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Comparison of the Diagnostic Test of Leukocyte Count, Percentage of Neurtrophyl, and C-Reactive protein (CRP) in Adult Patients With Simple and Complicated Acute Appendicitis Ishandono Dachlan, Imam Sofii Agus Barmawi
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 39, No 01 (2007)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Background: acute appendicitis is one of the acute abdomen conditions that needs an emergency surgical procedure to prevent severe complication. If the perforation is present, the complications are general peritonitis, abscess and postoperative complication such as fistula and operative wound infection. Late diagnosis can increase the mortality and morbidity. There are about 11.2%-30% cases with intestinal perforation caused by late diagnosis. The leukocyte count, percentage of neutrophyl and C-reactive protein (CRP) are valuable informations to diagnose the perforation and nonperforation acute appendicitis in adult patients.Method: a prospective cross sectional study was held on diagnostic test from patients database for acute appendicitis cases in Digestive Surgery Subdivision of Dr Sardjito Hospital from December 2005 until October 2006. The data was classified as simple and complicated acute appendicitis based on the histopathology result. Eighty two were found for both groups which fulfilled the inclusion and exclusion criteria. The diagnostic test Le. sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Likelihood Ratio (LR +), Likelihood Ratio (LR-I, accuracy and receiver operating characteristics (ROC) with area under the curve (AUC) were analyzed for the leukocyte count, neutrophyl, and C-reactive protein (CRP) in each group with histopathology result as a gold standard.Result: the leukocyte count, neutrophyl and C-reactive protein (CRP) had respectively sensitivity of: 70,07%; 74,54%; 89,09%; specificity 70,37%; 70,37%; 81,48%; Positive Predictive Value (PPV): 82,97%; 83,67%; 90,74%; Negative Predictive Value (NPV) 54,28%; 57,57%; 78,57%; Likelihood Ratio (LR+) 2,36%; 2,51 %; 4,56%, Likelihood Ratio (LR-) 0,42%; 0,22%; 0,13%, area under the curve (AUC) 0,797; 0,744; 0,891, and accuracy 70,73%; 73,17%, 86,56%.Conclusion: C-reactive protein (CRP) was a better diagnostic test to differ simple from complicated acute appendicitis in adult patient compared to leukocyte count and neutrophy!.Key words: simple and complicated acute appendicitis, leukocyte cout, neutrophyl, C- reactive protein

Penile granuloma caused by liquid silicone injection Ishandono Dachlan, Ishandono Dachlan
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 39, No 01 (2007)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Various alloplastic injectable implants have been developed for soft tissue augmentation withoutsurgery. Silicone is a polymer from a family of chemically related organo-silicone compounds that mayexist in any state from a fluid to a solid. Injectable liquid silicone has been used for various cosmetictreatments, mainly for soft tissue augmentation, for example lip, cheek, breast, buttock, and penile. Liquidsilicone has been implicated in variety of adverse inflammatory reactions, sometimes resulting in tissuedestruction.We describe an adverse granulomatous reaction after the injection of liquid silicone for penile augmentation.Penile granuloma can occur as an adverse effect of penile enlargement with the injection of high viscositysolution, like silicone (siliconoma), paraffin (paraffinoma), vaseline or mineral oil. Penile granuloma is arare case which needs an accurate management.We found 30-years old man that occurs 5 weeks after non medical injection of liquid silicone. Surgicalmanagement was done with an excision of the granuloma and round incision on the upper penile, exceptthe urethral part. There were no complications following the treatment. Histopathology examination showedthe appearance of silicone-like foreign body granuloma and fibrosis of the preputium.Â It is concluded that Injection liquid silicone for penile augmentation could cause adverse granulomatous.Â Surgical management can be done with an excision of the granuloma.Keywords: liquid silicone, penile granuloma, surgical excision.

The influence of non-selective and selective-COX-2 NSAIDs post-minor surgery for the turning of the bleeding time. Ishandono Dachlan, Ishandono Dachlan
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 33, No 03 (2001)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Background: NSAIDs remain among the most widely prescribed drugs worldwide, including for surgical cases. Their action are primarily by inhibiting cyclo-oxigenase (COX), the key enzyme catalyzing the biosynthesis of prostaglandins (PGs). There are two similar but distinct isoforms of the enzyme - COX-1 and COX-2. One of the effects of COX-1 inhibition (nonselective NSAIDs) is decreasing thromboxanes, which is one of the important factors in thrombocytes aggregation and blood clotting. The optimal thrombocyte aggregation is required in many surgical cases, especially in microsurgery.Objective: The aim of this study is to compare the influence of non-selective and selective-COX-2 NSAIDs in the turning of the bleeding time.Methods: A prospective study of five days using NSAIDs has been done. The subjects were randomly distributed into two groups, non-selective group and selective COX-2 inhibitor group. The bleeding time was measured prior and after five days using of NSAIDs. The result was analyzed with t-test. Results: The mean of the prior bleeding time was 2.85 minutes (non-selective group) and 2.90 minutes (selective-COX-2 Inhibitor group). After five days using of NSAIDs, the bleeding time was increased from 2.85 to 3.15 minutes (non-selective group) and 2.90 to 2.95 minutes (selective COX-2 Inhibitor group). The mean of the bleeding time difference were 0.3 minutes (non-selective group) and 0.05 minutes (selective COX-2 Inhibitor group). T-test analysis showed that bleeding time was increased significantly from 2,85 minutes up to 3.15 minutes (p=0.005) after five days using non-selective NSAIDs, while there was no significant increase of bleeding time, from 2.90 minutes up to 2.95 minutes (p=0.591) after five days using of selective COX-2 inhibitor NSAIDs.Conclusion: Selective COX-2 inhibitor NSAIDs did not increase the bleeding time, while non-selective NSAIDs increased bleeding time after five days usage.Keyword: NSAIDs - selective - COX2 inhibitor - bleeding time - thromboxanes

A comparison study on the blood transfusion reaction between the elective and the emergency operationâs patients Ishandono Dachlan, Hidayati Samsiarah
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 43, No 02 (2011)
Publisher : Universitas Gadjah Mada

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Blood transfusion is principally a process of transferring blood or blood components from one individual (the donor) toanother individual (the recipient). Blood transfusion can be either a life saving condition or a life threatening situation dueto the complications happened. Therefore, blood transfusion should be conducted with clear and accurate indication inorder to obtain a condition in which the advantages outweighs the disadvantages. The aim of this study was to evaluatethe differences of the blood transfusion reactions between the patients underwent the emergency surgery with theelective surgery. This was a cross sectional study using data from the medical records from January to December 2009and from the observation on blood transfusion patients from January to May 2010. Data were analyzed using independentt-test, Chi-square test or the logistic regression, with 95% confidence interval (p<0.05). Two hundred and sixty eightdata from medical records and directly observation on blood transfusion patients were obtained during the study. Thewere significant differences of patient reactions after blood transfusion on both types of operation and blood componentstransferred (p<0.05).The transfusion reactions were more frequent in emergency surgery (54.9%) compared withelective surgery (30.5%). Based on types of blood component transfered, the transfusion reaction was more frequentafter Whole Blood/WB transfusion (84.9%) compared with Packed Red Cell/PRC transfusion (25.1%) and Fresh FrozenPlasma/FFP transfusion (25%). The types of operation and blood products had been proven to be the risk factors in bloodtransfusion. Moreover the blood products contributed more in the transfusion reactions compared with the types ofoperation (p<0.05). Amount of transfused blood based on haemoglobin correction formula on both the emergency orelective operations was not significantly different (p>0.05). In conclusion, blood transfusion reactions happened morefrequently in emergency surgery than elective surgery. The WB also generated transfusion reaction more frequently thanthe PRC. The amount of blood required based on hemoglobin correction formula for most patients was similar to the bloodtransfused.Key words: blood transfusion-type of operation-transfusion reaction - whole blood-haemoboglobin correction formula

The diagnostic value of fine needle aspiration biopsy and ultrasonography on thyroid nodule in Dr. Sardjito General Hospital, Yogyakarta Ishandono Dachlan, Wicaksono Probowoso
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 44, No 02 (2012)
Publisher : Universitas Gadjah Mada

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As the prevalence of thyroid cancer increases, a diagnostic method that can identify malignancyÂ that warrants further surgical treatment is needed. Fine needle aspiration biopsy (FNAB) andÂ ultrasonography (USG) are preoperative test for diagnosing thyroid tumor. This research aimedÂ to calculate the diagnostic value of FNAB and USG on thyroid nodule patients in Dr. SardjitoÂ General Hospital, Yogyakarta. This was a diagnostic test study using a retrospective designusing data from medical records of patients with thyroid nodules from January 2006 to DecemberÂ 2010. The diagnositic value of FNAB and USG including sensitivity, specificity, positive predictiveÂ value (PPV), negative predictive value (NPV) and accuracy were calculated and compared withÂ histopathological examination as the gold standard. Ninety medical records data of patientsÂ consisting of 71 females and 19 males who were diagnosed thyroid nodule with FNAB or USGÂ before surgery were evaluated in this study. The results of FNAB of 90 patients were as follows:Â 54 (60.0%) benign, 6 (6.7%) malignant, and 30 (33.3%) follicular neoplasm. Meanwhile, theÂ results USG of 90 patients were as follows: 38 (42.2%) benign, 15 (16.7%) malignant and 37Â (41.1%) non determined. The diagnostic value of FNAB was described as follows: sensitivity of50.0%, specificity of 100%, PPV of 100%, NPV of 50.0% and an accuracy of 60.0%, whereasÂ the diagnostic value of USG was described as follows: sensitivity of 81.8%, specificity of87.5%, PPV 60%, NPV 94.5% and accuracy of 50.0%. In conclusion, the diagnostic value ofÂ FNAB and USG in stablishing diagnosis of thyroid nodule is still low. The FNAB has higherÂ accuracy compared to USG for diagnosing thyroid nodules.Keywords: diagnostic value - fine needle aspiration - ultrasonography - thyroid nodule -Â histopathological examination

Assessment of maximal urinary flow rate (Qmax) of urethral stricture patients three weeks post internal urethrotomy Sachse in Dr. Sardjito General Hospital Yogyakarta Ishandono Dachlan, Juni Ariston Tambunan Prawito Singodimedjo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 44, No 02 (2012)
Publisher : Universitas Gadjah Mada

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Urethral stricture is a common urologic problem in developing countries including Indonesia dueto its high prevalence. Internal urethrotomy is still the gold standard to return patients to a stateof normal voiding. To evaluate the outcome of the internal urethrotomy, uroflowmetry assessmentcan be conducted with its principal variable of maximal urinary flow rate (Qmax). Since 1985, inDr. Sardjito General Hospital Yogyakarta, the internal urethrotomy has been used as the maintreatment modality to manage the urethral stricture. However, its outcome has not beenevaluated. The aim of this study was to evaluate Qmax of urethral stricture patients postinternal urethrotomy Sachse in Dr. Sardjito General Hospital. This was a cross-sectional studyperformed starting from November 2009 to April 2010. The Qmax was assessed using theuroflowmeter three weeks after internal urethrotomy. The length and the locations of the patientsâstricture, as well as its correlation with Qmax were also measured and evaluated. Among 24patients selected, 13 patients who fulfilled the inclusion and exclusion criteria were involved inthis study. The mean of the Qmax of patients was 22.3Â±6.7 mL/s.The mean of Qmax ofpatients who had the length of urethral stricture of dâ 2 cm (14.8Â±3.8 mL/s) was significantlyhigher than patients who had length of Ã 2 cm (6.4Â±2.6 mL/s) (p=0.03), whereas patients whohad the location of urethral stricture on anterior (12.4Â±5.4 mL/s) were not significantly differentcompared to patients who had those on posterior (8.5Â±4.9 mL/s) (p=0.398). In conclusion, themajority of patients returned to a state of normal urinary tract function post internal urethrotomy.The Qmax of urethral stricture patients after internal urethrotomy are influenced by the lengthof the stricture but not by its location.Keywords: urethral stricture - urethrography - Sachse - uroflowmetry - Qmax

The occurence of complication in post punctured vasectomy vs standard method Ishandono Dachlan, Ishandono Dachlan
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 31, No 04 (1999)
Publisher : Universitas Gadjah Mada

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Background: Punctured Technique of Vasectomy is a simple and refined method of vasectomy. This method was introduced to make fewer complications and to remove the fear of surgical knife.Objective: This study was aimed to assess the ease of procedure, safety, and effectiveness of Punctured Technique of Vasectomy.Methods: A prospective study of 80 acceptors has been done at Dr. Sardjito Hospital Yogyakarta from January 1991 up to Jury 1991. These subjects were randomly distributed into two groups, Punctured Method (39) and Standard Method (41). Duration of operation and complication done during operation was recorded. The follow up for complication was recorded in the second week post-operative, and sperm analyses was done in the tenth week post-operative.Results: Duration of Punctured Method (9,7179 ÃÂ± 2,9731 minutes) was significantly different (p-value =0,0006) compared to that of Standard Method (12,1951 ÃÂ± 3,2421 minutes). There were two complications during Punctured Method operation compared to six complications during Standard Method operation (RR =1,54; 95%Cl: 0,97 - 2,46). In the second post-operative week, there was no complication in the Punctured Method group, while there was one wound infection in the Standard Method group. Sperm analysis both groups showed no active spermatozoon.Conclusion: Punctured Method is easier than Standard Method, and there was no difference of effectiveness in both methods.Key words: punctured vasectomy - complications - sperm - analysis

Sumbing Median (Midline Cleft) Dachlan, Ishandono; Handaya, A. Yuda; Sagiran, Sagiran
Mutiara Medika: Jurnal Kedokteran dan Kesehatan Vol 5, No 2 (2005)
Publisher : Universitas Muhammadiyah Yogyakarta

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Midline Cleft is a midline deformity of the upper lip and nose (Tessier Clasification of Cleft Number 0 ). It is rare and often accompanied by disorder of the central nervous system. Head CT Scan with a better architecture of the brain has a better prognosis and those with poor differentiation of brain die during infancy. The treatment of choice is surgical procedure to correct the deformity by Z-plasty or its modification. The aim of this stydy is to report the management of a midline cleftTwo Cases has been reported, The first case was a 13 year-old girl suffering from a midline upper lip cleft, she visited to Sardjito Hospital because of a cosmetic problem, and she had a good achievements at School, The head CT Scan showed a normal brain architecture. She had undergone an upper lip modification Z- Plasty. The second case was a 2 day-old male baby within absence of collumella and prolabial segment of lip (false median cleft), absence of the premaxilla skeletal and he suffers multiple anomalies, the head CT scan showed poor differentiation of brain.Result of this study showed that the one case has showed a good result after upper lip modification of Z-Plasty, the second case died before treated any surgical operation. It can concluded that midline cleft should be treated with observing other problems or anomalies especially of the brain structure and followed with delicate method of surgical procedure.Sumbing median adalah kelainan median pada bibir atas dan hidung (Klasifikasi Tessier, Cleft Nomor 0). Sumbing median adalah kelainan yang jarang terjadi dan biasanya disertai dengan gangguan sistem syaraf pusat. CT Scan kepala yang menunjukkan struktur otak baik mempunyai prognosis lebih baik, Gambaran struktur otak yang jelek biasanya meninggal pada awal kehidupan atau masa pertumbuhan. Terapi pilihan biasanya berupa prosedur pembedahan untuk mengoreksi kelainan, dengan teknik Z-plasty atau modifikasinya. Tujuan dari kajian ini adalah untuk melaporkan penatalaksanaan dua buah kasus sumbing median.Delaporkan dua kasus sumbing median, kasus pertama wanita usia 13 tahun menderita sumbing pada pertengahan bibir atas, pasien datang ke Rumah sakit Sardjito dengan keluhan kosmetik, pasien mempunyai prestasi yang baik di sekolah. CT Scan kepala menunjukan gambaran otak normal. Pasien dilakukan operasi Z- Plasty pada bibir atas. Kasus ke dua,pasien laki-laki usia 2 hari dengan tidak adanya collumella danprolabial, serta tidak adanya tulang premaxilla, pasien menderita anomali multipel, CT Scan kepala menunjukan gambaran otak yang tidak sempurna.Kasus pertama menunjukan hasil yang baik setelah dilakukan operasi Z-Plasty, kasus kedua meninggal sebelum dilakukan tindakan bedah. Oleh karena itu dapat disimpulkan bahwa penatalaksanaan sumbing median harus memperhatikan anomali lain terutama struktur otak dan perlu mempertimbangkan teknik operasi yang tepat untuk mendapatkan hasil yang baik.

The Effect Of Aloe Vera On Healing Process Of Incision Wound Mahandaru, Danu; Dachlan, Ishandono
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Considering the advantages of wound treatment in moist-state, many practitioners always keep the wound in the moist condition. One of the alternatives is by using aloe vera. It has moisturizing effect, anti inflammatory and can stimulate growth factor and fibroblast. In this study, the authors aim to compare the effect of the wound dressing with the dry gauze, moist gauze and aloe vera toward the tensile strength. Thirty Rattus Novergicus were divided into two experimental groups and 1 control group. We performed full thickness skin incision on the back of the rats, and then we sutured and nursed them by using moist gauze and Aloe Vera while the dry gauze group treated as the control. On the 10th day, we decapitated the rats and we took the trace of incisional skin for the tensile strength test. At last, the samples were measured by Zwick universal tensile strength testing machine. This research show that the group treated by dry gauze had tensile strength (35 ± 7 N/cm2) , with moist gauze (41 ± 7 N/cm2), and with Aloe Vera (68 ±17 N/cm2). There was a significant difference between the three groups regarding the tensile strength (p<0.001). Treatment of wound by using Aloe Vera is proven to be more effective than the dry gauze and moist gauze to increase the tensile strength.

Breast reconstruction with autologous tissue following mastectomy: two case reports of a delayed conventional transverse rectus abdominismyocutaneous (TRAM) and latissimus dorsi myocutaneous (LDM) flap surgery Seswandhana, Rosadi; Wicaksana, Aditya; Wahdini, Siti Isya; Dachlan, Ishandono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 50, No 4 (2018)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Breast cancer is the most common malignant tumor and the leading cause of death among females. Most women with breast cancer will undergo breast-conserving surgery (BCS) or lumpectomy, simple or total mastectomy, modified radical mastectomy or bilateral mastectomy. Breast reconstruction solves many of the problems. The goal is to return the patient to a near-normal state so that she is not handicapped in her daily living. Breast reconstruction is also intended to offer psychological benefits to women treated by mastectomy following a diagnosis of possibly terminal cancer. In these case reports, we reported two successful cosmetic reconstruction cases. The first case was a 39-years-old female with non-recurrent breast cancer consulted and was referred by the oncology surgeon to the Plastic Reconstructive, and Aesthetic Surgery Division, Department of Surgery, Dr. Sardjito General Hospital. She wanted to undergo breast reconstruction. We planned to operate three years following mastectomy. She was diagnosed with 3B-stage of right breast cancer before. After the surgery, the patient received six series of chemotherapy. She also underwent radiotherapy 25 times and hormonal therapy. We decided to perform a transverse rectus abdominis myocutaneous (TRAM) flap surgery on her with 22 months follow up. The procedure provided good results, and the patient was satisfied. The second case was a 32-year-old woman who after excision of a phyllodes tumor and wanted breast reconstruction. Reconstruction was performed four years after tumor removal using latissimus dorsi myocutaneous (LDM) flap. The surgery provided good results, and the patient was satisfied. We reported two successful cosmetic reconstruction cases of non-recurrent 3B-stage of right breast cancer post-mastectomy after pedicled TRAM flap surgery and left breast post excision of phyllodes tumor after LDM flap surgery.

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