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"ABSTRAKSalah satu komplikasi tersering PCNL adalah perdarahan. Penelitian ini bertujuan mengidentifikasi faktor prediktor jumlah total perdarahan PCNL, dan mengevaluasi pola transfusi darah. PCNL dilakukan acak oleh dua konsultan endourologi dan dianalisa prospektif. Pasien dewasa dengan batu ginjal pielum > 20 mm, kaliks inferior >10 mm, atau staghorn dijadikan sampel. Pasien dengan koagulopati, pengobatan antikoagulan, atau dilakukan konversi operasi terbuka dieksklusi. Pemeriksaan darah lengkap dilakukan pada awal dan 12, 24, 36, 72 jam paska-operasi. Faktor-faktor seperti stone burden, jenis kelamin, luas permukaan tubuh, perubahan kadar hematokrit dan jumlah transfusi darah dianalisa regresi untuk mendapatkan prediktor total blood loss (TBL). Didapatkan rerata TBL 560,92±428,43 ml dari total 85 pasien. Stone burden merupakan faktor paling berpengaruh terhadap TBL (p=0.037). Kebutuhan transfusi darah diprediksi dengan menghitung TBL (ml) = -153,379 + 0,229 stone burden (mm2) + 0,203 baseline serum hematokrit (%). Sebanyak 87,1% pasien tidak menerima transfusi peri-operatif, 3,5% menerima transfusi intra-operatif, 7,1% menerima transfusi post-operatif, 2,3% menerima transfusi intra dan post-operatif; sehingga menghasilkan cross-matched transfusion ratio 7,72. Rerata tranfusi darah peri-operatif 356,00±145,88 ml. Stone burden menjadi faktor prediktif paling berpengaruh terhadap jumlah perdarahan. Jumlah darah yang ditransfusikan dan dilakukan cross-matched ditemukan tinggi. Formula yang kami usulkan dapat mengurangi kejadian transfusi yang tidak dibutuhkan.

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ABSTRACTThe most common complication of PCNL is bleeding. We aimed to identify predictive factors of PCNL blood loss and evaluate transfusion practice. A prospective study was randomly performed by two consultants of endo-urology. Adults with kidney stones in pelvic >20mm, inferior calyx >10mm or staghorn were included; those with coagulopathy, under anti-coagulant treatment or open conversion were excluded. Full blood count was taken at baseline and during 12, 24, 36, 72-hours post-operatively. Factors such as stone burden, sex, body surface area, hematocrit level shifting and amount of blood transfused were analyzed statistically using regression to identify predictive factors of total blood loss (TBL). Mean TBL was 560.92±428.43 ml from 85 patients enrolled. Our results revealed that TBL (ml): -153.379 + 0.229xstone burden (mm2) + 0.203xbaseline serum hematocrit (%); considerably predicted the need for blood transfusion. Amount of 87.1% patients did not receive perioperative transfusion, 3.5% received intra-operative transfusion, 7.1% post-operative, 2.3% both intra and post-operative, giving a cross-matched transfusion ratio 7.72. Mean peri-operative blood transfused was 356.00±145.88 ml. Stone burden was the most influential PCNL blood loss predictive factor. Amount of blood transfused and cross-matched was relatively high. An appropriate blood order using our equation would reduce any unnecessary transfusions.;;;;"

"Telah dilakukan penelitian samar ganda acak untuk menilai manfaat pemberian Asam Traneksamat pada 54 penderita hemoroid interna yang baru berdarah. Umur, kelamin, berat badan, tinggi badan, beratnya hemoroid serta lamanya onset perdarahan telah dibuat sebanding pada kedua kelompok. Efek hemostatik berupa berhentinya perdarahan didapatkan pada 100% (23/23) kelompok Asam Traneksamat pada hemoroid grade 2 sementara hanya 78.26% (18/23) pada kelompok plasebo. Setelah obsevasi 3 hari perdarahan berhenti lebih awal pada kelompok Asam Traneksamat dan secara statistik bermakna. Sejak hari ke empat kedua kelompok berbeda dalam hal perdarahan ulang. Pada kelompok plasebo rerata median perdarahan ulang setelah 36 hari, sementara kelompok Asam Traneksamat tidak pernah mencapai nilai median tertentu sampai akhir observasi. Kesimpulan: Asam Traneksamat efektif untuk menghentikan perdarahan pada hemoroid berdarah, dan mencegah perdarahan ulang.

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Double blind randomized placebo controlled trial was conducted to evaluate the efficacy of Tranexamic acid in 54 patients with recent hemorrhoid bleeding. Age, gender, body weight, height, grade of hemorrhoid, time of onset of recent bleeding were comparable between two groups. Analysis of haemostatic effect or stop bleeding as an immediate outcome of this study revealed that in the grade 2 patients, 23/23 (100%) of tranexamic group and 18/23(78.26%) of placebo group the bleeding stop. After 3 days of observation, there was statistically significant different for the rate of stop bleeding as well as at the end of observation. Bleeding stop earlier in the Tranexamic group with median 4 days (3-5 days), compare to placebo, median 11(9.55-12.45). Analysis of recurrent bleeding as an outcome of this study revealed that in the placebo group 9/18(50%) of grade 2 patients and all grade 3 (100%)patients suffered from recurrent bleeding. Since the days 4, both group have significant different time for recurrent bleeding and at the end of observation, cumulative probability of free of bleeding between two groups significantly different. Median still stop bleeding in the placebo group was 36 days, and the tranexamic group never reaches the median until the end of observation. Conclusion: tranexamic acid was an effective drug to stop recent hemorrhoid bleeding and prevent further recurrent bleeding, significantly better than placebo."

"Latar Belakang. Perdarahan saluran cerna bagian atas (SCBA) masih menjadi masalah di Indonesia. Penanganan yang tepat serta identifikasi faktor-faktor yang dapat memengaruhi lamanya perawatan dapat mengurangi pembiayaan. Di Indonesia belum ada studi secara terkait faktor-faktor yang memengaruhi lamanya perawatan pasien dengan perdarahan SCBA.Tujuan.Mengetahui faktor-faktor apa saja yang memengaruhi lamanya perawatan pasien dengan perdarahan SCBA. Metode. Desain penelitian kohort retrospektif dilakukanpada yang datang dengan perdarahan SCBA yang berobat di Rumah Sakit Cipto Mangunkusumo. Pengambilan sampel secara konsekutif dan dilakukan analisis bivariat menggunakan uji Mann Whitney, hasil yang signifikan dilanjutkan analisis multivariat regresi multiple linier.Hasil. Penelitian melibatkan 133 subjek dengan rerata usia subjek 51 tahun (minimal 20 tahun, maksimal 83 tahun), subyek penelitian 57,1% subjek berjenis kelamin laki-laki. Analisis bivariat Endoskopi kurang dari 24 jam, Hemodinamik subyek, infeksi, gagal jantung, dan keganasan didapatkan memengaruhi lamanya perawatan pada pasien perdarahan SCBA. Analisis multivariat mendapatkan keganasan, hemodinamik, infeksi dan lama tunggu endoskopi merupakan variabel yang paling berpengaruh dengan R square: 0,374. Kesimpulan. Endoskopi lebih dari 24 jam, hemodinamik subyek, infeksi selama perawatan, gagal jantung dan keganasan merupakan faktor-faktor yang memengaruhi lamanya perawatan pasien dengan perdarhan SCBA.

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ABSTRACTBackground. Upper Gastrointestinal bleeding are prevalent cause of hospitalization. Risk factor identification of length of stay can minimize the cost. In Indonesia, there is no specific study about risk factor identification that prolong length of stay in upper Gastrointestinal bleeding patient. Objectives. To identification factors that influence length of stay patient with upper gastrointestinal bleedingMethods. This is a retrospective cohort study, analyzing medical record upper gastrointestinal bleeding patient in Cipto Mangunkusumo Hospital. Consecutive sampling was performed with bivariate analysis is performed by using Mann Whitney analysis and Multivariate analysis by Regression linier.Result. A total of 133 subject enrolled in this study, withmedian age of subject was 51 years (minimal 20 years, maximal 83 years), male (57,1%). In bivariate analysis, late endoscopy (>24 hours), hemodynamic instability, nosocomial infection, heart failure, and malignancy in gastrointestinal tract influence the length of stay patient with upper gastrointestinal bleeding. Multivariate analysis found late endoscopy (>24 hours), hemodynamic instability, nosocomial infection and malignancy has major impact.Conclusion. Late endoscopy (>24 hours), hemodynamic instability, nosocomial infection, and malignancy in gastrointestinal tract influence the length of stay patient with upper gastrointestinal bleeding."

"Backgrounds: Gastrointestinal bleeding such as hematemesis or melena are common conditions in clinical practice and endoscopic service. The mortality rate due to gastrointestinal bleeding is relatively high. In this study, we evaluate the causes of hematemesis melena for the last 5 years and the factors associated with the bleeding.Methods: The study was done retrospectively. We obtained data from medical record of patients that performed endoscopy of upper gastrointestinal tract in Division of Gastroenterology, Department of Internal medicine, Cipto Mangunkusumo hospital (Jakarta, Indonesia) during the period of 2001 to 2005.Results: Of 4.154 patients who underwent upper gastrointestinal tract endoscopy from 2001 to 2005, we found that 837 patients (20.1%) were due to upper gastrointestinal bleeding. They were 552 male (65.9%) and 285 female patients (34.1%). Mean age of male patients was 52.7 ± 15.82 years, while for female patients was 54.46 ± 17.6 years. Of 837 patients who came due to hematemesis were 150 patients (17.9%), melena were 310 patients (37.8%), both melena and hematemesis were 371 patients (44.3%), 557 cases (66.5 %) due to non varices. Endoscopic results showed that 280 cases (33.4%) were due to esophageal varices. In general, this study had demonstrated that esophageal varices was the most frequent cause of upper gastrointestinal bleeding. We found 229 cases of esophageal varices were coincidence with portal hypertensive gastropathy. While ulcer was found in 225 cases (26.9%) and most of them were gastric ulcer (51.1%). Of gastrointestinal bleeding caused by esophageal varices, most were grade HI in 138 cases (49.3%). The incidence of bleeding of bleeding were found more frequently in patients age group of 40 - 60 years (389 cases; 46.5%), > 60 years (305 cases; 36.2%), < 40 years (242 cases; 16.8%). The causes of bleeding in patients whose age > 60 years, most were caused by ulcer (37.4%). In this study, we also found that cancer as the cause of gastrointestinal bleeding in 26 cases (3.1%). Gastrointestinal cancer comprised of gastric cancer in 15 cases (57.7%), duodenal cancer in 7 cases (26.9%), and esophageal cancer in 4 patients (15.4%).Conclusion: The most frequent cause of upper gastrointestinal bleeding was esophageal varices and usually had reached stage HI. The non variceal cause of bleeding was gastric cancer. Upper gastrointestinal malignancy was also found to be the etiology of bleeding in this study."

"Skripsi ini membahas frekuensi distribusi perdarahan dan dry socket pada pasien usia 17-76 tahun di Rumah Sakit Gigi dan Mulut - Pendidikan Fakultas Kedokteran Gigi Universitas Indonesia periode Januari 2003 ? Oktober 2008. Penelitian ini adalah penelitian kuantitatif yang bersifat retrospektif dengan desain deskriptif. Hasil penelitian ini menyatakan bahwa tidak ditemukan komplikasi pasca ekstraksi berupa perdarahan, namun ditemukan kasus komplikasi pasca ekstraksi berupa dry socket, dimana komplikasi ini terjadi pada pasien berjenis kelamin perempuan, pada tindakan ekstraksi dengan teknik ekstraksi sederhana, dan terjadi pada tindakan ekstraksi gigi di regio posterior.

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The focus of this study is the distribution and frequency of bleeding and dry socket post tooth extraction, in patients with age 17-76 years old at RSGM-P Faculty of Dentistry University of Indonesia, period of January 2003 - October 2008. This research is a quantitative and retrospective research with descriptive design. The results prove that bleeding after tooth extraction was not found in this research, meanwhile dry socket post tooth extraction were found in women, by using the simple technique of tooth extraction, and found in the posterior region of tooth extraction. "