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e-CliniC
Published by Universitas Sam Ratulangi
ISSN : 23375949     EISSN : -     DOI : -
Core Subject : Health,
Health Professions
Jurnal e-CliniC (eCl) diterbitkan oleh Perhimpunan Ahli Anatomi Indonesia bekerja sama dengan Fakultas Kedokteran Universitas Sam Ratulangi Manado. Jurnal ini diterbitkan 3 (tiga) kali setahun (Maret, Juli, dan November). Sejak tahun 2016 Jurnal e-CliniC diterbitkan 2 (dua) kali setahun (Juni dan Desember). Jurnal e-CliniC memuat artikel penelitian, telaah ilmiah, dan laporan kasus di bidang ilmu kedokteran klinik.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 20 Documents
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Search results for , issue "Vol. 12 No. 2 (2024): e-CliniC" : 20 Documents clear
Median Nerve Repair Using Sural Nerve Grafting: A Case Report Prasetyo, Eko; Oley, Maximillian C.; Tjungkagi, Ferdinan; Manuhutu, Yovanka N.; Sitorus, Edwin H.
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.46200

Abstract

Peripheral nerve injuries (PNIs) have increased to nearly 2.8% of all trauma cases. It often occurs in the upper extremities, such as the median nerve. EMG can be used to confirm a PNI diagnosis. When continuity defects are present in the injured nerve, a nerve graft procedure may be indicated. The most common donor nerve for repair is the sural nerve. Different surgical options are available for the repair of PNI. We presented a 39-year-old woman whose left hand was cramping and did not fully clench. On physical examination, there was an irregular scar on the left arm 1/3 upper region. Sensory deficits were found in the distribution areas of the median nerve, from digiti 1 to 3 of the manus sinistra. EMG showed the lesion of the left median nerve, an axonetmesis was suspected. The patient was then treated with sural nerve grafting to the median nerve using fibrin glue. The postoperative result revealed improvement in hand function. Grafting sural nerve to median nerve using fibrin glue was rarely performed. According to several studies, nerve grafts usually used 6-0 sized synthetic, monofilament, non-absorbable polypropylene sutures. however, there was no difference in the results between fibrin glue and sutures, both have good outcomes. In conclusion, repairing of the median nerve injury using autograft (sural nerve) and fibrin glue can be an option to restore the function of the hand. Keywords: peripheral nerve injury; median nerve; sural nerve; nerve grafting
Pattern of Skull and Facial Bone Fracture in Craniomaxillofacial Trauma Associated with Traumatic Brain Injury: A Retrospective Analysis at Tertiary Hospital Prasetyo, Eko; Oley, Maximillian C.; Tjungkagi, Ferdinan; Manuhutu, Yovanka N.; Sonbay, Antonius E.
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.46477

Abstract

Abstract: Trauma is one of the primary causes of death during the first four decade.  Craniomaxillo-facial (CMF) trauma has become a common presentation in emergency departments of hospitals. The most presentation of CMF trauma includes skull and facial bone fracture and traumatic brain injury (TBI). This study aimed to obtain the pattern of skull and facial bone fracture in craniomaxillofacial trauma associated with traumatic brain injury. This was a retrospective study conducted on 501 patients from January 2020 to December 2021. Demographic data included age, sex, length of stay (LOS), and Glasgow coma scale (GCS). The results showed that from the total 501 patients with skull and facial bone fracture with or without traumatic brain injury, 406 (81%) were males and 95 (19%) were females. The age range of the patients was between 2 years and 86 years (mean±SD 33.9±18.2). The most common patient affected age ranged from 21 to 30 years. The average of LOS was 7.2±5.7 days (0-33) and the mean of GCS was 10.2±4.2. Based on types of cases, there were 232 cases (60%) of skull and facial bone fractures accompanied by TBI; 154 cases (40%) of only skull and facial bone fracture; and 339 (59.5%) cases of only TBI. In conclusion, the distribution of TBI increases in those with skull and facial bone fractures. On the other hand, the distribution of TBI is more common without fracture. Hence every skull and facial bone fracture must be carefully evaluated clinically and radiologically to rule out any underlying TBI. Keywords: skull and facial bone fracture; craniomaxillofacial trauma; traumatic brain injury
Endovascular Fistula Salvage for Preserving Arteriovenous Fistula Failure in Haemodialysis Patient: Tertiary Referral Hospital, a Single-Centre Experience Karundeng, Billy; Sumangkut, Richard; Tjandra, Djony; Khosama, Yuansun; Juliandi, Tomi
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.46644

Abstract

Abstract: Efficacy of endovascular intervention for the preservation of failing accesses is very important in hemodialysis patients. This study aimed to determine the efficacy of endovascular balloon angioplasty in preserving the patency of hemodialysis arteriovenous fistula (AVF) failure. This was a retrospective study of hemodialysis patients who received endovascular intervention due to access difficulties. A single-center study was created between January 2022 and June 2022. Fistulography was conducted on patients suspected of having access stenosis, and balloon angioplasty was performed in the same setting if stenosis of 50% was confirmed. Post-operative complications and access restenosis or failure were monitored. The results obtained 69 patients with hemodialysis access failure due to AVF stenosis, occlusion, and thrombosis that were admitted or referred to our hospital. The majority of patients were 40-60 years (50.7%); 88.4% patients were male and 11.6% were female, with a mean age of 56.3±11.6 (range, 18–77). The sites of AVF failure were brachiocephalic (81.1%) and radiocephalic (18.9%). There was no complication recorded. The procedure succes rate was 81.1%. In conclusion, endovascular balloon angioplasty is effective in restoring hemodialysis access patency. Recurrence is common, and interventions must be repeated. Keeping access open can save lives. Percutaneous transluminal angioplasty (PTA) can be used to achieve safely and successfully repair arteriovenous fistulas failure. Keywords: angioplasty; arteriovenous fistula; arteriovenous graft; hemodialysis
Management of Crush Injury’s Complications Using Hyperbaric Oxygen Therapy: Case Series Arikalang, Patrick S.; Hatibie, Mendy J.; Oley, Maximillian C.; Noersasongko, Albertus D.; Suharso, Tommy
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.46847

Abstract

Abstract: Crush injury occurs due to an external trauma mechanism that directly affects the skin, muscle, and bone tissue. Crush injuries can involve several parts of the body at the same time. When accompanied by handling, wound healing in crush injury can be long-term, so that it can affect the function of the patient. Various complications that can occur ranging from secondary infection, necrosis, recurrent bleeding, to compartment syndrome. We reported serial cases of crush injury with various clinical presentations and complications, varying in the age range of 16-65 years. All four patients were given multiple managements, such as open reduction external fixation and extensive debridement. There were complications such as secondary infection and delay in the wound healing process in patients who did not on time for follow-up. The four patients received additional treatment in the form of wound dressings hyperbaric oxygen therapy (HBOT) with 5-10 90-minute sessions under 2.4 ATA pressure for 10 consecutive days. Follow-up was carried out again within a period of one month to compare the wound condition before and after HBOT. The clinical condition was getting better, marked by the formation of granulation tissue. The state of hyperoxia in HBOT accelerated the inflammatory process and angiogenesis during the wound healing process characterized by the eradication of bacteria in the wound tissue and accelerated neovascularization formation. In conclusion, adequate therapy, wound dressing, and patient compliance affect patient outcome. Moreover, the addition of hyperbaric oxygen therapy has shown to accelerate the wound healing process and restore the patient's limb function. Keywords: crush injury; hyperbaric oxygen therapy; oxygen; wound healing
Keakuratan FNAB pada Limfadenitis Tuberkulosis di Kelenjar Getah Bening Leher di Manado Ijong, Jessie I.; Lumintang, Nico
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.46849

Abstract

Abstract: Tuberculous lymphadenitis is the most common type of extrapulmonary tuberculosis (TB). Fine needle biopsy aspiration (FNAB) is an initial diagnostic method to evaluate lymph node enlargement in the neck This study aimed to evaluate the accuracy of FNAB in tuberculous lymphadenitis in neck lymph nodes in Manado. This was is a retrospective and descriptive study using medical record data on the use of FNAB examination in patient with a history of lymph node enlargement years 2017-2018. The results obtained 160 FNAB samples with clinical lymph node enlargement in the neck; 86 samples (54%) with TB lymphadenitis, nine samples (6%) were suspected as TB lymphadenitis, and 65 samples (40%) were not TB lymphadenitis The incidence in women (61%) was higher than in men (39%). TB lymphadenitis was most common in women aged <19 years and men aged 20-30 years. In conclusion, FNAB remains an important option as one of the diagnostic supporting tools for lymph node enlargement especially to confirm the diagnosis of tuberculous lymphadenitis in the neck. Keywords: fine needle biopsy aspiration; tuberculous lymphadenitis; cytopathological diagnosis   Abstrak: Limfadenitis tuberkulosis (TB) merupakan bentuk TB ekstrapulmoner yang tersering. Fine needle biopsy aspiration (FNAB) ialah metode diagnostik awal untuk mengevaluasi pembesaran kelenjar getah bening di leher. Penelitian ini bertujuan untuk mengetahui keakuratan FNAB pada limfadenitis tuberkulosis di kelenjar getah bening leher di Manado. Jenis penelitian ialah deskriptif retrospektif menggunakan data rekam medik penggunaan pemeriksaan FNAB pada pasien yang memiliki riwayat pembesaran kelenjar getah bening di leher di Laboratorium Patologi Anatomi RSUP Prof R. D. Kandou Manado.tahun 2017-2018. Hasil penelitian mendapatkan 160 sampel FNAB dengan klinis pembesaran pada leher; 86 sampel (54%) dengan hasil FNAB limfadenitis TB, sembilan sampel (6%) dicurigai sebagai limfadenitis TB, dan 65 sampel (40%) bukan limfadenitis TB. Kejadian pada perempuan (61%) lebih tinggi daripada laki-laki (39%). Limfadenitis TB tersering pada perempuan berusia <19 tahun dan laki-laki 20-30 tahun. Simpulan penelitian ini ialah sampai saat ini FNAB tetap menjadi pilihan sebagai salah satu alat penunjang diagnostik untuk evaluasi pembesaran kelenjar getah bening terutama dalam menentukan limfadenitis TB di leher. Kata kunci: fine needle biopsy aspiration; limfadenitisis tuberculosis; diagnostik sitopatologi
Primary Closure of Gastric Perforation Using Seromuscular Omentum Insertion: A Case Report Kalitouw, Ferry; Salem, Billy; Sugito, Brian
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.46850

Abstract

Abstract: Gastric perforation is the most common disease and a surgical emergency with high morbidity and mortality; therefore, early and precise management is needed. However, no consensus has been accepted regarding the best surgical treatment for gastric perforation closure so far. Although surgery methods are varied, laparotomy, and omental patch repair are still the gold standard. The risk of leakage after primary closure accompanied by omentopexy is still common, resulting high morbidity and mortality. This study aimed to discuss about the modified method by means of primary closure with seromuscular omentum insertion in a gastric perforation case. We modified the usual method using primary closure with seromuscular omentum insertion, to get the best way for perforation closure and reduced risk of leakage. After a week of surgical perforation closure, the patient was discharged and further observation resulted in no leakage. In conclusion, modified method by using primary closure with seromuscular omentum insertion in gastric perforation has good result without any leakage and recurrence. Keywords: gastric perforation; omentum; primary closure
Small Lymphocytic Lymphoma Presenting as Breast Mass: A Rare Case Report Manginstar, Christian; Merung, Marselus A.; Saleh, Denny; Merung, Marcella
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.46852

Abstract

Abstract: Primary breast lymphoma is rare and it accounts for around 0.5% of malignant breast neoplasms. Small lymphocytic lymphoma (SLL) is a subtype of non-Hodgkin lymphoma originating from a B-cell lineage. This report presents a case of primary SLL of the breast with lung metastasis that had excellent clinical response. We reported a 67-year-old female complained a right breast mass that suddenly appeared after she got massage on her right left arm. The mass was swollen and painless with no systemic complications. The specimen was submitted to histopathology department and it revealed small diffuse lymphocytic lymphoma. Chest X-ray showed a lung metastasis. The patient was then treated with CHOP regimens (Cyclophosphamid, Doxorubicin, Vincristin, and Prednison) and the clinical result was excellent. The side effects of the medication were minimal. In conclusion, primary breast lymphocytic lymphoma is rare and this case highlights the differential diagnosis for a painless breast mass. The treatment must be individualized and multimodal, with chemotherapy being the most accepted treatment. Keywords: breast lymphoma; breast mass; malignancy
Medical Rehabilitation in Patient with Cerebral Palsy Spastic Diplegic GMFCS IV MACS I CFCS IV EDACS II Rondonuwu, Gloria; Gessal, Joudy; Angelina, Chelsy
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.46884

Abstract

Abstract: Children with cerebral palsy are present with three types of motor problems. The major disturbances in muscle tone, balance, strength, and selectivity are directly related to damage of the central nervous system. Treatment programs encompass physical and behavioral therapy, pharmacologic and surgical treatments, mechanical aids, and management of associated medical conditions. In physical, occupational, speech, and behavioral therapies, the goals include enhancing patient and caregiver interactions while providing family support. We reported a female, 7-year-old, with cerebral palsy spastic diplegic GMFCS IV MACS I CFCS IV EDACS II. The patient was treated with USD intensity 1 watt/cm2, frequency 3.3 MHz in 5 minutes and continuous stretching in four extremity for 10 minutes each. It showed improvement from the popliteal angle assessment and MAS score, therefore, additional invasive therapy, such as botox injection, might be not needed in the meantime. Stiffness in lower extremities especially at gastrocnemius muscle was treated with ESWT energy of 0.15mJ/mm2; total shots dose 1500 shocks per each treated muscle (gastrocnemius); frequency 4 Hz. The patient presented with lumbar hyperlordotic and anterior pelvic tilt, and also tended to sway posteriorly during standing and walking, resulting poor protection reaction on the anterior side. It will be beneficial to add abdominal core and hip extensor strengthening exercise into the program. For walking aids, we considered about using anterior walker or posterior walker. However, since the patient was 4 years old and could not take complex instruction, it might become challenging to modify the exercise protocol. Regular daily stretching was beneficial for the home program and should be continued. Referral to surgery was not required at this moment due to no joint contracture. Keywords: cerebral palsy; motor problem; gait rehabilitation
Korelasi antara Kadar Kalsidiol (25-Oh) dan Rasio Netrofil-Limfosit dengan Keganasan Nodul Tiroid Bogar, Bryan D.; Lumintang, Nico; Tandililing, Sherly; Wariki, Windy M.
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.48492

Abstract

Abstract: Thyroid malignancy has shown the highest annual incidence rate. Vitamin D deficiency (serum 25-hydroxyvitamin D levels) is one of the risk factors for thyroid malignancy. The neutrophil-lymphocyte ratio (NLR) reflects the balance between pro-tumor inflammatory response and anti-tumor immune response. This study aimed to investigate the relationship between serum 25-hydroxyvitamin D levels, NLR, and thyroid nodule malignancy. This was an observational and analytical study with cross-sectional design. Samples were patients with thyroid nodules admitted to Prof. Dr. R. D. Kandou Hospital, Manado, form August 2022 to March 2023. The results obtained a total of 46 patients with thyroid malignancy that  met the inclusion criteria. The patient characteristics were predominantly female (82.6%), with a mean age of 50.2 ± 14.74 years, normal thyroid hormone status (82.6%), mean serum 25-hydroxyvitamin D levels of 32.25 ng/mL, mean NLR of 5, and papillary carcinoma as the most common malignancy (43.48%). Spearman's correlation analysis revealed a significant association between thyroid malignancy and serum 25-hydroxyvitamin D levels (r =-0.501, p=0) as well as NLR (r 0.376, p=0.01). In conclusion, serum 25-hydroxyvitamin D levels and NLR can be used as indicators for predicting thyroid nodule malignancy. Keywords: thyroid malignancy; 25-hydroxyvitamin D; neutrophil-lymphocyte ratio   Abstrak: Keganasan tiroid mengalami peningkatan angka kejadian tertinggi pertahun. Kekurangan vitamin D (kadar kalsidiol) merupakan salah satu faktor risiko terjadinya keganasan tiroid. Rasio netrofil limfosit (RNL) mencerminkan keseimbangan antara respon inflamasi protumor dan respon imun antitumor. Penelitian ini bertujuan untuk mengevaluasi hubungan antara kadar 25-hydroxyvitamin D serum dan RNL dengan keganasan nodul tiroid. Jenis penelitian ialah analitik observasional dengan desain potong lintang. Sampel penelitian ialah pasein dengan nodul tiroid yang dirawat di RSUP Prof. Dr. R. D. Kandou Hospital, Manado, sejak Agustus 2022 s/d Maret 2023. Hasil penelitian mendapatkan 46 pasien dengan keganasan tiroid yang memenuhi kriteria. Karakteristik sampel tebanyak ialah jenis kelamin perempuan (82,6%), rerata usia (50,2±14,74 tahun), status hormon tiroid normal (82,6%), rerata kadar 25-hydroxyvitamin D 32,25 ng/mL, rerata RNL 5, dan jenis keganasan karsinoma papiler (43,48%). Uji analisis Spearman menunjukkan keganasan tiroid secara bermakna berhubungan dengan kadar kalsidiol (r=-0,501, p=0), dan RNL (r=0,376, p=0,01). Simpulan penelitian ini ialah kadar 25-hydroxyvitamin D serum dan RNL dapat digunakan sebagai indikator untuk memrediksi keganasan nodul tiroid. Kata Kunci: keganasan tiroid; 25-hydroxyvitamin D; rasio netrofil-limfosit
Penilaian Kemampuan Prognostic Nutritional Index Memrediksi Lama Penyembuhan Luka Operasi Paska Tindakan Laparotomi pada Pasien Kanker Kolorektal Suatan, Regina; Tjandra, Ferdinand; Salem, Billy; Langi, Frederik G.
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.51744

Abstract

Abstract: In colorectal cancer, surgical resection is the main curative therapeutic modality for localized, non-metastatic colorectal cancer at any age with good performance status and controlled comorbidities. Nutritional status is known to be a very important factor in the treatment of all types of surgery including preoperative and postoperative aspects. This study aimed to assess the ability of prognostic nutritional index (PNI) to predict the healing time of surgical wounds after laparotomy in patients with colorectal cancer. Samples were patients with colorectal cancer that underwent laparotomy at Prof. Dr. R. D. Kandou Hospital, Manado. The results showed that mean age of patients was 55 years and the mean body mass index (BMI) was 22. Patients with comorbids were 18.2%. The most common duration of wound healing according to Southampton wound grade system was grade 0 (63.6%), followed by grade 1 (18.2%), grade 2 (4.5%), and grade 3 (13.6%). The Spearman test showed a positive correlation between pre-operative PNI and duration of wound healing (r=0.582), and the 2-tailed significancy of 0.000. In conclusion, prognostic nutritional index can predict the duration of post-laparotomy wound healing in colorectal cancer patients. Keywords: colorectal cancer;  prognostic nutritional index; wound healing   Abstrak: Pada kanker kolorektal reseksi pembedahan merupakan modalitas terapi utama yang bersifat kuratif untuk stadium non metastasis yang masih terlokalisasi pada usia berapapun dengan status performance yang masih baik dan komorbiditas terkontrol. Status gizi diketahui menjadi faktor yang sangat penting dalam penanganan seluruh jenis bedah termasuk aspek pre operatif dan post operatif. Penelitian ini bertujuan untuk menilai kemampuan prognostic nutritional index (PNI) dalam memrediksi lama penyembuhan luka operasi paska tindakan laparotomi pada pasien dengan kanker kolorektal. Sampel penelitian ialah pasien dengan kanker kolorektal yang menjalani laparatomi di RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian mendapatkan rerata usia pasien ialah 55 tahun dan rerata indeks massa tubuh (IMT) ialah 22. Pasien yang memiliki penyakit penyerta sebesar 18,2%. Lama penyembuhan luka operasi menurut (Southampton Wound Grade System) terbanyak ialah grade 0 (63,6%), diikuti grade 1 (18,2%), grade 2 (4,5%), dan grade 3 (13,6%). Hasil uji korelasi Spearman terhadap korelasi antara PNI pre-OP dengan lama penyembuhan luka operasi bernilai positif 0,582, dengan nilai Sig. (2-tailed) sebesar 0,000. Simpulan penelitian ini ialah prognostic nutritional index dapat memrediksi lama penyembuhan luka operasi paska tindakan laparotomi pada pasien kanker kolorektal. Kata kunci: kanker kolorektal; prognostic nutritional index; penyembuhan luka operasi

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