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Achmad F. Kamal
Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Jakarta
Medicine & Pharmacology

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Effect of autoclave devitalization on autograft incorporation and bone morphogenetic protein of tibia in Sprague-Dawley rats Asmara, Anak A.G.Y.; Kamal, Achmad F.; Siregar, Nurjati C.; Prasetyo, Marcel
Medical Journal of Indonesia Vol 23, No 2 (2014): May
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (657.399 KB) | DOI: 10.13181/mji.v23i2.992

Abstract

Background: Heating process with autoclave is one of limb salvage modalities that are widely used. but the results are not satisfying, due to mechanical bone fragility. However, considering this treatment modality is widely accepted in terms of financial, religion and sociocultural aspects, we conducted a on study rats treated with resection and reconstruction with autoclave heating method to assess bone healing by sequential radiology, histopathologic osteoblasts count, and bone morphogenetic protein (BMP).Methods: Thirty six Sprague-Dawley rats were divided into two groups with one group being the autoclave group and others served as control group. In both groups, the tibial diaphysis was extracted en bloc for 7 mm. All groups were kept for 8 weeks and treated under the same condition except the autoclave group, where the extracted bones were put into autoclave at 134°C for 15 minutes and refixed again with k-wire. We performed radiological examination at 5th and 8th week using Lane and Sandhu radiological score. After extraction, the tibial bones were inspected for histological pattern using Salked modified score, osteoblast quantity counting and BMP-2 values.Results: There were statistically significant diffences between control and autoclave group on radiological score at 5th (5.12 ± 1.6 g vs 3.21 ± 2.42, p = 0.023) and 8th week (6.06 ± 1.71 vs 4.29 ± 2.53, p = 0.040), histological score between groups (6.06 ± 1.14 vs 4.14 ± 1.99, p = 0.005), osteoblast count (p < 0.001), and BMP-2 expression,  respectively.Conclusion: Autoclave recycling autograft lowered the speed of graft incorporation and BMP-2 expression. Therefore, autoclave recycling autograft as a method of limb salvage surgery must be reevaluated and not considered to be applied for treatment in bone malignancy.  
Effect of extracorporeal irradiation on segmental bone autograft incorporation in Sprague-Dawley rats Wahyudi, Muhammad; Kamal, Achmad F.; Siregar, Nurjati C.; Prasetyo, Marcel
Medical Journal of Indonesia Vol 23, No 3 (2014): August
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (623.873 KB) | DOI: 10.13181/mji.v23i3.1082

Abstract

Background: Bone graft has been widely used in bone tumor reconstructive surgery. Extracorporeal irradiation (ECI) is commonly used to eliminate malignant cells before bone autograft. However, it may have negative effects on autograft incorporation. This study aimed to evaluate the ability of bone autograft incorporation after extra corporeal irradiation.Methods: 24 Sprague-Dawley rats underwent 7-mm en bloc resection of tibial diaphysis, and were divided into 4 groups. The first group did not receive irradiation; the 2nd, 3rd, and 4th groups received 50, 150 and 300 Gy bone irradiation respectively, and then reimplanted. Radiologic score were evaluated at week-6 and -8, while histopathology, osteoblast count and BMP-2 expression were examined at week-8. Data were analyzed with ANOVA or Kruskal-Wallis tests.Results: At week-6, radiologic scores in group 150 and 300 Gy were significantly lower compared to control group (4 vs 6 dan 4 vs 6; p = 0.011; p = 0.01). The same results were also obtained at week-8 (5.40 vs 7.14; p = 0.009 in the group 150 Gy and 5.60 vs 7.14; p = 0.018 in the group 300 Gy. Histopathological scores of the groups receiving 50, 150 and 300 Gy were significantly lower compared to the control group (6 vs 7, p = 0.017; 4 vs 7, p = 0.005; 6 vs 7, p = 0.013). Osteoblast count and BMP-2 expression were not significantly different among all groups.Conclusion: ECI with the dose of 50 to 300 Gy is associated with delayed bone autograft incorporation. However, the osteoinductive and osteogenesis capacity for autograft incorporation were maintained.
Outcomes of stage IIB osteosarcoma treated by limb salvage surgery using extracorporeally irradiated (ECI) autograft Kamal, Achmad F.; Ismail, Ismail; Mi’raj, Faisal; Hutagalung, Errol U.
Medical Journal of Indonesia Vol 20, No 2 (2011): May
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (101.466 KB) | DOI: 10.13181/mji.v20i2.441

Abstract

Background: Extracorporeally irradiated (ECI) technique is an alternative of limb salvage procedure in treating osteosarcoma regarding limitation of endoprosthesis and allograft. This study evaluated the outcomes of limb salvage surgery using extracorporeally irradiated (ECI) autograft and its correlation with patient’s characteristics.Methods: Retrospective cohort design was performed to study 20 patients with stage IIB osteosarcoma treated by ECI autograft from 1995 to 2008. Survival, local recurrence, metastases, complications, union time and functional score based on Musculoskeletal Tumor Society scoring system-(MSTS) were evaluated. Kaplan-Meier method was used to describe survival, local recurrence free survival, and metastases free survival. The correlation among patient’s characteristics that were age, gender, duration, site of tumor size, type of osteosarcoma, SAP (serum alkaline phosphatase) level, type of biopsy, and type of Huvos were analyzed by Log rank test. Chi-square test was used to analyze the correlation between MSTS score and patient’s characteristics, local recurrence, metastases, complications.Results: Five-year survival was 54.97 ± 9.8 %, five-year local recurrence free survival was 66.5 ± 7.6%, and five year metastasis-free survival was 57.13 ± 10.04%. Six patients died, five were due to lung metastases and one due to complication of chemotherapy. Three underwent amputation after local recurrence. Kaplan-Meier curve showed that a good type of Huvos (III, IV) always gave better survival, local recurrence free survival, and metastases free survival than poor type of Huvos (I,II). Normal SAP level gave better local recurrence free survival compare to increased level of SAP. Mean of union rate was 8.13 months. MSTS mean score was good (70.63%) in patients with no evidence of disease. MSTS score was poor in patients with local recurrence (p = 0.025), metastases (p = 0.01), complications (p = 0.03), and the combined of those three outcomes (p = 0.001).Conclusions: Functional outcome was poor in patients with local recurrence, metastases, and complications. SAP level and type of Huvos could be studied further as predictive factors for the outcomes (survival, local recurrence, metastases). (Med J Indones 2011; 20:131-7)Keywords: extracorporeally irradiated autograft (ECI), osteosarcoma stage IIB, outcomes
Biocompatibility of various hydoxyapatite scaffolds evaluated by proliferation of rat’s bone marrow mesenchymal stem cells: an in vitro study Kamal, Achmad F.; Iskandriati, Diah; Dilogo, Ismail H.; Siregar, Nurjati C.; Hutagalung, Errol U.; Susworo, R.; Yusuf, Achmad A.; Bachtiar, Adang
Medical Journal of Indonesia Vol 22, No 4 (2013): November
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (516.004 KB) | DOI: 10.13181/mji.v22i4.600

Abstract

Background: Scaffold (biomaterial) biocompatibility test should be performed in vitro prior to in vivo stem cell application in animal or clinical trial. These test consists of direct and indirect toxicity test (MTT assay [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide]). Those tests were used to identify cell morphological changes, cell-substrate adhesion impairment, and reduction in cell proliferation activity.Methods: The tested scaffolds were hydroxyapatite-calcium sulphate (HA-CaSO4) (scaffold I), nano-particular HA paste (scaffold II), synthetic HA granule (scaffold III), bovine HA granule (scaffold IV), and morsellized bovine xenograft (scaffold V). Direct contact toxicity test and MTT assay [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] were performed on those groups. In direct contact toxicity test, we put granules of various scaffolds within plates and incubated together with mesenchymal stem cells (MSCs). In MTT assay we included phenol 20 mg/mL and 100 mg/mL group as positive control. Morphology, cell adhesion impairment, and cell growth were monitored daily until day-7. Cells counting in the direct contact toxicity test was conducted on day-7.Results: There were no changes on 24 hours observation after direct contact. On day-7, an impairment of cell adhesion to plastic substrates, changes in cell morphology, and cell death were observed, especially in scaffold I, scaffold II, and scaffold V. In MTT assay, only scaffold I, phenol 20 mg/mL, and phenol 100 mg/mL showed more than 50% inhibition at 24-hour and 7-day-observation. Extracts from scaffold II, III, IV, and V did not affect the viability and proliferation of bone marrow MSCs (inhibition value < 50%). Scaffold II, III, IV and V were proven non-cytotoxic and have good biocompatibility in vitro,  no statistical significant differences were observed among the scaffold groups (p > 0.05).Conclusion: We understand which scaffold was nontoxic or the least toxic to MSCs in vitro. Scaffold IV (bovine HA granule) showed the least toxic effect to rat’s bone marrow MSCs on direct contact test and MTT assay. (Med J Indones. 2013;22:202-8. doi: 10.13181/mji.v22i4.600)Keywords: Biocompatibility test, direct contact test, hydroxyapatite, MTT assay, scaffold
Primary malignant giant cell tumor of the patella: report of a rare case Yanuarso, Yanuarso; Kamal, Achmad F.; Hutagalung, Errol U.; Gumay, Saukani; Prabowo, Yogi
Medical Journal of Indonesia Vol 22, No 4 (2013): November
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (530.499 KB) | DOI: 10.13181/mji.v22i4.607

Abstract

Primary malignant giant cell tumor (GCT) at the patella bone is a very rare case. It is a high-grade sarcoma characterized by a lesion in which there are areas of synchronous high-grade sarcomatous next to areas of benign GCT. A limb sparing approach is applicable to virtually any bone lesion, whether low grade or high grade. We report a case with primary malignant GCT at the patella, from diagnostic to detailed limb sparing surgery procedure. Fifteen months after surgery, the patient had a good functional outcome without local recurrence and distant metastasis. (Med J Indones. 2013;22:238-42. doi: 10.13181/mji.v22i4.607)Keywords: Limb sparing surgery, primary malignant GCT, total patellectomy
Co-Authors A.A. Ketut Agung Cahyawan W Achmad A. Yusuf Adang Bachtiar Anak Agung Gde Yuda Asmara DIAH ISKANDRIATI Errol U. Hutagalung Faisal Mi’raj Ismail Hadisoebroto Dilogo Marcel Prasetyo Muhammad Wahyudi Nurjati C. Siregar R. Susworo Saukani Gumay Yanuarso Yanuarso Yogi Prabowo