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Department of Surgery, Faculty of Medicine, Universitas Indonesia RS dr. Cipto Mangunkusumo, Jakarta Jl. Diponegoro 71 Jakarta Pusat 10430, Indonesia
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INDONESIA
The New Ropanasuri Journal of Surgery
Published by Universitas Indonesia
ISSN : 25033328     EISSN : 25497871     DOI : 10.7454
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology
The journal focused on general surgery with the scope of surgical research and surgery-related studies.
Arjuna Subject : Kedokteran - Pembedahan
Articles 107 Documents
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Clinicopathological Predictors of Central Compartment Lymph Node Metastases in cN0 Papillary Thyroid Carcinoma Purnomo, Henricus SW.; Yulian, Erwin D.; Makes, Benyamin; Wangge, Grace
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Prevalence of the lymph node metastases of central neck compartment in papillary thyroid carcinoma (PTC) and its correlation with regional metastatic remains high. There are pros and cons on central neck dissection which is thought to solve the problem. Selection of appropriate patient to undergo central neck dissection is then essential. Thus, predictive factors were very useful in such selection, and we run a study aimed to find out the clinicopathological predictive factors for metastases of central compartment in subjects treated in Cipto Mangunkusumo General Hospital. Method. Data of 62 cN0 papillary thyroid carcinoma (PTC) subjects who underwent central neck dissection were collected consecutively and retrospectively studied. The correlations between clinicopathological factors such as age. Gender, tumor size, extra thyroid extension. Distant metastasis, completeness of resection, histopathology variant, lymphovascular invasion and central compartment metastases were the variables analyzed. Chi square. Fischer exact and stratification test were used. Significance found if p value of <0.05 with 95% confidence interval. Results. In this study, the prevalencein our hospital is 20.9%. The clinicopathological factors that statistically showed significance were the positive lymphovascular invasion (OR=14.40; p<0.05), tall cell variant (OR= 14.00; p <0.05), positive extra thyroid extension (OR=10.44; p<0.05) and age ≥45 years (OR= 9.47; p <0.05). Lymphovascular invasion showed a higher OR (OR=14.40). Conclusion. The lymphovascular invasion, tall cell variant, extra thyroidal extension and age might be the predictors for central compartment lymph node metastases in cN0 PTC patients. However, lymphovascular invasion has the highest risk factor for central neck compartment metastases.
External Validation of Belgian Outcome of Burn Injury Score on Burned Patient In Burn Unit dr. Cipto Mangunkusumo General Hospital Karlie, John; Wardhana, Aditya
The New Ropanasuri Journal of Surgery
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Introduction. The scoring system in burns is a merit in predicting mortality. To date, there’s no scoring system used as a standard prognostic tool at Cipto Mangunkusumo General Hospital’s Burn Unit. Belgian Outcome of Burn Injury (BOBI) Score, one of the best scoring systems in accordance to systematic review in 2013 was validated externally in a study. Method. A retrospective cohort study was conducted enrolling all burn patients managed during period of 2012 to 2013 in burn unit of Cipto Mangunkusumo General Hospital. The prediction model of BOBI score (age, total burned surface area, and inhalation injury) were variables to be analyzed statistically. ROC and AUC was analyzed to find out its accurate level of prediction. The strong AUC is found with the value of >80– 90%. Results. Out of 304 subjects enrolled, the mean age was 28 years, mean TBSA was 29%, inhalation injury was 15.7%, and overall mortality was 17.7%. The model gave an accurate prediction of mortality. The receiver operating characteristic analysis demonstrated an area under the curve of 0.96 (95% CI 0.94–0.99). Conclusion. The mortality prediction model (BOBI score) demonstrated a good accuracy. This model provide a good prediction tool and could be implemented in our burn management.
Clinical Duration as a Predictor for Bowel Resection in Intussusception Juliansyah, Amir; Sastiono, Sastiono
The New Ropanasuri Journal of Surgery
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Introduction. Delayed hospital presentation is a characteristic we found in management of intussusception in our institution. However, with this delayed, surgical intervention is the only option in treatment. Thus, duration of onset is an answered problem. We run a study aimed to find out whether duration is a predictor of bowel resection in management of intussusception. Method.We run retrospective study on idiopathic intussusception managed in period of January 2008 to December 2015 in Cipto Mangunkusumo Hospital, Jakarta. Those other than idiopathic and insufficient data were excluded. Period of onset, signs and symptoms, ultrasound and surgical treatment as well as intraoperative findings were set as the variables and subjected to statistical analysis using χ2 or Fisher’s exact test and t–test; significance is met if p value of <0.05. Analysis to find out cut–off point using receiver operating characteristic curve were carried out. Results. There were seventy–three subjects diagnosed as intussusception enrolled in the study. Median age was 7 months (3-48 month). Median period of onset to definitive treatment was 81 hours (15-256 hours). Bloody stools found in 90.4% instead of classic triad (28.7%). All subjects underwent surgical procedure, and out of 73 subjects, 61.6% underwent resection. We found clinical duration was associated to bowel resection (p 0.004) and area under curve 73.7% (p 0.001). The cut–off point as prediction of bowel resection was 78.5 hours with sensitivity of 67.9% and specificity of 71.1%. Conclusion. Surgical intervention is recommended for management of intussusception in those with clinical duration of more than 78.5 hours, instead of non–surgical reduction.
Comparison of Wells Score, D–Dimer and Combination of Wells Score and D–Dimer with Venous Duplex Ultrasonography in Diagnosis of Acute Deep Vein Thrombosis in Lower Extremity Lesmana, Andy; Pratama, Dedy; Wangge, Grace
The New Ropanasuri Journal of Surgery
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Introduction. Diagnosis of acute deep vein thrombosis (DVT) of lower extremity using available diagnostic tools such as venous duplex ultrasonography (VDUS) encountered problems including cost, time consuming and the operator. A simple and practical tool is required. Thus, we run a study aimed to evaluate the efficacy of Wells score, D–Dimer, or combination of both, compared to VDUS in early detection of acute DVT of lower extremity. Method. A diagnostic study was run using cross–sectional design in Department of Surgery enrolling all adult subjects of which suspected to acute DVT of lower extremity managed in period of January 2014 –December 2015 who met the criteria. The diagnosis was confirmed by VDUS. Those data of medical record were analyzed statistically with diagnostic study to find out the sensitivity and specificity. Results. The study enrolled of 85 subjects. The prevalence of acute DVT of lower extremity was 65.88%. Sensitivity and the highest negative predictive value of 100.00% were found in score combination of II and IV. While as the highest specificity of 89.66% and the highest positive predictive value of 92.68% were found in score combination of III. The score with balanced diagnostic value (sensitivity of 87.50% and specificity of 72.41%) was found in Wells score 3 level I. Conclusion. Wells score and VDUS showed comparable efficacy in detection of acute DVT of lower extremity. Thus, a score could be used as a diagnostic tool.
Infection of Double Lumen Catheter as Hemodialysis Access Basri, Novrizal S.; Patrianef, Patrianef
The New Ropanasuri Journal of Surgery
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Introduction. One of the most common complications in vascular access was bacteremia or bloodstream infection. The purpose of this study was to know the infection rate in dialysis double lumen catheter (DLC) and it’s relating factors. Method. This was a cross–sectional analytical study that was carried out by enrolling all ≥18–year–old subjects who underwent surgical insertion of DLC for hemodialysis during 2015 in Cipto Mangunkusumo General Hospital, Jakarta. Variables of bloodstream infection, age, gender, diabetes mellitus, history of previous DLC infection, history of catheter related bacteremia, site of insertion and duration were subjected to statistical analysis. Significance achieved if p value <0.05. Results. Out of all subjects, there were 19 (17.6%) subjects with bacteremia. Whereas, 5 (9.4%) subjects were those with tunneled DLC, and the remaining 14 (26.4%) were those with non–tunneled DLC. Factors found to be related with infection were the use of non–tunneled DLC (p = 0.043) and no history of previous DLC insertion (p = 0.038). Conclusion. Tunneled DLC was found superior to non–tunneled one to prevent catheter related bacteremia. The use of non–tunneled DLC should be avoided as hemodialysis access.
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.

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