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Abstrak :
Tujuan penelitian ini untuk melihat karakteristik elektrofisiologi dan hasil ablasi frekuensi radio (AFR) pada flutter atrium (FLA) yang belum tersedia hingga saat ini di Indonesia. Tiga buah kateter elektroda multipolar dimasukkan perkutan ke dalam jantung lalu ditempatkan di sinus koronarius (SK), berkas His dan mengitari anulus trikuspid. Kateter ablasi 8 mm digunakan untuk AFR linier cavotrikuspid isthmus (CTI) pada FLA tipikal dan kebalikan tipikal. Blok bidireksional ditentukan atas dasar pemanjangan waktu konduksi dinding lateral bawah ke ostium SK dan sebaliknya lebih dari 90 mdet, dan/atau dengan cara pemacuan diferensial. Terdapat 27 subyek dengan 30 FLA terdokumentasi yang terdiri dari 19 tipikal, 5 tipikal terbalik dan 6 atipikal. Hanya 9 pasien yang tidak mempunyai penyakit jantung struktural. Rerata panjang siklus takikardia (PST) adalah 261,79 ± 42,84, 226,5 ± 41,23, dan 195,4 ± 9,19 mdet masing-masing untuk FLA tipikal, kebalikan tipikal dan atipikal (p = 0,016). Konduksi CTI menempati 60% dari PST atau rerata 153,0 ± 67,37 mdet. Aktivasi SK terbagi menjadi 3 jenis yaitu proksimal ke distal, distal ke proksimal dan fusi. AFR pada FLA tipikal dan tipikal terbalik sukses sebanyak 96 % dengan tingkat kekambuhan 4,5 % pada rerata masa pengamatan 13 ± 8 bulan. Pada populasi penelitian ini jenis FLA terbanyak adalah FLA tipikal. Kebanyakan subyek menderita penyakit jantung struktural. AFR sangat efektif menyembuhkan FLA tipikal dan kebalikan tipikal. (Med J Indones 2007; 16:151-8)

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This study aimed to elaborate the electrophysiology characteristics and radiofrequency ablation (RFA) results of atrial flutter (AFL) which has not been established in Indonesia. Three multipolar catheters were inserted percutaneously and positioned into coronary sinus (CS), His bundle area and around tricuspid annulus. Eight mm ablation catheter was used to make linear ablation at CTI of typical and reverse typical AFL. Bidirectional block was confirmed by conduction time prolongation of more than 90 msec from low lateral to CS ostium and vice versa, and/or by means of differential pacing. Thirty AFL from 27 patients comprised of 19 typical AFL, 5 reverse typical AFL and 6 atypical AFL enrolled the study. Mean tachycardia cycle length (TCL) were 261.8 ± 42.84, 226.5 ± 41.23, and 195.4 ± 9.19 msec, respectively (p = 0.016). CTI conduction time occupied up to 60% of TCL with mean conduction time of 153.0 ± 67.37 msec. CS activation distributed to three categories which comprised of proximal to distal, distal to proximal and fusion activation. Only nine of 27 patients had no structural heart disease. RFA of symptomatic typical and reverse typical AFL demonstrated 96% success and 4.5 % recurrence rate during 13 ± 8 months follow up. Typical AFL is the predominant type of AFL in our population. The majority of AFL cases suffered from structural heart disease. RFA was highly effective to cure typical and reverse typical AFL. (Med J Indones 2007; 16:151-8)

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The purpose of this reserach is to find out the influence of laser shooting to the ovaries stem of eye,ablation of crab's eye to the level of egg's maruty,the diameter of eggs and the number of eggs scylla serrata.....

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ABSTRAK
Pada saat ini, penyakit kanker telah menjadi salah satu masalah yang sulit diatasi. Penyakit ini tidak hanya sulit untuk disembuhkan, tetapi juga sulit untuk dideteksi dan dapat menyebabkan kematian. Untuk itu direkayasa metode terapi RF ablation untuk terapi kanker. Metode RF ablation merupakan sebuah metode minimally invasive dimana aplikator dimasukkan ke dalam tubuh untuk pemanasan local terapi sel kanker. Sel kanker tersebut yang terkena suhu lebih dari 60 ⁰C akan mengalami kehancuran seketika karena sel yang terpapar suhu lebih dari 60⁰C dalam waktu yang lama akan mengalami kehancuran. Untuk kesuksesan terapi, cakupan distribusi temperatur lokal yang sempurna pada sel kanker harus tercapai Skripsi ini bertujuan untuk mendapatkan aplikator bekerja pada frekuensi kerja biomedis 2,45 GHz dan zona ablasi yang menyelimuti seluruh bagian sel kanker. Simulasi dilakukan menggunakan phantom sederhana yang merepresentasikan struktur tubuh manusia dewasa beserta model hati dan sel kanker pada hati. Aplikator yang telah didesain kemudian difabrikasi, diukur dalam keadaan free space dan dengan phantom agar-agar serta hati sapi. Parameter yang diukur merupakan parameter S11 dimana diperoleh magnitude koefisien refleksi -17,6 dB pada 1685 MHz. Hasil pengukuran dengan phantom agar- agar didapat -25,3 dB pada 2,45 GHz. Sedangkan hasil pengukuran menggunakan phantom hati sapi didapat -14,25 dB pada 910 MHz.

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ABSTRACT
At this time, cancer has become one of the problems that are difficult to overcome. The disease is not only difficult to cure, but it is also difficult to detect and can cause death. For that reason, RF ablation treatment method was engineered to cure cancer. RF ablation method is a method in which the antenna applicator is inserted into the body to heat cancer cells. The cancer cells were exposed to temperature more than 60 ⁰C will experience instantaneous cell death because the cells are exposed to temperature of more than 60 ⁰C in a long time will suffer cell destruction. For the success of the treatment, the perfect temperatur distribution coverage on the cancer cells to be achieved. This final project purpose is to obtain applicator that operates at biomedical frequency 2.45 GHz and ablation zone that engulfed entire cancerous cell Simulations are performed using a simple phantom which represents the adult human body structure along with models of liver and liver cancer cells. The designed applicator then fabricated and measured in free space environment and agar-agar phantom also bovine liver phantom environment. Measured parameters is S11 parameter where the magnitude of reflection coefficient is-17.6 dB at 1685 MHz. Measurement result with agar-agar phantom is -25,3 dB at 2.45 GHz. Measurement results with bovine liver phantom is -14.25 dB at 910 MHz.

Abstrak :
Pendahuluan: Rabdomiosarkoma adalah high grade malignancy sekaligus sarkoma jaringan lunak tersering pada anak dan remaja. Limb salvage surgery LSS semakin luas dianut dan dipraktekkan sebagai prioritas oleh karena kemajuan kemoterapi dan radioterapi. Data demografi dan evaluasi tatalaksana itu beserta kaitannya dengan analisis kesintasan belum pernah ada di Indonesia. Metode: Desain penelitian ini adalah kohort retrospektif, yang dilakukan di Departemen Orthopaedi, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo, Jakarta, Indonesia. Pada Januari 2005-Desember 2016, 43 pasien rabdomiosarkoma ekstrimitas dan pelvis dianalisis secara demografi. Dari jumlah tersebut, 28 pasien menjalani tatalaksana dan dianalisis kesintasannya terkait berbagai faktor. Dari jumlah itu, 15 pasien dibagi menjadi dua kelompok salvage atau ablasi dan dianalisis luaran fungsionalnya setelah satu tahun pasca operasi dengan skor MSTS. Hasil: Distribusi umur menunjukkan kemaknaan terhadap jenis pleomorfik, yang hanya ditemukan pada dewasa p=0,035. Luaran fungsional kelompok salvage rerata = 13,4 secara bermakna p=0,005 lebih baik dibandingkan ablasi rerata = 22,23. Insiden metastasis secara bermakna menurunkan kesintasan p=0,034. Angka kesintasan adalah 3,53 dan median kesintasan adalah 14 bulan. Distribusi umur berupa kurva bimodal dengan insiden dekade awal dibentuk oleh tipe embrional dan diatas 45 tahun oleh tipe plemorfik. Simpulan: Fungsi ekstrimitas pasca salvage menunjang fungsi sehari-hari dan tidak terpengaruh morbiditas pasca operasi, serta tidak berpengaruh pada kesintasan juga rekurensi. Karenanya, prosedur itu menjadi prioritas dibanding ablasi. Pengananan awal agresif pada pencegahan metastasis dapat meningkatkan kesintasan. Modalitas kemoterapi multiagen, radioterapi, dan bedah memberikan kecenderungan hasil terbaik. ...... Introduction Introduction Rhabdomyosarcoma, classified as high grade sarcoma, comprises the most common soft tissue sarcoma in children and adolescent, in which the treatment has been advancing. Limb salvage surgery has been acknowledged and performed widely as the priority on local control of pelvic and extremity rhabdomyosarcoma, due to the advancement on radiotherapy and chemotherapy. The established data on patients demography and current treatments evaluation in Indonesia, are not available yet, especially in the concern of survival. Method: The study design is retrospective cohort, which was performed in Orthopaedics and Traumatology Department, Cipto Mangunkusumo National Primary Referral Hospital, Jakarta, Indonesia. From January 2005 to December 2016, 43 patients, diagnosed as extremity or pelvic rhabdomyosarcoma, were analyzed for demography. 28 patients of them, underwent treatment, and were analyzed for survival analysis. Subsequently, 15 patients of them were divided into two groups ablation and salvage , and analyzed for one year postoperative functional outcome in Musculoskeletal Tumour Society score. Result: Age distribution has association on pleomorphic type, which is only found on adults p 0,035. Functional outcome on salvage group mean 22.23 has better outcome p 0,005 result ablation group mean 13.4. Of all oncologic parameters, metastasis has association with worsening 5 years survival p 0,034. The 5 years survival rate is 3.53 and median survival is 14 months. Age distribution shows bimodal curve on incidence, which comprised from embryonal type on first decade and pleomorphic type after fourth decade. Conclusion: The extremity function after salvage procedure reassure daily life and had not influenced by postoperative morbidity, also has no association with survival and recurrence. Therefore, salvage procedure has become priority comparing to ablation. Early aggressive management on metastatic prevention may increase survival. Combination on multiagent chemotherapy, radiotherapy, and wide excision has the most favorable survival.

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Latar Belakang: Fibrilasi Atrium (FA) merupakan salah satu kelainan terbanyak di bidang irama jantung. Pasien FA memiliki resiko stroke dan gagal jantung lebih tinggi dari pasien tanpa FA. Prevalensi FA berkisar 1-2% di dunia dan di Rumah sakit Jantung dan Pembuluh darah Harapan Kita berkisar 9,8%. Salah satu strategi pengobatan dengan mengonversi irama kembali menjadi sinus baik dengan medikamentosa atau elektrikal. Strategi pengobatan elektrikal dengan kateter radiofrekuensi ablasi merupakan opsi dengan keberhasilan cukup tinggi. Angka Rekurensi FA jangka panjang masih cukup tinggi berkisar 40-60%. Beberapa faktor telah diketahui dapat mempengaruhi terjadinya rekurensi fibrilasi atrium jangka panjang. Faktor-faktor tersebut diharapkan dapat digunakan untuk dibuat suatu sistem skor prediksi rekurensi Fibrilasi atrium jangka panjang. Tujuan: Membuat sistem skor dapat memprediksi rekurensi FA jangka panjang. Mendapatkan angka kejadian rekurensi FA jangka panjang. Metode: Penelitian ini merupakan studi kohort retrospektif yang dilakukan di Rumah Sakit Penyakit Jantung dan Pembuluh darah Harapan Kita. Penelitian ini memantau titik awal yaitu dilakukan kateter ablasi radiofrekuensi sampai dengan pemantauan 12 bulan atau terjadi kejadian rekurensi FA dalam periode pemantauan. Di lakukan uji bivariate semua variabel independen dan perancu, dilanjutkan multivariat, analisis kurva Kaplan-Meier pada variabel yang lolos dalam uji multivariate, dan dilanjutkaan pembuatan sistem skoring. Hasil: Penelitian ini mendapatkan angka rekurensi FA jangka panjang 48,5%.Tiga variabel yang lolos dalam uji multivariat yaitu rekurensi awal FA (HR 3,32; IK: 1,82-6,04), jenis FA (HR 2,17; IK 1,02-3,87), DAKi (HR 1,83; IK 1,21-3,26). Analisa Kaplan-Meier didapatkan penurunan angka bebas rekurensi FA pada rekurensi awal FA, jenis FA persisten, DAKi ≥40,5 mm (43%, 32%,30%). Nilai kemungkinan rekurensi FA masing-masing skor yaitu 0: 17%, 1: 38%, 2: 58%, 3: 76%, 4: 90%. Nilai Area under curve (AUC) dari total skor adalah 0,79 dengan nilai kalibrasi yaitu 0,138. Kesimpulan: Sistem skoring KHALID (reKurensi jangka panjang Hasil ablasi Atrial fibriLasi InDonesia)dapat dipakai untuk memprediksi rekurensi FA jangka panjang pada pasien yang menjalani fibrilasi atrium nonvalvular yang menjalani kateter radiofrekuensi ablasi. Angka rekurensi FA jangka panjang yaitu 48,5%.

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Background: Atrial Fibrillation (AF) is one of the most abnormalities in the field of arrhythmia. AF patients had a higher risk of stroke and heart failure than patients without AF. Prevalence of AF ranges from 1-2% in the world and in the Cardiovascular Harapan Kita Hospital range from 9.8%. One of the treatment strategies is converting the rhytm back into a sinus either with medical or electriacal. The strategy of electrical treatment with catheter ablation radiofrequency is a option with considerable success. Long-term recurrence of AF are still quite high ranging from 40-60%. Several factors have been known to affect long term recurrence of AF. These factors are expected to be used to establish a system of score to predict of long term AF recurrence. Objective: To create a scoring system can predict long-term AF recurrence. To get data of prevalence longterm AF recurrence. Method: This is a retrospective cohort study conducted in Cardiovascular Harapan Kita Hospital. This study monitors the starting point of Radiofrekuency ablation catheter up to 12 months monitoring or recurrence of AF event within the monitoring period. In doing bivariate test all independent and confounding variables, followrd by multivariate, Kaplan-Meier curve analysis on the variables that passed in multivariate test, followed by making scoring system. Results: This Study obtained a prevalence of long-term recurrence AF of 48.5%. Three variables that passed in multivariate test were early recurrence (HR 3.32;CI 1,82-6,04), FA type (HR 2.17;CI 1.02-3.87), Left atrium diameter (HR 1.83; CI 1.21-3.26). Kaplan-Meier curve analysis obtained a decrease in free of AF recurrence numbers in early recurrence, persisten AF type, left Atrium diameter ≥ 40.5 mm (43%, 32%, 30%). The probabilities to get AF recurrence based on score is 0: 17%, 1: 38%, 2: 58%, 3: 76%, 4: 90%. The value of Area under Curve (AUC) of total score is 0.79 with a calibration valure of 0.138. Conclusion: The KHALID scoring system can be used to predict long term of AF recurrence in patient with nonvalvular AF undergoing radiofrequency ablation catheter. The Prevalence of long-term of AF recurrence is 48.5%.

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Latar belakang: Chronic venous insufficiency (CVI) menyebabkan penurunan kualitas hidup secara signifikan dan kehilangan produktivitas. Salah satu modalitas tatalaksana CVI adalah endovenous laser ablation (EVLA). Namun, EVLA dapat menyebabkan komplikasi umum seperti nyeri, lebam, trombosis vena, maupun perdarahan. Terapi kompresi dapat membantu pemulihan pasca prosedur EVLA dengan mengurangi nyeri dan mempercepat pemulihan. Namun, hingga saat ini studi yang membandingkan keberhasilan penggunaan stoking kompresi dibandingkan stoking kompresi ditambah compression pad masih belum banyak dilakukan, terutama di Indonesia. Metode: Studi potong lintang ini dilakukan di Rumah Sakit Cipto Mangunkusumo Jakarta dan rumah sakit jejaring pada bulan Januari 2023 – Juni 2023. Analisis data menggunakan SPSS 20.0 secara univariat dan bivariat. Hasil: Sebanyak 52 pasien menjadi subjek penelitian, 27 pasien (51,9%) mendapatkan stoking kompresi ditambah compression pad sedangkan 25 pasien (48,1%) hanya stoking kompresi. Tingkat oklusi vena antara penggunaan stoking kompresi ditambah pad dengan stoking kompresi tidak signifikan (p=1,00). Selisih skor VCSS antara kedua kelompok subjek tidak signifikan (p=0,707). Durasi operasi pada kelompok stoking kompresi lebih singkat secara signifikan dibandingkan stoking kompresi ditambah compression pad (p<0,001). Lama pemulihan antara kedua kelompok yang berkorelasi signifikan (p=0,075). Diameter vena saphena magna (GSV) berhubungan signifikan (p=0,030) dengan oklusi vena dimana diameter GSV yang lebih besar atau ≥10 mm memiliki risiko kegagalan terapi yang lebih tinggi. Kesimpulan: Pada penelitian ini, ditemukan bahwa durasi operasi secara signifikan lebih singkat pada kelompok pasien yang menggunakan stoking kompresi. Tidak terdapat perbedaan signifikan dalam hal keberhasilan oklusi vena, selisih skor VCSS, dan lama pemulihan antara penggunaan stoking kompresi atau ditambah compression pad. ......Background: Chronic venous insufficiency (CVI) causes a significant reduction in quality of life and loss of productivity. One of the treatment modalities for CVI is endovenous laser ablation (EVLA). However, EVLA can cause general complications such as pain, bruising, venous thrombosis, or bleeding. Compression therapy can help recovery after the EVLA procedure by reducing pain and improve healing. However, until now there have not been many studies comparing the success of using compression stockings compared to compression stockings plus compression pads , especially in Indonesia. Methods: This cross-sectional study was conducted at Cipto Mangunkusumo Hospital Jakarta and network hospitals in January 2023 – June 2023. Data analysis used SPSS 20.0 univariately and bivariately. Results: A total of 52 patients were research subjects, 27 patients (51.9%) received compression stockings plus a compression pad while 25 patients (48.1%) only received compression stockings. The occlusion rate between the use of compression stockings plus pads and compression stockings was not significant (p=1.00). The difference in VCSS scores between the two groups of subjects was not significant (p=0.707). The duration of surgery in the compression stockings group was significantly shorter than compression stockings plus compression pads (p<0.001). The recovery time between the two groups was significantly correlated (p=0.075). The diameter of the great saphenous vein (GSV) was significantly related (p=0.030) to the occlusion rate, where a larger GSV diameter or ≥10 mm had a higher risk of therapy failure. Conclusion: In this study, it was found that the duration of surgery was significantly shorter in the group of patients who used compression stockings. There was no significant difference in the success of vein occlusion, the difference in VCSS scores, and the recovery time between the use of compression stockings or adding a compression pad

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Ablasi AV junction terbukti efektif pada pasien atrial fibrillasi (AF) yang refrakter dengan isolasi vena pulmonalis maupun antiarimia.

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Ablasi A V junction terbukti efektif pada pasien atrial flbrilasi (AF) yang refrakter dengan isolasi vena pulmonalis inaupun antiaritmia. Akan tetapi pada hampir 15% kasus ablasi AV junction dengan teknik konvensional (sisi-kanan) gagal. Penelitian ini berinjuan mempelajari karakterislik potensial berkas His pada ablasi AV junction secara konvensional inaupun dengan teknik sisi-kiri. Dua puluh pasien AF yang simtomatik dan refrakter terhadap antiarimia (rerata umur 60,539,28 tahun, 11 wanita) dilakukan ablasi AV junction dengan teknik konvensional. Bila 10 kali aplikasi energi frekuensi-radio tidak dapat menyebabkan blok A V total, maka ablasi dilakukan melalui sisi-kiri. Amplitud berkas His yang terekam pada tempat ablasi dianalisa. Seluruh pasien berhasil diablasi, 17 dengan cam konvensional dan 3 pasien degan teknik sisi-kiri setelah teknik konvensional gagal. Amplitud berkas His pada sisi-kiri lebih besar daripada sisi-kanan yang berkesesuaian (16,0 ±4,99 mm vs. 6,9 ±4,02 mm, p = 0,001, 95% IK -14,0 to -4,3). Dengan nilai titikpotong amplitude berkas His sisi-kanan > 4,87 mm didapatkan sensitifitas 8!.3% dan spesiftsitas 53,8% untuk keberhasilan ablasi pada sisi yang bersangkutan. Teknik sisi-kiri pada ablasi AV junction efektif bila teknik konvensional gagal. Pada pasien dengan amplitud berkas His sisi-kanan yang rendah (< 4, 87 mm) dianjurkan untuk ablasi dengan teknik sisi-kiri untuk menghindari pemberian energi frekuensi-radio yang tidak perlu. (MedJ Indones 2006; 15:109-14)

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AV junction ablation has been proven effective to treat symptomatic atrial fibrillation refractory to antiarrhythmias or fail of pulmonary vein isolation. However, about 15% of conventional right-sided approach AV junction ablation failed to produce complete heart block. This study aimed to characterize His bundle potential at ablation site during conventional or left-sided approach of AV junction ablation. Twenty symptomatic AF patient (age of 60.5 ±9.28 and 11 are females) underwent conventional AV junction ablation. If 10 applications of radiofrequency energy are failed, then the ablation was performed by left-sided approach. Seventeen patients are successfully ablated by conventional approach. In 3 patients, conventional was failed but successfully ablated bv left-sided approach. The His bundle amplitude at ablation site was significantly larger in left-sided than correspondence right-sided (16.0 ±4.99 mm vs. 6.9 ±4.02 mm respectively, p = 0.001, 95% Cl -14.0 to -4.3). ROC analysis of His bundle potential amplitude recorded from right-sided revealed that cut off point of > 4.87 mm given the sensitivity of 81.3% and specificity of 53.8% for successful right-sided approach of AV junction ablation. In case of failed conventional approach, the left-sided approach is effective for AV junction ablation. An early switch to the left-sided approach may avoid multiple RF applications in patients with a low amplitude His-bundle potential (< 4.87 mm). (MedJIndones 2006; 15:109-14)

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ASBTRACT
Purpose: Very few studies have investigated the efficacy of ganglionated plexus ablation during the conventional maze procedure. In this study, we sought to evaluate its additive effect in reducing recurrent atrial fibrillation after concomitant maze surgery. Methods: A retrospective study was conducted of 79 patients who underwent Cox maze IV concomitantly with open-heart surgery with (GP group) or without (Maze group) ganglionated plexus mapping. All active ganglionated plexuses were ablated. The two groups were compared and their follow-up data were analyzed. Results: Active ganglionated plexuses were found in 81% of patients who underwent ganglionated plexus mapping. The rates of freedom from atrial fibrillation at 1 year in the GP and Maze groups were 77 and 75%, respectively. The cumulative freedom from atrial fibrillation at follow-up (27.7 ± 17.3 months) was comparable in the two groups (p = 0.427). A multivariate analysis revealed that persistent atrial fibrillation for more than 90 months was an independent predictor of recurrent atrial fibrillation. Conclusion: Ganglionated plexus ablation with Cox maze IV did not reduce the incidence of recurrent atrial fibrillation in comparison to Maze alone.