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Reginald L. Lefrandt
Universitas Sam Ratulangi Manado

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CORRELATION BETWEEN ALLEN’S AND INVERSE ALLEN’S TESTS WITH DIAMETERS OF ULNAR AND RADIAL ARTERIES Supit, Alice I.; Budiono, Bambang; Lefrandt, Reginald L.
JURNAL BIOMEDIK : JBM Vol 5, No 2 (2013): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.5.2.2013.2590

Abstract

Abstrak: Arteri radialis semakin sering dipergunakan sebagai akses alternatif angiografi koroner dan intervensi karena dibanding akses femoralis, komplikasi perdarahan lebih rendah, mobilisasi lebih dini, dan biaya lebih murah. Terdapat beberapa hal yang dapat mengurangi keberhasilan prosedur ini; salah satunya ialah kegagalan pungsi karena ukuran a. radialis yang kecil. Studi sebelumnya menunjukkan bahwa uji Allen dapat digunakan untuk mendeteksi arteri dengan diameter yang lebih besar. Penelitian ini bertujuan untuk mengevaluasi apakah uji Allen dan inverse Allen berkorelasi dengan diameter a. ulnaris dan a. radialis. Penelitian ini berlangsung dari Juli hingga Desember 2012 di Laboratorium Kateterisasi Rumah Sakit Awal Bros Makassar. Pasien menjalani uji Allen dan inverse Allen sebelum prosedur. Ukuran diameter dalam dari lumen arteri radialis dan ulnaris diukur oleh operator dengan menggunakan analisis angiografi kuantitatif (operator tidak mengetahui hasil uji Allen). Uji Spearman?s rho digunakan untuk menganalisis korelasi antara uji Allen dan inverse Allen dengan diameter a. radialis dan a. ulnaris dengan P < 0,05 dianggap bermakna. Analisis statistik menggunakan SPSS versi 19. Hasil penelitian memperlihatkan 121 pasien (98 laki-laki dan 23 perempuan, rerata usia 57,5 (SD ± 11,9 tahun). Frekuensi crossover 3,3%. Uji Allen dan inverse Allen normal pada 116 pasien (95,8%). Rerata diameter a. radialis dan ulnaris ialah 2,14 (SD ± 0,34 mm) dan 1,95 (SD ± 0,45 mm). Uji korelasi Spearman?s rho menunjukkan korelasi bermakna antara uji Allen dan diameter a. ulnaris (P = 0,000; r = -0,485); uji inverse Allen dan diameter a. radialis (P = 0,015; r = -0,220). Simpulan: Terdapat korelasi bermakna antara uji Allen  dengan diameter a. ulnaris, dan uji inverse Allen dengan diameter a. radialis. Kedua uji ini sederhana dan dapat memberikan informasi tentang arteri mana memiliki diameter yang lebih besar. Bila uji Allen normal, maka a.ulnaris dapat dipergunakan sebagai akses alternatif ketika akses radialis gagal atau bahkan sebagai akses inisial jika uji inverse Allen abnormal atau waktu uji Allen lebih singkat dari inverse Allen, terutama untuk prosedur intervensi yang memerlukan arteri yang lebih besar sebagai akses. Kata kunci: uji Allen, uji inverse Allen, diameter, arteri radial, arteri ulnaris.   Abstract: Radial artery has been increasingly used as an alternative site for coronary angiography and intervention because of its advantages over femoral access, such as: a reduction in bleeding complications, early mobilisation, and lower cost. Despite these advantages, there are some challenges that reduce procedural success. One of them is the puncture failure owing to the small vessel size. A previous study has demonstrated consistently that the Allen test may be used for detecting the artery with the largest diameter. This study aimed to evaluate whether the Allen?s and inverse Allen?s tests correlate to the diameters of ulnar and radial arteries. This study was conducted from July to December 2012 in the Catheterization Laboratory of Awal Bros Hospital Makassar. Patients underwent the Allen?s and inverse Allen?s test before the procedure. The inner luminal diameters of radial and ulnar arteries were measured by an operator using quantitative angiographic analysis software. The operator was blinded to the results of the Allen?s tests. The Pearson correlation test was used to analyze the correlation between Allen?s and inverse Allen?s test with the diameters of the radial and ulnar arteries. A P-value of < 0.05 was considered as statistically significant. Statistical analysis was performed with Statistical Package for Social Sciences (SPSS) version 19. The results showed that there were 121 patients (98 males and 23 females, the mean age being 57.5 (SD ± 11.9 years). The crossover rate was 3.3%. Both of the Allen?s and inverse Allen?s tests were normal in 116 patients (95.8%). By using a quantitative coronary analysis software, the mean diameters of the radial and the ulnar arteries were  2.14 (SD ± 0.34 mm) and 1.95 (SD ± 0.45 mm), respectively. The Spearman?s rho correlation test showed significant correlations between the Allen?s test and diameters of ulnar arteries (P = 0.000; r = -0.485), and between the inverse Allen?s test and diameters of radial arteries (P = 0.015; r = -0.220). Conclusion: The Allen?s test correlated to the diameters of the ulnar arteries and the inverse Allen?s test correlated to the diameters of the radial arteries. The normal Allen?s test indicated that the ulnar artery might be used as an alternative access site when the radial approach failed or even as an initial access if the inverse Allen?s test was abnormal or the Allen?s test was shorter than the inverse Allen?s test, especially for the intervention procedure which needed a larger artery as the access site. These tests are simple and may provide some important information about arteries with larger diameters. Future studies with larger series of patients will be necessary to confirm our results. Keywords: Allen?s test, inverse Allen?s test, diameter, radial artery, ulnar artery.
Profil lipid pada wanita dengan sindrom koroner akut ., Ronaldi; Adriana, Ike; Rotty, Monique; Lefrandt, Reginald L.; Panda, Agnes L.
Jurnal Biomedik : JBM Vol 8, No 2 (2016): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.8.2.2016.12666

Abstract

Abstract: Females with acute coronary syndrome (ACS) display different characteristics from the opposite gender. Currently, only limited data were available regarding the characteristic of ACS in females, especially in Manado. This study aimed to obtain the lipid profile of females with ACS at Prof. Dr. R. D. Kandou Hospital Manado in 2012-2013. This was a descriptive retrospective study with a cross sectional design. Subjects were all female patients with ACS who were admitted to Prof. Dr. R. D. Kandou Hospital Manado from January 2012 to December 2013. Data were collected based on the medical record. Exclusion criteria included incomplete data and non-ACS as the main diagnosis. There were 81 women as subjects in this study. The mean age was 61.59±10.78 years. Unstable angina pectoris, non-ST elevation myocardial infarction, ST elevation myocardial infarction were found in 38 (46.9%), 15 (18.5%), and 28 (34.6%) patients consecutively. Mean value of total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), and trygliserida levels were as follows: 218.17±48.88, 145.91±47.30, 39.72±15.99, and 153±65.55 mg/dl. High level of total cholesterol, LDL, and trygliserida were found in 52 (64.2%), 50 (61.7%), 14 (17.3%) patients consecutively meanwhile low HDL level was found in 51(63%) patients. Diabetes mellitus and hypertension were found in 24 (29.6%) and 58 (71.6%) patients. The mean length of stay was 8.44±4.36 days.Keywords: female, lipid profile, acute coronary syndromeAbstrak: Wanita dengan sindrom koroner akut (SKA) menampilkan karakteristik yang berbeda daripada laki-laki dengan SKA. Sampai saat ini, masih tersedia sedikit data mengenai karakteristik SKA pada wanita. Penelitian ini bertujuan mendapatkan gambaran profil lipid pada wanita dengan SKA yang dirawat di RSUP Prof. Dr. R. D. Kandou. Jenis penelitian ini deskriptif retrospektif dengan desain potong lintang. Subyek penelitian ialah pasien wanita dengan SKA yang dirawat di RSUP Prof. Dr. R. D. Kandou, Manado dari Januari 2012-Desember 2013. Data dikumpulkan dari rekam medis. Kriteria eksklusi meliputi data yang tidak lengkap dan diagnosis selain SKA sebagai diagnosis utama. Hasil penelitian mendapatkan subyek 81 pasien wanita dengan usia rata-rata 61,59±10,78 tahun. Angina pektoris tak stabil ditemukan pada 38 pasien (46,9%), non-ST segment elevation myocardial infarction pada 15 pasien (18,5%), dan ST segment elevation myocardial infarction pada 28 pasien (34,6%). Kadar rerata kolesterol total, low density lipoprotein (LDL), high density lipoprotein (HDL), dan trigliserida ialah berturut-turut 218,17±48,88, 145,91±47,30, 39,72±15,99, dan 153±65,55 mg/dl. Kadar kolesterol total, LDL, trigliserida yang tinggi ditemukan berturut-turut pada 52 pasien (64,2%), 50 pasien (61,7%), dan 14 pasien (17,3%) sedangkan kadar HDL yang rendah ditemukan pada 51 pasien (63%). Diabetes melitus dan hipertensi ditemukan pada 24 pasien (29,6%) dan 58 pasien (71,6%). Rerata lama perawatan di rumah sakit ialah 8,44±4,36 hari.Kata kunci: wanita, profil lipid, sindrom koroner akut
TYPES OF LESIONS AND THE INCIDENCE OF TOTAL OCCLUSION OF CORONARY ARTERY IN METABOLIC SYNDROME Purabaya, Andhi; Luntungan, Marshell; Budiono, Bambang; Lefrandt, Reginald L.
Jurnal Biomedik : JBM Vol 5, No 2 (2013): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.5.2.2013.2591

Abstract

Abstrak: Sindroma metabolik merupakan gabungan kelainan-kelainan metabolik, termasuk obesitas sentral, penurunan high density lipoprotein, peningkatan trigliserida, peningkatan tekanan darah, dan hiperglikemia, yang berpotensi meningkatkan risiko aterosklerosis. ACC/AHA membuat klasifikasi lesi koroner (tipe A, B, dan C) untuk memrediksi tingkat keberhasilan dan risiko tindakan intervensi. Beberapa studi lain menunjukkan derajat keparahan dari jenis lesi koroner terkait dengan outcome jangka panjang. Penelitian ini bertujuan untuk mengetahui perbedaan jenis lesi dan insidensi dari lesi oklusi total pada pasien dengan sindrom metabolik. Sejumlah 43 pasien berturut-turut dengan atau tanpa sindrom metabolik yang menjalani angiografi koroner di Rumah Sakit Awal Bros sejak tanggal 1 Jan sampai 15 Februari 2013 dimasukkan sebagai sampel penelitian. Pasien dikategorikan sebagai penyandang sindrom metabolik bila memenuhi definisi NCEP ATP III untuk populasi Asia. Hasil penelitian memperlihatkan bahwa dari 43 pasien, 25 (58%) didiagnosis sebagai sindrom metabolik. Pada kelompok sindrom metabolik ditemukan  jenis lesi koroner tipe A 0%, tipe B 40%, dan tipe C 60%, dengan insidensi oklusi total 48%. Pada kelompok bukan sindrom metabolik ditemukan bahwa lesi koroner yang tidak bermakna 16,5%, tipe A 22,5%, tipe B 55,5%, dan tipe  C 5,5%, dengan insidensi oklusi total 0%. Terdapat perbedaan bermakna dalam tingkat keparahan lesi koroner dan insidensi oklusi total arteri koroner di antara kedua kelompok (P < 0.001). Simpulan: Sindrom metabolik berhubungan dengan tingkat keparahan jenis lesi koroner dan peningkatan insidensi oklusi total pada arteri koroner. Kata kunci: sindroma metabolik, tipe lesi, penyakit arteri koroner.  Abstract: The constellation of metabolic abnormalities including centrally distributed obesity, decreased high-density lipoprotein, elevated triglycerides, elevated blood pressure, and hyperglycaemia are known as the metabolic syndrome. Metabolic syndrome amplifies and accelerates the risk of atherosclerosis. ACC/AHA classified coronary lesions into type A, B, and C to predict successful intervention rates and risks. Other studies show the severity of coronary type lesions associated with long-term outcomes. This study aimed to find out the difference in types of lesions and incidence of total occlusion lesions in patients with metabolic syndrome. A total 43 consecutive patients with or without metabolic syndrome who underwent coronary angiography in Awal Bros Hospital were enrolled from 1st January until 15th February 2013. Patients were categorized as having metabolic syndrome when they met the NCEP ATP III definition for Asian Population. The results showed that from 43 patients, 25 (58%) considered as having metabolic syndrome. In the metabolic syndrome group, it was found that the coronary type lesion A was 0%, B was 40%, and C was 60%, with the incidence of total occlusion being 48%. In non-metabolic syndrome, it was found that non-significant coronary lession was 16.5%, type A was 22.5%, B was 55.5%, and C was 5.5%, with the incidence of total occlusions being 0%. There was a significant difference in the severity of coronary lesions and the incidences of total occlusion in the coronary artery between the two groups (P < 0.001). Conclusion: Metabolic syndrome was associated with changes in severity of types of coronary lesions  and an increased incidence of total occlusions in the coronary artery. Keywords: metabolic syndrome, type of lesion, coronary artery disease.
PROFILE OF ATRIAL FIBRILATION IN PROF. R.D. KANDOU HOSPITAL MANADO FROM SEPTEMBER 2012 – FEBRUARY 2013 Kawilarang, Michael S.; Suhartono, Iman Y.; Moeljono, Elfan; Wangko, Loretta C.; Panda, Agnes L.; Lefrandt, Reginald L.
Jurnal Biomedik : JBM Vol 5, No 2 (2013): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.5.2.2013.2595

Abstract

Abstrak: Fibrilasi atrial merupakan gangguan irama jantung menetap yang paling sering dijumpai di praktek sehari-hari, ditandai oleh adanya aktivasi atrium yang tidak terorganisasi dan kontraksi atrium dan ventrikel yang tidak terkoodinasi. Meskipun banyak laporan mengenai fibrilasi atrial di Indonesia, tetapi hal ini belum pernah dilaporkan di Sulawesi Utara. Penelitian ini bertujuan untuk mendapatkan profil fibrilasi atrial di Manado. Data diambil dari pasien fibrilasi atrial di Bagian Jantung dan Pembuluh Darah, Prof R D Kandou, Manado, sejak September 2012-Februari 2013. Variabel yang diamati ialah jenis kelamin, usia, penyakit penyerta, ekokardiografi, dan terapi. Sebanyak 84 pasien diikutsertakan dalam penelitian ini, terdiri dari 42 laki-laki dan 42 perempuan dengan usia 21-84 tahun dengan rincian 53 pasien berusia ≥60 tahun dan 30 pasien <60 tahun. Pada 59 pasien yang dilakukan ekokardiografi, 39 pasien (66,1%) mempunyai fraksi ejeksi ≥55%; dan 20 pasien (33,9%) <55% (rerata 55,8%). Pembesaran atrium kiri ditemukan pada 33 pasien (55,9%) dan trombus pada 13 pasien (22%). Penyakit penyerta yang ditemukan ialah: hipertensi pada 35 pasien (41,7%); gagal jantung 40 pasien (40,76%); penyakit jantung koroner 20 pasien (23,8%); penyakit jantung katub 21 pasien (25%); penyakit paru 6 pasien (7%); hipertiroid 5 pasien (6%); dan tanpa penyakit penyerta 1 pasien (1,2%). Pada 70 pasien (83,3%) diberikan terapi bisoprolol; 2 pasien (2,4%) digoksin; 3 pasien (3,5%) amiodaron; 7 pasien (8,4%) bisoprolol dan digoksin; dan 2 (2,4%) bisoprolol dan amiodaron. Obat antikoagulan oral diberikan pada 28 pasien (33,03%), dan aspirin pada 40 pasien (47,6%). Stroke ditemukan pada 4 pasien (4,8%); satu orang diantaranya meninggal akibat stroke. Simpulan: Fibrilasi atrial lebih sering ditemukan pada usia lanjut. Gagal jantung dan hipertensi merupakan penyakit penyerta yang tersering, sehingga perlu diwaspadai. Bisoprolol merupakan pilihan terapi yang tersering diberikan, dan angka komplikasi dan kematiannya rendah. Kata kunci: fibrilasi atrial, penyakit penyerta, terapi.   Abstract: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice characterized by disorganized atrial activation and uncoordinated contraction of the atria and ventricle. Although there are many reports regarding the profile of atrial fibrillation (AF) in Indonesia, none have been published in North Sulawesi. This study aimed to provide epidemiological data regarding atrial fibrillation profile in Manado. We reviewed medical records of outpatients diagnosed with AF in the Department of Cardiology and Vascular Medicine, Prof. Dr. R.D. Kandou Hospital, Manado, from September 2012-February 2013. Relevant variables such as gender, age, co-morbids, echocardiography, and medical therapy were documented. The results showed that a total of 84 patients with AF were enrolled in the study. There were 42 males (50%) and 42 females (50%) with age ranges from 21 to 84 years (mean 60.74 years), of these 53 patients (63%) were ≥60 years and 31 patients (37%) <60 years. From the total 84 patients, 59 patients underwent echocardiography examinations: 39 patients (66.1%) had ejection fraction (EF) ≥55%; and 20 patients (33.9%) had EF <55% (mean 55.8%). Left atrial enlargement was found in 33 patients (55.9%) and thrombus was found in 13 patients (22%). Besides suffering from AF, 35 patients (41.7%) had hypertension, 40 (40.76%) had congestive heart failure, 20 (23.8%) had coronary artery disease, 21 (25%) had valvular heart diseases, 6 (7%) had pulmonary diseases, 5 (6%) had hyperthyroidism, and 1 (1.2%)  had no comorbid. Seventy patients (83.3%) were treated with bisoprolol, 2 (2.4%) with digoxin, 3 (3.5%) with amiodarone, 7 (8.4%) with bisoprolol and digoxin, and 2 (2.4%) with bisoprolol and amiodarone. Oral anticoagulant was used in 28 patients (33.3%), and aspirin in 40 patients (47.6%). Strokes were found in four patients (4.8%); one died due to stroke. Conclusion: The prevalence of AF was higher in the elderly. Congestive heart failure and hypertension were the most common co-morbids found, thus, greater awareness is needed. Bisoprolol was used as the highest proportion of treatment in AF patients, and the complication and mortality rates were low. Keywords: atrial fibrillation, comorbids, therapy.