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INDONESIA
Medicina
Published by Universitas Udayana
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Core Subject : Health,
Medicine & Pharmacology
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Articles 13 Documents
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Search results for , issue "Vol 46 No 3 (2015): September 2015" : 13 Documents clear
RETRO-ORBITA EXTRAPLEURAL SOLITARY FIBROUS TUMOR Mahastuti, Ni Made; Saputra, Herman; Gotra, I Made
Medicina Vol 46 No 3 (2015): September 2015
Publisher : Medicina

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (296.745 KB)

Abstract

Extrapleural solitary fibrous tumor (SFT) merupakan tumor jaringan mesenkimal tipe fibroblastikdengan gambaran haemangipericytoma-like branching vascular yang menonjol dan sangat jarangdijumpai. Penderita perempuan usia 38 tahun mengeluh mata kanan menonjol sejak 2 tahun yanglalu.  Klinis ditemukan massa menonjol di belakang mata kanan. Pada pencitraan CT scan tampakmassa solid heterogen di cavum orbita kanan, tidak menginfiltrasi bulbus okuli. Makroskopis, massasolid berbatas tegas di regio retro orbita, berukuran 6,5 x 6,5 x 6 cm. Mikroskopis, tumor berbatastegas, sebagian besar tampak hiperselular mengandung proliferasi sel spindel neoplastik diselingidengan haemangipericytoma-like branching vascular yang menonjol. Mitosis sulit ditemukan. Pulasanimunohistokimia CD34 positif kuat dan Ki67 kurang dari 5%.  Pasien didiagnosis retro-orbitaextrapleural SFT  berdasarkan temuan klinis, radiologis, makroskopis, mikroskopis yang khas sertapemeriksaan imunohistokimia.  [MEDICINA 2015;46:195-200].Extrapleural solitary fibrous tumor (SFT) is an ubiquitous mesenchymal tumour of fibroblastic type,which shows a prominent  haemangipericytoma-like branching vascular. A 38 years old woman camewith protruding right eye since 2 years ago. Clinical examination found a protruding mass in the rightretro orbita. Computed tomography scan demonstrated heterogen solid mass in right cavum orbitawithout infiltration into bulbus oculi. Macroscopically, the tumour appeared as well circumscribedsolid mass 6,5 x 6,5 x 6cm. Microscopic examination showed well circumscribed tumour, hypercellular,consist of neoplastic spindle cell proliferation intermingled with  prominent haemangiopericytomalikebranching vascular pattern . Mitoses are rarely found. CD34 stained strongly positive with lowexpressionof  Ki67 (< 5%). The diagnosis was made based on the clinical data, radiologic, histopathologicfindings,and also immunohistochemistry staining. [MEDICINA2015;46:195-200].
PERBANDINGAN VALIDITAS SISTEM SKORING ACUTE PHYSIOLOGICAL CHRONIC HEALTH EVALUATION II, SEQUENTIAL ORGAN FAILURE ASSESSMENT, DAN CUSTOMIZED SEQUENTIAL ORGAN FAILURE ASSESSMENT UNTUK MEMPERKIRAKAN MORTALITAS PASIEN NON-BEDAH YANG DIRAWAT DI RUANG PERAWATA Taofik, Stefanus; Subagiartha, I Made; Senapathi, Tjokorda Gde Agung
Medicina Vol 46 No 3 (2015): September 2015
Publisher : Medicina

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Abstract

Penerapan sistem jaminan kesehatan nasional (SJKN) dalam pelayanan di ruang terapi intensif (RTI) mendorong pelayanan di RTI untuk lebih efektif dan efisien. Prediksi hasil perawatan penting baik secara administrasi ataupun klinis dalam manajemen RTI. Pasien non-bedah meskipun jumlahnya tidak banyak, namun memiliki angka mortalitas yang tinggi. Untuk mendapatkan sistem skoring yang baik dan mudah diterapkan dilakukan penilaian missing value, dan diskriminasi dari masing masing sistem skoring. Penelitian ini melibatkan 184 pasien non-bedah yang dirawat di RTI RSUP Sanglah Denpasar yang diambil secara retrospektif dari data tanggal 1 Januari 2014 sampai dengan 31 Desember 2014. Semua pasien dilakukan penilaian APACHE II, SOFA, dan CSOFA. Uji analisis regresi logistik dilakukan untuk menilai pengaruh masing masing sub-variabel terhadap mortalitas, dan selanjutnya mencari cut off point dari analisis kurva ROC untuk mendapatkan sensitivitas dan spesifisitas masing masing. Area under receiver operating characteristic (AuROC) pada acute physiological and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), dan customized sequential organ failure assessment (CSOFA) berturut turut didapatkan 0,892, 0,919, dan 0,9172. Missing value terbanyak didapatkan berturut turut pada SOFA, APACHE II, dan CSOFA sebesar 84,23%, 8,15%, dan 1,65%, dengan dominan sub-variabel hepar (bilirubin). Uji regresi logistik memperlihatkan sub-variabel neurologi, dan kardiovaskular memberikan hubungan bermakna terhadap mortalitas dengan RO 4,58, dan 2,24. Sub-variabel lain yang berpengaruh antara lain acute kidney injury (AKI), sepsis, dan penyakit kronis dengan RO 8,14, dan 3,89. Sistem skoring CSOFA lebih valid dalam memperkirakan mortalitas pasien di RTI RSUP Sanglah Denpasar, karena mempunyai nilai diskriminasi yang lebih baik dan missing value yang lebih sedikit dibandingkan dengan sistem skoring APACHE II dan SOFA. [MEDICINA 2015;46:145-51].Application of sistem jaminan kesehatan nasional (SJKN) in intensive care unit (ICU) service encourages ICU services for being more effective and efficient. Prediction of mortality is important either for administration or clinical in ICU management. Even non-surgical patient population is not large, but it has high mortality rate. To gain good and easy to used scoring system, we assessed missing value, and discrimination for all scoring system. This research enrolled 184 non-surgical patients in ICU of Sanglah Hospital restrospectively started from 1 st january to 31 december 2014. All patient assessed by acute physiological and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), and customized sequential organ failure assessment (CSOFA). Analytic logistic regression test was used to determine each sub-variable correlation with mortality, and then to gain cut off point of ROC analytical curve to get sensitivity and specificity. Area under receiver operating characteristic (AuROC) for APACHE, SOFA, and CSOFA were 0.892, 0.919, and 0.9172 consecutively. The missing value for SOFA, APACHE II, and CSOFA is 84.23%, 8.15%, dan 1.65%, which was dominated by bilirubin parameter. Logistic regression analysis shows sub-variable neurology, and cardiovascular respiration gave significant correlation with mortality with OR 4.58 and 2.24. Other significant subvariable were AKI and sepsis with OR 8.14 and 3.89. Customized sequential organ failure assessment scoring system is more valid than APACHE II and SOFA to predict mortality, because it had better discrimination value and less missing value. [MEDICINA 2015;46:145-51].
KORELASI NEGATIF ANTARA CHARLSON COMORBIDITY INDEX DENGAN JUMLAH LIMFOSIT TOTAL DAN KADAR ALBUMIN PADA PASIEN GERIATRI Suastika, Ngakan Ketut Wira; Aryana, IGP Suka; Kuswardhani, RA Tuty
Medicina Vol 46 No 3 (2015): September 2015
Publisher : Medicina

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (157.114 KB)

Abstract

Charlson comorbidity index (CCI) merupakan metode untuk memprediksi mortalitas denganmengklasifikasikan berbagai kondisi komorbid dan telah digunakan secara luas untuk mengukurbeban penyakit. Malnutrisi juga berhubungan dengan peningkatan angka mortalitas dan morbiditas.Jumlah total limfosit (total lymphocyte count/TLC) dan kadar albumin berhubungan dengan penurunanfungsi tubuh pada malnutrisi. Penelitian ini bertujuan untuk mengetahui korelasi antara CCI denganTLC dan kadar albumin pada pasien geriatri.Penelitian ini merupakan penelitian potong lintanganalitik yang dilakukan di RSUP Sanglah Denpasar pada bulan Juli 2013 sampai dengan Maret2014. Subyek penelitian adalah pasien geriatri yang menjalani perawatan di RSUP Sanglah Denpasar.Sampel didapat dengan cara consecutive sampling. Untuk mengetahui korelasi antara CCI denganTLC dan kadar albumin digunakan uji korelasi Spearman.Sebanyak 80 sampel termasuk dalampenelitian ini. Sebanyak 50 (62,5%) adalah laki-laki dan 30 (37,5%) adalah perempuan dengan medianumur 74,0 (66-98) tahun. Terdapat korelasi negatif kuat yang signifikan antara CCI dengan TLC (r =-0,791; P<0,0001) dan juga korelasi negatif kuat antara CCI dan kadar albumin (r = -0,844; P<0,0001).Disimpulkan terdapat korelasi negatif kuat antara CCI dengan TLC dan kadar albumin. [MEDICINA2015;46:170-3].The charlson comorbidity index (CCI) is a method for predicting mortality by classifying comorbidconditions has been widely utilized to measure burden of disease. Malnutrition is also related toincreased mortality and morbidity rate. Total lymphocyte count (TLC) and albumin level is related todecreased body function in malnutrition. The objective of this study was to determine the correlationbetween the CCI score with TLC and albumin levels in geriatric patients.This study was a crosssectionalanalytic study conducted in Sanglah Hospital from July 2013 to March 2014. Subjects of thisstudywere geriatric patients who hospitalized at Sanglah Hospital. Patients were collected byconsecutivesampling. Spearman correlation test was used to determine the correlation between CCIscorewith TLC and albumin level. A total of 80 samples were included in this study, of which 50(62.5%)was male and 30 (37.5%) was female with a median of age was 74 (66-98) years old. There wasasignificant strong negative correlation between the CCI score and TLC (r = -0.791; P<0.0001) and alsoasignificant strong negative correlation between the CCI and albumin level (r = -0.844; P<0.0001). Itwasconcluded that there is astrong negative correlation between  the CCI score with TLC and albuminlevels.[MEDICINA2015;46:170-3].

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