana penting yang dilakukan pada pasien dengan penyakit ginjal kronik (PGK) stadium 5 atau penyakit ginjal stadium akhir. Komplikasi akses hemodialisis lebih rendah pada penggunaan akses hemodialisis autogen dibandingkan dengan penggunaan akses prostetik. Maturitas fistula arteriovena sangat menentukan keberhasilan suatu akses vaskular untuk hemodialisis. Maturitas fistula arteriovena tergantung dengan persiapan pre operasi pembuatan fistula arteriovena. Penelitian ini diharapkan pemeriksaan peak systolic velocity pada arteri radialis preoperatif dan intraoperatif dapat memprediksi keberhasilan maturasi dari fistula arteriovena radisefalika. Subjek dan Metode: Subjek adalah pasien-pasien yang akan dibuat FAV radiosefalika dengan USG mapping sesuai standar. Sesaat setelah anastomosis diukur peak systolic velocity dengan USG Doppler probe linear. Penelitian ini menggunakan desain potong lintang analitik untuk mendapatkan hubungan maturasi FAV dengan peak systolic velocity preoperatif dan intraoperatif. Hasil: FAV radiosefalika (n=71) pada 71 pasien dibuat dan dievaluasi dalam 6 minggu. Rerata PSV preoperatif pada fistula yang matur secara signifikan lebih tinggi dibandingkan yang tidak matur (54,6+11,7 cm/s dan 26,7+7,7 cm/s; P<0,001). Rerata PSV intraoperatif pada fistula yang matur secara signifikan lebih tinggi dibandingkan yang tidak matur (57,9+12,6 cm/s dan 27,1+8,1 cm/s; P<0,001). Rerata selisih PSV pada fistula yang matur secara signifikan lebih tinggi dibandingkan yang tidak matur (3 cm/s dan 0 cm/s; P<0,001).  PSV preoperatif dengan nilai cut-off sebesar 40 cm/s memiliki sensitifitas 91,7%; spesifisitas 95,6%; akurasi 92,9%; positve predictive value 97,8%; dan negative predicvtive value 84,6%. PSV intraoperatif dengan nilai cut-off sebesar 42 cm/s memiliki sensitifitas 91,7%; spesifisitas 95,6%; akurasi 92,9%; positve predictive value 97,8%; dan negative predicvtive value 84,6%. Selisih PSV dengan nilai cut-off sebesar 42 cm/s memiliki sensitifitas  91,7%; spesifisitas 95,6%; akurasi 92,9%; positve predictive value 97,8%; dan negative predicvtive value 84,6%. Kesimpulan: PSV preoperatif >40 cm/s dan PSV intraoperatif >42 cm/s memiliki nilai prediktor yang baik untuk maturasi FAV radiosefalika,sehingga dapat menjadi acuan menentukan perlu tidaknya penilaian lebih lanjut dan tindakan revisi saat intraoperatif, yang pada akhirnya diharapkan dapat menurunkan angka kegagalan maturasi fistula arteriovenous.

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Background: Hemodialysis is one of the important treatments in patients with stage 5 chronic kidney disease (CKD) or end-stage renal disease. Complications of hemodialysis access are lower in the use of access to autogenous hemodialysis compared to the use of prosthetic access. The maturity of arteriovenous fistula greatly determines the success of a vascular access to hemodialysis. The maturity of arteriovenous fistula depends on the preoperative preparation of arteriovenous fistula making. This study is expected to examine the peak systolic velocity of radial arteries in the preoperative and intraoperative to predict the successful maturation of radiocephalic arteriovene fistulas. Subjects and Methods: Subjects are patients who will be made radiocephalic FAV with ultrasound mapping according to the standard. Shortly after anastomosis, a peak systolic velocity is measured with a linear ultrasound Doppler probe. This study uses a cross-sectional analytic design to obtain the relationship of FAV maturation with preoperative and intraoperative peak systolic velocity. Results: Radiosefalic FAV (n = 71) in 71 patients was made and evaluated in 6 weeks. The mean of preoperative PSV in mature fistulas was significantly higher than those who were immature (54.6 + 11.7 cm / s and 26.7 + 7.7 cm / s; P <0.001). The mean intraoperative PSV in mature fistulas was significantly higher than that which was immature (57.9 + 12.6 cm / s and 27.1 + 8.1 cm / s; P <0.001). The mean difference in PSV in mature fistulas was significantly higher than that of immature (3 cm / s and 0 cm / s; P <0.001). Preoperative PSV with a cut-off value of 40 cm / s has a sensitivity of 91.7%; specificity 95.6%; 92.9% accuracy; positve predictive value 97.8%; and negative predictive value of 84.6%. The intraoperative PSV with a cut-off value of 42 cm / s has a sensitivity of 91.7%; specificity 95.6%; 92.9% accuracy; positve predictive value 97.8%; and negative predictive value of 84.6%. The difference in PSV with a cut-off value of 42 cm / s has a sensitivity of 91.7%; specificity 95.6%; 92.9% accuracy; positve predictive value 97.8%; and negative predictive value of 84.6%. Conclusions: Preoperative PSV> 40 cm / s and intraoperative PSV> 42 cm / s have a good predictor value for radiocephalic FAV maturation, so that it can be a reference in determining whether or not further assessment and revision actions are intraoperative, which is ultimately expected to reduce the number failure of maturation of arteriovenous fistulas.

Abstrak :
Lataar Belakang : Pasca nefrektomi ginjal, terjadi proses kompensasi dari ginjal sisa dalam bentuk hiperfiltrasi untuk mempertahankan laju filtrasi glomerulus, yang dapat berujung pada penyakit ginjal kronik. Sejumlah penelitian menemukan adanya perubahan hemodinamika vaskular ginjal pada ginjal sisa donor yang diperiksa menggunakan ultrasonografi (USG) Doppler. Akan tetapi penelitian tersebut umumnya berfokus pada jangka panjang, dan menggunakan parameter indeks resistensi (RI), belum banyak penelitian yang memfokuskan pada parameter indeks pulsatilitas (PI) dalam jangka pendek, yang dapat bermanfaat untuk memperkirakan prognosis donor. Tujuan : Penelitian ini bertujuan untuk mengetahui gambaran USG Doppler dan adanya perbedaan nilai PI pada ginjal sisa donor transplantasi ginjal antara sebelum dan sesudah nefrektomi dalam jangka pendek. Metode : Desain penelitian merupakan studi prospektif historikal tanpa pembanding menggunakan data sekunder. Sampel adalah donor hidup transplantasi ginjal yang telah menjalani nefrektomi di RSUPN Cipto Mangunkusumo (RSCM) periode Maret 2019 hingga Januari 2020. Data USG Doppler berupa parameter PI a. renalis, segmental, interlobar, dan arkuata di superior, mid, dan inferior ginjal yang tidak dioperasi/ginjal sisa beserta rerata seluruhnya mulai dari preoperasi, H+1, H+7, dan H+30 pasca operasi. Hasil : Didapatkan 40 sampel USG Doppler ginjal sisa donor (rentang usia 24 hingga 66 tahun). Gambaran USG Doppler pada nilai rerata PI preoperatif, H+1, H+7, dan H+30 pasca operasi secara berturut-turut adalah: a. renalis: 1,33, 1,42, 1,31, dan 1,08; a. segmentalis: 1,24, 1,27, 1,18, dan 1,17. a. interlobaris: 1,11, 1,20, 1,19, dan 1,08; a. arkuata: 1,09, 1,14, 1,06, dan 1,02. Pada analisis kemaknaan dengan ANOVA tidak ada perbedaan bermakna pada perubahan rerata nilai PI a. renalis, segmentalis, interlobar, dan arkuata baik keseluruhan maupun per segmen ginjal, kecuali a. interlobar mid ginjal (p = 0,049). Akan tetapi pada analisis post hoc membandingkan dua titik waktu berbeda, tidak didapatkan perbedaan yang bermakna Kesimpulan : Tidak terdapat perbedaan bermakna dari nilai PI ginjal sisa donor sebelum dan sesudah nefrektomi dalam jangka pendek. ......Background : After kidney nephrectomy, there is a compensation process in remnant kidney in the form of hyperfiltration to preserve glomerular filtration rate, which may lead to chronic kidney disease. Several studies found changes in renal vascular hemodynamics in donor’s remnant kidney, examined by Doppler ultrasound (US). However those studies mostly focused on long term and used resistive index (RI), while not many studies focused on pulsatility index (PI) in short term, which may be beneficial to predict donor’s prognosis. Objective : This study aimed to know the Doppler US of and differences in PI values in renal transplantation donor’s remnant kidney before and after nephrectomy within short term. Method : The study design is historical prospective without comparison using secondary data. Samples are renal transplantation donor underwent nephrectomy in Cipto Mangunkusumo National Central General Hospital (RSUPN-CM) from March 2019 until January 2020. Doppler ultrasound data presented in the form of PI parameter of renal, segmental, interlobar, and arcuate arteries, in superior, middle, and inferior kidney of unoperated/remnant kidney and their mean, from pre-surgery, D+1, D+7, and D+30 after surgery. Result : This study obtained 40 samples of donor’s remnant kidney Doppler US (age range 24-66 years old). Doppler US of mean PI from pre-surgery, D+1, D+7, and D+30 after surgery consecutively were: renal artery: 1.33, 1.42, 1.31, and 1.08;segmental artery: 1.24, 1.27, 1.18, and 1.17; interlobar artery: 1.11, 1.20, 1.19, and 1.08; arcuate artery: 1.09, 1.14, 1.06, and 1.02. Significance analysis using ANOVA showed no significant difference of PI value changes of renal, segmental, interlobar, and arcuate artery, both in the mean of whole and segments of kidney, except interlobar artery in the middle segment of kidney (p = 0.049). However, post hoc analysis comparing two different time points showed no significant difference. Conclusion : There was no significant difference of donor’s remnant kidney PI value before and after nephrectomy within short term.

Abstrak :
Latar belakang: Komplikasi vena hepatika merupakan komplikasi vaskular pascatransplantasi hati yang penting karena dapat mengakibatkan kongesti hati, sirosis dan kegagalan cangkok, dengan insidens lebih tinggi pada Transplantasi Donor Hidup (LDLT) dibandingkan teknik transplantasi lainnya. Tujuan: Mengetahui parameter ultrasonografi (USG) Doppler vaskular vena hepatika periode awal pascatransplantasi yang dapat berperan sebagai prediktor komplikasi vena hepatika Metode: Penelitian dilakukan pada 44 pasien pediatrik yang menjalani LDLT di RSUPN Dr. Ciptomangunkusumo dari tahun 2010 hingga Juli 2022 yang memiliki imaging USG Doppler vaskular pada hari pertama hingga ketiga pascatransplantasi. Kecepatan dan pola gelombang vena hepatika dari USG Doppler dievaluasi pada kelompok dengan dan tanpa komplikasi vena hepatika pada tahun pertama pascatransplantasi. Nilai titik potong kecepatan vena hepatika ditentukan menggunakan receiver operating curve. Hasil: Kecepatan vena hepatika pada hari kedua pascaoperasi secara signifikan lebih rendah pada pasien dengan komplikasi vena hepatika, dengan nilai tengah 21,3 (16,6-23,3) cm/detik, dibandingkan 28,9 (10,7-75,0) cm/detik pada pasien tanpa komplikasi vena hepatika, (nilai p = 0,018). Nilai titik potong kecepatan vena hepatika hari kedua pascaoperasi dalam membedakan komplikasi dan tanpa komplikasi vena hepatika adalah 23,65 cm/detik, sensitivitas 100%, spesifisitas 76,3%, AUC 0,803 (IK95% 0,679-0,927), dan nilai p = 0,018. Tidak terdapat perbedaan proporsi pola gelombang monofasik vena hepatika antara pasien dengan komplikasi vena hepatika dibandingkan dengan pasien tanpa komplikasi vena hepatika. Kesimpulan: Kecepatan vena hepatika yang rendah pada USG Doppler vaskular periode awal pascaoperasi terutama di hari kedua dapat membantu memprediksi komplikasi vena hepatika sehingga meningkatkan kewaspadaan dini terhadap komplikasi vena hepatika pada tahun pertama pascatransplantasi. ......Background: Hepatic vein complication is an important postoperative complication in pediatric liver transplantation in which liver congestion may progress to cirrhosis and graft failure, with higher incidence in living donor liver transplantation (LDLT) compared to other liver transplantation technique. Objective: This study aims to identify the role of Doppler ultrasound parameters of hepatic vein in early postoperative period of pediatric LDLT as predictors of hepatic vein complications. Methods: From 2010 to July 2022, there were 44 pediatric LDLT patients in RSUPN Dr. Ciptomangunkusumo who had Doppler ultrasound imaging from first until third postoperative day. Hepatic vein velocity and waveform were compared in patients with and without hepatic vein complications in one year follow up. Cut off point of hepatic vein velocity is determined using receiver operating curve. Results: Hepatic vein velocity in second postoperative day is significantly lower in patients with hepatic vein complication, with median of 21,3 (16,6-23,3) cm/s compared to 28,9 (10,7-75,0) cm/s in patients without hepatic vein complication (p value = 0,018), with cut off value to differentiate both group is 23,65 cm/s, sensitivity 100%, specificity 76,3%, AUC 0,803 (CI95% 0,679-0,927), and p value = 0,018. There is no difference in monophasic waveform proportion between patients with and without hepatic vein complication. Conclusion: Lower hepatic vein velocity in early postoperative Doppler ultrasound of pediatric LDLT, especially in second postoperative day, may aid to predict hepatic vein complication in first year follow up. Such finding may increase awareness of hepatic vein complication in the first year after transplantation.

Abstrak :
Latar belakang: Pasien dengan tumor muskuloskeletal (MSK) ganas menunjukkan insidens deep vein thrombosis (DVT) bervariasi. USG Doppler berwarna merupakan modalitas terpilih untuk evaluasi DVT. Tujuan: Menilai hubungan trombus, kecepatan aliran, dan ketebalan dinding vena pada USG Doppler berwarna vena profunda ekstremitas bawah pada pasien dengan tumor primer MSK ganas. Metode: Penelitian ini menggunakan data primer dari pemeriksaan USG Doppler berwarna vena profunda ekstremitas bawah, yaitu trombus, ketebalan dinding vena, dan kecepatan aliran vena, serta data sekunder, yaitu ukuran tumor dari magnetic resonance imaging (MRI) atau computed tomography >(CT) scan dan durasi gejala tumor dari rekam medis. Penelitian dilakukan di Departemen Radiologi dan Poliklinik Orthopaedi dan Traumatologi Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPNCM) bulan Agustus 2020 hingga Maret 2022. Hasil: Terdapat 10% insidens trombus pada sistem vena profunda ekstremitas bawah pada 30 subyek dengan tumor primer MSK ganas. Subyek dengan trombus cenderung memiliki volume tumor lebih besar dibandingkan tanpa trombus, namun secara statistik tidak bermakna. Kesimpulan: Dimensi dan volume tumor pada subyek dengan trombus cenderung lebih besar dibandingkan tanpa trombus. Pada penderita tumor MSK ganas, dapat ditemukan gambaran klinis dan laboratoris yang menyerupai DVT namun belum tentu didapatkan trombus, sehingga USG Doppler berwarna penting untuk membedakan ada tidaknya DVT. ......Background: Patients with malignant musculoskeletal (MSK) tumors show variable incidence of deep vein thrombosis (DVT). Color Doppler ultrasound (CDUS) is the modality of choice for DVT evaluation. Objective: To assess the relationship of thrombus, flow velocity, and venous wall thickness on CDUS of lower extremities deep veins in patients with primary malignant MSK tumors. Methods: Primary data from CDUS of lower extremities deep vein, including thrombus, venous wall thickness, and venous flow velocity. Tumor size was taken from magnetic resonance imaging (MRI) or computed tomography (CT) scans. Duration of tumor symptoms was taken from medical records. The study was conducted at the Department of Radiology and the Orthopaedi and Traumatology Polyclinic of the Cipto Mangunkusumo National General Hospital (RSUPNCM) from August 2020 to March 2022. Results: There was 10% incidence of thrombus in 30 subjects. Subjects with thrombus tended to have larger tumor volume but it was not statistically significant. Conclusion: Tumor dimensions and volume in subjects with thrombus tend to be larger than those without thrombus. In patients with malignant MSK tumors, clinical and laboratory features that resemble DVT can be found, but not necessarily a thrombus, therefore CDUS is important for distinguishing the presence or absence of DVT.

Abstrak :
Latar Belakang: Lidokain, selain sebagai anestesia lokal klasik, juga berkembang penggunaannya secara sistemik untuk ajuvan anestesia. Salah satu manfaatnya ialah dalam neuroanestesi untuk relaksasi otak namun mekanisme kerjanya masih belum sepenuhnya diketahui. Penelitian ini bertujuan untuk mengevaluasi pengaruh lidokain sistemik terhadap cerebral blood flow (CBF) yang dinilai dengan mean flow velocity (MFV) arteri serebral media (MCA) bilateral menggunakan alat Transcranial Doppler (TCD). Metode: Metode penelitian ini menggunakan desain uji klinis acak tersamar ganda di Instalasi Bedah Pusat RSUPN dr. Cipto Mangunkusumo Jakarta, berlangsung pada bulan September-Desember 2023. Pada hari operasi, penilaian MFV MCA kanan dan kiri dilakukan menggunakan TCD pada tiga tahap waktu yang berbeda: sebelum anestesi, setelah anestesi, dan 1 jam setelah infus NaCl 0,9% pada kelompok kontrol atau infus lidokain pada kelompok uji. Analisis data dilakukan dengan menggunakan aplikasi SPSS versi 26. Hasil: Dalam penelitian ini, 34 subjek memenuhi kriteria inklusi dan dibagi menjadi kelompok kontrol (infus NaCl 0,9%) dan kelompok lidokain (bolus lidokain 1,5 mg/kg dan infus lidokain 1,5 mg/kg/jam). Demografi subjek menunjukkan proporsi laki-laki dan perempuan yang seimbang di kedua kelompok, serta tidak ada perbedaan signifikan dalam rerata usia. Hasil pengukuran MFV MCA kanan dan kiri sebelum dan setelah pembiusan umum tidak menunjukkan perbedaan signifikan. Setelah satu jam pemberian infus lidokain, terdapat perbedaan signifikan (p <0,001) antara rerata kelompok kontrol 69,63 (22,7-85,1) cm/detik dan rerata kelompok lidokain 44,07 (21,3-61,1) cm/detik pada MCA kanan. Hal serupa terjadi pada MFV MCA kiri, di mana perbedaan signifikan (p=0,001) antara rerata kelompok kontrol 60,3 (18,4-85,1) cm/detik dan rerata kelompok lidokain 48,27 (18,3-66,3) cm/detik. Simpulan: Nilai MFV MCA lebih rendah pada pasien yang menerima infus lidokain intraoperatif dibandingkan dengan plasebo dan berbeda signifikan secara statistik pada MCA kanan (p <0,001) dan MCA kiri (p=0,001). ......Introduction: Lidocaine, besides being a classical local anesthetic, has also evolved for systemic use in adjunct anesthesia. One of its benefits lies in neuroanesthesia for brain relaxation, although its mechanism of action is not fully understood. This study aims to evaluate the systemic effects of lidocaine on cerebral blood flow (CBF) assessed through the mean flow velocity (MFV) of bilateral middle cerebral arteries (MCA) using Transcranial Doppler (TCD). Methods: This research is a double-blind randomized clinical trial design at the Central Surgery Installation of RSUPN dr. Cipto Mangunkusumo Jakarta, conducted from September to December 2023. On the day of surgery, assessments of MFV in the right and left MCAs were performed using TCD at three different time points: before anesthesia, after anesthesia, and 1 hour after the infusion of 0.9% NaCl in the control group or lidocaine infusion in the experimental group. Data analysis was conducted using SPSS version 26. Results: In this study, 34 subjects met inclusion criteria and were divided into a control group (0.9% NaCl infusion) and a lidocaine group (1.5 mg/kg bolus followed by 1.5 mg/kg/h infusion). Subject demographics showed a balanced gender distribution with no significant age differences between the two groups. Measurements of MFV in the right and left MCAs before and after general anesthesia did not exhibit significant differences. However, one hour after lidocaine infusion, there were significant differences (p <0.001) between the mean control group values of 69.63 (22.7 - 85.1) cm/s and the lidocaine group values of 44.07 (21.3-61.1) cm/s in the right MCA. Similar findings occurred in the left MCA, with significant differences (p=0.001) between the mean control group values of 60.3 (18.4 - 85.1) cm/s and the lidocaine group values of 48.27 (18.3-66.3) cm/s. Conclusion: The MFV values in the MCA were significantly lower in patients receiving intraoperative lidocaine infusion compared to placebo, both in the right MCA (p <0.001) and the left MCA (p=0.001).

Abstrak :
Latar Belakang: Sindrom ovarium polikistik dan obesitas memperlihatkan dampak pada kemampuan endometrium untuk menerima hasil konsepsi. Penggunaan Ultrasonografi Doppler memiliki peran penting dalam pemeriksaan reseptivitas endometrium karena efisiensi dan prosedur non-traumatis. Tujuan dari penelitian ini adalah untuk menyelidiki efek modifikasi gaya hidup pada penerimaan endometrium wanita obesitas dengan sindrom ovarium polikistik menggunakan ultrasonografi. Metode: Penelitian observasional ini dilakukan di Rumah Sakit Umum Cipto Mangunkusumo Jakarta, Indonesia dari Agustus 2019 hingga Mei 2020. Total 32 subjek yang berpartisipasi dalam penelitian ini pada awalnya. Karena kasus loss to follow up, subjek akhir dikurangi menjadi 14 orang. Subyek pertama dievaluasi dengan USG trans-vaginal untuk melihat gambar endometrium, kemudian disarankan untuk mendapatkan konseling gizi oleh ahli gizi klinis dan kemudian ditindaklanjuti selama 6 bulan menggunakan ultrasonografi trans-vaginal. Hasil: Sebanyak 19 subjek menerima konseling gizi oleh spesialis Gizi Klinis. Tapi kemudian, hanya 14 subjek yang dievaluasi dengan Ultrasonografi. Ada beberapa hasil yang signifikan antara sebelum dan sesudah perawatan beberapa subjek seperti kalori, berat badan, indeks massa tubuh, lingkar pinggang (p<0,05) dan jenis zona vaskular, volume endometrium, indeks aliran vaskular dalam endometrium (p<0,05). Kesimpulan: Belum didapatkan korelasi yang signifikan antara perubahan antropometri dan asupan kalori harian dengan perubahan Zona Vaskular endometrium disebabkan tingginya angka loss to follow-up dan belum tekontrolnya asupan kalori harian dari setiap subjek.

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Background: Polycystic Ovarian Syndrome and obesity have shown an impact on endometrium ability to accept the results conception. The use of a Doppler Ultrasonography has an important role in the examination of endometrial receptivity due to efficiency and non traumatic procedure. The aim of this study is to investigate the effect of lifestyle modification on endometrial receptivity of obese women with polycystic Ovarian Syndrome using ultrasonography. Methods: This observational study was conducted at Cipto Mangunkusumo General Hospital Jakarta, Indonesia from August 2019 to May 2020. From a total of 32 subjects were participated in this study. Due to loss of follow up case, the final subject was decrease into 14 person. The subjects were firstly evaluated with the trans-vaginal ultrasound to see the picture of the endometrium, then advised to get nutrition counseling by Clinical nutritionist and then followed up for 6 months using trans- vaginal ultrasonography. Results: A total 19 subjects were received nutrition counseling by Clinical Nutritionist. But then, only 14 subjects were evaluated by Ultrasonography. There were several significant results between before and after treatment of some subjects such as calories, body weight, body mass index, waist circumference (p<0,05) and type of the vascular zone, endometrium volume, vascular flow index in endometrium (p<0,05). In this study, no significant results have been found on the correlation between dietary changes and changes of endometrial receptivity. Conclusion: No significant correlation has been found between changes in antropometrics and daily calorie intake with changes in endometrial vascular zones due to high loss to follow-up rates and uncontrolled daily caloric intake for each subject.