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Majalah Kedokteran Bandung
Published by Universitas Padjadjaran
ISSN : 0126074X     EISSN : 23386223     DOI : 10.15395/mkb
Core Subject : Health,
Medicine & Pharmacology
Majalah Kedokteran Bandung (MKB)/Bandung Medical Journal publishes peer-reviewed original articles and case reports in basic medical research, clinical research, and applied medical science. This journal is published quarterly (March, June, September, and December) by Faculty of Medicine Universitas Padjadjaran. Articles are original research that needs to be disseminated and written in English. All submitted manuscripts will go through the double-blind peer review and editorial review before being granted with acceptance for publication.
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Perbandingan Derajat Hiperemis Pascabedah Pterigium Inflamasi antara Teknik Lem Fibrin Otologus dan Teknik Jahitan Rifada, Maula; Prawirakoesoema, Loekman; Dalimoenthe, Nadjwa Zamalek; Enus, Sutarya
Majalah Kedokteran Bandung Vol 45, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tandur konjungtiva bulbi merupakan baku emas pada pembedahan pterigium yang secara umum metode penempelannya dengan menggunakan jahitan, namun memiliki beberapa kekurangan, di antaranya waktu pembedahan cukup lama, menimbulkan reaksi inflamasi, dan kemungkinan komplikasi. Saat ini dikembangkan penggunaan lem fibrin untuk penempelan tandur konjungtiva bulbi sebagai alternatif prosedur pengganti jahitan. Penelitian ini bertujuan untuk mengetahui derajat hiperemis pascabedah pterigium inflamasi antara teknik lem fibrin otologus (LFO) dan teknik jahitan. Penelitian ini merupakan uji klinis acak terkontrol tersamar tunggal yang dilaksanakan di Pusat Mata Nasional Rumah Sakit Mata Cicendo Bandung dari bulan Oktober−Desember 2010. Subjek penelitian dibagi menjadi dua kelompok secara acak dan hasilnya terdapat 12 penderita kelompok LFO dan 14 penderita kelompok jahitan. Pemantauan dilakukan pada minggu pertama, kedua, dan keempat pascabedah serta dilakukan pengambilan foto lampu celah biomikroskop digital. Benang jahitan disamarkan menggunakan perangkat lunak penyunting foto dan satu orang pengamat menilai secara objektif derajat hiperemis pada foto digital. Analisis statistik dilakukan menggunakan Uji Mann Whitney. Hasil penelitian menunjukkan bahwa derajat hiperemis secara bermakna lebih kecil pada minggu pertama, kedua, dan keempat pada kelompok teknik LFO (derajat hiperemis 2,5; 2; dan 1,5) dibandingkan dengan kelompok teknik jahitan (derajat hiperemis 4; 3; dan 2) (p<0,05). Simpulan, penggunaan LFO untuk melekatkan tandur konjungtiva bulbi pada pembedahan pterigium inflamasi menghasilkan derajat hiperemis yang lebih kecil dibandingkan dengan penggunaan jahitan. [MKB. 2013;45(3):174–9]Kata kunci: Lem fibrin otologus, pterigium inflamasi Comparison of Hyperemia Degree between Autologous Fibrin Glue and Suture Technique Post Inflammed Pterygium SurgeryConjunctival autograft is the gold standard in pterygium surgery which is regularly secured with suture, butthis method has few drawbacks of prolonged operating time, provoke ocular inflammation and potential risk for suture related complication. The use of fibrin glue has become an alternative procedure in conjuntival graft transplantation. The aim of this study was to compare hyperemia degree post inflamed pterygium surgery between autologous fibrin glue (AFG) and suture technique. This was a randomized, controlled, single blind clinical trial that conducted in National Eye Center, Cicendo Eye Hospital Bandung from October−December 2010. Subjects were randomly assigned to two groups and as result 12 patients belong to AFG group and 14 belong to suture group. Digital slit-lamp photographs were taken at 1st week, 2nd week and 4th week postoperatively for observation. Sutures were masked using photo-editing software and one masked observers objectively graded the digital photograph for degree of hyperemia. Statistical analysis was performed using Mann Whitney Test. The results of this study showed that the degree of hyperemia was significantly lower in AFG group (hyperemia degree 2.5, 2 and 1.5) than in suture group (hyperemia degree 4, 3 and 2) at 1st week, 2nd week and 4th week post operatively (p<0.05). In conclusion, the use of AFG for graft fixation in inflamed pterygium surgery produced significantly lower hyperemia degree. [MKB. 2013;45(3):174–9]Key words: Autologous fibrin glue, inflammed pterygium DOI: http://dx.doi.org/10.15395/mkb.v45n3.148
Apakah Epidural Preemtif Menghambat Stres Pembedahan dengan Sempurna? Ahmad, Muh. Rumli; Bisri, Tatang
Majalah Kedokteran Bandung Vol 45, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Analgesia preemtif adalah pemberian regimen analgesik sebelum onset stimulus noksius. Kerusakan jaringan akibat pembedahan menimbulkan rangsang noksius, melalui dua jalur input noksius ke susunan saraf pusat (SSP), melalui jalur neural dan jalur sirkulasi. Penelitian uji klinik tersamar ganda mengikutsertakan 48 pasien yang menjalani pembedahan orthopedi tungkai bawah. Dibagi 2 kelompok: kelompok I (n=24) diberikan bupivakain 0,25% 10 mL dan kelompok II (n=24) diberikan NaCl 0,9% melalui epidural sebagai kontrol sebelum dilakukan induksi. Kedua kelompok diberikan anestesi umum. Selama pembedahan pada kelompok I diberikan 5 mL bupivakain 0,25% selang 90 menit, sedangkan pada kelompok kontrol diberikan 5 mL NaCl 0,9% dengan selang waktu yang sama. Pascabedah kedua kelompok diberikan bupivakain 0,25% secara kontinu 4 mL/jam sampai 24 jam pascabedah. Pengukuran kadar sitokin: tumor necrosis factor- α (TNF-α), interleukin-1β (IL-1β), IL-6 dan IL-10 dilakukan sebelum induksi anestesi, pascabedah dini, jam ke-4, 8, dan 24 pascabedah. Kelompok I memperlihatkan dinamika kadar proinflamasi lebih rendah dibandingkan dengan kelompok II namun secara statisik tidak bermakna (p>0,05). Sebaliknya, kadar sitokin antiinflamasi lebih tinggi pada kelompok epidural, namun tidak berbeda bermakna (p>0,05). Intensitas nyeri pada 4 jam, 8 jam, 24 jam pascabedah secara nyata lebih rendah pada kelompok I (p<0,05). Respons hemodinamik juga ditemukan lebih rendah pada kelompok I walaupun tidak berbeda nyata ( p>0,05) kecuali pada pascabedah dini namun tidak secara sempurna. Simpulan, pemberian analgetik epidural preemtif menghasilkan analgesia disertai hemodinamik yang stabil dibandingkan tanpa epidural preemtif, namun epidural premtif tidak dapat menekan produksi sitokin proinflamasi dan antiinflamasi. [MKB. 2013;45(3):147–54]Kata kunci: Epidural preemtif, hemodinamik, intensitas nyeri, sitokin Does Preemptive Epidural Analgesia Completely Blok Surgical Stress Responses?Preemptive analgesia is initiating an analgesic regimen before the onset of the noxious stimulus. Damages to the tissue caused by surgical trauma generate noxious response conveyed to the central nervous system (CNS) by two pathways, neural pathway and circulatory pathway. This study is a double- blinded clinical trial that included 48 patients undergoing lower extremity orthopedic surgery. The subjects were divided into two groups: group I (n=24) received 10 mL bupivacaine 0.25% from epidural route, and group II (n=24) received 10 mL NaCl 0.9% from epidural route as the control group before induction of anesthesia. Both groups were anesthetized under general anesthesia. Group I received 5 mL bupivacaine 0,5% every 90 minutes and group II received 5 mL NaCl 0,9 with similar time intraoperatively. Post-operatively, both groups received continuous bupivacaine 0,25% 4 mL/ hour until 24 hours after surgery. Measurements of cytokine levels: tumor necrosis factor-α (TNF-α), interleukin- 1β (IL-1β), IL-6 and IL-10 were done before induction of anesthesia, in the early post-operative period, at 4, 8, and 24 hours after surgery. Group I showed lower level proinflammatory cytokines level compared with group II but the difference was not statistically significant (p>0.05). The level of anti-inflammatory cytokine was higher in group I, but the difference was not statistically significant (p>0.05). Pain intensity at 4 hours, 8 hours, 24 jam hours post operative was lower significantly (p<0.05) Hemodynamic responses was lower in group I but not significant (p>0.05) excepst at early postoperative period (p<0.05). Generally, preemptive epidural analgesia was able to suppress the cytokine responses, but not completely. In conclusion, preemptive epidural analgesia is associated with better analgesia and better hemodynamic stability compared without preemptive epidural, but unable to suppress the production of proinflammatory and anti-inflammatory cytokines. [MKB. 2013;45(3):147–54]Key words: Cytokines, hemodynamic, pain intensity, preemptive epidural DOI: http://dx.doi.org/10.15395/mkb.v45n3.144
Functional Independence Measure Penderita Cedera Servikal Arifin, Muhammad Zafrullah; Henky, Jefri
Majalah Kedokteran Bandung Vol 45, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Cedera servikal merupakan salah satu cedera tulang belakang terbanyak pada penderita trauma. Di Amerika Serikat tahun 2008 dari 100.000 kasus cedera tulang belakang, 2/3 merupakan kasus cedera servikal. Penilaian awal dilakukan berdasarkan American Spinal Cord Injury Association (ASIA) Impairment Score, sedangkan hasil setelah penatalaksanaannya sering diabaikan untuk evaluasi keberhasilan ahli di rumah sakit. Tujuan penelitian untuk mengetahui nilai functional independence measure (FIM) penderita cedera servikal dengan manajemen konservatif dan korelasinya dengan usia, jenis kelamin, jenis trauma, onset trauma, abnormalitas tulang servikal, lesi cervical spine, dan ASIA Impairment Score. Dilakukan studi kohor prospektif pada semua pasien cedera servikal yang memenuhi kriteria inklusi di Departemen Bedah Saraf Rumah Sakit (RS) Dr. Hasan Sadikin Bandung. Subjek dikelompokkan berdasarkan usia, jenis kelamin, trauma tunggal/multipel, akut/kronik, abnormalitas tulang servikal, lesi komplet/inkomplet, ASIA Impairment Score, dan komplikasi awal cedera. Pada penderita dilakukan penilaian FIM di Poliklinik Bedah Saraf. Data dianalisis menggunakan uji-t dan uji chi-kuadrat dengan p<0,05. Terdapat 17 penderita cedera servikal yang dirawat di Departemen Bedah Saraf RS Dr. Hasan Sadikin Bandung periode April 2009–April 2010. Observasi kohor prospektif nilai FIM rata-rata penderita cedera servikal adalah 4+1,63. Analisis chi-kuadrat menyatakan bahwa tidak terdapat hubungan usia (p=0,064), jenis kelamin (p=0,144), jenis trauma penyerta (p=0,959), onset cedera (p=0,220), abnormalitas tulang servikal (p=0,869) dengan besarnya nilai FIM pasien cedera servikal. Terdapat hubungan jenis lesi cervical spine (p=0,037), ASIA Impairment Score (p<0,001) dengan besarnya nilai FIM penderita cedera servikal. Simpulan, jenis lesi cervical spine dan ASIA Impairment Score memiliki hubungan bermakna dengan besarnya nilai FIM penderita 3 bulan pascacedera servikal. [MKB. 2013;45(3):180–6]Functional Independence Measure in Patients with Cervical Spine InjuryCervical spine injury is one of the most common spinal cord injuries in trauma patients. From 100,000 spinal cord injury cases reported in the United States of America (2008), 2/3 involved cervical spine injury. American Spinal Cord Injury Association (ASIA) Impairment Score is used as an initial assessment but further prognostic outcome of these patients is often not paid enough attention. The objective of this study was to find the value of functional independence measure (FIM) cervical spine injury patients with conservative management and correlation with age, sex, type of trauma, onset of trauma, cervical bone abnormalities, type of spinal lesion and ASIA Impairment Score. A prospective cohort study was performed to all patients with cervical spine injury which fullfil the inclusion criteria treated in Neurosurgery Department of Dr. Hasan Sadikin Hospital Bandung. The subjects were classified based on age, sex, single/multiple trauma, acute/chronic, cervical bone abnormalities, complete/incomplete lesion, ASIA impairment score and initial complication. The patients were performed to FIM examination in Outpatient clinic of Neurosurgery. T-test and chi-square test with p<0.05 were done to analyze the data. There were 17 cervical spine injury patients treated in Neurosurgery Department of Dr. Hasan Sadikin Hospital Bandung during April 2009–April 2010. The average FIM value of cervical spine injury in those patients was 4+1.63 by cohort prospective study. There were no correlation between FIM value with age (p=0.064), sex (p=0.144), type of trauma (p=0.959), onset of trauma (p=0.220) and cervical bone abnormalities (p=0.869). We found a significant correlation between FIM value with type of cervical spine lesion (p=0.037) and ASIA Impairment Score (p<0.001) in cervical spine patients. In conclusion, type of cervical spine lesion and ASIA impairment score have significant correlation with FIM value of patients in 3 months after cervical injury.[MKB. 2013;45(3):180–6] DOI: http://dx.doi.org/10.15395/mkb.v45n3.15
Peningkatan Ketebalan Miokardium Mencit (Mus musculus L.) Akibat Paparan Medan Listrik Tegangan Tinggi Busman, Hendri; Muhartono, Muhartono
Majalah Kedokteran Bandung Vol 45, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pembangunan saluran transmisi listrik tegangan tinggi diduga dapat merugikan manusia atau makhluk hidup lain. Tujuan penelitian untuk mengetahui pengaruh paparan medan listrik tegangan tinggi pada ketebalan miokardium ventrikel kiri mencit jantan (Mus musculus L.). Penelitian dilaksanakan di Laboratorium Zoologi Fakultas Matematika dan Ilmu Pengetahuan Alam Universitas Lampung serta Laboratorium Patologi Balai Penyidikan dan Pengujian Veteriner Regional III Bandar Lampung, pada bulan Juni−November 2011.Penelitian menggunakan rancangan acak lengkap dengan 4 perlakuan, ulangan 6 kali, dan dibagi dalam empat kelompok. Kelompok kontrol (K) tidak diberi perlakuan, kelompok 1 (P1) diberi paparan 5 kV/m, kelompok 2 (P2) diberi paparan 6 kV/m, dan kelompok 3 (P3) diberi paparan 7 kV/m, masing-masing 8 jam/hari selama 37 hari. Data dianalisis menggunakan analysis of variance. Hasil penelitian didapatkan ketebalan miokardium ventrikel kiri mencit jantan pada K sebesar 1.329,83±173,29 μm; P1 sebesar 1.507,50±109,24 μm; P2 sebesar 1.536,70±103.42 μm; dan P3 sebesar 1.574.23±123,36 μm. Terdapat peningkatan ketebalan miokardium rata-rata dengan bertambahnya daya paparan medan listrik (p=0,019). Simpulan, terdapat hubungan antara paparan medan listrik tegangan tinggi dan perubahan ukuran ketebalan miokardium ventrikel kiri mencit jantan, semakin tinggi paparan medan listrik semakin tebal miokardium ventrikel kiri mencit jantan. [MKB. 2013;45(3):155–60] Increased Thickness Myocardium Mice (Mus musculus L.) Caused by Exposure to High Voltage Electric FieldDevelopment of high voltage power transmission line could be expected to harm humans or other living creatures. Research objective was to determine the effect of exposure tohigh-voltage electric field to the thickness of the left ventricular myocardium male mice (Mus musculus L.). The experiment was conducted at the Laboratory of Zoology Faculty of Mathematics and Natural Sciencesat the University of Lampung and Central Pathology Laboratory Regional Veterinary Investigation III Bandar Lampung, in June−November 2011. Research using completely randomized design with 4 treatments, replicated 6 times and divided into four groups.The control group (K) was not given treatment, group 1 (P1) given exposure to 5 kV/m, group 2 (P2) given exposure to 6 kV/m and group 3 (P3) given exposure to 7 kV/m for 8 hours/day, to 37 days. Data were analyzed using analysis of variance. The results obtained thickness of the left ventricular myocardium of male mice at K1,329.83±173.29 μm; P1 at 1,507.50±109.24 μm; P2 at 1,536.70±103.42 μm, and P3 at 1,574.23±123.36 μm. There was an increase in the average thickness of the myocardium with increasing exposure to power an electric field with a statistical test obtained (p=0.019). In conclusion, there is a significant relationship between exposure to high-voltage electric field to change the size of the thickness of the left ventricular myocardium male mice, the higher the electric field exposure thicker left ventricular myocardium male mice. [MKB. 2013;45(3):155–60] DOI: http://dx.doi.org/10.15395/mkb.v45n3.145
Hubungan Ekspresi Ki-67 dengan Grading Histopatologi Liposarkoma Afiati, -; Hernowo, Bethy S.
Majalah Kedokteran Bandung Vol 45, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Liposarkoma merupakan salah satu tumor ganas jaringan lunak dan terbanyak ditemukan pada usia dewasa antara dekade 5 dan 7 serta jarang terjadi pada usia anak. Liposarkoma sering terjadi pada ekstremitas bawah (fosa poplitea dan paha bagian tengah), retroperitoneal, perirenal, mesenteric region, dan area bahu. Penelitian ini bersifat retrospektif dari 30 kasus liposarkoma yang diambil dari data Departemen Patologi Anatomi Rumah Sakit Dr. Hasan Sadikin Bandung yang terdiri atas 20 kasus low-grade liposarcoma dan 10 kasus high-grade liposarcoma. Penelitian dilakukan periode Februari–Mei 2011. Dilakukan pemeriksaan khusus imunohistokimia dengan menggunakan antibodi monoklonal Ki-67 yang berfungsi sebagai marker proliferasi sel, dengan tujuan melihat ekspresi Ki-67 dan apakah terdapat hubungan antara ekspresi Ki-67 dan grading histopatologi liposarkoma. Ekspresi dan intensitas warna Ki-67 pada sel tumor dibagi menjadi sangat rendah (<20% positif), rendah (20– 50% positif), sedang (50–80% positif) dan tinggi (>80% positif), sedangkan untuk intensitas warna Ki-67 dibagi menjadi lemah, sedang, dan kuat. Terdapat perbedaan yang signifikan antara ekspresi dan intensitas Ki-67 pada low-grade liposarcoma dan high-grade liposarcoma (p<0,0001). Simpulan, ekspresi Ki-67 yang tinggi dengan intensitas yang kuat hanya didapatkan pada high-grade liposarcoma yang juga berhubungan dengan progresivitas tumor. [MKB. 2013;45(3):187–91]Correlation of Ki-67 Expression with Histopathological Grading ofLiposarcomaLiposarcoma, a malignant tumor of mesenchymal origin, was one of the most common sarcomas of adults and occurs primarily in the fifth through seventh decades of life. The occurrence in children was rare. Liposarcoma were occur most frequently in the lower extremities (popliteal fossa and medial thigh), retroperitoneal, perirenal, mesenteric region and shoulder area. Retrospective study was conducted by reviewing the data from Pathology Anatomy Department Dr. Hasan Sadikin Hospital Bandung. There were 30 cases of liposarcoma, whereas lowgrade of liposarcoma 20 cases and high-grade of liposarcoma 10 cases. Research was done during February–May 2011. Immunohistochemical staining examination used monoclonal antibody Ki-67 as marker cell proliferation with the aim for looking Ki-67 expression and related with histopatholgy grade of liposarcoma. The tumor cells which showed Ki-67 expression were divided into very low (<20% positive), low (20–50% positive), moderate (50–80% positive) and high (>80% positive), whereas the intensity of Ki-67 staining was into weak, moderate and strong. There were significant differences between the Ki-67 expression and intensity level according to the histopathological types of liposarcoma (p<0.0001). In conclusions, Ki-67 expression increases with strong intensity of Ki-67 only in high-grade liposarcoma, so relates with progressivity of tumor. [MKB. 2013;45(3):187–91]DOI: http://dx.doi.org/10.15395/mkb.v45n3.149 
Ekstrak Etanol Propolis Isolat Menurunkan Derajat Inflamasi dan Kadar Malondialdehid pada Serum Tikus Model Sepsis Prasetyo, Diding Heri; Suparyanti, Endang Listyaningsih; Guntur H., A.
Majalah Kedokteran Bandung Vol 45, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Peran propolis lebah sebagai terapi adjuvan pada pengelolaan sepsis telah dievaluasi. Penelitian ini bertujuan untuk mempelajari efek perlindungan propolis pada sepsis akibat inokulasi cecal, derajat inflamasi intestinal, dan kadar malondialdehid (MDA) serum. Penelitian dilakukan di Laboratorium Histologi dan Biomedik, Fakultas Kedokteran, Universitas Sebelas Maret, Surakarta, selama periode April–September 2011. Empat puluh tikus Rattus norvegicus L jantan dibagi menjadi lima kelompok: kontrol, sepsis, sepsis+antibiotik, sepsis+propolis, dan sepsis+antibiotik+propolis. Pada hari kedelapan, semua hewan coba dikorbankan untuk diukur konsentrasi MDA serum dan perubahan histopatologi di intestinal. Uji konsentrasi MDA serum menggunakan analysis of variance (ANOVA), sedangkan derajat inflamasi intestinal dengan Uji Kruskall-Wallis, dan untuk menentukan perbedaan kemaknaan digunakan p<0,05. Kadar MDA serum masing-masing kelompok: kontrol 0,27±0,07 μmol/L; sepsis 0,39±0,05 μmol/L; sepsis+antibiotik 0,15±0,03 μmol/L; sepsis+ propolis 0,09±0,05 μmol/L; dan sepsis+antibiotik+propolis 0,21±0,11 μmol/L. Derajat inflamasi intestinal menunjukkan kelompok kontrol derajat 0–3; sepsis derajat 3–4; sepsis+antibiotik derajat 1–3; sepsis+propolis 1–3; dan sepsis+antibiotik+propolis derajat 0–2. Simpulan, ekstrak etanol propolis menurunkan derajat inflamasi intestinal dan kadar MDA serum pada hewan coba model sepsis. [MKB. 2013;45(3):161–6] Ethanol extract of Propolis Reduces the Level of Inflammation and Serum Malondialdehyde in Sepsis Rats ModelThe role of bee propolis as a adjuvant therapy in the management of sepsis was evaluated. The aim of the study was to investigate the protective effect of propolis against cecal inoculum induced sepsis, the level of intestinal inflammation, and serum malondialdehyde (MDA) concentrations. The study was conducted at School of Medicine, Sebelas Maret University, Surakarta, in April to September 2011. Forty male Rattus norvegicus L rats were divided into five groups: control, sepsis, sepsis+antibiotic, sepsis+propolis and propolis+antibiotic+sepsis groups. On the eighth day, all experimental animals were sacrificed. Serum concentrations of MDA were evaluated. In addition, the histopathological changes in intestinal were assessed. Kruskall-Wallis test with Mann-Whitney analysis were used to determine significant differences. Results were expressed as mean±standard error of the mean, and value of p<0.05 was considered statistically significant. Malondialdehyde serum means levels were control group 0.27±0.07 μmol/L, sepsis 0.39±0.05 μmol/L, sepsis+antibiotic 0.15±0.03 μmol/L, sepsis+ propolis 0.09±0.05 μmol/L, and sepsis+antibiotic+propolis 0.21±0.11 μmol/L respectively. The levels of intestinal inflammation were control groups 0 to 3, sepsis 3 to 4, sepsis+antibiotic 1 to 3, sepsis+propolis 1 to 3, and sepsis+antibiotic+propolis 0 to 2, respectively. In conclusions, ethanol extract of propolis reduces the levels of intestinal inflammation and serum MDA in sepsis animal models. [MKB. 2013;45(3):161–6] DOI: http://dx.doi.org/10.15395/mkb.v45n3.146
EFEKTIVITAS MEMBRAN AMNION LIOFILISASI (HANDMADE TUBULAR) SEBAGAI NERVE CONDUIT PADA PERBAIKAN CEDERA SARAF PERIFER TIKUS DENGAN GAP 5 MM G. Gandadikusumah, R. Dadan; Rasyid, Hermawan N.; Hidajat, Nucki N.; Ismiarto, Yoyos D.
Majalah Kedokteran Bandung Vol 45, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Cedera saraf perifer dengan gap sekitar 5?30 mm baik akibat cedera langsung (87%) maupun iatrogenik (12%) mendapat perhatian khusus karena dapat mengakibatkan kecacatan di kemudian hari. Untuk itu dibutuhkan metode perbaikan saraf dengan tanpa menambah morbiditas penderita, salah satunya dengan metode entubulasi berbahan alamiah atau sintetik. Penelitian berupa eksperimental hewan coba dengan rancang acak sederhana telah dilakukan di Laboratorium Departemen Farmakologi, Fakultas Kedokteran, Universitas Padjadjaran Bandung periode Mei 2012. Sampel tikus Wistar dewasa dengan jumlah 14 dibagi menjadi 2 kelompok. Setelah dibuat gap pada saraf iskiadikus, pada kelompok perlakuan dilakukan pemasangan nerve conduit dengan bahan membran amnion liofilisasi yang telah dibuat secara manual sebelumnya (handmade tubular). Pada kelompok kontrol tanpa pemasangan nerve conduit. Setelah observasi selama 21 hari, dilakukan uji konduksi dan pemeriksaan histopatologi. Data diolah dengan analisis statistik nonparametrik sign test. Semua hewan coba selamat tanpa ada yang mengalami komplikasi pascaoperasi. Hasil penelitian didapatkan perbedaan yang signifikan antara kelompok perlakuan dan kontrol, uji konduksi sebesar 0,016 (p<0,05), pertumbuhan saraf hingga distal gap sebesar 0,063 (p<0,05), arah pertumbuhan saraf yang tidak radier sebesar 0,031 (p<0,05). Pada reaksi peradangan tampak minimal dan tidak terdapat perbedaan antara kedua kelompok. Simpulan, membran amnion liofilisasi (handmade tubular) efektif untuk digunakan sebagai nerve conduit dalam perbaikan cedera saraf perifer tikus dengan gap 5 mm. [MKB. 2013;45(3):192?9] Effectivity of Handmade Tubular Lyophilized Amnion Membrane as a Nerve Conduit in Repairing of Peripheral Nerve Injury with 5 mm Gap in RatsPeripheral nerve injury with 5?30 mm gap which is caused by direct injury cases (87%) or iatrogenic (12%) become a special concern because it could cause a serious disability in the future. Therefore, we need many kinds of nerve repair methods without adding morbidity to the patient. One of the methods is entubulation method, by using natural or synthetic material. This was an animal experimental research by using simple random design in Departement Pharmachology Laboratory, Faculty of Medicine, Universitas Padjadjaran Bandung in May 2012. The samples were used 14 Wistar rats, divided into 2 groups. After creating gap on sciatic nerve, nerve conduit was installed on case group by using handmade tubular lyophilized amnion membrane. Nerve conduit was not installed in control group. After 21 days observation, conduction test and histopathology examination were done. Data were analyzed by using non-parametric statistical analysis sign test. All animals survived without any serious surgical complication. Result showed a significant difference between groups; the conduction test=0.016 (p<0.05), nerve growth to distal gap=0.063 (p<0.05), no radier direction of nerve growth=0.031 (p<0.05). Reaction of inflammation was minimum and there was no difference between two groups. In conclusion, handmade tubular lyophilized amnion membrane is effective as nerve conduit in repair of peripheral nerve injury with 5 mm gap. [MKB. 2013;45(3):192?9] DOI: http://dx.doi.org/10.15395/mkb.v45n3.150
PERBANDINGAN PULIHNYA SYOK PADA SINDROM SYOK DENGUE MEMAKAI RINGER LAKTAT DAN NATRIUM LAKTAT HIPERTONIK Christianty, Monique; Somasetia, Dadang H.; Sjahrodji, Azhali M.
Majalah Kedokteran Bandung Vol 45, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Resusitasi cairan memakai kristaloid isotonik sering menyebabkan kelebihan cairan dan jejas reperfusi. Inovasi terbaru resusitasi cairan pada penderita syok yaitu natrium laktat hipertonik. Saat ini belum ada penelitian yang memakai natrium laktat hipertonik untuk resusitasi cairan sindrom syok dengue (SSD). Tujuan penelitian ini untuk mengetahui perbedaan pulihnya syok setelah resusitasi cairan SSD anak memakai natrium laktat hipertonik dibandingkan dengan Ringer laktat (RL). Penelitian ini merupakan uji klinis terkontrol acak tersamar tunggal di Departemen Ilmu Kesehatan Anak Rumah Sakit Dr. Hasan Sadikin Bandung, bulan Juni 2008?Juni 2010. Didapatkan 62 subjek, usia 2?14 tahun memenuhi kriteria inklusi, empat subjek drop out sehingga 58 subjek yang dapat dianalisis. Kelompok I (30 subjek) mendapat natrium laktat hipertonik dan kelompok II (28 subjek) mendapat RL. Dilakukan pengamatan waktu pengisian kapiler dan kadar laktat darah sebagai penanda pulihnya syok. Analisis statistik digunakan uji-t, Uji Friedman, dan uji chi-kuadrat. Hasil penelitian didapatkan perbedaan bermakna kecepatan pulihnya syok setelah resusitasi cairan memakai natrium laktat hipertonik dibandingkan dengan RL (p<0,05). Perbedaan pulihnya waktu pengisian kapiler tampak pada menit ke-30, jam ke-1, dan jam ke-2 (p<0,05). Perbedaan penurunan kadar laktat darah tampak pada jam ke-12 (p<0,05). Disimpulkan resusitasi cairan memakai natrium laktat hipertonik pada SSD anak memulihkan syok lebih cepat dibandingkan dengan RL. [MKB. 2013;45(3):135?40]Kata kunci: Laktat darah, natrium laktat hipertonik, sindrom syok dengue, waktu pengisian kapiler Comparison of Shock Recovery in Dengue Shock Syndrome Using Ringer Lactate and Hypertonic Sodium LactateStandardized dengue shock syndrome (DSS) fluid resuscitation using isotonic crystalloid often cause fluid overload and reperfusion injury. The new innovation of fluid resuscitation in shock patients is using hypertonic sodium lactate. The study on fluid resuscitation using hypertonic sodium lactate in DSS children has never performed previously. This study aimed to find shock recovery difference between DSS children using hypertonic sodium lactate and Ringer lactate (RL). Study method was single blind randomized controlled trial. There were 62 children, 2?14 years met the inclusion criteria in pediatric division, Departement of Child Health Dr. Hasan Sadikin Hospital Bandung, June 2008?June 2010, four subjects were dropped out and 58 subjects were participated. Group I (30 subjects) received hypertonic sodium lactate and group II (28 subjects) received RL. The subjects were observed for capillary refill time and blood lactate as shock recovery predictor. Statistical analysis using t-test, Friedman test, and chi-square. The result showed fluid resuscitation using hypertonic sodium lactate was faster in shock recovery than RL (p<0.05). The significant difference of capillary refill time recovery start at 30 minutes, first, and second hour observation (p<0.05). The significant difference decrease in blood lactate showed at twelfth hour observation (p<0,05). This study concluded fluid resuscitation on DSS children using hypertonic sodium lactate has faster shock recovery compared to RL. [MKB. 2013;45(3):135?40]Key words: Blood lactate, capillary refill time, dengue shock syndrome, hypertonic sodium lactate DOI: http://dx.doi.org/10.15395/mkb.v45n3.142
RADIOTERAPI EKSTERNAL TERHADAP NILAI AMBANG EKSITABILITAS SARAF FASIALIS PADA RADIOTERAPI EKSTERNAL PENDERITA KARSINOMA NASOFARING Altila, Yunaldi; Samiadi, Dindy; Aroeman, Nur Akbar
Majalah Kedokteran Bandung Vol 45, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Radioterapi eksternal (external beam radiation therapy/EBRT) merupakan pengobatan utama karsinoma nasofaring. Efek samping radioterapi eksternal yaitu neuropati saraf tepi. Radioterapi eksternal menyebabkan perubahan perbandingan antara akson dan area total serabut saraf. Tujuan penelitian ini menilai pengaruh radioterapi eksternal pada perubahan nilai ambang eksitabilitas saraf fasialis pada penderita karsinoma nasofaring. Jenis penelitian adalah studi analitik observasional dengan rancangan pre-post design. Penelitian dilakukan di Departemen Ilmu Kesehatan Telinga Hidung Tenggorok?Bedah Kepala Leher Rumah Sakit Dr. Hasan Sadikin Bandung bulan September?November 2012. Pada penelitian ini dilakukan pemeriksaan nerve excitability test (NET) praradioterapi, fraksinasi radiasi ke-15, fraksinasi ke-33, dan 4 minggu pascaradioterapi. Hasil penelitian ini dihitung dengan menggunakan uji-t berpasangan. Terdapat 26 subjek mengalami peningkatan nilai NET selama radioterapi sesuai dengan kemaknaan jumlah fraksinasinya (p<0,001). Hal tersebut tidak mempunyai hubungan yang signifikan dengan jenis kelamin dan usia penderita. Simpulan, terjadi peningkatan nilai NET sesuai bertambahnya fraksinasi radiasi, namun 4 minggu pascaradioterapi mengalami penurunan nilai NET mendekati >nilai praradioterapi pada penderita karsinoma nasofaring. [MKB. 2013;45(3):167?73]Facial Nerve Excitability Values on Nasopharyngeal Carcinoma Patients who Undergo External Beam RadiotherapyExternal radiotherapy is the main treatment for nasopharyngeal carcinoma. One of complication of the external beam radiotherapy (EBRT) is peripheral neuropathy. External radiotherapy could cause changes in ratio between axons and the total area of the nerve fibers. The purpose of this study was to assess the influence of EBRT to the changes in the value of the facial nerve excitability in nasopharyngeal carcinoma. This research was observational analytic study by pre and post design and it was performed in the months September until November, year 2012 at the Otolaryngology?Head and Neck Surgery Department of Dr. Hasan Sadikin Hospital Bandung. Nerve excitability test (NET) examination was performed just before EBRT, fractionation the 15th, fractionation the 30th, and four weeks after EBRT. Analytical statistic calculated by using paired t-test. They were 26 subjects had significant of NET value increased during radiotherapy according to the number of fractionation (p<0.001). It does not have a significant relationship with gender and age of the patient. In conclusions, there is increased NET value corresponding increase in fractionation radiation, but they would be decreases approaching the original value as before EBRT on nasopharyngeal carcinoma patients. [MKB. 2013;45(3):167?73] DOI: http://dx.doi.org/10.15395/mkb.v45n3.147

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