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All Journal e-CliniC Syifa' MEDIKA: Jurnal Kedokteran dan Kesehatan Medical Scope Journal (MSJ) Jurnal Impresi Indonesia International Journal of Health and Pharmaceutical (IJHP) Jurnal Sehat Indonesia (JUSINDO)
Sukanto, Wega
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Sensitivitas dan Spesifisitas Pain, Incentive Spirometry, Cough Score sebagai Prediktor Acute Respiratory Distress Syndrome pada Pasien dengan Patah Tulang Iga akibat Trauma Tumpul Toraks Rustandi, Danny K.; Tangkilisan, Adrian; Sukanto, Wega; Marpaung, Elfrida L.
e-CliniC Vol 9, No 2 (2021): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v9i2.34508

Abstract

Abstract: Thoracic trauma is one of the most common causes of death in trauma cases due to acute respiratory distress syndrome (ARDS). Definitive diagnosis and rapid identification are challenges in ARDS due to blunt thoracic trauma. The PIC score (pain, incentive spirometry, cough) is used to evaluate and monitor patients during treatment. This study was aimed to assess the specificity and sensitivity of the PIC Score in predicting the occurrence of ARDS in patients with rib fractures due to blunt thoracic trauma. This study used a prospective cohort design with a correlation analysis using data of dependency modeling via R-line copula, ROC curve analysis, and regression analysis. The results showed a total of 25 patients with an average age of 52 years, male sex was predominant (84% vs 16%). On admission, most patients had fractures of three ribs (40%). The PIC score tended to be lower in patients with higher number of rib fractures. The relationship between the PIC score and the PaO2/FiO2 ratio on day 7th of treatment showed a positive correlation, supporting the possibility of using the PIC score to predict ARDS. The sensitivity and specificity of the PIC score in predicting ARDS in blunt thoracic trauma were quite high (sensitivity 80.2% and specificity 80.9%) with an accuracy of 80.9%. In conclusion, the PIC score can predict accurately the occurrence of ARDS in patients with rib fractures due to blunt thoracic trauma.Keywords: blunt thoracic trauma; ARDS; PIC score  Abstrak: Trauma toraks merupakan salah satu penyebab kematian terbanyak dalam kasus trauma acute respiratory distress syndrome (ARDS). Diagnosis pasti dan identifikasi segera merupakan tantangan dalam penanganan ARDS akibat trauma tumpul toraks. PIC score (pain, incentive spirometry, cough) digunakan untuk mengevaluasi dan memonitor pasien selama perawatan. Penelitian ini bertujuan untuk menilai spesifisitas dan sensitivitas PIC score dalam memrediksi terjadinya ARDS pada pasien patah tulang iga akibat trauma tumpul toraks. Pada penelitian ini digunakan rancangan prospective cohort dengan penilaian korelasi analisis menggunakan data hasil pemodelan dependensi via R-line copula, analisis kurva ROC, dan analisis regresi. Hasil penelitian mendapatkan total 25 pasien dengan rerata usia 52 tahun, didominasi oleh laki-laki (84% vs 16%). Saat masuk kebanyakan pasien mengalami patah tulang pada tiga tulang iga (40%). PIC score cenderung lebih rendah pada pasien dengan jumlah patah tulang iga yang lebih banyak. Hubungan antara PIC score dan rasio PaO2/FiO2 pada hari ke-7 perawatan menunjukkan adanya korelasi positif; hal ini mendukung kemungkinan penggunaan PIC score untuk memrediksi ARDS. Sensitivitas dan spesifisitas PIC score dalam memrediksi ARDS pada trauma tumpul toraks cukup tinggi (sensitivitas 80,2% dan spesifisitas 80,9%) dengan akurasi 80,9%. Simpulan penelitian ini ialah PIC score dapat memrediksi terjadinya ARDS secara akurat pada pasien patah tulang iga akibat trauma tumpul toraks.Kata kunci: trauma tumpul toraks; ARDS; PIC score
Efek Terapi Adjuvan Extracorporal Shockwave terhadap Penyembuhan Ulkus Kaki Diabetik Penyandang Diabetes Melitus Tipe 2 dengan Penanda Vascular Endothelial Growth Factor Tampubolon, Harris J.; Tangkilisan, Adrian; Sukanto, Wega; Korompips, Grace E. C.
e-CliniC Vol 9, No 2 (2021): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v9i2.36158

Abstract

Abstract: Diabetic foot ulcer (DFU) prevalence tends to increase every year. Within 30 seconds it is predicted that one leg will be amputated due to DFU. New blood formation triggered by adjuvant extracorporeal shock wave therapy (ESWT) on increasing VEGF level is expected to promote DFU healing. This study was aimed to prove whether ESWT as an adjuvant therapy could stimulate DFU healing by increasing VEGF serum level. This was a quasi-experimental study using two groups, the ESWT and the control groups. Two repeated measurements of VEGF levels and PEDIS scores were performed. The ESWT group (17 patients) received the adjuvant ESWT and the control group (7 patients) received conventional wound care therapy. Both groups received 8-time treatment for 4 weeks. Measurements of VEGF levels and PEDIS scores were performed at baseline and after 4 weeks. The results showed that the PEDIS score of the ESWT group decreased, albeit, not in the control group. The VEGF level of the ESWT group significantly increased (mean rank=13.24) compared to the control group (mean rank=7.33). The Wilcoxon signed-ranks test indicated that the PEDIS score in ESWT group had a significant decrease compared to the control group (mean rank=7.50), Z=-3.372, p=<.001. The Pearson correlation test showed a significant relationship between VEGF value and the PEDIS score reduction (81.4%).  In conclusion, the adjuvant ESWT therapy could promote DFU healing (reduced PEDIS score) and increase VEGF levels in DFU patients.Keywords: ESWT; VEGF; diabetic foot ulcer (DFU) Abstrak: Prevalensi ulkus kaki dibetik (UKD) terus meningkat setiap tahunnya dan dalam 30 detik diprediksi terdapat satu kaki yang diamputasi karena UKD. Pembentukan pembuluh darah baru yang dipicu oleh penggunaan adjuvan ESWT terhadap peningkatan kadar VEGF diharapkan dapat memper-cepat penyembuhan UKD. Penelitian ini bertujuan untuk membuktikan terapi adjuvan ESWT dapat meningkatkan kadar VEGF dalam penyembuhan UKD. Jenis penelitan ialah kuasi-eksperimental yang membandingkan dua kelompok perlakuan (ESWT vs kontrol) melalui dua pengukuran berulang terhadap kadar VEGF dan skor pedis. Kelompok ESWT (17 pasien) mendapatkan terapi adjuvan ESWT dan kelompok kontrol (7 pasien) mendapatkan terapi konvensional perawatan luka. Kedua kelompok mendapatkan perlakuan 2 kali per minggu selama 4 minggu. Pengukuran kadar VEGF dan skor pedis pada baseline dan setelah selesai 4 minggu perlakuan. Hasil penelitian mendapatkan penurunan skor PEDIS hanya pada kelompok ESWT (14 pasien), Kadar VEGF kelompok perlakuan didapatkan meningkat bermakna (mean rank=13,24) dibandingkan kelompok kontrol (mean rank=7,33) (p<0,001). Wilcoxon Signed-Ranks Test mengindikasikan bahwa nilai skor PEDIS kelompok ESWT mengalami penurunan bermakna dibandingkan kelompok kontrol (mean rank=7,0), Z=-3,372, p=<0,001. Uji korelasi Pearson menunjukkan hubungan bermakna antara perubahan nilai VEGF dengan skor pedis (81,4%). Simpulan penelitian ini ialah terapi adjuvan ESWT dapat memicu penyembuhan UKD (menurunkan skor PEDIS) dan meningkatkan kadar VEGF pada pasien UKDKata kunci: ESWT; VEGF; ulkus kaki diabetik (UKD)
Sternotomy or Thoracotomy: Which One? Tangkilisan, Adrian; Sukanto, Wega; Tamburian, Christha; Lolongan, Gerald R.
e-CliniC Vol. 12 No. 1 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i1.46259

Abstract

Abstract: Penetrating injuries to the chest present a frequent and challenging problems. Median sternotomy and thoracotomy are two choices to explore any trauma to the chest. We report a 37-year-old man with wound and pain in his left chest due to being stabbed with a knife one hour ago. On physical examination, an open wound measured 5x1.5 cm as high as the third rib parallel to the left parasternal line, the edges of the wound bed were flattened by the periosteum. Laboratory examination showed leukocytosis. FAST showed an important left pleural effusion and pericardial fluid. CTA study showed the presence of air in the anterior mediastinum and the left pleural cavity. In the fifth intercostal space, a left anterolateral thoracotomy was performed and 800 ml of blood was evacuated from the left chest. The left lung was lowered to open the pericardium, which caused a further drop in blood pressure; then, the pericardium was opened and a blood clot (1500 ml) was removed. An epicardial wounds were found on the anterior surface of the right ventricle. The left anterior coronary artery was actively bleeding. The hemorrhagic lesion was stitched with 4.0 polypropylene reinforced with a Teflon strip. The patient recovered uneventfully on the sixth postoperative day. During the 14-month follow-up, the patient was fine and back to work. In conclusion, surgeon must be able to decide the technique of approach in the operating room considering the site of injury and the presence of involving organ. Thoracotomy patient can also receive median sternotomy if the cardiac injuries could not be repaired through thoracotomy. In addition, some patients with median sternotomy also received additional thoracotomy due to their pulmonary injuries. Keywords: penetrating injuries; thoracotomy; sternotomy; cardiac injury
Selective Embolization of Arteriovenous Malformation in Gross Hematuria Post-Renorrhaphy: A Case Report Tangkilisan, Adrian; Sukanto, Wega; Paat, Rigel; Iskandar, Edward
Medical Scope Journal Vol. 7 No. 2 (2025): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v7i2.58642

Abstract

Abstract: Management approaches for renal trauma vary from conservative methods for contusions to surgical interventions for severe injuries. Postoperative renal artery embolization (RAE) is crucial to control bleeding and preserve renal parenchymal tissue integrity. We reported a patient presented with hematuria 30 minutes after sustaining a stab wound to the right waist, accompanied by severe pain, dizziness, and cold sweats. Physical examination revealed a penetrating wound in the right flank, gross hematuria, and signs of hypovolemic shock. The patient was diagnosed with grade II hypovolemic shock due to a renal laceration and duodenal rupture, initial resuscitation and conservative management were followed by exploratory laparotomy and renorrhaphy. Persistent gross hematuria post-renorrhaphy necessitated embolization. Hypovolemic shock resulted from significant bleeding from duodenal and renal lacerations. Renorrhaphy effectively minimized renal parenchymal damage without urine extravasation. Subsequent angiography revealed gross hematuria, indicating renal arteriovenous malformation (AVM). Embolization using a vortex coil successfully managed bleeding from large vessels and improved perfusion in the lesion area. In conclusion, renal trauma poses serious risks, including hypotension and hemorrhagic shock. Prompt resuscitation followed by surgical repair and angiographic embolization are essential. Embolization remains a generally safe and effective method for achieving selective hemostasis in such cases. Keywords: renal trauma; gross hematuria; renorrhaphy; renal-artery embolization
Odontogenic Necrotizing Fasciitis in the Neck and Thoracic Region: A Case Report Tangkilisan, Adrian; Sukanto, Wega; Tamburian, Christa; Satriadi, Wayan
e-CliniC Vol. 13 No. 1 (2025): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v13i1.54850

Abstract

Abstract: Mediastinitis and necrotizing fasciitis are the most threatening complications of odontogenic infection that are not appropriately treated. We reported a 32-year-old woman with odontogenic necrotizing fasciitis in the neck and thoracic region due to second and third lower molar infection that started and progressed in ten weeks. This disease course was initiated by a small abscess in the submandibular region that spread to the neck and right chest. This condition did not progress into mediastinitis which had a poorer prognosis. Early rupture of the abscess may prevent the extent of the infection into the mediastinum. The patient’s condition improved after consuming antibiotic, analgesic, and debridement performed on her. The case management was consistent with the literature. The patient only came for first follow-up and then loss-to-follow-up. Therefore, skin flap surgery cannot be conducted. Keywords: necrotizing fasciitis; odontogenic source; neck; thoracic region
Cardiac Stab Wound in Remote Area: A Case Report Sukanto, Wega; Tamburian, Christha Z.; Aruperes, Marturia I.
e-CliniC Vol. 13 No. 2 (2025): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v13i2.61045

Abstract

Abstract: Penetrating cardiac injuries are life-threatening emergencies requiring immediate surgical intervention. We presented a case of cardiac stab wound leading to cardiac tamponade and rupture of the pulmonary artery and right ventricle who survived long enough to undergo emergency procedure. A 25-year-old male was stabbed in the left chest approximately nine hours before admission. He experienced chest pain and dyspnea but remained conscious. After initially treated at a local hospital, he was later referred to a tertiary facility. On assessment, he was tachycardic, tachypneic, and had distant heart sounds. Laboratory findings revealed leukocytosis, thrombocytosis, hyperglycemia, metabolic acidosis, lactic acidosis, and anemia. Chest radiograph showed a bottle-shaped heart, passive atelectasis, and a rightward shift of the thoracic vertebrae. The initial suspicion was cardiac tamponade due to myocardial rupture. Sternotomy revealed a pericardial hematoma (150 mL), a right ventricular tear extending to the pulmonary artery, and pneumothorax. Surgical repair was performed with drainage placement. After intervention, echocardiograph examination showed no myocardial damage or infarction, a dysfunction in diastolic which showed an impaired in relaxation of the left ventricle which is a temporary consequence of trauma, pericardial effusion or surgical intervention. In conclusion, this case underscores necessity of early surgical intervention even if this patient succeeded surviving for long hours before surgery. While this patient showed promising recovery, close postoperative monitoring remains crucial to detect functional changes and prevent complications. Keywords: emergency sternotomy; vulnus ictum; chest trauma; sharp cardiac injury; repair of artery pulmonary; rupture of right ventricle
Analisis Rasio Neutrofil Limfosit pada Pasien Carcinoma Mammae dengan Risiko Kejadian Efusi Pleura Lolongan, Gerald Randy; Tangkilisan, Adrian; Sukanto, Wega; Langi, Fima Lanra Fredrik G.
Syifa'Medika Vol 16, No 1 (2025): Syifa Medika : Jurnal Kedokteran dan Kesehatan
Publisher : Faculty of Medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32502/sm.v16i1.9839

Abstract

Kanker payudara merupakan salah satu jenis kanker yang paling sering ditemukan, dengan komplikasi seperti efusi pleura yang dapat memperburuk prognosis pasien. Penelitian ini bertujuan untuk menganalisis hubungan antara rasio neutrofil-limfosit (RNL) dan kejadian efusi pleura pada pasien karsinoma mammae di RSUP Prof Dr. R.D. Kandou Manado. Penelitian ini menggunakan desain potong lintang dengan pendekatan retrospektif, melibatkan 196 pasien kanker payudara, yang terbagi menjadi dua kelompok: pasien dengan dan tanpa efusi pleura. Hasil penelitian menunjukkan bahwa meskipun ada kecenderungan peningkatan RNL pada pasien dengan efusi pleura, faktor-faktor lain seperti stadium kanker dan pembesaran kelenjar getah bening supraklavikula lebih dominan dalam memprediksi efusi pleura. RNL tidak terbukti menjadi biomarker yang kuat untuk memprediksi efusi pleura secara independen. Penelitian ini memberikan wawasan mengenai potensi NLR dalam memprediksi komplikasi pada pasien kanker payudara, namun penelitian lebih lanjut diperlukan untuk mengidentifikasi biomarker yang lebih sensitif dalam memprediksi efusi pleura.
Partial Sternotomy Due To Intrathoracic Foreign Body Suspected Implant Migration: A Case Report Tangkilisan, Adrian; Riahna, Else; Sukanto, Wega; Zenithy Tamburian, Christha; Kent Paat, Rigel
International Journal of Health and Pharmaceutical (IJHP) Vol. 5 No. 2 (2025): May 2025 ( Indonesia - Iraq - Malaysia)
Publisher : CV. Inara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51601/ijhp.v5i2.410

Abstract

Intrathoracic foreign bodies pose notable surgical challenges, particularly with concerns of implant migration. This case report details a 55-year-old male admitted to the ICU, exhibiting symptoms of coughing and hematemesis following partial sternotomy due to presumed implant migration. Comprehensive clinical assessment revealed stable vital signs and leukocytosis, but no signs of infection. The management strategy included a multidisciplinary approach encompassing infection control, wound care, and pharmacologic support. Partial sternotomy was performed, allowing for effective retrieval with minimized postoperative complications. Postoperative care emphasized respiratory support and regular monitoring of laboratory parameters to detect potential complications. The case underscores the importance of integrating traditional and innovative surgical techniques while prioritizing patient safety and health outcomes. Close monitoring and a tailored care plan were essential in managing the escalating symptoms and potential complications arising from the intrathoracic foreign body.
Faktor Prediktor Terjadinya Delayed Hemothorax pada Pasien dengan Riwayat Trauma Tumpul Toraks di RSUP Prof Dr. R.D. Kandou Manado Stefanus, Gufi George; Sukanto, Wega; Tangkilisan, Adrian; Langi, F. L. Fredrik G.; Prasetyo, Eko; Tamburian, Christha; Saleh, Denny
Jurnal Sehat Indonesia (JUSINDO) Vol. 6 No. 02 (2024): Jurnal Sehat Indonesia (JUSINDO)
Publisher : CV. Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/jsi.v6i02.133

Abstract

Trauma toraks merupakan penyebab signifikan dari morbiditas dan mortalitas, terutama dalam konteks multitrauma, dengan dampak kematian berkisar antara 20% hingga 25%. Penelitian ini bertujuan untuk mengetahui faktor prediktor terjadinya delayed hemothorax pada pasien dengan riwayat trauma tumpul toraks di RSUP Prof. Dr. R.D. Kandou Manado. Metode yang di guanakan metode penelitian dengan pendekatan kohort retrospektif, dengan cara consecutive sampling, analisis data dengan analisis deskriptif. Adapun hasil penelitian, ditemukan bahwa faktor prediktor yang signifikan adalah adanya fraktur tulang iga, jumlah fraktur iga 3 atau lebih, dan lokasi fraktur tulang iga. Usia dan kejadian kontusio paru tidak ditemukan sebagai faktor prediktor yang signifikan. Hasil penelitian juga menunjukkan bahwa pasien yang memiliki fraktur pada tulang iga ke 10-12, 6-9, dan 3-5 memiliki risiko lebih tinggi untuk mengalami delayed hemothorax.
EFFUSIVE CONSTRICTIVE PERICARDITIS: HOW TO DIFFERENTIATE WITH CARDIAC TAMPONADE Sukanto, Wega; Tangkilisan, Adrian; Tamburian, Christa; Stefanus, Gufi George
Jurnal Impresi Indonesia Vol. 2 No. 10 (2023): Jurnal Impresi Indonesia
Publisher : Riviera Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58344/jii.v2i10.3766

Abstract

Constrictive-effusive pericarditis (ECP) is a rare syndrome but is gaining increasing attention in the classification of pericardial diseases. The aim of this research is to identify the differences in clinical symptoms between constrictive pericardial effusion and cardiac tamponade, such as chest pain, shortness of breath, blood pressure, heart rate, and other symptoms. We report the case of a 67-year-old man who had exertional dyspnea, lack of energy, fatigue, and pleuritic chest pain for the past 6 months. X-rays showed pericardial effusion and pericardial thickening with calcification indicating constrictive pericarditis. Echocardiographic examination also revealed similar findings. The patient then underwent pericardiectomy, during which the pericardial effusion was evacuated. However, after this procedure, cardiac contractions were still limited, underlying the constrictive process. This case illustrates the complexity in differentiating constrictive pericarditis from cardiac tamponade and the importance of accurate diagnosis in the management of this pericardial disease. In this case report, we discuss the clinical findings, diagnostic measures, and management implications in a patient with overt constrictive pericarditis.
Co-Authors Adrian Tangkilisan, Adrian Aruperes, Marturia I. Eko Prasetyo Gufi George Stefanus, Gufi George Iskandar, Edward Kent Paat, Rigel Korompips, Grace E. C. Lolongan, Gerald R. Lolongan, Gerald Randy Marpaung, Elfrida L. Paat, Rigel Riahna, Else Rustandi, Danny K. Saleh, Denny Satriadi, Wayan Tamburian, Christa Tamburian, Christha Tamburian, Christha Z. Tampubolon, Harris J. Zenithy Tamburian, Christha