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All Journal The Indonesian Biomedical Journal Acta Biochimica Indonesiana Jurnal Plastik Rekonstruksi The New Ropanasuri Journal of Surgery Jurnal Rekonstruksi dan Estetik
Yefta Moenadjat
Department Of Surgery, Faculty Of Medicine, Universitas Indonesia, Jakarta
Biochemistry, Genetics & Molecular Biology Civil Engineering, Building, Construction & Architecture Health Professions Immunology & microbiology Medicine & Pharmacology Public Health Other

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Compliance of Patients with Locally Advanced Colorectal Cancer to Chemotherapy Using FOLFOX compared to XELOX Regimen Kusnadi, Dana S.; Putranto, Agi S.; Saunar, Rofi Y.; Kekalih, Aria; Moenadjat, Yefta
The New Ropanasuri Journal of Surgery
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Introduction. Adjuvant chemotherapy become the treatment of choice in advance colorectal cancer to prevent recurrence. Studies showed that FOLFOX and XELOX regimen has been proven to increase overall survival rate and disease free survival. This study is aimed to compare XELOX response to FOLFOX regimen in our center, which is characterized by advanced stage neoplasm in the first presentation with low compliance. It also aimed to find out affecting factors of such response. Method. We run a retrospective study enrolled of 133 subjects with colorectal carcinoma of stage III and high–risk stage II who received adjuvant chemotherapy and treated in dr. Cipto Mangunkusumo– and Fatmawati General Hospital. Consecutive sampling was instituted, CEA level and one year mortality rate was recorded as variables of the efficacy, which was then associated with subjects’ compliance. Statistical analysis was done using Chi square or Fisher test, and a multivariate logistic regression. Significance was found as the difference met <0.05 with confidence interval of 95%. Results. We found there is no significant difference between the two regimens with efficacy (p = 0.61). There is significant correlation between the regimen (p = 0.001 and 0.000); with compliance is found much higher in FOLFOX (86% compared to 45%). We also found statistically significant of influencing factors the efficacy, i.e. Karnofsky score >90 (OR = 5.8; p = 0.004), body mass index both of normal and more (OR = 4.7; p = 0.006), and with histopathologic grading of moderate differentiated (OR = 6.3; p = 0.003). Conclusion. FOLFOX and XELOX regimen has been shown to have a same efficacy in response in our center. However, compliance showed a strong correlation to efficacy and FOLFOX regimen showed much higher rather than XELOX. Karnofsky score and body mass index should be subjects of consideration to increase the response of such adjuvant chemotherapy.
Qualitative Study on Endothelial Cell–to–cell–junction Disassembly in Severe Burn Injury Moenadjat, Yefta; Siregar, Nurjati C.; Wanandi, Septelia I.; Sadikin, Mohamad
The New Ropanasuri Journal of Surgery
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Introduction. Endothelial gap in severe burn injury remain a mystery. Capillary leaks possess its own characteristics, which is found in burned– and non–burned area. The gaps remain up to 10 post burned days or more. This is somehow representing the feature of systemic capillary leaks syndrome at the first date. VE–cadherin of adherens endothelial junction molecules known to be temporarily disassembled following thermal exposure, but there’s a question about reversibility. Question is also addressed to occludin of the tight junction molecules. We run a study to investigate these junction molecules. Method. We run an investigation to find out both molecules qualitatively descriptive on 30 burn patients enrolled, consist of 20 severe– and 10 of non–severe burn. Samples of moderate size vein taken from burned– and non–burned area were subjected to study of histomorphology and immunohistochemistry. Light microscopic study and polymerase chain reaction test were carried out to compare the features and its expression. Analysis is carried out to find the difference, specificity and sensitivity. Results. Samples took within the first 8 hours following ER presentation showed severely deteriorated endothelial lining and both ofVE–cadherin and occludin dissociation. This endothelial junction disassembly was found in both of burned– and non–burned area; both of severe– and non– severe burn as well. In burned area, mRNA expression of VE–cadherin found to be increased, as occludin decreased. In severe burned group, mRNA expression of VE–cadherin as well as occludin found to be increased. VE–cadherin synthesis was found to be earlier than occludin. Conclusion. Dissociation of both of endothelial cell–to–cell molecules junction show no differences between the two groups, and between burned– and non–burned areas.
Problem based management in delayed presented burned in dr. Cipto Mangunkusumo General Hospital, Jakarta Moenadjat, Yefta; Mulya, Dina
The New Ropanasuri Journal of Surgery
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Introduction. Burn injured victims managed in Burn Unit of dr. Cipto Mangunkusumo General Hospital, Jakarta (RSCM) is dominated by delayed presentation and categorized as the difficult cases. Though had been rescued before being referred to our unit, these cases were characterized by massive edema and minimal to nil responsiveness to standard burn fluid resuscitation and were followed by high mortality. Method. A retrospective study run on those resuscitated in period of 1998–2010 using different protocols aimed to find out the most suitable formula to treat these subjects. Pediatric–, chemical– and electrical burns was excluded. Hydration status, hemodynamic– and perfusion indices, complication(s), mortality as well as survival days were variables of interest subjected to statistical analysis. Significance met if p <0.05. Results. Out of 1768 subjects managed, 659 were enrolled in the study. Mortality in those treated in first period was 44.9% with survival 10.10 pbd ± 7.39, in the second period was 54.6% with survival 8.55 pbd ± 6.39, in the third period was 43.4% with survival 11.34 pbd ± 7.34, and the last period was 13.4% with survival 18.78 ± 6.32 pbd. Conclusion. In these characteristics, perfusion targeted resuscitation showed to be superior than volume oriented. Even though mortality remains the problem, survival days markedly increased.
Need for the Development of Indonesian Clinical Practice Guideline Moenadjat, Yefta
The New Ropanasuri Journal of Surgery
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Effect of Preconditioning and Hypothermia in Ischemia–Reperfusion Injury to the Endothelial Cells of Blood Vessels in Oryctolagus cuniculus Ismet, Mohamad F.; Moenadjat, Yefta; Kekalih, Aria
The New Ropanasuri Journal of Surgery
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Introduction. Ischemia/reperfusion injury (I/RI) remain a problem in post–hypoxia period, leading to remote organ injury. Studies showed that ischemic preconditioning (IPC) and hypothermia (HI) let destructive effect of ischemia to be minimized. The aim of study was to find out the impacts of interventions such as IPC and HI on morphology and function of the endothelial distal to ligation (ischemia) and contralateral vessel (I/RI). Method. An experimental study carried out by ligation the right common femoral artery of Oryctolagus cuniculus to induce ischemia. Endothelial cells distal to ligation and contralateral side was subjected to investigation. The effect of IPC and HI were investigated and compared to those in I/RI. Results. Morphological study showed significant difference scores between endothelial damage in ipsilateral vessels in interventional subjects with control, and intervention with I/RI group (p 0.05). Conclusion. Ischemia may lead to remote endothelial dysfunction; IPC and HI showed the efficacy to minimize the impact of reperfusion.
Effect of Ischemia Preconditioning and Hypothermia to Gastric Mucosal Reperfusion Injury Post Ischemia in Lower Extremities of Oryctolagus cuniculus Ngatio, Benjamin; Moenadjat, Yefta; Kekalih, Aria
The New Ropanasuri Journal of Surgery
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Introduction. Immediate revascularization of ischemic tissue does not always produce positive results since various reactions following formation of reactive oxygen species and activation of complement system might lead to ischemia/reperfusion injury (I/RI). It was hypothesized that ischemia preconditioning (IPC) and hypothermia (HI) have a role to reduce the impact of (I/RI). Method. An experimental study was carried out on Oryctolagus cuniculus (New Zealand White rabbit) to find out the efficacy of IPC and HI. Subjects were divided into four groups; a control (consist of two subjects) and three treatment groups (each consist of six subjects), namely I/RI group, IPC group, and HI group. In I/RI group, right common femoral artery was ligated under anesthesia and ligation was maintained for four hours, and then released for eight hours. In IPC group, arterial ligation for two minutes and released for three minutes protocol was carried out in two cycles. In HI group, right lower extremity was wrapped with iced aluminum foil. In the last two groups mentioned, the ligation released after 4 hours and treated as in I/RI group. Subjects were sacrificed, and samples of stomach was taken through laparotomy. Histopathology exam and tissue malondialdehyde (MDA) were variables of interests. Statistical analysis was carried out using SPSS ver. 20, and significance met if p
Epidemiology of Microorganisms in intraabdominal infection/complicated intraabdominal infections in six centers of surgical care in Indonesia: A preliminary study Moenadjat, Yefta; Lalisang, Toar JM.; Saunar, Rofy S.; Usman, Nurhayat; Handaya, Adeodatus Y.; Iswanto, J.; Nasution, Safruddin; Karuniawati, Anis; Loho, Tony; Widyahening, Indah S.
The New Ropanasuri Journal of Surgery
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Introduction. Data of complicated intraabdominal infections (cIAI) and the epidemiology of causative microorganisms which is Indonesian characteristics is required to develop a guideline. Thus, a preliminary study run to find out such characteristics. Method. Data of subjects with cIAI managed in six centers of teaching hospital in Indonesia in period of 2015–2016 were collected. Those data of source of infection, the epidemiology of microorganism and susceptibility of antibiotics were descriptively provided. Results. Source of infection were perforated appendicitis (26.64%), perforated gastric and duodenal ulcer (22.70%), small bowel perforation (11.84%), large bowel perforation (13.16%), postoperative (9.54%), and others (16.2%). Escherichia coli and Klebsiella pneumonia were the most microorganisms found in the pus specimen. The sensitivity of Escherichia coli and Klebsiella pneumonia to cephalosporins were in range of 14.1– 42% and 28.7–35.6%, respectively. Conclusion. Perforated appendicitis, perforated gastric and duodenal ulcer, small bowel perforation, large bowel perforation, and postoperative in sequent are the main causal of cIAIin Indonesia. The epidemiology predominated by Gram negative, particularly Escherichia coli and Klebsiella pneumonia.
Critical Appraisal to Intraabdominal and Complicated Intraabdominal Guidelines to Develop Indonesian Specific Clinical Practice Guidelines Moenadjat, Yefta; Mulya, Dina D.; Lalisang, Toar JM.
The New Ropanasuri Journal of Surgery
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Introduction. There were many clinical practice guidelines (CPG) intraabdominal infection/complicated intraabdominal infections (cIAI) have been developed since 1992 and were periodically updated recently. But to date, the implementation in Indonesia encountering problems. One is Indonesian characteristics which is differed to the population of where the CPG developed. To adapt a CPG, the quality of CPG should be first critically appraised. The best will be used furthers as the subject to be adapted, with modification regarding Indonesian characteristics. Method. A literature search carried out on guidelines databases to find out CPG on cIAI (1992–2017). The assessment preceded using AGREE II tools (MyAGREE platform) focused on 23 assessments in 6 domains (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence). Such an assessment placed a guideline in rating of 1 to 7. Updated guidelines were assessed using Checklist for the Reporting of Updated Guidelines (CheckUp). Appraised CPG were discussed. Results. There were 33 CPG in full text downloaded and subjected to selection criteria. Duplicates and those irrelevant were excluded. In the assessment there were 18 CPG included and 13 guidelines places the strong recommended category, two can be recommended and other 2 were not recommended. All updated CPG met the criteria of the best quality updates. Conclusion. Two cIAI–CPG were met the criteria of the quality guidelines to be adopted. These guidelines were developed in accordance with appropriateness in development a CPG and were updated.
Correlation between Blood Types and Intraabdominal Infection: A Preliminary Study Robby, Rizky DK.; Moenadjat, Yefta
The New Ropanasuri Journal of Surgery
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Introduction. Intra-abdominal infection (IAI) remain a clinical problem with high mortality rate. Among factors contributed to this mortality, the important one is blood type that never be considered. It was thought to have correlation with a certain type. Thus, a retrospective study as a preliminary study run to find out the evidence. Method. A descriptive analytic with cross sectional design was run. Data of those diagnosed with intraabdominal infection due to abdominal trauma and gastrointestinal infections managed at dr Cipto Mangunkusumo General Hospital was taken from medical record. ABO blood types and microbial culture results in two groups were the focus of a study and were analyzed statistically. Results. In the study, out of 230 subjects, there were 22 subjects (9.6%) with postoperative intra-abdominal infection were observed during January 2014-March 2016. There was a significant correlation between blood transfusion (p <0.001, OR = 0.02) with intraabdominal infection. However, there was no significant correlations found in blood type to the occurrence of intra-abdominal infection. Conclusion. The study unable to show that blood type has a correlation to intra-abdominal infection in those diagnosed with abdominal trauma and gastrointestinal infections.
Hepatic Reperfusion Injury following Remote Ischemia: Experimental Study on Oryctolagus cuniculus Maulanisa, Sinta C.; Moenadjat, Yefta; Kekalih, Aria
The New Ropanasuri Journal of Surgery
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Introduction. Ischemia/reperfusion (I/RI) injury following limb ischemia is realized to be responsible for remote organs injury which is found in vary, commence with mild injury to a severe one. Nevertheless, liver is an organ susceptible to such an injury. There were studies on I/RI, where ischemia in those studies were induced by direct ligation of hepatic vessels. However, study of remote ischemia was infrequently found. Thus, we run a study aimed to find out hepatic injury following ischemia induced by ligation of an artery with a significant anatomical distance. Method. An experimental study was conducted on New Zealand white rabbit. Ischemia was induced by ligation of right common femoral artery under anesthesia. Ligation was maintained for four hours period. Afterwards, ligation was released, and rabbit was set free in the cage for eight hours period. Laparotomy was carried out to take liver specimens of three different area, namely central, midzonal, and peripheral. These specimens were subjected to study histopathology and biochemical examination for malondialdehyde as well as HIF–1α. In addition, liver function test was carried out for serum bilirubin and transaminases. Results. The study on histomorphologyshowed hepatic injury of central, midzonal and peripheral of the ischemic/reperfusion injury group, which was mostly sinusoidal dilatation. There was a significant statistical different of the three hepatics–zones (central, p = 0.028, midzonal, p = 0.012, and peripheral, p = 0.030). MDA levels showed a significant increase in the ischemic/reperfusion group (p = 0.012, sig α <0.05). Tissue HIF–1α level increased denoted tissue hypoxia in the treatment group. Liver function test showed no abnormality. Conclusion. Oxidative stress and sinusoidal changes were found in three zones, i.e. central, midzonal and peripheral following ischemic of a significant anatomical distance.
Co-Authors Abdul Halim Sadikin Agus Firmansyah Ahmad Aulia Jusuf Anis Karuniawati Aria Kekalih Atmodiwirjo, Parintosa Benjamin Ngatio, Benjamin Camy F. Surjadi Caroline T. Sardjono Dalima A.W. Astrawinata Damayanti Sekarsari Ferry Sandra Handaya, Adeodatus Y. Hasibuan, Muhamad Irfan A Indah S. Widyahening Iskandar Rahardjo Budianto Ismet, Mohamad F. Iswanto, J. Jeanne A. Pawitan Jeo, Wifanto S. Jeo, Wifanto Saditya Kusnadi, Dana S. Lalisang, Toar JM. Lia Damayanti Marini Stephanie Maulanisa, Sinta C. Maurin Merlina Mazni, Yarman Mohamad Rachadian Ramadan Mohamad Sadikin Mulya, Dina Mulya, Dina D. Nasution, Safruddin Novi Sylvia Hardiany Nurjati C. Siregar Pratama, Dennis W. Puspasari, Antonia Valentine Putranto, Agi S Putranto, Agi S. Radiana D. Antarianto Ramdhani, Aris Retno Asti Werdhani Rianto Setiabudy Robby, Rizky DK. Saukani Gumay Saunar, Rofi Y. Saunar, Rofy S. Septelia I. Wanandi Suharto, Wuryantoro Syafina, Adinda B Toar J.M. Lalisang Tony Loho Twidy Tarcisia, Twidy Usman, Nurhayat Vanto, Yoni Vivian Soetikno Yuyus Kusnadi