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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 :
ABSTRAK
Latar belakangModalitas akses vaskular yang sering digunakan untuk melakukan tindakan hemodialisis HD regular pada anak dengan gagal ginjal adalah tunneled double lumen catheter TDLC , yang telah meningkat penggunaannya dari 60 pada tahun 2011 menjadi 78 pada tahun 2014 di Indonesia. Angka kejadian sumbatan yang disebabkan trombosis adalah sekitar 50 . Kondisi tersebut dapat terjadi dalam waktu 24 jam pertama setelah pemasangan TDLC, dan biasanya berkembang dalam waktu 2 minggu, kemudian menyebabkan early catheter dysfunction. Alteplase rT-pa merupakan salah satu pilihan trombolitik untuk disfungsi TDLC, di samping heparin, streptokinase, dan urokinase. pemasangan kateter vena sentral, dan biasanya berkembang dalam waktu 2 minggu.Subjek dan Metode : Studi kasus kontrol dengan subyek penelitian anak berusia 0-18 tahun dan mengalami penyakit ginjal kronik PGK stadium 4-5 yang menjalani HD regular di RSCM. Analisis statistik dengan uji statistik Mann-Whitney, Chi-square, Fisher rsquo;s exact, regresi linear, dan Receiver Operating Characteristic ROC . Pengujian dilakukan dengan menggunakan piranti lunak SPSS version 20 for Windows.Hasil : Selama periode Januari 2016 sampai November 2017 terdapat 111 subyek yang memenuhi kriteria; 65 subyek 58,6 laki laki dan 46 subyek 41,1 perempuan. Analisis bivariat menunjukkan masing-masing kadar albumin

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ABSTRACT
BackgroundThe frequent vascular access modality used to perform regular hemodialysis HD actions in children with renal failure is a tunneled double lumen catheter TDLC , which has increased its use from 60 in 2011 to 78 by 2014 in Indonesia. Problems common to the TDLC are blockage and infection. The incidence of blockage caused by thrombosis is about 50 . The condition can occur within the first 24 hours after the installation of TDLC, and usually develops within 2 weeks, then causes early catheter dysfunction. Alteplase rT pa is one of the thrombolytic options for TDLC dysfunction, in addition to heparin, streptokinase, and urokinase. central venous catheter insertion, and usually develops within 2 weeks.MethodA case control study with children aged 0 18 years old and chronic kidney disease PGK stage 4 5 who underwent regular HD at RSCM. Statistical analysis with Mann Whitney statistical test, Chi square, Fisher 39 s exact, linear regression, and Receiver Operating Characteristic ROC . The test was performed using SPSS version 20 for Windows softwareResultDuring the period January 2016 to November 2017 there were 111 subjects meeting the criteria 65 subjects 58.6 male and 46 female subjects 41.1 . Bivariate analysis showed that each albumin

Abstrak :
ABSTRAK
Latar belakangModalitas akses vaskular yang sering digunakan untuk melakukan tindakan HD pada anak adalah penggunaan tunneled double lumen catheter TDLC , yang telah meningkat penggunaannya dari 60 pada tahun 2011 sampai 78 pada tahun 2014 dari semua pilihan akses vaskuler untunneled catheter, tunneled catheter, AVF dan AVG . Belum ada data mengenai lama penggunaan kateter tersebut berhubungan dengan posisi pemasangan, lokasi ujung kateter, bakteremia yang berhubungan dengan kateter, dan status nutrisi. Penelitian ini bertujuan untuk menelaah faktor-faktor yang memengaruhi lama penggunaan kateter tersebut.MetodeStudi deskriptif dengan desain cross sectional dengan subjek penelitian anak berusia 2-18 tahun dan menderita penyakit ginjal kronik stadium 4-5 yang menjalani HD reguler di RSCM. Data berasal dari rekam medis. Berdasarkan data dari registrasi pasien didapatkan terdapat 70 pasien anak yang dipasang TLDC antara bulan Agustus 2012 sampai Agustus 2016. Semua kateter yang dipasang adalah Hemo-Cath LT diproduksi oleh Medcomp , Harleysville, PA, USA . Lima belas pasien dieksklusi karena data yang tidak lengkap. Sehingga didapatkan 55 pasien yang masuk kriteria inklusi. Analisis statistik dengan uji statistik Mann-Whitney, Kruskall-Wallis, regresi linear. Pengujian dilakukan dengan menggunakan piranti lunak SPSS version 20 for Windows.HasilSelama periode Agustus 2012 sampai Agustus 2016 didapatkan 55 subjek yang memenuhi kriteria; 32 subjek 58,2 laki laki dan 23 subjek 41,8 perempuan. Rerata lama penggunaan TDLC 125 hari. Lama penggunaan TDLC pada kelompok posisi ujung kateter di mid atrium lebih panjang dibandingkan pada kelompok posisi ujung kateter di luar mid atrium kanan 154 20-491 hari vs 86,5 35-228 hari;

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ABSTRACT BackgroundThe most common vascular access used for hemodialysis HD in children is tunneled double lumen catheter TDLC . The use of TDLC increased from 60 in 2011 to 78 in 2014 among all vascular access options untunneled catheter, tunneled cathteter, arteriovenous fistula AVF and arteriovenous graft AVG . There is no data about duration of catheter use associated with site of insertion, tip position, catheter related bacteremia, nutritional status and underlying disease. The study aimed to find out factors influencing the duration of catheter use.MethodA cross sectional descriptive study was carried out enrolling subjects of 2 18 years old with stage 4 5 chronic kidney disease undergoing regular HD in Cipto Mangunkusumo Hospital since August 2012 until August 2016. Data was collected from patients rsquo medical records at RSCM medical records department. Informations gathered included age, sex, weight, height, duration of TDLC use, site of insertion, catheter tip position based on plain thoracic photo, history of diagnosis of catheter related bacteremia, and primary disease.Review of the procedural databese for TDLC placement on pediactrics patient revealed 70 patients between August 2012 and August 2016. All of catheters were Hemo Cath LT Manufactured by Medcomp , Harleysville, PA, USA . fifteen patiens were excluded because of incomplete medical records. Therefore, the study consisted of 55 patients. Statistical analysis was performed using Mann Whitney, Kruskall Wallis, and linear regression with SPSS version 20 for windows.ResultIn period of August 2012 until August 2016 there were 55 subjects who met the criteria 32 subjects 58.2 were males and 23 subjects 41.8 were females. Median duration of catheter use was 125 days. Duration of catheter use with the tip position in the mid atrium group is longer than in those higher than mid right atrium superior vena cava 154 20 491 days vs. 86.5 35 228 days p