Penile carcinoma is a malignancy of the penis that is commonly found in Indonesia, the cause is not known with certainty but involves multifactor. This retrospective descriptive research design to know the characteristics of patients with penis carcinoma at Sanglah Hospital Denpasar in 2014. Most patients age group 40 to 60 years, have no formal education and work as a farmer. Patients receive neo-adjuvant or adjuvant chemotherapy and partial surgery or total penectomy with superficial inguinal lymph node dissection. Histopathologic results obtained 90 percent were squamous cell carcinoma (SCC) and 70 percent moderately differentiated (G2) and 10 percent intravenous or intraneural invasion. Forty percent of patients come with a pathological stage T₃ and 20 percent N₁. First-trimester follow-up 1 patient died of recurrent tumors of inguinal KGB and pulmonary metastases, then the second trimester 1 patient died due to adjuvant chemotherapy (without recurrent tumor and metastasis). Most patients come with an advanced stage that greatly affects the outcome of chemotherapy or surgery.

Dispnea adalah keluhan yang sering memerlukan penanganan darurat tetapi intensitas dan tingkatannya berbeda-beda. Anamnesis yang lengkap sangat penting untuk memperoleh kepastian apakah pasien benar-benar menderita dispnea. Apabila dispnea telah ditegakkan, maka sangat penting untuk memperoleh data-data mengenai penyebab dispnea dan menilai gejala dan tanda lain yang berhubungan dengan dispnea. Dengan mendapatkan data yang lengkap kita dapat melakukan penanganan dispnea secara cepat dan tepat. Pada laporan ini disampaikan kasus laki-laki usia 19 tahun, dikonsulkan ke intensif dengan sesak nafas dan penurunan kesadaran post open reduction internal fixation (ORIF) et causa open fracture right tibia middle third grade II; open  fracture right fibula segmental; closed fracture left distal radius frykman VIII; closed frckture right distal radius frykman VIII hari ketiga. Pemeriksaan klinis dan pemeriksaan penunjang yang ada mendukung diagnosa acute respiratory distress syndrome (ARDS). Selama perawatan di ruang intensif, pasien mendapatkan farmakoterapi dan lung protective ventilation. Pasien mulai bisa disapih dari ventilator di hari ke 4, ekstubasi di hari ke 13 dan pada hari ke 17 pasien dipindahkan ke ruang perawatan. Target utama tatalaksana acute respiratory distress syndrome  adalah mengembangkan alveoli secara optimal untuk mempertahankan gas arteri dan oksigenasi jaringan yang adekuat, keseimbangan cairan dan asam basa serta sirkulasi yang memadai sampai integritas membran kapiler kembali normal.  Selain itu juga ditujukan untuk mengatasi faktor-faktor pencetus dan hal-hal lain serta memberikan terapi penunjang.

Retinopathy of prematurity (ROP) is a major cause of visual impairment in premature infants that are actually very likely to be avoided. The risk factors that most influence on the incidence of ROP is oxygen. This research was conducted to determine the effect of duration, fraction and method of applying oxygen on the incidence of ROP in premature infants at Sanglah Hospital. This research is an analytic observational with case control study design, where the study was divided into two groups, namely the case group and the control group. Data were analyzed using bivariate using chi-square test and analyzed by multivariate logistic regression. Statistical significance was assessed using IK 95% and the P value at the limit of α = 0.05. After multivariate analysis was conducted with logistic regression to variable oxygen usage duration> 7 days, the oxygen fraction> 40% and oxygen use with CPAP or mechanical ventilation, it was found that the most influential variable is the application of oxygen fraction> 40% where the value adjusted RO 40.8 with a range of 2.8 to 594.8 IK 95%, P = 0.007.

 

 

Background: Acute urinary retention is one of the most common emergencies in urology. Mostly found in male patients with Benign Prostatic Hyperplasia (BPH). This study aims to determine the relationship of prostate volume and intravesical prostatic protrusion with the incidence of acute urinary retention in BPH patients.

Methods: The design of this study was an observational analytic study with a cross sectional approach. The population is all the patient with a diagnosis of BPH that coming to the surgical polyclinic of the District Hospital of Buleleng District within the period of May to August 2017. Eighty-two patients met the study criteria. Data analysis was performed using univariat and bivariate analysis with confidence interval P <0.05.

Results: Bivariate analysis showed that prostate volume 41-70cc and > 70cc  [OR 5.6 (95% CI 1.7─17.9), P=0.002; OR 13.6 (95% CI 2.7─98.1), P=0.001] and intravesical prostatic protrusion 0.6-1.0 cm and > 1,0 cm [OR 6.2 (95% CI 1.9─19.8), P=0.001; OR 7.4 (95% CI 2.3─24.4), P=0.001] has a statistically significant association with the incidence of acute retention in BPH patients.

Conclusions: The greater the prostate volume and intravesical prostatic protrusion the greater the risk of acute urinary retention in BPH patients.

 

 

 

Deep Vein Thrombosis (DVT), oftenly become post operative complication on long bone internal fixation procedure and might leading to high morbidity to patients. D-Dimer is a fibrin degradation product which may become accurate marker for DVT. This research purpose is to prove that administration of Rivaroxaban in lowering D-Dimer level post operatively after internal fixation of lower extremities long bone.

              This research  is pre post experimental test with double blind sampling which consist of 40 samples, which is divided into 2 groups contains  20 samples each. First group was given 10 mg Rivaroxaban per oral 6 - 10 hours post-operation, on the second group  was given placebo. D-Dimer level checked in 1 day pre-operative, 1 day post-operative and 3 days post-operative.

               D-Dimer  mean measured in Rivaroxaban group, pre-operative 0.54 mg/L, 1 day post-operative 1.17 mg/L, 3 days post-operative 1.03 mg/L. D-Dimer  Mean result in placebo group, pre-operative 0.77 mg/L, 1 day post-operative 5.74 mg/L, 3 days post-operative  3.89 mg/L. This research using independent t-Test in pre operative in both groups with no difference with significance of 0.07 (p>0.05), 1 day post operative with significance 0.002 (p<0.05) and on 3 days post-operative with significance 0.002 (p<0.05).

              This research proves that administration of Rivaroxaban decreasing D-Dimer level on lower extremities long bone internal fixation operation. This result support that Rivaroxabanas is an effective thromboprophylaxis medicamentosa to DVT.

 

 

 

 

Prolong Joint immobilization can lead cartilage damage. One of mechanism is release of proteolitic enzim such as MMP3. Simvastatin has capacity to become anti proteolitic enzyme which is released by chondrocyte. Oral simvastatin administration on joint immobilization can prevent cartilage damage monitored by lower serum COMP level and higher chondrocyte number on cartilage compared without simvastatin administration.This research was Randomized  post-test only group design consists of 38 female rabbit as subject. All of rabbit’s knee were immobilized by cast and divided into 2 group. First group with no simvastatin administration and second group with oral simvastatin administration 20mg/kg/day for 6 week. Chondrocyte number on cartilage and serum COMP level was measured at the end of the six weeks study.Statistic analysis showed higher chondrocyte number and lower serum COMP level of rabbit’sknee with simvastatin administration compared with group rabbit with no simvastatin administration. Independent t-test analysis showed that difference were significant, with serum COMP p = 0.000 (p < 0.05) and chondrocyte number p = 0.000 (p< 0.05).Oral simvastatin administration on rabbit with knee joint immobilization have higher chondrocyte number and lower serum COMP level compared with group with no simvastatin administration.

 

immobilization, simvastatin, chondrocyte, COMP

The prevalence of obesity in children has increased from year to year. One of Etiology of obesity is the nutritional factor. The objective of this study is to compare the of energy, carbohydrate, protein and fat intake with dietary allowances in obese children. This cross-sectional analytic study carried out in Sanglah Hospital  in 2011-2016. There are 57 subjects with the average intake and dietary allowances subjects for energy is 2378.3 and 1678.07 (p 0.001; 700.24 95% CI 569.05-831.43), carbohydrate 1414.63 and  922.94 (p 0.001; 491.96 95% CI 391.69-591.68) , protein 373.02 and 169.47 (p 0.001; 203.54 95% CI 175.04-232.04), fat 561.28 and 561.63 (p 0.992; -0.34 95% CI -65.05-64.35). Energy, carbohydrate and protein intake is positively correlated with body mass index with the value of r and p each is r 0.44 (0.01 p), r 0.383 (p 0.03) and r 0.413  (p 0.01). Fat intake did not correlate with body mass index with the value of r 0.188 (p 0.161). In obese children energy, carbohydrate and protein  intake is higher than dietary allowances according to age and gender. Protein intake had the highest correlation with body mass index than carbohydrates and fats. 

Depression in elderly have many different and heterogeneous symptoms that includes pathological conditions, and pathological abnormalities tobe our concerned to screening and to treat it.  Research methode using analytical cross-sectional study design (community-based studies) carried out among populations of elderly in the city of Denpasar (age ≥ 60 years). Eighty seven elderly people in the city of Denpasar ( age [60-98] years old with mean 69.28 ± 7.905). The prevalence of mild depression in elderly is 45(51.7%), and severe depression is 33(36.8%). The prevalence of elderly with suspected cognitive impairment is 16 (18.4%) while the prevalence of elderly people with true cognitive impairment is 49(56.3%). There is a significant correlation between depression and  cognitive impairment at elderly people in Denpasar (P= 0.001; γ = 0.368). The conclusion for this study is depression has correlation with cognitive impairment at elederly people in Denpasar.

 

 

 

Malnutrition is one of the common problem in dialytic patient. It closely related to the morbidity and mortality like susceptibility to the infection, long standing fatigue and disruption of wound healing. Therefore, asesment of nutritional status and nutritional management play a central role in nephrological practice. The aim of this study to investigate the nutritional status in dialytic patient over 5 years at Sanglah Hospital. A cross-sectional study was performed on 38 maintenance dialytic patients over 5 years in Sanglah Hospital from August until September 2014. There is several method to evaluate nutritional status in chronic dialytic patients, body mass index, subjective global assessment-dialysis malnutrition score (SGA-DMS), muscle strength from dynamometer handgrip measurement and biochemical parameter laboratorium like albumin and serum total iron binding capacity (TIBC) were used. Based on body mass index; 15,8%  patient was suffered from malnutrition and overweight 28,9%, meanwhile on albumin parameter 39,5% mild malnutrition; 7,9% moderate malnutrition and 2,6% severe malnutrition. Serum TIBC showed 7,9% severe malnutrition; 31,6% mild malnutrition and 31,6% moderate malnutrition. From handgrip strength, 72,7% was suffered from malnutrition. Using malnutirition score (SGA-DMS), be obtained mild malnutrition about 18,4%. Malnutrition is common among dialytic patients but majority in maintenance dialytic patients over 5 years at Sanglah Hospital include in good nutritional status and mild malnutrition. In additon, majority dialytic patients suffer from a muscle mass loss.

 

 

Meningitis can be caused by several microorganisms such as bacteria, viruses or fungi. Meningitis is a fairly serious health problem and has a high rate of morbidity and mortality. This study aims to determine the proportion and characteristics of patients with bacterial meningitis. Data taken in the form of secondary data based on medical records from patients of adult bacterial meningitis who treated at Sanglah General Hospital in 2016. Descriptive analysis was conducted to determine the proportion and characteristics of patients with bacterial meningitis using SPSS 20.0 for windows. The number of samples collected as many as 37 people with adult bacterial meningitis that meet the criteria of inclusion and exclusion to be sampled in this study. Based on the outcome of treatment, 4 people (10.8%) were found with death outcome and 33 people (89.2%) with alive outcome. The sexes in both groups were found to be dominantly male (86.5%), i.e. 2 subjects (6.3%) in the death outcome and 30 subjects (93.7%) in alive outcome. All the subjects age more than 60 year old were found with alive outcome ( 4 people (100%)). This research found that people with bacterial meningitis experienced 3 seizures (8.1%) and all had live (100%). Out of 30 subjects with decrease of consciousness, 26 people (86,7%) were found in the alive outcome compared to 4 people (13.3%) in the dead outcome.

 

 

Background

Definitif treatment of maxillofacial fracture is to restore  premorbid occlusion. Precise anatomic reduction and stabilize fracture will give better result.

Method

Observational with cross sectional method studied 42 medical reports patients with history of reduction maxillofacial fractures within 3 months post operative treatment. We collected  demographic and post operative outcome for analysis data.

Result

Prevalence of malocclusion post reduction facial fracture was 4 (9,5%). Variable that influenced malocclusion post reduction facial fracture in bivariate analysis were complex fracture (OR 0,818; p:0,045) and time from trauma to operation more than 7 days (OR 11,6; p:0,013). Multivariate analysis showing positive value for complex fracture and time to operation but no variabel dominant to others.

Conclusion

Complex maxillofacial fracture and delayed operation more than 7 days influenced malocclusion post reduction.

Prevalence of functional dispepsia has been increase. Functional dispepsia influenced by many risk factor, one of the risk factor is coping strategy. There was no research have been done about the association between coping strategy and functional dispepsia in outpatient at polyclinic in Denpasar. This research aim to find the association between coping strategy and functional dispepsia in Denpasar. This is an analytical observational research. The sample of this research is dispepsia patient at polyclinic of internal medicine department Wangaya General Hospital in Denpasar. The sample was taken bya randomized systematic method. The sample that met the inclution and exclution criteria was told to fill coping orientation to the problem experienced (COPE) and depression anxiety stress scale (DASS) 42 questionaire that had been validated to asses coping strategy. The diagnose od dispepsia was done by the internist. The data was analysed by bivariat and multivariat by logistic regretion test. The subjects of the research were 62 patient. The maen age of the subject is 47 years old, 50% of male, 58.10% ofbachelor,  51.6% was diagnosed with functional dispepsia. Subject with depression (17.70%), anxiety (35.5%), and stress (19.40%). Religious coping had association with functional dispepsia (OR 1.130; 95% CI = 1.020-1.250, p = 0.019). Active acceptance, avidance, and emotion focus coping had no association with dispepsia (p>0.05). The conclution of this research is there is association between religious coping and functional dispepsia in General Wangaya Hospital, Denpasar.

 

    

Fluctuations in blood pressure (BP) are one of the most common complication among hemodialysis (HD) patient. Hypotension is the most common complication, but intradialytic hypertension (IDH) can also occur during HD. Several factors such as ages, diabetes, URR, BMI, plasma albumin, hemoglobin level, electrolytes and medication may associate with this condition. The aim of the study was to determine which factor may associate with IDH among HD patients. We performed a cross sectional study including 81 HD. Subjects without and with IDH (an increase in systolic BP pre to postdialysis ≥10 mmHg, in 2 consecutive HD sessions), were assessed for ages, diabetes, urea reduction ratio (URR), BMI, plasma albumin, hemoglobin level, natrium (Na), Na gradient (NaG), kalium (K), and the use of antihypertensive and erythropoetin. Among 81 patients (69% male), there were 14 subject (17,3%) with IDH. Ages were 47.2 ± 13.1 years, HD length were 24 (3-180) months, BMI were 21.9 ± 3.1 kg/m², dry body weight were 58 ± 10 kg, hemoglobin were 9.9 ± 1.8 g/dL, albumin were 4.1 ± 0.3 g/dL, Na, NaG and K were 138 ± 3.3, 2.1 ± 3.4, and 5.1 ± 0.7 respectively. URR were 0,67 ± 0.13, Kt/V were 1.44 ± 0.4. We found a significant association between albumin with IDH among HD patients, p <0.05, OR 0.25 (CI 0.076-0.850).

Conclusions:  Among HD patients, there was a significant association between albumin with IDH.

 

 

Objectives: The Brain Natriuretic peptide (BNP) is a peptide responsible for the homeostasis of the cardiovascular system. 

In this study, the kinetics of BNP blood plasma levels after pneumonectomy, where certain hemodynamic alterations do occur, are analyzed and a possible predictive value of postoperative complications is examined. 

Methods:  Thirty-five patients enrolled, underwent a scheduled pneumonectomy for non-small cell cancer of the lung.  The BNP plasma levels were recorded pre-operatively, immediately after the ligation of pulmonary artery, at 3 and at 24 hours postoperatively. 

The collected data were analyzed with descriptive statistical analysis, using students t-test Chi-square, ANOVA, and Pearson’s correlation coefficient. The differences considered significant at p < 0.05. 

Results: BNP showed a statistically significant increase after the ligation of the pulmonary artery in all of the patients. The patients were divided into 2 groups according to the presence or not of the complications. In the complications group the BNP increase was significantly greater than in the non-complication group. There is direct correlation of BNP value at 24 hours post-operatively and the occurrence of complications. The cut-off value was set at 100pgr/ml (sensitivity 91,6% and specificity 93.75%). Pre operatively BNP values above 15pgr/ml have 17,41% probability for a complication to occur. (60% sensitivity and 70.83% specificity)

Conclusion: The results of the study of the BNP after pneumonectomy are interesting and are in the path of a safety and economical routine clinical use for the prediction and prevention of post-operative complications. 

 

Pencapaian ASI eksklusif sudah menjadi target global, namun pada pelaksanaannya masih banyak terdapat kendala yang ditemui. Beberapa studi menyatakan terdapat berbagai faktor yang mempengaruhi pencapaian ASI eksklusif. Pengetahuan merupakan salah satu faktor perubahan perilaku, termasuk dalam tindakan melakukan ASI eksklusif. Tujuan penelitian ini adalah untuk mencari hubungan pengetahuan ibu dengan pencapaian ASI eksklusif anak dalam perawatan di ruang Kaswari RSUD Wangaya kota Denpasar. Penelitian ini merupakan studi observasional analitik dengan rancangan potong lintang. Sampel penelitian adalah 42 ibu dari anak dalam perawatan pada bulan Februari-Maret 2018 di RSUD Wangaya yang berusia ≥ 6 bulan tanpa kelainan kongenital, defisiensi imun, dan riwayat perawatan inkubator/ NICU/ PICU. Data diambil dari kuisioner dengan cronbach’s alpha 0,749 yang mencakup pengetahuan tentang definisi ASI eksklusif, produksi ASI, manfaat ASI bagi bayi dan ibu, cara pemberian ASI, serta persepsi mengenai kendala eksternal yang seharusnya dapat diatasi. Didapatkan 71,43% Sampel memiliki pengetahuan yang rendah. 33,3% Ibu berpengetahuan baik memberikan ASI eksklusif. Pertanyaan tentang manfaat ASI bagi ibu menyusui memperoleh perentase jawaban benar yang paling rendah (35,71%). Dengan uji korelasi Koefisien kontingensi didapatkan pengetahuan ibu memiliki korelasi positif lemah dengan pencapaian ASI eksklusif tanpa perbedaan statistik yang bermakna (c=0.178, p=0.241). Dapat disimpulkan, pengetahuan ibu tidak mempunyai hubungan bermakna dengan pencapaian ASI eksklusif pada anak yang dirawat di ruang Kaswari RSUD Wangaya Kota Denpasar.

3-day-old neonate, given a diagnosis of esophageal atresia (EA) with tracheoesophageal fistula (TEF), which is large and just above the carina, was scheduled for TEF repair. Routine anesthetic management focuses on adequate ventilation and avoidance of gastric distension during positive pressure ventilation. Using a balloon-tipped embolectomy catheter or a Fogarty catheter to block the fistula under the guidance of fiberoptic scope has been described. In most of the medical centers, however, the pediatric fiberoptic scope may not be available. We present a case of a newborn undergoing type C EA/TEF repair and describe a simple intra-operative technique that could temporarily occlude the gastroesophageal junction, allowing stable vital signs of patient and definitive repair of the tracheoesophageal fistula.

Giant aneurysm is rare complication of Kawasaki disease (KD) and has highest risk for arterial occlusion. We report an 8.5 years old boy who was diagnosed with giant aneurysm, after diagnosed  with KD. Echocardiography during acute phase was found lesions at left main ostium coronary artery (LMCA), left anterior descending artery (LAD), and right coronary artery (RCA). Patient was treated with single dose intravenous immuno globulin (IVIG) at 14^th of illness. Recurrent fever, hypoalbuminemia, rising c-reactive protein (CRP), and thrombocytosis occurred after IVIG administration, patient then given methylprednisolone pulse dose. Coronary angiography showed giant aneurysm LMCA, proximal left circumflex artery (LCx), proximal RCA, proximal LAD and total occlusion proximal RCA but no ischemia found through electrocardiogram tests. The patient control regularly with aspirin, warfarin, and bisoprolol therapy. The patient does not have any complain. Unresponsive and late intravenous immunoglobulin therapy in KD are significant risk factors for coronary artery lesions.

 

 

Glicogen-rich, clear cell carcinoma (GRCC) merupakan karsinoma payudara yang jarang dimana lebih dari 90% sitoplasma sel neoplastik terlihat jernih karena mengandung glikogen. Insidensi kasus ini yaitu 1-3% dari keseluruhan karsinoma payudara.Pasienadalahseorangperempuan berusia 22 tahundengankeluhanbenjolanpadapayudarakanandisertainyeri. Pada pemeriksaan USG disimpulkan massa solid dengan komponen kalsifikasi didalamnya pada payudara kanan disertai dua satelit nodul. Makroskopis didapatkan jaringan biopsi tumor yang pada irisan tampak massa putih, batas tidak tegas, konsistensi padat. Mikroskopis massa tumor tersusun dari proliferasi sel-sel epitel neoplastik  dengan sitoplasma jernih. Hasil pemeriksaan periodic acid schiff (PAS) didapatkan positifdan memperlihatkan reaksi yang labil dengan diastase. Diagnosis dibuat berdasarkan data klinis, pemeriksaaan radiologi, makroskopis dan mikroskopis serta ditunjang pemeriksaan histokimia PAS dan PAS-diastase.

Systemic onset Juvenile Idiopathic Arthritis (JIA) accounts for approximately 4-15% of JIA, and has the worst prognosis. Treatment option in SJIA is still limited. Interleukin-6 receptor antagonist is the second line therapy, has been used widely in adult rheumatoid arthritis patients, but no report of pediatric population in Indonesia. To report the efficacy of interleukin-6 receptor antagonist-Tocilizumab in difficult to treat-SJIA management. An 11-years old boy was diagnosed with SJIA and treated with Ibuprofen, then switched to high dose pulse steroid therapy, continued by weekly methotrexate for 6 weeks, however flare up color the clinical manifestation. Following ACR Guideline 2013, tocilizumab every 2 weeks was started. After 4 weeks, the MD Global scores reduced from 10.7 to 3, ACR 70 was achieved, no systemic manifestations were found with normal lab result. Tocilizumab shows beneficial effects in SJIA patient

 

Epilepsy is a brain disorder characterized by a tendency to induce a continuous epileptic outbreak, with neurobiological, cognitive, psychological and social consequences. This definition requires the occurrence of at least 1 epileptic seizure. Psychotic is the presence of symptoms of delusions, hallucinations, speech and behavior disorganized or katatonia behavior lasted approximately for 1 day to less than 1 month, where after psychotic episodes the patient returned to normal function as before. Epilepsy is a risk factor for psychotic events. The case of a 46-year-old man has been diagnosed with epilepsy since 20 years ago, uncontrolled seizures with an intra-oral 3x100mg phenytoin drug, Phenobarbital 3x60mg intra oral and 2x1mg intra oral folate. EEG and CT-Head scores obtained results within normal limits. Patients complained of changes in behavior by the family after 14 years of epilepsy. Patients diagnosed with other mental disorders YDT due to brain damage and dysfunction, this condition is also called psychotic disorders in epilepsy.

Primary cardiac tumor is very rarely with an incidence 0.001-0.3% from all tumor. About 90% of primary cardiac tumor is benign, and the most common tumor is myxoma. Cardiac myxoma most commonly found in the fourth and seventh decades of life with clinical symptoms depend on the location, size, shape, mobility and rate of growth. We reported a case of cardiac myxoma found in the left atrium of 49 years-old man with a chief complaint feeling tired from a month. In thorax CT and echocardiography examination found a solid mass in left intra-atrium suspected intra- atrial myxoma. Macroscopically, a mass with irregular shape, tan, and rubbery. Microscopically, the mass consist of proliferation of elongated, fusiform or stellate cells with ovoid or elongated nucleus, and eosinophilic cytoplasm, forming cord and partially scattered single cells between myxoid stromal, others appear surrounding capillaries or small vessels. The proliferation of capillary blood vessels also observed. Based on clinical, radiological, and histopathological examination this case concluded as cardiac myxoma.