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Neutrophil Lymphocytes Ratio (NLR) of One-Step and Multi-Step Procedure for Hirschsprung Disease Patients At Arifin Achmad General Hospital Dita Kartika Sari; TB Odih Rhomdani Wahid; Ismar Ismar; Laode Burhanuddin; Yolla Fitri Elmi
Jurnal Ilmu Kedokteran Vol 18, No 1 (2024): Jurnal Ilmu Kedokteran
Publisher : Fakultas Kedokteran Universitas Riau

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26891/JIK.v18i1.2024.45-49

Hirschsprung disease (HD) is a congenital anomaly due to intestinal aganglionosis starting from the internal anal sphincter and spreading to the proximal area with varies extension of the segment. Definitive treatment for this abnormality is to perform surgery to remove the aganglionic bowel and can be carried out in one-step and multi-step procedure. In the process of wound healing after surgery, it involves inflammatory mediators as a marker of whether there is a stress response from the endocrine system such as neutrophil-lymphocyte ratio (NLR). This study aims to compare NLR as an inflammatory biomarker in one-step and multi-step procedure of hirschsprung disease patients at Arifin Achmad Hospital. The design of this study was cross-sectional using medical records and using total sampling for number of samples. Age, gender, and method of surgery were evaluated by univariate and bivariate to determine whether there were statistical differences. Seven HD patient taken from Mei-October at Arifin Achmad Hospital taken for evaluated. The results showed that the most samples were in < 1-month-old (42.9%) and male (71,4%) for gender. The average number of NLR was in 7.33 after one-step procedure and 2.77 for multi-step procedure. This number of NLR both not statistically different neither for the post-operative examination nor the comparison between procedure.

A Clinical Dilemma Of Bilateral Hematosalpinx In Ectopic Pregnancy: Case Report Putri, Ratu Astuti Dwi; Hidayat, Fadler; Suhaimi, Donel; Rhomdaniwahid, Tubagus Odih
Medica Hospitalia : Journal of Clinical Medicine Vol. 11 No. 3 (2024): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v11i3.1052

Background: Blastocyst implantation outside the uterine cavity leads to ectopic pregnancy. About 96% of ectopic pregnancies occur in the fallopian tubes, where it most frequently occurs; the fimbrial end accounts for 11% of all ectopic pregnancies. There was an uncommon type of ectopic pregnancy called bilateral tubal ectopic pregnancy. Bilateral tubal ectopic pregnancy is estimated to affect 1 out of 725 - 1580 ectopic pregnancies or 1 out of 200,000 live births. However, the villi quickly penetrate the endosalpinx once the implantation of the ectopic pregnancy has occurred before reaching the tubal wall and peritoneum. Vascular growth and a peritubal hematoma or hematosalpinx, which frequently involves the contralateral tubal section, are also present with this penetration. The purpose of this article is to report on the dilemmas that often occur in the case of bilateral hematosalpinx in ectopic pregnancy. Case Description: In this report, we discuss a 33-year-old woman with a positive pregnancy test and transvaginal ultrasound result that was suggestive of ectopic pregnancy in a stable hemodynamic state. The patient underwent an exploratory laparotomy, which showed bilateral hematosalpinx with right ectopic pregnancy with damaged fimbria. The left fallopian tube had a blue-purple bulge that suggested hematosalpinx secondary to ectopic pregnancy rather than bilateral ectopic pregnancy condition. The decision for deﬁnitive management was made, right salpingectomy puncture and drainage of the hematosalpinx were performed without complication. The ﬁnal diagnosis was conﬁrmed on pathology examination that showing chorionic villi within the right damaged fimbria, focal decidua, a few trophoblast-like cells that indicated ectopic pregnancy in the left tubal cavity. Conclusion: This approach encourages both shared decision-making and preparedness, both of which are required to provide patient-centered and comprehensive caremanagement such as bilateral hematosalpinx in ectopic pregnancy case, that must always be individualized, and patient's desire for future conception must be taken into account.

Pancreas-Sparing Mucosectomy for a Complex Gastric Duplication Cyst: A Case Report Filza Rifqi Aufa Aslam; Ismar Ibrahim; Tubagus Odih Rhomdani Wahid; Andrea Valentino; Salamullah; Indrajaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1371

Background: Gastric duplication (GD) is a rare congenital anomaly, representing 2–9% of all gastrointestinal duplications. These embryologic abnormalities are typically managed by complete surgical resection due to the risk of complications, including malignancy. However, this standard approach becomes perilous when the duplication cyst is intimately adherent to vital organs. We present a case where a large gastric duplication cyst was inseparable from the pancreas, necessitating a deviation from standard management. Case presentation: An 8-month-old female infant presented with a four-month history of non-bilious vomiting and progressive abdominal distension. A palpable, cystic, 8x5 cm mass was identified in the left upper abdomen. Abdominal ultrasound revealed a loculated, septated cystic lesion, and a barium study demonstrated a significant filling defect on the greater curvature of the stomach. Initial management was delayed as the family sought alternative medicine. Surgical exploration revealed a large gastric duplication cyst arising from the greater curvature, which was found to be densely adherent to the body and tail of the pancreas. To avoid catastrophic pancreatic injury, a complete resection was abandoned in favor of a pancreas-sparing mucosectomy. The entire mucosal lining of the duplication was excised, and the shared muscular wall was preserved and repaired. Postoperatively, the patient had a transient ileus but recovered well, with complete resolution of symptoms. At an 11-day follow-up, she was thriving, feeding well, and had gained significant weight. Histopathology confirmed a benign gastric duplication cyst. Conclusion: This case highlights that for complex gastric duplication cysts where resection would endanger vital structures, complete mucosal excision is a safe, effective, and organ-preserving surgical alternative. This technique successfully mitigates the risks of both the untreated anomaly and iatrogenic surgical complications, underscoring the importance of surgical judgment and adaptability in managing rare congenital anomalies.

Pancreas-Sparing Mucosectomy for a Complex Gastric Duplication Cyst: A Case Report Filza Rifqi Aufa Aslam; Ismar Ibrahim; Tubagus Odih Rhomdani Wahid; Andrea Valentino; Salamullah; Indrajaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1371

Background: Gastric duplication (GD) is a rare congenital anomaly, representing 2–9% of all gastrointestinal duplications. These embryologic abnormalities are typically managed by complete surgical resection due to the risk of complications, including malignancy. However, this standard approach becomes perilous when the duplication cyst is intimately adherent to vital organs. We present a case where a large gastric duplication cyst was inseparable from the pancreas, necessitating a deviation from standard management. Case presentation: An 8-month-old female infant presented with a four-month history of non-bilious vomiting and progressive abdominal distension. A palpable, cystic, 8x5 cm mass was identified in the left upper abdomen. Abdominal ultrasound revealed a loculated, septated cystic lesion, and a barium study demonstrated a significant filling defect on the greater curvature of the stomach. Initial management was delayed as the family sought alternative medicine. Surgical exploration revealed a large gastric duplication cyst arising from the greater curvature, which was found to be densely adherent to the body and tail of the pancreas. To avoid catastrophic pancreatic injury, a complete resection was abandoned in favor of a pancreas-sparing mucosectomy. The entire mucosal lining of the duplication was excised, and the shared muscular wall was preserved and repaired. Postoperatively, the patient had a transient ileus but recovered well, with complete resolution of symptoms. At an 11-day follow-up, she was thriving, feeding well, and had gained significant weight. Histopathology confirmed a benign gastric duplication cyst. Conclusion: This case highlights that for complex gastric duplication cysts where resection would endanger vital structures, complete mucosal excision is a safe, effective, and organ-preserving surgical alternative. This technique successfully mitigates the risks of both the untreated anomaly and iatrogenic surgical complications, underscoring the importance of surgical judgment and adaptability in managing rare congenital anomalies.

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