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All Journal e-CliniC JURNAL BIOMEDIK Syifa' MEDIKA: Jurnal Kedokteran dan Kesehatan Medical Scope Journal (MSJ) Jurnal Impresi Indonesia International Journal of Health and Pharmaceutical (IJHP) Jurnal Sehat Indonesia (JUSINDO)
Adrian Tangkilisan, Adrian
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Pola trauma tembus toraks di Instalasi Rawat Darurat Bedah RSUP Prof. Dr. R. D. Kandou Manado periode Juli 2013 – Juni 2015 Kissra, Christianto; Tangkilisan, Adrian; Sapan, Heber B.
e-CliniC Vol 4, No 2 (2016): Jurnal e-CliniC (eCl)
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.4.2.2016.13880

Abstract

Abstract: Trauma continues to be major public health problem worldwide since it is associated with high morbidity and mortality in developed and developing countries. Penetrating thoracic trauma respresents a common and challenging problem whether it is caused either by gunshot or by non-gunshot-related accidents (stabs, traffic accidents). This study was aimed to obtain the profile of penetrating thoracic trauma in Surgery Emergency Unit of Prof. Dr. R. D. Kandou Hospital Manado from July 2013 to June 2015. This was a retrospactive descriptive study using the medical record data of penetrating thoracic trauma patients. The results showed that there were 31 patients of penetrating thoracic trauma out of 108 patients of thoracic trauma patients. Most cases occurred in 2014 (48.41%). Based on age group, the majority of patients were at the age group 16-30 years old (58.05%). Based on sex, most patients were males (96.80%). The most common causes of penetrating thoracic trauma was puncture wounds/stabs (80.64%) and the most common intrathoracic complication was hemothorax (58.1%).Keywords: trauma, penetrating thoracic trauma. Abstrak: Trauma merupakan masalah kesehatan masyarakat yang utama di seluruh dunia karena dikaitkan dengan morbiditas dan mortalitas yang tinggi baik di negara maju dan berkembang. Trauma tembus toraks merupakan masalah umum dan menantang, baik oleh tembakan atau non-tembakan-kecelakanaan (tikaman, kecelakaan lalu lintas). Penelitian ini bertujuan untuk mendapatkan pola trauma tembus toraks di IRDB RSUP Prof. Dr. R. D. Kandou Manado periode Juli 2013 – Juni 2015. Jenis penelitian ialah deskriptif retrospektif dengan menggunakan data rekam medik pasien trauma tembus toraks di IRDB RSU Prof. Dr. R. D. Kandou Manado. Hasil penelitian mendapatkan jumlah kasus trauma tembus toraks sebanyak 31 pasien dari 108 pasien trauma toraks. Kasus terbanyak terjadi pada tahun 2014 (48,41%). Berdasarkan kelompok usia mayoritas penderita trauma tembus toraks (58,05%)pada usia 16-30 tahun. Berdasarkan jenis kelamin sebagian besar penderita (96,80%) berjenis kelamin laki-laki. Penyebab trauma tembus toraks terbanyak karena luka tusukan/tikaman (80,64%), dan komplikasi intratoraks terbanyak yaitu hemotoraks (58,1%). Kata kunci: trauma, trauma tembus toraks
Pola trauma tumpul toraks non penetrans, penanganan, dan hasil akhir di Instalasi Rawat Darurat Bedah RSUP Prof. Dr. R. D. Kandou Manado periode Januari 2014 – Juni 2016 Pitojo, Kevin G.; Tangkilisan, Adrian; Monoarfa, Alwin
e-CliniC Vol 4, No 2 (2016): Jurnal e-CliniC (eCl)
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v4i2.14564

Abstract

Abstract: Trauma is reported as the main cause of death, hospitalization, and long-term disability. Blunt thoracic trauma is a common problem in society which can be caused by traffic accidents, fallen from height, impact, and others. This study was aimed to obtain the profile of non-enetrating blunt thoracic trauma in surgery emergency unit of Prof. Dr. R. D. Kandou General Hospital Manado from January 2014 to June 2016. This was a retrospective descriptive study using all medical records of non-penetrating blunt thoracic trauma. The results showed that there were 35 cases of non penetrating blunt thoracic trauma out of a total of 120 cases. The majority of cases occurred in 2014 and 2016 (37.1%); age group 21-30 years (28.5%), and males (85.7%). The most common cause was traffic accidents (74.2%) meanwhile most treatment performed was conservative treatment (77.1%) and the outcome of most non-penetrating blunt thoracic trauma was uncomplicated (77.1%).Keywords: trauma, blunt thoracic trauma Abstrak: Trauma dilaporkan menjadi penyebab utama kematian, perawatan di rumah sakit dan kecacatan jangka panjang. Trauma tumpul toraks merupakan masalah umum bagi masyarakat, yang bisa disebabkan oleh kecelakaan lalu lintas, jatuh dari ketinggian, benturan, dan lain-lain. Penelitian ini bertujuan untuk mendapatkan data tentang trauma tumpul toraks non penetrans di IRDB RSU Prof Dr. R. D. Kandou Manado periode Januari 2014-Juni 2016. Jenis penelitian ialah deskriptif retrospektif dengan menggunakan semua data rekam medik pasien trauma tumpul toraks non-penetrans. Hasil peneltiian mendapatkan jumlah kasus trauma tumpul toraks non penetrans sebanyak 35 pasien dari total 120 pasien dengan kasus terbanyak terjadi pada tahun 2014 dan 2016 (37,1%), kelompok usia 21-30 tahun (28,5%), dan jenis kelamin laki-laki (85,7%). Penyebab tersering ialah kecelakaan lalu lintas (74,2%) sedangkan penanganan yang paling banyak dilakukan ialah penanganan konservatif (77,1%). Hasil akhir trauma tumpul toraks non-penetrans yang didapat umumnya tanpa komplikasi (77,1%).Kata kunci: trauma, trauma tumpul
ANGKA KEJADIAN APENDISITIS DI RSUP PROF. DR. R. D. KANDOU MANADO PERIODE OKTOBER 2012 – SEPTEMBER 2015 Thomas, Gloria A.; Lahunduitan, Ishak; Tangkilisan, Adrian
e-CliniC Vol 4, No 1 (2016): Jurnal e-CliniC (eCl)
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v4i1.10960

Abstract

Abstract: Appendicitis is an inflammation of vermiform appendix. Acute inflammation of the appendix needs to be treated immediately to prevent fatal complications. The incidence among females and males is slightly comparable, however, the incidence is higher among males than females in the age range between 20-30 years. The fundamental clinical decision in the diagnosis of a patient with suspected appendicitis is whether to do an operation or not. The meaningful evaluation of acute appendicitis balances early operative intervention to prevent operative risks. This study aimed to obtain the incidence of appendicitis at Prof. Dr. R.D Kandou Hosiptal Manado from October 2012 to September 2015. This was a  retrospective descriptive study using data of the Department of Medical Record Prof. Dr. R.D Kandou Manado Hospital. The results showed that there were 650 patients. Most patients had acute appendicitis as many as 412 patients (63%) meanwhile chronic appendicitis was found in 38 patients (6%). Of 650 patients, 200 patients had complications; 193 patients (30%) with perforated appendicitis and 7 patients (1%) with appendicular mass. The most frequent age group to develop appendicitis was 20-29 years. The number of male patients was higher than the females. Keywords: appendicitis, incidence  Abstrak: Apendisitis adalah adanya peradangan pada apendiks vermiformis. Peradangan akut pada apendiks memerlukan tindak bedah segera untuk mencegah komplikasi yang umumnya berbahaya. Insidens pada perempuan dan laki-laki umumnya sebanding, kecuali pada umur 20-30 tahun insidens pada laki-laki lebih tinggi. Keputusan klinis mendasar dalam mendiagnosis pasien dengan dugaan apendisitis ialah apakah perlu dilakukannya operasi atau tidak.  Evaluasi yang baik dari kasus apendisitis akut dapat mengurangi intervensi untuk operasi awal, dengan harapan dapat mengurangi risiko operasi yang tidak diperlukan. Penelitian ini bertujuan untuk mengetahui angka kejadian apendisitis di RSUP Prof. Dr. R. D, Kandou Manado periode Oktober 2012 – September 2015. Metode penelitian yang digunakan ialah deskriptif retrospektif dengan menggunakan data di Bagian Rekam Medik RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian menunjukkan bahwa selama periode Oktober 2012 – September 2015 terdapat 650 pasien. Jumlah pasien terbanyak ialah apendisitis akut yaitu 412 pasien (63%) sedangkan apendisitis kronik sebanyak 38 pasien (6%). Dari 650 pasien, yang mengalami komplikasi sebanyak 200 pasien yang terdiri dari 193 pasien (30%) dengan komplikasi apendisitis perforasi dan 7 pasien (1%) dengan periapendikuler infiltrat. Kelompok umur tersering yang menderita apendisitis ialah 20-29 tahun. Jumlah pasien laki-laki lebih banyak daripada perempuan. Kata kunci: apendisitis, angka kejadian  
Sensitivitas dan Spesifisitas Pain, Incentive Spirometry, Cough Score sebagai Prediktor Acute Respiratory Distress Syndrome pada Pasien dengan Patah Tulang Iga akibat Trauma Tumpul Toraks Rustandi, Danny K.; Tangkilisan, Adrian; Sukanto, Wega; Marpaung, Elfrida L.
e-CliniC Vol 9, No 2 (2021): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v9i2.34508

Abstract

Abstract: Thoracic trauma is one of the most common causes of death in trauma cases due to acute respiratory distress syndrome (ARDS). Definitive diagnosis and rapid identification are challenges in ARDS due to blunt thoracic trauma. The PIC score (pain, incentive spirometry, cough) is used to evaluate and monitor patients during treatment. This study was aimed to assess the specificity and sensitivity of the PIC Score in predicting the occurrence of ARDS in patients with rib fractures due to blunt thoracic trauma. This study used a prospective cohort design with a correlation analysis using data of dependency modeling via R-line copula, ROC curve analysis, and regression analysis. The results showed a total of 25 patients with an average age of 52 years, male sex was predominant (84% vs 16%). On admission, most patients had fractures of three ribs (40%). The PIC score tended to be lower in patients with higher number of rib fractures. The relationship between the PIC score and the PaO2/FiO2 ratio on day 7th of treatment showed a positive correlation, supporting the possibility of using the PIC score to predict ARDS. The sensitivity and specificity of the PIC score in predicting ARDS in blunt thoracic trauma were quite high (sensitivity 80.2% and specificity 80.9%) with an accuracy of 80.9%. In conclusion, the PIC score can predict accurately the occurrence of ARDS in patients with rib fractures due to blunt thoracic trauma.Keywords: blunt thoracic trauma; ARDS; PIC score  Abstrak: Trauma toraks merupakan salah satu penyebab kematian terbanyak dalam kasus trauma acute respiratory distress syndrome (ARDS). Diagnosis pasti dan identifikasi segera merupakan tantangan dalam penanganan ARDS akibat trauma tumpul toraks. PIC score (pain, incentive spirometry, cough) digunakan untuk mengevaluasi dan memonitor pasien selama perawatan. Penelitian ini bertujuan untuk menilai spesifisitas dan sensitivitas PIC score dalam memrediksi terjadinya ARDS pada pasien patah tulang iga akibat trauma tumpul toraks. Pada penelitian ini digunakan rancangan prospective cohort dengan penilaian korelasi analisis menggunakan data hasil pemodelan dependensi via R-line copula, analisis kurva ROC, dan analisis regresi. Hasil penelitian mendapatkan total 25 pasien dengan rerata usia 52 tahun, didominasi oleh laki-laki (84% vs 16%). Saat masuk kebanyakan pasien mengalami patah tulang pada tiga tulang iga (40%). PIC score cenderung lebih rendah pada pasien dengan jumlah patah tulang iga yang lebih banyak. Hubungan antara PIC score dan rasio PaO2/FiO2 pada hari ke-7 perawatan menunjukkan adanya korelasi positif; hal ini mendukung kemungkinan penggunaan PIC score untuk memrediksi ARDS. Sensitivitas dan spesifisitas PIC score dalam memrediksi ARDS pada trauma tumpul toraks cukup tinggi (sensitivitas 80,2% dan spesifisitas 80,9%) dengan akurasi 80,9%. Simpulan penelitian ini ialah PIC score dapat memrediksi terjadinya ARDS secara akurat pada pasien patah tulang iga akibat trauma tumpul toraks.Kata kunci: trauma tumpul toraks; ARDS; PIC score
Efek Terapi Adjuvan Extracorporal Shockwave terhadap Penyembuhan Ulkus Kaki Diabetik Penyandang Diabetes Melitus Tipe 2 dengan Penanda Vascular Endothelial Growth Factor Tampubolon, Harris J.; Tangkilisan, Adrian; Sukanto, Wega; Korompips, Grace E. C.
e-CliniC Vol 9, No 2 (2021): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v9i2.36158

Abstract

Abstract: Diabetic foot ulcer (DFU) prevalence tends to increase every year. Within 30 seconds it is predicted that one leg will be amputated due to DFU. New blood formation triggered by adjuvant extracorporeal shock wave therapy (ESWT) on increasing VEGF level is expected to promote DFU healing. This study was aimed to prove whether ESWT as an adjuvant therapy could stimulate DFU healing by increasing VEGF serum level. This was a quasi-experimental study using two groups, the ESWT and the control groups. Two repeated measurements of VEGF levels and PEDIS scores were performed. The ESWT group (17 patients) received the adjuvant ESWT and the control group (7 patients) received conventional wound care therapy. Both groups received 8-time treatment for 4 weeks. Measurements of VEGF levels and PEDIS scores were performed at baseline and after 4 weeks. The results showed that the PEDIS score of the ESWT group decreased, albeit, not in the control group. The VEGF level of the ESWT group significantly increased (mean rank=13.24) compared to the control group (mean rank=7.33). The Wilcoxon signed-ranks test indicated that the PEDIS score in ESWT group had a significant decrease compared to the control group (mean rank=7.50), Z=-3.372, p=<.001. The Pearson correlation test showed a significant relationship between VEGF value and the PEDIS score reduction (81.4%).  In conclusion, the adjuvant ESWT therapy could promote DFU healing (reduced PEDIS score) and increase VEGF levels in DFU patients.Keywords: ESWT; VEGF; diabetic foot ulcer (DFU) Abstrak: Prevalensi ulkus kaki dibetik (UKD) terus meningkat setiap tahunnya dan dalam 30 detik diprediksi terdapat satu kaki yang diamputasi karena UKD. Pembentukan pembuluh darah baru yang dipicu oleh penggunaan adjuvan ESWT terhadap peningkatan kadar VEGF diharapkan dapat memper-cepat penyembuhan UKD. Penelitian ini bertujuan untuk membuktikan terapi adjuvan ESWT dapat meningkatkan kadar VEGF dalam penyembuhan UKD. Jenis penelitan ialah kuasi-eksperimental yang membandingkan dua kelompok perlakuan (ESWT vs kontrol) melalui dua pengukuran berulang terhadap kadar VEGF dan skor pedis. Kelompok ESWT (17 pasien) mendapatkan terapi adjuvan ESWT dan kelompok kontrol (7 pasien) mendapatkan terapi konvensional perawatan luka. Kedua kelompok mendapatkan perlakuan 2 kali per minggu selama 4 minggu. Pengukuran kadar VEGF dan skor pedis pada baseline dan setelah selesai 4 minggu perlakuan. Hasil penelitian mendapatkan penurunan skor PEDIS hanya pada kelompok ESWT (14 pasien), Kadar VEGF kelompok perlakuan didapatkan meningkat bermakna (mean rank=13,24) dibandingkan kelompok kontrol (mean rank=7,33) (p<0,001). Wilcoxon Signed-Ranks Test mengindikasikan bahwa nilai skor PEDIS kelompok ESWT mengalami penurunan bermakna dibandingkan kelompok kontrol (mean rank=7,0), Z=-3,372, p=<0,001. Uji korelasi Pearson menunjukkan hubungan bermakna antara perubahan nilai VEGF dengan skor pedis (81,4%). Simpulan penelitian ini ialah terapi adjuvan ESWT dapat memicu penyembuhan UKD (menurunkan skor PEDIS) dan meningkatkan kadar VEGF pada pasien UKDKata kunci: ESWT; VEGF; ulkus kaki diabetik (UKD)
Sternotomy or Thoracotomy: Which One? Tangkilisan, Adrian; Sukanto, Wega; Tamburian, Christha; Lolongan, Gerald R.
e-CliniC Vol. 12 No. 1 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i1.46259

Abstract

Abstract: Penetrating injuries to the chest present a frequent and challenging problems. Median sternotomy and thoracotomy are two choices to explore any trauma to the chest. We report a 37-year-old man with wound and pain in his left chest due to being stabbed with a knife one hour ago. On physical examination, an open wound measured 5x1.5 cm as high as the third rib parallel to the left parasternal line, the edges of the wound bed were flattened by the periosteum. Laboratory examination showed leukocytosis. FAST showed an important left pleural effusion and pericardial fluid. CTA study showed the presence of air in the anterior mediastinum and the left pleural cavity. In the fifth intercostal space, a left anterolateral thoracotomy was performed and 800 ml of blood was evacuated from the left chest. The left lung was lowered to open the pericardium, which caused a further drop in blood pressure; then, the pericardium was opened and a blood clot (1500 ml) was removed. An epicardial wounds were found on the anterior surface of the right ventricle. The left anterior coronary artery was actively bleeding. The hemorrhagic lesion was stitched with 4.0 polypropylene reinforced with a Teflon strip. The patient recovered uneventfully on the sixth postoperative day. During the 14-month follow-up, the patient was fine and back to work. In conclusion, surgeon must be able to decide the technique of approach in the operating room considering the site of injury and the presence of involving organ. Thoracotomy patient can also receive median sternotomy if the cardiac injuries could not be repaired through thoracotomy. In addition, some patients with median sternotomy also received additional thoracotomy due to their pulmonary injuries. Keywords: penetrating injuries; thoracotomy; sternotomy; cardiac injury
Odontogenic Necrotizing Fasciitis in the Neck and Thoracic Region: A Case Report Tangkilisan, Adrian; Sukanto, Wega; Tamburian, Christa; Satriadi, Wayan
e-CliniC Vol. 13 No. 1 (2025): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v13i1.54850

Abstract

Abstract: Mediastinitis and necrotizing fasciitis are the most threatening complications of odontogenic infection that are not appropriately treated. We reported a 32-year-old woman with odontogenic necrotizing fasciitis in the neck and thoracic region due to second and third lower molar infection that started and progressed in ten weeks. This disease course was initiated by a small abscess in the submandibular region that spread to the neck and right chest. This condition did not progress into mediastinitis which had a poorer prognosis. Early rupture of the abscess may prevent the extent of the infection into the mediastinum. The patient’s condition improved after consuming antibiotic, analgesic, and debridement performed on her. The case management was consistent with the literature. The patient only came for first follow-up and then loss-to-follow-up. Therefore, skin flap surgery cannot be conducted. Keywords: necrotizing fasciitis; odontogenic source; neck; thoracic region
Partial Intestinal Obstruction Caused by Left Diaphragmatic Hernia: A Case Report Pirade, Audi; Paat, Rigel K.; Tangkilisan, Adrian
e-CliniC Vol. 14 No. 1 (2026): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v14i1.65769

Abstract

Abstract: Diaphragmatic hernia in adults is a rare but potentially serious condition that often presents with non-specific gastrointestinal and respiratory symptoms. This case highlights a left-sided diaphragmatic hernia complicated by partial intestinal obstruction. We reported a 54-year-old male presented with a one-week history of progressive abdominal bloating and intermittent abdominal pain, accompanied by nausea but no vomiting or fever. Bowel movements and flatus were present. In examination, he was hemodynamically stable with abdominal distension and positive bowel sounds. Nasogastric tube drainage produced greenish fluid. Digital rectal examination showed normal stool without blood or mucus. Chest X-ray suggested a left diaphragmatic hernia, and abdominal X-ray revealed partial bowel obstruction without signs of pneumoperitoneum. Laboratory findings were within normal limits, except for mild hypokalemia (K⁺ 3.3 mmol/L). A diagnosis of partial mechanical intestinal obstruction due to a left diaphragmatic hernia was made. The patient underwent an urgent non-contrast abdominal CT followed by combined laparotomy and thoracotomy. Intraoperatively, a diaphragmatic defect (3×3 cm and 10×10 cm) with adhesions between the left lung and diaphragm was identified. Adhesiolysis was performed, and the defect was repaired using non-absorbable sutures, followed by diaphragmatic plication and chest tube insertion. In conclusion, this case underscores the importance of including diaphragmatic hernia in the differential diagnosis of adult patients with persistent abdominal symptoms. Timely imaging and a multidisciplinary surgical approach enabled resolution of obstruction and definitive repair, preventing serious complications. In conclusion, early recognition and appropriate surgical management are key to optimizing outcomes in adult diaphragmatic hernia with bowel involvement. Keywords: diaphragmatic hernia; intestinal obstruction
Co-Authors Alwin Monoarfa Audi Pirade Eko Prasetyo Gloria A. Thomas, Gloria A. Gufi George Stefanus, Gufi George Heber B. Sapan, Heber B. Ishak Lahunduitan, Ishak Iskandar, Edward Kent Paat, Rigel Kissra, Christianto Korompips, Grace E. C. Lolongan, Gerald R. Lolongan, Gerald Randy Marpaung, Elfrida L. Paat, Rigel Paat, Rigel K. Pitojo, Kevin G. Pontoh, Pramijaya R. Riahna, Else Rustandi, Danny K. Saleh, Denny Satriadi, Wayan Soesanto, Hendry Sukanto, Wega Tamburian, Christa Tamburian, Christha Tamburian, Christha Z. Tampubolon, Harris J. Tjiptadi, Vincent D. Zenithy Tamburian, Christha