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Abstrak :
ABSTRACT
The prognosis of hepatocellular carcinoma (HCC) patients with tumor thrombus (TT) in the inferior vena cava (IVC) or right atrium (RA) is extremely poor. We reviewed the recent surgical treatments and outcomes of this form of advanced HCC. TT is classified into three types according to its anatomic location relative to the heart: the inferior hepatic type (type I), where the TT is in the IVC below the diaphragm; the superior hepatic type (type II), where the TT is in the IVC above the diaphragm, but still outside the RA; and the intracardiac type (type III), where the TT is above the diaphragm and has entered the RA. Type I can be treated relatively easily by standard radical hepatectomy. For type II, the intrathoracic IVC is approached via the abdominal cavity and an incision in the diaphragm with total hepatic vascular exclusion (THVE). For type III, hepatectomy plus thrombectomy is generally performed under cardiopulmonary bypass. If the TT is only just inside the RA, THVE can be performed by mobilizing the liver caudally. The median overall survival of HCC patients with TT in the IVC or RA, who undergo curative resection, is 19.0-30.8 months. As postoperative recurrence is likely to develop, even after curative surgery, effective postoperative adjuvant chemotherapy is required.

Abstrak :
Latar belakang. Risiko Venous Thromboembolism (VTE) yang terkait dengan keganasan adalah 4,1 kali lipat lebih besar dibandingkan dengan pasien tanpa keganasan. Pasien keganasan memiliki risiko perdarahan yang lebih besar dengan terapi antikoagulan yang umum digunakan. Inferior Vena Cava Filter (IVCF) telah direkomendasikan sebagai alternatif yang kontroversial. Tujuan. Untuk menemukan bukti ilmiah tertinggi dalam keamanan, manfaat, dan dampak klinis IVCF untuk mengelola VTE terkait keganasan. Metode. Sesuai dengan pedoman PRISMA, pada situs berbasis data Cochrane, PubMed, dan ClinicalKey dicari menggunakan kata kunci ("Inferior Vena Cava Filter" or "IVCF") and (“Anticoagulant”) and ("Cancer" or "Malignancy") and ("Venous Thromboembolism" or "VTE" or "Pulmonary Embolism" or "Deep Vein Thrombosis") and ("Safety" or "Benefit" or "Complication" or "Recurrence" or "Survival Rate" or "Mortality"). Artikel-artikel ini ditinjau dan dinilai. Hasil. Ada 10 artikel yang ditinjau (1.191 partisipan). Komplikasi IVCF yang ditemukan: migrasi filter (0,9%), trombosis vena cava (3,7%), PE berulang (2,8%); fraktur filter (0,9%); dan penetrasi IVCF (0,9%). Tidak ada kematian yang ditemukan pada pasien karena komplikasi karena penyisipan filter (LOE 2). Penyisipan IVCF dapat mengurangi tingkat PE tetapi dengan peningkatan jumlah DVT (DVT: dengan filter vs tanpa filter: 35,7% vs 27,5%; HR 1,52; CI95 % 1,02–2,27; p = 0,042; PE: 6,2% vs. 15,1 %; HR 0,37; 95% CI 0,17–0,79; p = 0,008). Enam studi tidak menemukan peningkatan yang signifikan secara statistik dalam mortalitas terkait PE. Kesimpulan. IVCF aman dan bermanfaat untuk pengelolaan VTE terkait keganasan, terutama pada pasien dengan kontraindikasi antikoagulan (LOE 2, 3 dan 4). ......Background. The risk of venous thromboembolism (VTE) associated with malignancy is 4.1-fold greater compared to patients without malignancy. Malignancy patient have greater risk of bleeding with the commonly used anticoagulant therapy. Inferior Vena Cava Filter (IVCF) have been recommended as an controversial alternative. Objective. To find the highest evidence in the safety, benefit, and clinical outcome of the IVCF for managing VTE associated with malignancy. Method. Aligning with PRISMA guidelines, online databases Cochrane, PubMed, ScienceDirect and ClinicalKey were searched using keywords ("Inferior Vena Cava Filter" or "IVCF") and (“Anticoagulant”) and ("Cancer" or "Malignancy") and ("Venous Thromboembolism" or "VTE" or "Pulmonary Embolism" or "Deep Vein Thrombosis") and ("Safety" or "Benefit" or "Complication" or "Recurrence" or "Survival Rate" or "Mortality"). These articles were reviewed and appraised. Results. There were 10 articles reviewed (1,191 participants). Complication of IVCF found: filter migration (0.9%), vena cava thrombosis (3.7%), recurrent PE (2.8%); filter fracture (0.9%); and IVCF penetration (0.9%). No mortality was found in patients due to complications due to filter insertion (LOE 2). IVCF insertion can reduce PE rates but with an increase in the number of DVT (DVT: with filter vs without filters: 35.7% vs 27.5%; HR 1.52; CI95 % 1.02–2.27; p = 0.042 ; PE: 6.2% vs. 15.1%; HR 0.37; 95% CI 0.17–0.79; p = 0.008). Six studies found no statistically significant increase in PE-related mortality. Conclusion. IVCF is safe and beneficial for the management of malignancy-associated VTE, especially in patients with contraindications to anticoagulants (LOE 2, 3 and 4).

Abstrak :
Latar Belakang : Syok sepsis merupakan kondisi mengancam nyawa dengan beban morbiditas dan mortalitas tinggi terutama di Asia Tenggara. Perencanaan resusitasi cairan yang optimal pada pasien sepsis membutuhkan panduan status hemodinamik tubuh, namun pengukuran Central Venous Pressure (CVP) yang saat ini paling umum digunakan merupakan tindakan invasif dengan segala kekurangannya. Sejumlah penelitian sebelumnya mengajukan pemeriksaan ultrasonografi vena cava inferior (USG IVC) sebagai metode alternatif estimasi status hemodinamik tubuh, namun dengan hasil yang bervariasi. Diskrepansi hasil penelitian sebelumnya dan kurangnya data penelitian pada populasi syok sepsis di Indonesia menunjukkan perlunya ada penelitian lebih lanjut. Tujuan : Penelitian ini bertujuan untuk mengetahui korelasi antara parameter USG IVC berupa diameter, Collapsibility Index (CI), dan velositas maksimal (maxV) terhadap nilai CVP. Metode : Desain penelitian merupakan studi korelasi dengan teknik potong lintang. Data primer didapatkan dari hasil pemeriksaan USG IVC dan CVP menggunakan manometer manual dari sampel pasien syok sepsis yang dirawat di RSUPN Cipto Mangunkusumo dengan waktu penelitian Juli hingga Oktober 2020. Pengukuran diameter, CI, dan maxV dari IVC diambil di regio subxiphoid, dilakukan sendiri oleh peneliti dengan supervisi langsung dari spesialis radiologi konsultan abdomen. Hasil : Didapatkan 27 sampel USG IVC tanpa perbedaan proporsi yang bermakna antar subyek berdasarkan umur dan jenis kelaminnya. Didapatkan korelasi positif sedang antara diameter dengan nilai CVP (r = 0,459, p = 0,016), korelasi negatif sedang antara CI dengan nilai CVP (r = - 0,571, p = 0,002), dan tidak ada korelasi yang bermakna secara statistik antara maxV dengan nilai CVP (r = 0,074, p = 0,715). Kesimpulan : Korelasi bermakna antara diameter dan CI IVC terhadap nilai CVP menunjukkan bahwa pemeriksaan USG IVC dapat digunakan sebagai metode pemeriksaan alternatif non-invasif untuk estimasi nilai CVP dalam perencanaan penatalaksanaan pasien syok sepsis. ...... Background : Septic shock is one of life-threatening condition with high morbidity and mortality rate, especially in the South East Asia. Optimal fluid resuscitation planning requires adequate portrayal of hemodynamic status, but the most often used indicator, Central Venous Pressure (CVP), is an invasive procedure with all its drawbacks. Several studies has been done worldwide to propose Inferior Vena Cava Ultrasonography (IVC USG) as an alternative method to estimate hemodynamic status, to varying degree of success. These discrepancies from previous studies, and the lack of data for septic shock population in Indonesia suggests the need for further study. Objective : This study aims to determine the correlation strength between IVC USG parameters such as diameter, Collapsibility Index (CI), and maximum velocity (maxV) with CVP. Method : The study design is cross-sectional correlation study. Primary data was acquired from IVC USG examination results and CVP values was acquired by manual measurement from septic shock patients in Cipto Mangunkusumo National Central General Hospital (RSUPN CM) from July until October 2020. Measurements of diameter, CI, and maxV were done in the subxiphoid region under direct supervision from abdominal consultant radiologist. Result: In total, 27 samples of IVC USG were acquired without statistically significant difference of proportion across age and gender. Moderate positive correlation were found between diameter and CVP (r = 0,459, p = 0,016). Moderate negative correlation were found between CI and CVP (r = - 0,571, p = 0,002). No statistically significant correlation were found between maxV and CVP (r = 0,074, p = 0,715). Conclusion : Significant correlation between IVC diameter and CI with CVP values implies that IVC USG is an acceptable non-invasive alternative method to estimate CVP values in accordance to septic shock therapy planning.