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ABSTRAK
LatarBelakang: Menentukan prediktor yang paling akurat dalam menilai sulitvisualisasi laring(DVL) dengan menggunakan skor mallampati (MMT) , Jarak sternomental(SMD) dan jarak buka mulut(IIG), baik secara tunggal maupun dalam kombinasi. Metode: Sebanyak 283 pasien ikut serta dalam penelitian dan dievaluasi kemungkinan mereka mengalami sulit visualisasi laring. Kesulitan visualisasi laring dinilai dengan laringoskopi langsung berdasarkan klasifikasi Cormack Lehane (CL). Skor CL derajat III dan IV ditentukan sebagai sulit visualisasi laring. Kondisi ini juga diperkirakan dengan menggunakan prediktor jalan napas, yaitu MMT, SMD dan IIG. Titik potong untuk masing-masing prediktor adalah skor Mallampati III dan IV, ≤ 12,5 cm, dan ≤ 3 cm. Selanjutnya, ditentukan nilai sensitivitas, spesifisitas, nilai prediksi positif dan negatif serta nilai area di bawah kurva (AUC) dari setiap prediktor tersebut, baik secara tunggal maupun dalam kombinasi. Prediktor independen DVL ditentukan dengan melakukan analisis regresi logistik. Hasil: Sulit visualisasi laring ditemukan pada 29 (10,2%) subyek penelitian. Nilai sensitivitas, spesifisitas, prediksi positif dan luas AUC prediktor jalan napas adalah: MMT (20,8%; 99,7%; 71,4%; 68%), SMD (72,4%; 97,2%; 75%; 88%), dan IIG (41,4%; 99,4%; 85,7%; 73%). Penelitian kami menunjukkan bahwa kombinasi prediktor terbaik adalah gabungan prediktor SMD + IIG. Kombinasi tiga prediktor MMT + SMD + IIG ternyata menunjukkan nilai AUC yang sama dengan kombinasi dua prediktor SMD + IIG. Kesimpulan: Penelitian ini menganjurkan gabungan prediktor IIG + SMD sebagai model diagnostik yang optimal untuk memperkirakan sulit visualisasi laring pada populasi ras Melayu di Indonesia.

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ABSTRAK
Background: To determine the most accurate predictor in evaluating difficult visualization of larynx (DVL) using indicators of modified mallampati test (MMT), sternomental distance (SMD) and inter incisor gap (IIG), either in isolation or in combination. Methods: Two hundred eighty three patients were participated in the study and evaluated for their possibility of having DVL. The difficulty of larynx visualization was evaluated using direct laryngoscopy based on grading of the Cormack and Lehane (CL) classification. The CL grades III and IV were considered as difficult visualization of larynx. DVL was also predicted using the airway predictors of MMT, SMD and IIG. The cut-off points for the airway predictors were Mallampati III and IV; ≤ 12,5 cm, and ≤ 3 cm, respectively. Moreover, sensitivity, specificity, positive and negative predictive value and area under the curve (AUC) of each predictor were determined, either in isolation or in combination. Independent predictors of DVL were determined using logistic regression analysis. Results: Difficulty to visualize the larynx was found in 29 (10.2%) subjects. The sensitivity, specificity, positive predictive value and AUC for the airway predictors were: MMT (20.8%; 99.7%; 71.4%; 68%), SMD (72.4%; 97.2%; 75%; 88%), and IIG (41.4%; 99.4%; 85.7%; 73%). The best combination of predictors was SMD + IIG with an AUC of 90.2%. Triple combination of MMT + SMD + IIG showed the same value of AUC with combination of two predictors, SMD + IIG. Conclusion: This study suggests the combination of IIG + SMD predictors as the optimal diagnostic model to predict DVL in a Malay race population in Indonesia.

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Latar Belakang: Penelitian yang menghubungkan parameter kraniofasial dengan kesulitan visualisasi laring banyak dilakukan, namun tidak satu pun digunakan secara baku dalam pemeriksaan praoperatif pasien anak. Penelitian serupa pada ras Melayu baru dilakukan satu kali dan tidak menentukan parameter yang paling berkorelasi dengan kesulitan visualisasi laring. Metodologi: Penelitian ini merupakan penelitian prospektif. Pengumpulan data dilakukan secara konsekutif pada 295 pasien anak 1-3 tahun yang akan menjalani anestesia umum. Dilakukan pengukuran jarak tepi bawah bibir ke ujung mentum, jarak tragus telinga ke sudut mulut dan jarak mentohioid. Tingkat kesulitan visualisasi laring menggunakan klasifikasi skor Cormack-Lehane dengan kategori mudah dan sulit visualisasi laring. Dilakukan analisis data untuk mencari parameter yang paling tepat untuk memprediksi kesulitan visualisasi laring. Hasil: Kesulitan visualisasi laring (Cormack-lehane III dan IV) ditemukan sebesar 8.1%. Analisis multivariat dengan variabel bebas skala numerik menunjukkan tidak ada parameter yang berkorelasi dengan kesulitan visualisasi laring (p>0.05) sedangkan berdasarkan variabel bebas berskala kategorik didapatkan jarak tragus telinga ke sudut mulut memiliki hubungan bermakna dengan kesulitan visualisasi laring (p=0.013), namun hasil ini secara klinis tidak bermakna. Kesimpulan: Parameter kraniofasial tidak dapat memprediksi kesulitan visualisasi laring anak ras Melayu usia 1-3 tahun. Harus dicari parameterparameter lain pada anak ras Melayu yang lebih baik memprediksi kesulitan visualisasi laring.

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ABSTRACT
Background: Many research have been done to observe correlation between craniofacial parameters with difficulty of larynx visualization, but none of them are used as a gold standard for preoperative examination in children patients. A similar research in Malay race children has ever done but it did not determine which parameters that most correlated with difficulty of larynx visualization. Methodology: In a prospective study, data collection was performed consecutively in 295 pediatric patients 1-3 years whose received general anesthesia. Distance from edges lower lip to mental tip, ear tragus to the mouth angle and mentohioid are measured in this study. Difficulty level of larynx visualization is using Cormack-Lehane scores and categorized into easy and difficult larynx visualization. Data analysis was performed to find the most appropiate parameters which can predict difficulty of larynx visualization. Results: Difficulty of larynx visualization (Cormack-Lehane III and IV) was found as many as 8.1%. Multivariat analysis with numeric scale as independent variable show no parameter correlated with the difficulty of larynx visualization (p> 0.05). Multivariat analysis with categoric scale as independent variable obtained only distance from ear tragus to the mouth angle which has significant relationship (p = 0.013), but these results is not clinically significant. Conclusion: Craniofacial parameters can not be used to predict difficulty of larynx visualization in Malay race children 1-3 years. Research using other better parameters should be done to predict difficulty of larynx visualization.

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Kanker Iaring adalah suatu ienis kanker yang menyerang pada bagian pangkal tenggorok si penderitanya. Dampak dari kanker Iaring tersebut adalah tidak bisa berbicara dan terdapat lubang pada lehemya akibat operasi pengangkatan tumor pada laring. Tidak bersuara membuat pasien sulit untuk berkomunikasi, sehingga dapat menimbuikan perasaan iidak berguna, cepat marsh, dan menurunnya rasa percaya diri (Smee & Bridger, 1994). Adanya dampak tersebut membuat seorang penderita kanker laring harus menghadapi masa sulit dalam kehidupannya dan tidak sedikit diantara mereka yang menga1ami keterpurukan. Penderita kanker laring harus melewali masa sullt dan awal diagnosis hingga kembali bisa bersuara. Butuh perjuangan ketika mereka hams melewati masa sulit tersebut. Perjuangan melawan penderitaannya diperlukan agar mereka hangkit kembali dan menjalani kehidupan yang lebih baik. Kebangkilan dari keadaan yang tidak menguntungkan disebut dengan resiliensi (Siebert, 2005). Penelitian ini berlujuan untuk menggali bagaimana seorang pasien kanker Iaring dapat bangkit dari kondisi yang tidak menguntungkan dan hal-hal apa saja yang mereka lakukan agar bisa beradaptasl dengan hilangnya pita suara akibat operasi lafingektomi. Penelitian ini menggunakan melode kuaiitatif dengan rnelibalkan 2 partisipan bemsia 39 dan 59 tahun dan dengan pengumpulan data melalui wawancara. Hasil penelitian menunjukkan bahwa kedua partislpan memiliki tujuh karakteristik resiliensi dalam dirinya, dimana ketujuh karaktenstik tersebut mereka gunakan untuk mangatasi semua permasalahan yang berhubungan dengan kanker larngnya. Analisa hasil menunjukkan bahwa pada subjek pertama ditemukan karakteristik insight, kemandirian, hubungan, inisiatif, kreatif dan moralitas sangat berperan besar dalam dirinya. Untuk karakteristik humor tidak ditemukan pada subjek pertama. Sedangkan untuk subjek kedua ditemukan ketujuh karakteristik tersebut dalam dirinya. ......Larynx cancer refers to specific cancer that attacking throat areas. The adverse effects of this cancer for the patient including loosing their ability to speak and there is a hole in the patient's neck as a part of tumor’s surgery. The loosing of one's ability to speak makes the patient facing hard to communicate. This situation arising feeling of worthless, irritable, and decreasing self confident (Smee & Bridger, 1994). Furthermore, those adverse effects makes the larynx cancer patient facing hard situation in their life. In a few cases, they often feel that their life had ruined. Person who suffering from larynx cancer has through hard situation from the first they get the diagnose until they can get back their ability to speak. To handling with the hard situation, the patient should striving for all the struggle. The patient's striving against their suffering is needed to get back their normal lives. The bounce back from the adverse situation is called resiliency (Siebert, 2005). The purpose of this study are to find out how the patient can bounce back from the adverse situation and what they do to adapt the situation that differ from their past lives including loosing of their ability to speak. This study using qualitative approach on two subject (age 39 and 59) by interviews and observations. The result shows that both subject has seven resl|ient’s characteristics. Also, both of the subject uses that characteristic to handling all the problems that related to their larynx cancer. The analysis result found that in the first subject, his insight, independency, relation, creativity. and morality characteristics has a major contribution to his lives. Furthermore, the humor characteristics did not found in the first subject. While, inthe second subject has all the characteristics in his lives.

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Mual dan muntah akibat kemoterapi merupakan salah satu efek samping kemoterapi yang paling sering terjadi dan terbukti secara signifikan menurunkan kemampuan pasien dalam melakukan aktifiyas sehari-hari, beresiko menimbulkan komplikasi fisik seperti malnutrisi dan dapat mempengaruhi kesediaan pasien menyelesaikan pengobatan primer kanker. Tujuan penerapan EBN ini adalah menilai efektifitas posisi semi fowler m mengurangi mual dan muntah akibat kemoterapi pada pasien kanker, dan menemukan berbagai kelebihan dan kekurangan posisi semi fowler dalam mengurangi mual dan muntah akibat kemoterapi. Hasil penelusuran database didapatkan satu jurnal utama yang dijadikan acuan penanganan mual muntah akibat kemoterapi. Posisi semifowler diberikan selama 3-4 jam dimulai saat kemoterapi dimulai. Skala mual muntah diukur saat kemoterapi dimulai dan setiap 3 jam setelah kemoterapi diberikan sampai dengan 24 jam dengan menggunakan VAS dan catatan harian muntah pasien. 17 pasien dilibatkan dalam penerapan EBN ini. Hasil penerapan EBN ini menunjukkan peningkatan rata-rata keparahan mual dan muntah mulai jam ke 3 dan mencapai puncaknya pada jam ke 18, namun selanjutnya mulai terjadi penurunan keparahan mual dan muntah, demikian juga dengan rata-rata frekuensi mual dan muntah, terjadi peningkatan rata-rata frekuensi mual dan muntah pada jam ke 18 dan selanjutnya mulai terjadi penurunan rata-rata frekuensi mual dan muntah. Berdasarkan hasil penerapan EBN ini menunjukkan posisi semi fowler dapat diterapkan dalam menurunkan keparahan mual dan muntah pada pasien kemoterapi. ......Chemotherapy-induced nausea and vomiting (CINV) is one of the most common side effects of chemotherapy and has been shown to significantly reduce the patient's ability to carry out daily activities, at risk of causing physical complications such as malnutrition and can affect the patient's willingness to complete primary cancer treatment. The aim of the EBN implementation is to assess the effectiveness of semi fowler's position to reduce chemotherapy nausea and vomiting in cancer patients, and find various advantages and disadvantages of semi fowler position in reducing nausea and vomiting due to chemotherapy. The search results of the database found that one main journal was used as a reference for handling nausea and vomiting due to chemotherapy. The semifowler position is given for 3-4 hours starting when chemotherapy starts. The scale of nausea vomiting was measured when chemotherapy was started and every 3 hours after chemotherapy was given up to 24 hours using VAS and the patient's vomiting diary. 17 patients were involved in implementing the EBN. The results of the EBN implementation showed an increase in the severity of nausea and vomiting starting at 3 o'clock and reaching its peak at 18 o'clock, but subsequently it began to decrease the severity of nausea and vomiting, as well as the average frequency of nausea and vomiting. the average frequency of nausea and vomiting at the 18th hour and subsequently began to decrease the average frequency of nausea and vomiting. Based on the results of the EBN application, the semi fowler position was effective in reducing the severity of nausea and vomiting in chemotherapy patients.

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Indonesian Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV: 51-56 An important phase in endodontic treatment is the irrigation of the root canal system. Desirable function of irrigation are antimicrobial activity, dissolution of necrotic tissue and nontoxicity to the periradicular tissue. Toxicity of NaOCl solution on vital tissue is still controversial. Severe compilations may occur if this solution is inadvertently exposed to the oral mucosa, and it is very hazardous. The purpose of this paper is to caution dentists on the hazards of using NaOCl irrigation in endodontic treatment. A case is presented in which 2.5% NaOCL solution was accidentally streaming into patient's throat because the irrigating needle was not securely attached to the syringe, with the result that the patient had difficulty in breathing. The patient was promptly taken to a pulmonologist, internist, and ENT. The patient was given dexamethasone 10 mg iv injection, delladryl 1cc iv, and nebulizer with 1 ampoule of steroid, 1 ampoule of ventolin and 5cc NaCl 3x within 24 hours, and after 24 hours the condition was increased. From this case it is concluded that the 2.5% NaOCl solution is very alkaline and irritating resulting in edema of the larynx and plugging up of the respiratory system. Clinicians need to be cautious in using NaOCl solution to avoid_endangering the patient's life.