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Abstrak :
Indonesia Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV: 308-311 The temporomandibular join has a very important role in the stomatognathic system. It's main function is for the opening and closing movement, mastication, and speech. It is located anterior to the ear. The temporomandibular joint connects maxilla and mandible through the articular fossa, hence the slightest change that happens would cause serious matters such as pain, eating, speech disorder, difficulty in opening and closing movement, headache, and event trismus. In a child or an adolescent, the symptoms are often vague; everything is interpreted as "pain". This is probably why temporomandibular disorder are often undetect by dentists. Therefore, patience and accuracy is needed to determine the actual disorder through means of clinical and radiographic examination. The radiographic examination suitable for child is the transcranial projection. This projection is believed to be more accurate amongst other projections for child patients.

Abstrak :
Latar belakang - Mikroangiopati serebral merupakan salah satu komplikasi vaskular pada Diabetes Mellitus (DM). Salah satu parameter pada Transcranial Doppler (TCD) yang menilai adanya resistensi distal dari arteri yang diperiksa yang dapat merefleksikan adanya mikroangiopati di otak adalah Pulsatility Index (PI). Penelitian ini menghubungkan antara rerata PI arteri serebri media (Middle Cerebral Artery/MCA) dengan kejadian retinopati diabetik yang merupakan komplikasi yang paling spesifik dan tersering pada DM tipe 2. Tujuan - Untuk mengetahui perbedaan rerata nilai PI MCA pada penyandang DM tipe 2 di otak pada penyandang DM tipe 2 beserta titik potongnya pada kurva ROC dan faktor-faktor yang mempengaruhinya. Metode - Penelitian ini adalah penelitian potong lintang dengan 60 subyek DM tipe 2 tanpa komplikasi makrovaskular, terdiri dari 29 pasien retinopati dan 31 pasien tanpa retinopati dari poliklinik rawat jalan endokrin RS Cipto Mangunkusumo periode November 2013 ? April 2014. Dilakukan pemeriksaan TCD untuk menilai PI MCA. Usia, riwayat hipertensi, dislipidemia, lama menyandang DM tipe 2 dan HbA1c dianalisis sebagai faktor perancu. Hasil - Pada penyandang DM tipe 2 dengan retinopati memiliki nilai rerata PI arteri serebri media yang lebih tinggi secara bermakna (1,17±0,25) dibandingkan dengan penyandang DM tipe 2 tanpa retinopati (1,05±0,26) dengan p=0,001. Usia, riwayat hipertensi, dislipidemia, lama menyandang DM tipe 2 dan HbA1c tidak berhubungan terhadap perubahan rerata PI MCA (p=0,187; p=0,608; p= 0,734; p=0,159; p=0,548). Titik potong nilai PI MCA pada penyandang DM tipe 2 dengan retinopati adalah pada nilai PI ≥ 1,025 dengan sensitifitas 70% dan spesifisitas 54%. Simpulan - Pada penelitian ini, didapatkan perbedaan rerata nilai PI MCA secara bermakana antara kelompok dengan dan tanpa retinopati dengan nilai titik potong nilai PI MCA pada penyandang DM tipe 2 dengan retinopati adalah pada nilai PI ≥ 1,025 dengan sensitifitas 70% dan spesifisitas 54%. ...... Background - Cerebral microangiopathy is one of the most important complications in diabetes mellitus. Elevation in pulsatility index (PI) as measured by Transcranial Doppler (TCD) have been postulated to reflect increased vascular resistance distal of artery being examined. This study correlate PI mean of middle cerebral artery (MCA) with retinal mikroangiopathy which is the most common and specific in diabetic patients. Objective - To determine differences in PI MCA group with and without retinopathy in type 2 diabetic patients and to find the cuttpoint value at ROC curve. Methods - The study was carried out in sixty diabetic patients (with no other vascular abnormality), divided into 2 group, 29 type 2 diabetic patients with retinopathy and 31 diabetic patients without retinopathy. TCD was performed to record pulsatility index of MCA then analyzed to find the cuttpoint value. Ages, duration of diabetes, HbA1c levels, history of hypertension and dyslipidemia was analyzes as a confonding factor. Results - The PI of MCA are significantly higher in diabetic patients with retinopathy than without retinopathy (P=0.001) with cutt of point at PI> 1,025 with 70% sensitivity and 54% spesificity. Age, HbA1c level, diabetes duration, history of hypertension and dislipidemia does not have a meaningful relationship with change cerebral status (p = 1.000, p = 0.657, p = 0.354, p = 0.538). Conclusions - There are significant differences beetwen mean of pulsatility index in diabetic patients with and without retinopaty. The Cuttpoint are at PI > 1,025 with 70% sensitivity and 54% spesifisity.

Abstrak :
Latar belakang: Halusinasi auditorik verbal (HAV) dialami 70% dari 23 juta penderita gangguan skizofrenia di seluruh dunia. Data pasien skizofrenia di rawat jalan Departemen Psikiatri RSCM/FKUI periode tahun 2016-2017 kasus HAV resisten pengobatan berkisar 25-30%. Tujuan penelitian ini mengetahui abnormalitas spasiotemporal aktivitas neural otak kondisi istirahat yang berhubungan dengan HAV pada orang dengan skizofrenia (ODS) dan peran rTMS dalam memodulasi abnormalitas tersebut. Metode: Penelitian ini dilakukan di Departemen Psikiatri dan Departemen Neurologi FKUI/RSCM selama Maret 2017 sampai Maret 2019 dengan desain uji klinis acak plasebo tersamar ganda. Studi  mengikutsertakan 120 orang yaitu 40 ODS dengan halusinasi, 40 ODS tanpa halusinasi, 20 subjek saudara kandung dan 20 subjek sehat. Kriteria kelompok intervensi rTMS pasien skizofrenia HAV resisten pengobatan usia dewasa 18-59 tahun. Pemeriksaan dimensi temporal dan spasial aktivitas otak keadaan istirahat menggunakan perekaman elektroensefelografi (EEG). Pemeriksaan simtom halusinasi menggunakan instrumen PSYRATS dan uji kemampuan pemantauan-sumber. Dilakukan rTMS 1 Hz 90% AM 1000 pulse di titik T3P3 selama 10 hari berturut-turut. Data klinis pasien diperoleh dari wawancara atau catatan medis. Informed consentdiperoleh dari pasien dan orang tua atau pasangan pasien.  Hasil: Ditemukan perbedaan kekuatan amplitudo gelombang theta di prefrontal kiri dan kanan (skizofrenia = 15.19±4.54 mV, sehat= 7.37±2.49 mV, p 0.004), frontal kiri dan kanan (skizofrenia=18.62±17.55 mV, sehat = 9.90±3.77 mV p 0.007), temporal kiri dan kanan (skizofrenia= 6.97±7.26 mV, sehat= 3.59±1.34 mV , p 0.010). Kelompok skizofrenia ditemukan penurunan gandeng-fase amplitudo theta/gamma di frontal-parietal kiri F3-P3 (sehat=28.06, skizofrenia=24.06), frontal-temporal kiri F3-T3 (sehat=30.89, skizofrenia=22.47) dan frontal sentral kanan FP2-C4 (sehat=25.78, skizofrenia=25.00). Didapatkan peningkatan konektivitas fungsional di jejaring mode-standar yang berkaitan dengan kemampuan ODS memantau sumber stimulus. Antara jejaring mode-standar dengan sentral-eksekutif didapatkan korelasi positif di BA 8L-39L (r = 0.792, p = 0.000), BA 29L-40L (r = 0.522, p = 0.032) dan BA8R-39R (r = 0.480, p = 0.004). Korelasi positif abnormal antara jejaring mode-standar dan eksekutif-pusat berhubungan dengan kesulitan ODS membedakan sumber stimulus. Pemberian rTMS 1 Hz menurunkan konektivitas jejaring mode-standar dan menurunkan gandeng theta-gamma yang menghasilkan perbaikan gejala HAV dan kemampuan pemantauan sumber. Simpulan: Pada ODS keseimbangan aktivitas otak istirahat bergeser ke kekuatan frekuensi rendah, demikian juga peningkatan koherensi kortikal. Didapatkan hiperkonektivitas jejaring mode standar, korelasi abnormal antara DMN dan CEN, serta gandeng theta-beta DMN yang berhubungan dengan halusinasi auditorik verbal. Pemberian rTMS bisa memodulasi abnormalitas spasiotemporal tersebut mendekati kondisi normal dan berakibat perbaikan gejala halusinasi. EEG concordance alfa prefrontal frontal otak berpotensi menjadi kandidat penanda biologi respon terhadap terapi rTMS. 

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Background: Auditory Verbal Hallucinations (AVH) occur in 70% of 23 million people with schizophrenia worldwide. According to the 2016-2017 data on schizophrenia patients in the Outpatient Clinic of the Department of Psychiatry RSCM / FKUI, AVH treatment-resistant cases reach about 25-30%. The aim of this study was to determine the spatiotemporal properties of resting brain neural activities that cause changes in perceptions and abnormal space-time experience in people with schizophrenia, which then manifest as auditory verbal hallucinations, and also to determine the role of transcranial magnetic repetitive stimulation (rTMS) on modulating spatiotemporal abnormalities.  Method: This study was a double-blind placebo-controlled clinical trial conducted in the Department of Psychiatry and the Department of Neurology of FMUI/RSCM  from March 2017 to March 2019. The study included 120 subjects consisting of 40 schizophrenia patients with hallucinations, 40 schizophrenia patients without hallucinations, 20 siblings of the patients, and 20 healthy subjects. The criteria for the rTMS intervention group were treatment-resistant schizophrenia with AVH of 18-59 years of age. Electroencephalography (EEG) was used to examine temporal and spatial dimensions of resting brain activities. The PSYRATS instrument and source-monitoring ability test were used to assess symptoms of hallucinations. Patients clinical data were collected from interviews or medical records. Informed consents were obtained from patients and their parents or spouses. Results: Differences in amplitude strength of theta fequency were found at the left and right prefrontal cortices (schizophrenia = 15.19±4.54 mV, healthy = 7.37±2.49 mV, p 0.004), left and right frontal cortices (schizophrenia=18.62±17.55 mV, healthy = 9.90±3.77 mV p 0.007), left and right temporal cortices (schizophrenia= 6.97±7.26 mV, healthy = 3.59±1.34 mV , p 0.010). Temporal cortical activities were shifted to low frequency fluctuations, and there were also decreasing relationships between various brain frequencies. The increase of functional connectivity in default-mode networks was found, which relates to schizophrenics ability to monitor sources of stimuli. This abnormal positive correlation between the default mode and the central executives network might disturb schizophrenics ability to distinguish internal stimuli from external stimuli. The administration of 1Hz of rTMS decreases connectivity in default-mode networks and theta-gamma coupling resulting in improved symptoms of HAV and source monitoring capabilities. Conclusion: In people with schizophrenia, the balance of resting activity shift to low frequency power, as well as increase in its cortical coherence. It also found functional hyperconnectivity in default mode network among schizophrenia patients with HAV and abnormal positive correlation between DMN-CEN. The resting state theta-gamma coupling was increased in patient with schizophrenia that might underlie HAV. The administration of rTMS modulate spatiotemporal abnormalities to near-normal conditions, resulting in the improvement in hallucinatory symptoms. The alpha EEG cordances of prefrontal and frontal cortices has the potential to become a biological marker of response to rTMS therapy.

Abstrak :
Pendahuluan : Overjet yang besar pada maloklusi kelas II divisi 1 ditengarai mampu menimbulkan gangguan pada sendi temporomandibula. Perawatan ortodontik dengan pencabutan dua gigi premolar bertujuan untuk memperbaiki profil serta menyeimbangkan oklusi. Tujuan dari penelitian ini adalah untuk menganalisis perubahan posisi kondilus sebelum dan sesudah perawatan ortodontik. Metode : Digunakan 60 foto transkranial sebelum dan sesudah perawatan ortodontik. Subjek penelitian dipilih berdasarkan kriteria inklusi berupa kasus maloklusi kelas II divisi 1, ANB ³ 50, overjet ³ 6 mm, memiliki gangguan sendi temporomandibula sebelum perawatan ortodontik dimulai serta memiliki foto transkranial. Evaluasi posisi kondilus dilakukan dengan mengukur jarak Anterior Joint Space, Posterior Joint Space dan Superior Space yang diterjemahkan menjadi posisi supero-anterior dan posisi non supero-anterior pada kondilus kanan dan kiri. Perubahan posisi kondilus sebelum dan sesudah perawatan ortodontik diuji menggunakan Mc Nemar. Hasil : Diketahui bahwa tidak ada perbedaan bermakna (p>0,05) posisi kondilus sebelum dan sesudah perawatan ortodontik pada kasus maloklusi kelas II divisi 1 dengan pencabutan dua gigi premolar. 19 subjek memiliki posisi supero-anterior pada kondilus kanan dan kiri sebelum dan sesudah perawatan, sedangkan 11 subjek memiliki posisi non supero-anterior pada kondilus kanan dan kiri sebelum dan sesudah perawatan. Kesimpulan : Perawatan ortodontik disertai pencabutan dua gigi premolar menyebabkan perubahan posisi kondilus, namun tidak berbeda bermakna secara statistik. Sebelum dan sesudah perawatan ortodontik, sebagian besar kondilus tetap berada di posisi superoanterior. Sesudah perawatan ortodontik, gejala berupa rasa tidak nyaman saat membuka mulut lebar dan keterbatasan membuka mulut sudah hilang, sedangkan gejala berupa kliking dan krepitasi masih ada.

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Introduction : Increased overjet in malocclusion class II div 1 leads to temporomandibular joint dysfunction. Orthodontic treatment with upper premolars extraction is due to correct profile and to harmonize occlusion. This paper will analyze alteration condylar position before and after orthodontic treatment. Methods : Transcranial projection was performed of 60 radiographs (30 radiograph before and 30 radiograph after orthodontic treatment). Subjects were choosed based on inclusion criteria : malocclusion class II div 1, ANB ³ 50, overjet ³ 6 mm, patient had temporomandibular symptoms before orthodontic treatment, and all patients had transcranial radiograph. Condylar position was determined according to Anterior Joint Space, Posterior Joint Space and Superior Space which convert to supero-anterior position condyle right and left and non supero-anterior position condyle right and left. The Mc Nemar Test was used to analyze the data. Results : No statistically significant (p>0,05) alteration condyle position before and after orthodontic treatment with extraction upper premolar. 19 subjects had supero-anterior condyle position, before and after orthodontic treatment and 11 subjects had non superoanterior condyle position before and after orthodontic treatment. Conclusion : The results of this study showed that orthodontic treatment with extraction upper premolars cause alteration condylar positions, but not statistically significant. Before and after orthodontic treatment, most of all condyles showed in superoanterior positions.

Abstrak :
Latar Belakang: Lidokain, selain sebagai anestesia lokal klasik, juga berkembang penggunaannya secara sistemik untuk ajuvan anestesia. Salah satu manfaatnya ialah dalam neuroanestesi untuk relaksasi otak namun mekanisme kerjanya masih belum sepenuhnya diketahui. Penelitian ini bertujuan untuk mengevaluasi pengaruh lidokain sistemik terhadap cerebral blood flow (CBF) yang dinilai dengan mean flow velocity (MFV) arteri serebral media (MCA) bilateral menggunakan alat Transcranial Doppler (TCD). Metode: Metode penelitian ini menggunakan desain uji klinis acak tersamar ganda di Instalasi Bedah Pusat RSUPN dr. Cipto Mangunkusumo Jakarta, berlangsung pada bulan September-Desember 2023. Pada hari operasi, penilaian MFV MCA kanan dan kiri dilakukan menggunakan TCD pada tiga tahap waktu yang berbeda: sebelum anestesi, setelah anestesi, dan 1 jam setelah infus NaCl 0,9% pada kelompok kontrol atau infus lidokain pada kelompok uji. Analisis data dilakukan dengan menggunakan aplikasi SPSS versi 26. Hasil: Dalam penelitian ini, 34 subjek memenuhi kriteria inklusi dan dibagi menjadi kelompok kontrol (infus NaCl 0,9%) dan kelompok lidokain (bolus lidokain 1,5 mg/kg dan infus lidokain 1,5 mg/kg/jam). Demografi subjek menunjukkan proporsi laki-laki dan perempuan yang seimbang di kedua kelompok, serta tidak ada perbedaan signifikan dalam rerata usia. Hasil pengukuran MFV MCA kanan dan kiri sebelum dan setelah pembiusan umum tidak menunjukkan perbedaan signifikan. Setelah satu jam pemberian infus lidokain, terdapat perbedaan signifikan (p <0,001) antara rerata kelompok kontrol 69,63 (22,7-85,1) cm/detik dan rerata kelompok lidokain 44,07 (21,3-61,1) cm/detik pada MCA kanan. Hal serupa terjadi pada MFV MCA kiri, di mana perbedaan signifikan (p=0,001) antara rerata kelompok kontrol 60,3 (18,4-85,1) cm/detik dan rerata kelompok lidokain 48,27 (18,3-66,3) cm/detik. Simpulan: Nilai MFV MCA lebih rendah pada pasien yang menerima infus lidokain intraoperatif dibandingkan dengan plasebo dan berbeda signifikan secara statistik pada MCA kanan (p <0,001) dan MCA kiri (p=0,001). ......Introduction: Lidocaine, besides being a classical local anesthetic, has also evolved for systemic use in adjunct anesthesia. One of its benefits lies in neuroanesthesia for brain relaxation, although its mechanism of action is not fully understood. This study aims to evaluate the systemic effects of lidocaine on cerebral blood flow (CBF) assessed through the mean flow velocity (MFV) of bilateral middle cerebral arteries (MCA) using Transcranial Doppler (TCD). Methods: This research is a double-blind randomized clinical trial design at the Central Surgery Installation of RSUPN dr. Cipto Mangunkusumo Jakarta, conducted from September to December 2023. On the day of surgery, assessments of MFV in the right and left MCAs were performed using TCD at three different time points: before anesthesia, after anesthesia, and 1 hour after the infusion of 0.9% NaCl in the control group or lidocaine infusion in the experimental group. Data analysis was conducted using SPSS version 26. Results: In this study, 34 subjects met inclusion criteria and were divided into a control group (0.9% NaCl infusion) and a lidocaine group (1.5 mg/kg bolus followed by 1.5 mg/kg/h infusion). Subject demographics showed a balanced gender distribution with no significant age differences between the two groups. Measurements of MFV in the right and left MCAs before and after general anesthesia did not exhibit significant differences. However, one hour after lidocaine infusion, there were significant differences (p <0.001) between the mean control group values of 69.63 (22.7 - 85.1) cm/s and the lidocaine group values of 44.07 (21.3-61.1) cm/s in the right MCA. Similar findings occurred in the left MCA, with significant differences (p=0.001) between the mean control group values of 60.3 (18.4 - 85.1) cm/s and the lidocaine group values of 48.27 (18.3-66.3) cm/s. Conclusion: The MFV values in the MCA were significantly lower in patients receiving intraoperative lidocaine infusion compared to placebo, both in the right MCA (p <0.001) and the left MCA (p=0.001).