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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
Publisher : UI Scholars Hub

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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
Publisher : UI Scholars Hub

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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.
Postoperative Wound Irrigation Using Distilled Water in Preventing Surgical Site Infection in a Tertiary Hospital: A retrospective Cohort and Cost-effective Study Jeo, Wifanto S.; Pratama, Dennis W.; Vanto, Yoni; Kekalih, Aria; Moenadjat, Yefta
The New Ropanasuri Journal of Surgery
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Background. The incidence of surgical site infections (SSIs) is reducing following the global campaign that requires all the stakeholder involvement. However, of all hospital-acquired infection prevention programs, wound irrigation is hard to be implemented in our hospital. There is a belief that the wound irrigation procedure leading to the spreading of infection. In contrast, the use of antiseptic and topical antibiotic, as well as systemic antibiotic, is uncontrolled high. Thus, we run a cost-effective study of wound irrigation to change the practice. Method. We carried out a prospective cohort study comparing wound irrigation and the standard protocol in wound care in those underwent median laparotomy during the period of January to July 2018. A total of 80 subjects enrolled in this study, which divided into two groups, 40 for each group. The first group was those treated using antiseptics (povidone-iodine) and antibiotic contained paraffin tulle, while the second group was those treated using irrigation. This study performed in the digestive surgery division, which initiated irrigation protocol for wound irrigation. Stitch specimen taken for bacterial culture proceeded on 7th day postoperative and clinical signs of infection following CDC criteria was observed then statistically analyzed. The committee of ethics Faculty of Medicine Universitas Indonesia approved the study. Results. The bacterial culture showed no significant difference (p = 0.82) between the two groups. Clinical signs are showing no significant difference between the two groups (p = 1.00). In the cost perspective, the application of wound irrigation saving IDR 57,500,00 or four USD per subject. Conclusion. Wound irrigation using distilled water efficiently prevent SSIs.
Capsular Contracture, Prolonged Use of Breast Implants with Pleural Effusion: a Case Report Moenadjat, Yefta
The New Ropanasuri Journal of Surgery
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A case with prolonged implanted breast prosthesis experienced a prolonged capsular contracture complicated with pleural effusion. A complete capsular removal proceeded instead of removal of the prosthesis solely. The present case aimed to share experiences that may add to the scientific horizon regarding the rare complications of breast prosthesis and rarely reported.
Minireview: Covid–19: Criticism of The Pathogenesis Based on The Tropism Moenadjat, Yefta
The New Ropanasuri Journal of Surgery
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Academic Atmosphere in Training Program of Surgery Moenadjat, Yefta
The New Ropanasuri Journal of Surgery
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Prediction of Liver Volume from Liver Transplant Donor using Biometric Formula compared with Computed Topography Volumetry Putranto, Agi S; Syafina, Adinda B; Sekarsari, Damayanti; Mazni, Yarman; Moenadjat, Yefta
The New Ropanasuri Journal of Surgery
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Introduction. Liver volume calculation is critical in assessing the compatibility and resectability of the graft in living donor liver transplants (LDLT). An accurate estimation of liver volume is a predictor for successful LDLT. The gold standard of liver volume estimation is CT Volumetry. Despite several limitations in the availability of software, facility, and time consumed, there is still disagreement of biometric formula to predict liver volume in Indonesia. Methods: A cross-sectional design study was carried out in Dr. Cipto Mangunkusumo General Hospital, enrolling those who underwent liver transplantation from 1st January 2010 – 3rd October 2019. Bodyweight, body height, body mass index, body surface area, and CT volumetry were the variables of interest in the study and were subjected to analysis. Result. Body weight, body height, and body surface area are found from multivariate analysis in this research. Multivariate logistic regression of body weight with caudal liver volume giving out liver volume estimated equation of estimate liver volume of 479.23 + 13.95 (bodyweight). The equation in this study proposes a biometric formula to estimate liver volume using bodyweight based on Indonesian anthropometry. Conclusion: Bodyweight is proposed for equation formation based on a characteristic patient feature in Indonesia. Accuracy testing of the liver estimation equation discovered in this study proposed an entirely satisfactory result in the Indonesian population