bluuebunny/crossref_metadata_2025 huggingface dataset:
Faktor Risiko Terjadinya Batu Empedu di RSUP Dr. Wahidin Sudirohusodo Makassar
Authors: Sueta Made Agus Dwianthara , Warsinggih Warsinggih
Published: June 2019

Tujuan: untuk mengetahui apakah terdapat hubungan beberapa faktor seperti jenis kelamin, usia, diabetes, obesitas, dan hiperlipidemia, sebagai penyebab munculnya batu empedu di RSUP Dr. Wahidin Sudirohusodo. Metode: penelitian ini dilakukan dengan pengambilan sampel secara retrospektif pada pasien yang dirawat diruang bedah di Rumah Sakit Wahidin Sudirohusodo Makassar bulan Januari sampai dengan Desember 2013, sampel diambil secara konsekutif berurutan sebesar jumlah sampel yang dibutuhkan. Hasil: sampel yang masuk kriteria inklusi dari penelitian ini sebanyak 196 orang.  Dari 196 orang 114 (58,5%) orang dengan batu empedu, 101 perempuan (51,5%) dan 95 laki-laki (48,5%). Terdapat 86 (75,4%) penderita dengan batu empedu yang berusia di bawah 40 tahun dan 28 (24,6%) penderita berusia lebih dari 40 tahun. Berdasarkan jenis kelamin 26 (22,8%) penderita laki-laki dengan batu empedu dan 88 (77,2%) perempuan dengan batu empedu. Penderita DM dengan batu empedu sebanyak 103 (90,4%), pasien dengan obesitasyang menderita batu empedu sejumlah 97 (85,1%), 88 (77,2%) penderita dengan kadar trigliserida yang meningkat dengan batu empedu, dan 95 (83,3 %) pasien dengan kadar kolesterol yang meningkat mengalami batu empedu. Simpulan: jenis kelamin perempuan, usia di bawah 40 tahun, penderita diabetes, obesitas dan hiperlipidemia merupakan faktor risiko menimbulkan batu empedu.
Dosis Efektif Enoxaparin dalam Mencegah Terjadinya Trombosis pada Anastomosis Arteri Femoralis Tikus
Authors: Adnyana I Made Suka , Saputro Iswinarno Doso
Published: June 2019

Tujuan: untuk mengetahui dosis efektif enoxaparin dalam mencegah terjadinya trombosis pada anastomosis mikrovaskular. Metode: penelitian ini bersifat eksperimental dengan rancangan the randomized post test only control group design. Terdapat 33 tikus jantan Rattus norvegicus Wistar strain yang dikelompokkan menjadi tiga perlakuan yaitu perlakuan A (enoxaparin 0,75 mg/kg), B (enoxaparin 1  mg/kg), dan C (kontrol). Tuck model anastomosis dilakukan pada arteri femoralis, kemudian luas trombus yang terjadi pada pembuluh darah dibandingkan dengan diameter lumen pembuluh darah diukur dengan graticule lens dan dinyatakan dalam persen. Hasil: trombus terbentuk pada semua subyek penelitian baik pada kelompok perlakuan maupun kontrol. Rerata persentase luas trombus pada kelompok enoxaparin 0,75 mg/kg adalah 24,3%, enoxaparin 1 mg/kg sebesar 19,8% dan kelompok NaCl 0,9% sebesar 79,4%. Terdapat perbedaan antara perlakuan pemberian enoxaparin dosis 0,75 mg/kg dan 1 mg/kg dengan kontrol, namun tidak ada perbedaan bermakna rerata persentase luas trombus diantara kelompok enoxaparin dosis 0,75 mg/kg dan dosis 1 mg/kg (p=0,624). Perlu dilakukan penelitian secara klinis guna melihat efektivitas enoxaparin dalam meningkatkan patensi anastomosis pada free flap maupun replantasi. Simpulan: pemberian enoxaparin dosis 0,75 mg/kg dan enoxaparin dosis 1 mg/kg secara subkutan efektif mengurangi persentase luas trombus pada anastomosis arteri femoralis tikus. Tidak terdapat perbedaan efektivitas yang bermakna dalam mengurangi persentase luas trombus pada anastomosis arteri femoralis tikus setelah diberikan dosis enoxaparin 0,75 mg/kg dan 1 mg/kg secara subkutan.
Predictive Factors of Inguinal Lymph Node Metastasis in Men with Penile Cancer at Sanglah Hospital, Denpasar, Bali
Authors: Harmaya AK , Yudiana IW , Oka AAG , Djatisoesanto W
Published: June 2019

Objective: to know the predictive factors of inguinal lymph node metastasis in men with penile cancer. Methods: this was a retrospective study on 65 patients with penile cancer in Sanglah Hospital, Denpasar, Bali from 2011 to 2015. Patients were included in analysis if they had undergone partial or total penectomy, and inguinal lymph-node dissection or excisional biopsy. Inguinal lymph node metastasis was defined as tumor positive node based on histopathology finding in patients who underwent inguinal lymph node dissection or excisional biopsy. Data retrieved from this study was analyzed by Chi Square and Kruskal-Wallis test. Results: a total of 65 patients diagnosed as penile cancer in Sanglah Hospital, Denpasar, Bali from 2011 to 2015. Mean age of these patients was 53.24 ± 13.42 years. The youngest age was 27 years old and the oldest was 86 years old. Fifteen patients were excluded for different reasons, remaining 50 patients for further analysis. From 50 patients included in analysis, 25 patient (50%) had inguinal lymph node metastasis. There were significant correlation between pathologic stage of the primary tumor (p=0.021), histologic grade (p=0.020), and vascular invasion (p=0.008) with the presence of inguinal lymph node metastasis. Based on pathologic stage of the primary tumor, only 1 of 7 patients (14%) with pT1 had inguinal lymph node metastasis compared with 10 of 24 patients (42%) with pT2, 10 of 15 patients (67%) with pT3, and 4 of 4 patients with pT4 (100%). Based on histologic grade, only 2 of 9 patients (22%) with grade I had inguinal lymph node metastasis compared with 18 of 36 patients (50%) with grade II, and 5 of 5 patients (100%) with grade III. Based on vascular invasion, only 15 of 38 patients (39%) without vascular invasion had inguinal lymph node metastasis compared with 10 of 12 patients (83%) with vascular invasion. No significant correlation was found between age and the presence of inguinal lymph node metastasis (p=0.829). Conclusion: pathologic stage of the primary tumor, histologic grade, and vascular invasion were predictive factors of inguinal lymph node metastasis in men with penile cancer.
Hubungan Antara Ekspresi Cyclooxygenase-2 dan Gambaran Klinikopatologikal dari Kanker Kolorektal di RSUP Sanglah
Authors: Setiawan Gede Budhi , Sudarsa Wayan , Manuaba I.B. Tjakra Wibawa
Published: June 2019

Tujuan: untuk menyelidiki hubungan dari ekspresi cyclooxygenase-2 (COX-2) dengan gambaran klinikopatologikal pasien dengan kanker kolorektal (CRC). Metode: ekspresi COX-2 diperiksa mengunakan imunohistokimia pada 46 pasien dengan kanker kolorektal, di Rumah Sakit Sanglah Denpasar, antara bulan September 2004 dan November 2005. Dilakukan analisis hubungan ekspresi COX-2 dengan gambaran klinikopatologikal. Hasil: pewarnaan COX-2 terekspresi pada 91,3% sampel. Ekspresi COX-2 sebesar 94,6%, dan 100% pada stadium III dan IV CRC, dan berkorelasi positif dengan tahap TNM dari CRC (Spearman’s rho 0,846, p<0,05). Ekspresi COX-2 100% pada CRC yang berdiferensiasi buruk dan berkorelasi positif (Spearman’s rho 0,456, p<0,05). Tidak ada korelasi antara ekspresi COX-2 dan usia pasien, jenis kelamin, lokasi tumor, dan jenis histopatologi CRC (p>0,05). Simpulan: ekspresi COX-2 diregulasi pada CRC, dan berhubungan dengan TNM, dan diferensiasi. Hasil ini lebih mendukung bukti bahwa COX-2 mungkin terlibat dalam karsinogenesis dari CRC.
Perbedaan Kadar Plasminogen Activator Inhibitor-1 Cairan Peritoneum Tikus Wistar antara yang Diberi Vitamin E Topikal atau Ketorolak Intramuskular atau Simvastatin Oral atau Kombinasi Ketiganya pada Tikus Wistar yang Dilakukan Abrasi Ileum
Authors: Ariyanta Kadek Deddy , Kusmayadi Dikki Drajat , Diposarosa Rizki
Published: June 2019

Tujuan: untuk membuktikan adanya perbedaan kadar plasminogen activator inhibitor-1 (PAI-1) cairan peritoneum tikus Wistar antara yang tidak diberi obat, diberi obat tunggal vitamin E topikal atau ketorolak intramuskular atau simvastatin oral dengan yang diberi obat kombinasi ketiganya pada tikus Wistar yang dilakukan abrasi ileum. Metode: penelitian eksperimental laboratorik, menggunakan tikus Wistar jantan. Tiga puluh ekor tikus Wistar dilakukan abrasi ileum dan dibagi 5 kelompok: kontrol (K); perlakuan 1, diberi vitamin E topikal (P1); perlakuan 2, diberi ketorolak intramuskular (P2); perlakuan 3, diberi simvastatin oral (P3); dan perlakuan 4, diberi kombinasi vitamin E topikal, ketorolak intramuskular, dan simvastatin oral (P4). Cairan peritoneum diambil 7 hari kemudian untuk mendapatkan kadar PAI-1 cairan intraperitoneum. Uji beda kadar PAI-1 cairan peritoneum dengan uji one way ANOVA dan Dunett’s T3. Hasil: kadar PAI-1 cairan peritoneum tikus Wistar yang dilakukan abrasi ileum antara kelompok kontrol dengan kelompok kombinasi (p=0,046), kelompok vitamin E dengan kombinasi (p=0,000), kelompok ketorolak dengan kombinasi (p=0,000), dan kelompok simvastatin dengan kombinasi (p=0,002). Simpulan: kadar PAI-1 cairan peritoneum lebih rendah secara bermakna pada kelompok yang diberi perlakuan kombinasi dibandingkan dengan pemberian obat tunggal dan yang tidak diberi.
Profile of Abdominal Trauma Patient Underwent Surgery in Emergency Operating Room of Sanglah General Hospital from January until December 2015
Authors: Halim Reza , Sueta Made Agus Dwianthara
Published: June 2019

Objective: to investigate the characteristics of patients, presentation of the abdominal organ that involved, and clinical data associated with this event. Methods: this is a descriptive study with retrospective design. Total samples were all patients with abdominal trauma who underwent surgery on the emergency operating theatre of Sanglah General Hospital between January and December 2015. Baseline data of patients were obtained from the medical records. Results: within the study period, a total of 104 patients with abdominal trauma who underwent surgery in the emergency operating room of Sanglah General Hospital were identified. Man comprised 87.5% of the patients and mostly were 17-45 years old (75%). The motor vehicle accident occurred majority on the weekend (65%). Liver and spleen were the most affected organ (55%). Splenectomy (35%) and liver repair surgery (33%) were the most often performed procedures. Conclusion: Abdominal trauma caused by motor vehicle accident occurred mostly on the weekend. Two most affected organs in abdominal trauma were liver and spleen. Splenectomy and liver repair surgery were the procedures performed for these trauma patients.
Hepatolitiasis: Kasus Serial di RSUD Dr. Soetomo
Authors: Mahayasa Made , Lesmana Tommy
Published: June 2019

Latar Belakang: hepatolitiasis adalah batu empedu pada saluran empedu liver dengan insidensi 20-30% dari semua pasien yang menjalani operasi untuk penyakit batu empedu. Ada beberapa pilihan operasi hepatolitiasis, seperti hepatektomi, eksplorasi common bile duct (CBD), dan drainase saluran intrahepatik atau cholangioenterostomy (access loop procedures), dan teknik perkutaneus. Pada laporan kasus serial ini, akan dibahas aspek pemilihan operasi pada pasien dengan hepatolitiasis. Kasus: kasus pertama adalah laki-laki, 60 tahun, dirawat di Rumah Sakit Dr. Soetomo dengan nyeri abdomen kuadran kanan atas sejak 2 minggu. Diagnosis dengan USG (ultrasonografi) abdomen dan MRCP (magnetic resonance cholangiopancreatography) menunjukkan terdapat beberapa batu di IHBD (intra hepatic bile duct), CHD (common hepatic duct), CBD, GB (gall bladder), dan sistem bilier yang melebar. Pada pasien dilakukan tindakan kolesistektomi, eksplorasi duktus, dan by pass bilio-digestive Roux en Y (access loop procedures). Kasus kedua adalah perempuan, 45 tahun, dirawat di Rumah Sakit Dr. Soetomo dengan didiagnosis batu IHBD dan CBD. Penderita telah dilakukan kolesistektomi sejak 12 tahun yang lalu. Durante operasi ditemukan atrofi lobus kiri hati. Pada pasien, dilakukan operasi dengan eksplorasi duktus, by pass bilio-digestive Roux en Y (access loop procedures), dan hepatektomi lobus kiri. Simpulan: kasus hepatolitiasis jarang terjadi di Rumah Sakit Dr. Soetomo Surabaya. Diagnosis lengkap memerlukan kombinasi modalitas pencitraan. Pembedahan tetap menjadi pilihan utama pengobatan definitif. Menurut strategi terapeutik saat ini untuk hepatolitiasis, hepatektomi tampaknya merupakan pengobatan yang paling efektif untuk pasien dengan hepatolitiasis kiri yang terisolasi jika prosedur pembedahan lain tidak dapat mengatasi semua lesi terkait. Perawatan yang baik dapat memberikan luaran yang baik.
Sternocleidomastoid-Clavicle Myoosseus Flap in Patient with Plate Displacement Post Resection and Reconstruction of Ameloblastoma
Authors: Natawidjaja Ronald , Setiawan Gede Budhi
Published: June 2019

Background: ameloblastoma is a common tumor found in head and neck disorder. The definitive treatment include resection of tumor and reconstruction for filling the large defect which left after tumor resection. The reconstruction option which can be done is flap method. In this case, we used sternocleidomastoid-clavicle myoosseus flap in our patient with post traumatic plate displacement post resection and reconstruction of ameloblastoma. Case: a 22-year-old woman presented with unstability of jaw after hitting her chin to the table since 3 days prior to admission. On 2011, she had history of ameloblastoma which got resected and reconstructed with fibular graft and plate in the same year. While the plate seemed to be broken, she was managed with plate removal and reconstruct with sternocleidomastoid-clavicle myoosseus flap. Post operation, patient managed with gradual diet from liquid to solid. Observation Post Operation Day (POD) 3, flap is vital. Patient is discharged on POD 7 and visit as outpatient every 3-5 days until POD 14. Finally, we remove the suture, operation scar is good, and the flap is vital during one year follow up. Conclusion: sternocleidomastoid-clavicle myoosseus flap is practical and safe procedure, which can be used as alternative option in  mandible reconstruction.
Transfer Jari Kedua Jari Kaki untuk Rekonstruksi Jari Pertama Jari Tangan Setelah Trauma Listrik (Laporan Kasus)
Authors: Hamid Agus Roy R.H. , Rizaliyana Sitti , Noer M. Sjaifuddin , Aniko Gwendy
Published: June 2019

Latar belakang: jari pertama memiliki peran yang sangat penting pada fungsi tangan. Rekonstruksi jari pertama jari tangan dapat dilakukan menggunakan jari pertama jari. Jari kedua jari kaki dapat digunakan apabila jari pertama jari kaki tidak dapat digunakan sebagai lokasi donor, misalnya, ketika tingkatan amputasi melebihi dari sepertiga proksimal metakarpal pertama dan diperlukan tulang metatarsal dengan panjang yang signifikan untuk menyediakan ukuran yang cukup pada rekonstruksi jari pertama tangan. Kasus: dilaporkan satu kasus, laki-laki, 24 tahun, datang ke Instalasi Gawat Darurat, Rumah Sakit Dr. Soetomo dengan hilangnya jari pertama jari tangan setelah trauma listrik. Pada pasien telah dilakukan debridemen dan flap lokal pada pergelangan tangan kiri dan skin graft pada tengan kanan. Flap viable dan hangat. Setelah hari ke-5 operasi, graft take 100%, dan pasien bisa kembali ke rumah. Tiga bulan setelah pembedahan, pasien datang ke poliklinik rawat jalan untuk evaluasi. Kondisi jari baik namun pergerakannya terbatas. Kemudian, pada pasien direncanakan untuk rekonstruksi jari pertama dengan transfer jari kedua jari kaki. Hasilnya, evaluasi jari pertama yang baru, dengan keadaan yang baik, dapat bergerak tetapi tidak dapat fleksi dan ekstensi penuh. Simpulan: pilihan rekonstruksi untuk mengembalikan fungsi jari pertama jari tangan termasuk transfer jari kedua jari kaki ke jari pertama jari tangan atau pollicization jari telunjuk. Jari kaki ke jari tangan untuk rekonstruksi jari pertama dapat memberikan hasil yang sangat baik dan tingkat kepuasan pasien yang tinggi.
Tumor Neuroendokrin: Kasus Serial di RSUD Dr. Soetomo
Authors: Mahayasa Made , Wibowo Paulus Soetamto
Published: June 2019

Latar belakang: tumor neuroendokrin (NETs) adalah neoplasma yang dapat mensekresi hormon dengan sindrom klinis yang bervariasi. Meskipun insidennya relatif rendah, NETs merupakan tantangan klinis karena presentasi klinis yang bervariasi dan tidak ada modalitas pencitraan awal yang dapat efektif. Kasus: didapatkan 5 kasus tumor neuroendokrin selama kurun waktu 2 tahun (2008-2010). Hampir sebagian besar pasien yaitu 80% mengeluh nyeri abdomen dan 1 orang pasien (20%) dengan keluhan sulit defekasi. Dari pemeriksaan pencitraan awal, ditunjukkan bahwa terdapat 2 subjek dengan asal tumor dari pankreas, 1 dari paraaorta kiri, 1 dari supra-renalis, dan 1 dari presakral. Pemeriksaan jaringan tumor melalui FNAB (fine needle aspiration biopsy) mengonfirmasi adanya Malignant Neuroendocrine Tumor pada semua pasien. Pada pemeriksaan penanda jaringan intraseluler semua menunjukkan peningkatan NSE yaitu berkisar dari 30,9-218,40 ng/ml. Dari penilaian resektabilitas tumor didapatkan 1 orang resektabel, 3 orang non-resektabel, dan 1 orang lagi menolak tindakan. Pada sebuah kasus dilakukan reseksi luas, yaitu tumor neuroendokrin pre-sakral yang sudah infiltrasi ke os sakrum (S3-4). Selama follow up paska operasi pasien ini didapatkan metastasis pada hepar dan meninggal 2 tahun kemudian. Simpulan: tumor neuroendokrin adalah bentuk neoplasma yang jarang dan muncul dengan berbagai variasi klinis. Penegakan diagnosis jaringan dapat dilakukan dengan FNAB guiding USG (ultrasonografi) atau CT dan pemeriksaan penanda jaringan NSE. Penentuan resektabilitas tumor dapat dilakukan dengan pemeriksaan CT, MSCT (multislice computed tomography) atau MRI (magnetic resonance imaging. Kesulitan dalam hal tindakan dan mortalitas yang tinggi disebabkan karena hampir sebagian besar pasien datang dalam keadaan tumor yang sudah lanjut.
Bochdalek Hernia
Authors: Putra Yuliaji Narendra , Wahid Tubagus Odih Rhomdani , Alam Guntur Surya , Rohadi Rohadi
Published: June 2019

Background: Bochdalek hernia is a congenital defect on posterolateral diaphragm with an abnormal connection between the thoracic cavity and the abdominal cavity. This disease causes protrusion of abdominal organs into the thoracic cavity. Case: an 8-day-old baby girl admitted to hospital with shortness of breath 24 hours after delivered. The baby was born spontaneously assisted by midwife. Upon born, the baby was crying strongly and meconium came out 2 hours after birth. On physical examination, the abdomen was inspected flat. Darm contour and darm steifung was observed, and peristaltic sound was heard on left lung. Radiological examination demonstrated a diaphragmatic hernia with ileus obstruction. The patient underwent laparatomy and stomach, ileum, transverse colon, and spleen, was found on foramen Bochdalek. Post-surgery chest X Ray showed favourable result. Ten days after treatment, the patient was discharged in a good condition with no respiratory or digestive problems. After 1 months the patient’s condition remained good and there were no respiratory or digestive complaints. Conclusion: In a rare case like Bochadalek hernia, laparotomy performed as a promising attempt to return the anatomic position of organ.
Evaluasi Faktor Risiko yang Mempengaruhi Luaran Operasi Endorectal Pull-Through Soave Modifikasi Soewarno pada Penyakit Hirschsprung
Authors: Putra Yuliaji Narendra
Published: June 2019

Tujuan: untuk mengevaluasi luaran operasi endorectal pull-through Soave modifikasi Soewarna pada pasien Hirschsprung. Metode: penelitian ini adalah penelitian deskriptif pada 48 penderita Hirschsprung, dimana data dikumpulkan dengan wawancara langsung ke orang tua penderita. Setelah didapatkan skoring, kemudian dinilai angka keberhasilan penatalaksanaan operasi Soave modifikasi Soewarno, kemudian dilakukan analisis dengan menggunakan uji statistik Chi-kuadrat. Analisis antara skor Klotz dengan faktor prognostik, seperti berat badan lahir, status gizi, berat badan saat operasi, kadar albumin, kadar hemoglobin, kadar kalium, lama perawatan, dan jenis kelamin di analisis dengan uji Chi-Kuadrat. Hasil: pada penelitian ini, didapatkan pada faktor-faktor risiko yang mempengaruhi luaran operasi endorectal pull-through Soave modifikasi Soewarno adalah status gizi p<0,001 dengan RR 28,0 dan albumin p=0,047 dengan RR 1,23. Faktor risiko hemoglobin (p=0,372), kalium (p=0,256), berat badan lahir (p=0,66), berat badan saat operasi (p=0,0605), lama operasi (p=0,941), dan lama perawatan (p=0,683) tidak berpengaruh secara signifikan. Simpulan: Status gizi dan kadar albumin menjadi faktor prognosis signifikan terhadap luaran pasien dengan penyakit Hirchsprung yang dilakukan tindakan operasi Soave modifikasi Soewarno.
Case Report of A Neonate with Congenital Superior Lumbar Hernia
Authors: Hokardi Stephanus Haryanto , Sael Neil Angelo S.
Published: June 2019

Background: congenital lumbar hernias are rare. It constitutes to 20% of all lumbar hernias which is less than 1.5% of all the abdominal wall hernias. There are no more than 50 cases reported in literature till date. We report a case of congenital lumbar hernia in a preterm female neonate located on the superior lumbar triangle. Case: a preterm female neonate was born, presented with a mass at the right lumbar area with a size of 8x8 cm, round, movable with bluish discoloration, well delineated border, no visible veins, increases in size when the patient cries, and reduces easily. Ultrasonography revealed a right posterolateral abdominal mass measuring 4.2x2.88x1.59 cm. CT scan revealed right posterolateral mid-abdominal wall hernia with protrusion and no intestinal obstruction. The patient underwent exploratory laparotomy, where hernia defect was about 2 cm in diameter in the right posterior abdominal wall, pararenal area, and just below the 12th rib. The ascending colon and parts of the ileum were adherent inside the hernia defect at the right lumbar area. Primary closure of the hernia defect was done by suturing the psoas major and the transversus abdominis and internal oblique muscles. The postoperative, patient had good bowel movement, no abdominal distention or vomiting. Feeding was then started and well tolerated. After two weeks follow-up, there were no signs or symptoms of intestinal obstruction such as nausea and vomiting. Patient is being fed regularly and passes bowel movement almost 2-3 times a day. Conclusion: appropriate diagnosis of the extent of the defect through the advent of CT scan and early detection of other congenital anomalies should be routine in these cases. Open surgery with primary repair is almost always done but we can consider laparoscopic approach in the future with uncomplicated lumbar hernias.
Bilateral Giant Fibroadenoma of The Breast: A Case Report
Authors: Christian Jasmine Stephanie , Adiputra Putu Anda Tusta , Christian INW Steven
Published: June 2019

Background: fibroadenoma of the breast is one of the ANDI (Aberration of the Normal Development and Involution of the Breast) groups. Benign breast disorders are common in females younger than 30 years, but such masses are not common in juvenile or pre-menarche age groups. The exact pathological diagnosis can be investigated after surgery. For treatment, surgical procedures are needed to remove the lump. Case: a 30-year-old girl visited the outpatient clinic with psychological distress due to the presence of lumps in her both breasts. The lumps have been growing bigger and bigger in the last 3 years. On the physical examination both breasts are huge. FNAB showed the interpretation of atypical ductal hyperplasia and excisional biopsy examination confirmed the presence of bilateral giant fibroadenoma of breast. In this patient, the treatment was carried out in two-staged surgery due to her initial rejection to undergo total breast lumps and tissue removal. Several lumps still remained in the right breast which was indicated for the second surgery. The following surgery was done to remove all of the lumps and breast tissue with reduction breast surgery. Conclusion: conducting breast surgery on the young girl or un-married is not easy as many physical and psychology problems should be considered. Therefore, conducting breast surgery, in this case, should be performed wisely as the recurrence of the lumps was still possible.
Goiter Multinodul dengan Pelebaran ke Retrosternal: Laporan Kasus
Authors: Setiawan Gede Budhi
Published: June 2019

Latar belakang: goiter multinodul retrosternal merupakan massa tiroid yang meluas sampai sternum hingga mengisi ruang inlet torakal. Dapat disebut retrosternal multinodul tiroid apabila massa tiroid lebih dari separuhnya berada di dalam inlet torakal. Pembedahan merupakan pilihan utama. Pilihan pembedahan yaitu dengan insisi collar dan sternotomi, clamshell insisi, bahkan sampai thorakotomi. Kasus: dilaporkan kasus pasien wanita 62 tahun dengan goiter multinodul hingga retrosternal. Hasil USG menunjukkan struma diffusa kiri dengan kista multipel kompleks pada tiroid kanan. CT Scan didapatkan massa tiroid multipel kiri dengan gambaran nekrosis sentral dan kalsifikasi egg shell, dan infiltrasi toraks. Dari foto toraks didapatkan massa di leher kiri yang meluas hingga rongga toraks yang tampak mendesak trakea ke kanan. Telah dilakukan total tiroidektomi, sternotomi, dan trakeostomi. Simpulan: Operasi pengangkatan goiter substernal dapat dilakukan dengan pendekatan leher di sebagian besar pasien tetapi dalam beberapa kondisi, pasien melakukan pendekatan leher dan sternotomi.
Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Macroadenoma as Minimal Invasive Approach: Case Report
Authors: Febyan Febyan , Setiajaya Handrianto
Published: June 2019

Background: pituitary tumor accounted for 15% of benign intracranial tumors. Clinical symptoms found in the form of visual disturbances, and hormonal manifestations, surgery is one of the main managements. Endoscopic endonasal transsphenoidal surgery (EETS) is a minimally invasive approach for this case. The advantages of EETS is better efficacy than traditional technique, and shorter hospital stays, less mean blood loss, and earlier return to daily activities. Case: we reported a rare example of a male patient aged 37 years old with the main clinical features were visual disturbances, sexual malfunction and bitemporal hemianopsia on physical examination. Magnetic resonance imaging (MRI) showed macroadenoma pituitary, the size 2.41 x 2.98 x 3.20 cm. We explained about minimally invasive surgery such as EETS and the patient was agreed to performed EETS. Conclusion: endoscopic endonasal transsphenoidal surgery is a minimally invasive technique for tumor pituitary cases and safe when compared to traditional medicine.
Perbedaan Karakteristik Pasien Kanker Payudara Stadium Dini Dengan dan Tanpa Metastasis Kelenjar Getah Bening Aksila di RSUP Sanglah Denpasar
Authors: Wetan NGAA Manik Yuniawaty
Published: June 2019

Tujuan: untuk mengetahui perbedaan karakteristik kanker payudara stadium dini dengan dan tanpa metastasis kelenjar getah bening aksila di RSUP Sanglah. Metode: penelitian ini adalah penelitian deksriptif pada pasien kanker payudara stadium dini dengan dan tanpa mengalami metastasis kelenjar getah bening aksila di RSUP Sanglah. Data dicatat dari rekam medis mengenai, usia, status menopause, letak kanker payudara, ukuran tumor, varian histopatologi, subtipe, dan status hormonal. Data disajikan dalam bentuk tabel dan dianalisis bivariat dengan uji Chi-Square atau t-independent dengan interval kepercayaan (CI) 95% dan p<0,05. Hasil: penelitian ini dilakukan pada masing-masing 22 pasien kanker payudara stadium dini dengan dan tanpa metastasis ke kelenjar getah bening aksila di RSUP Sanglah. Ada perbedaan yang bermakna usia (45 tahun dan 53 tahun; p=0,012) dan status menopause (68,2% premenopause dan 31,8% postmenopause; p=0,016) pada subjek kanker payudara stadium dini dengan dan tanpa metastasis KGB aksila. Tidak ditemukan perbedaan bermakna mengenai letak kanker payudara, ukuran tumor, varian histopatologi, subtipe, dan status hormonal. Simpulan: usia dan status menopause berbeda secara bermakna pada subjek kanker payudara stadium dini dengan metastasis kelenjar getah bening aksila di RSUP Sanglah.
Testicular Seminoma: Correlation Between Staging and Chemotherapy Response, Two Years Overall Survival Rate
Authors: Pramana Ida Bagus Putra , Hakim Lukman , Djatisoesanto Wahjoe , Hardjowijoto Sunaryo
Published: June 2019

Objective: to determine the patient’s characteristics, correlation between staging and chemotherapy response, furthermore two years overall survival rate. Methods: a retrospective analytic study was conducted. Data were obtained from medical records in January 2008 to December 2014 and analyzed using SPSS 17.0. All of correlation between staging and chemotherapy response, primary tumor staging (pT) and metastasis (M), regional lymph nodes staging (N) and metastasis (M), serum tumor marker and chemotherapy response were tested by Spearman correlation test. Two years overall survival rate was analyzed by Kaplan-Meier. Data ratio with normal distribution was tested by Paired T-test. Results: the mean age of patients were 31.03 ± 13.751 years, with seven patients (15.6%) had previous history of undescended testis. Based on TNM staging, we found that most patients had already develop into stage pT3 (46.7%), N3 (57.7%), and M0 (57.7%). A significant correlation between staging and chemotherapy response was shown with stage I of testicular seminoma had completely chemotherapy response (100%) and two years overall survival rate in stage I was 100%, whereas in metastatic seminoma (stage II and III) was 60%, with Hazard Ratio 0.63 (p=0.294; 95%CI 0.276-1.476). Conclusion: patients in early stage of testicular seminoma will give a better response to chemotherapy and will have better survival rate compared to those with metastatic seminoma.
PEMBERIAN PILATES EXERCISE DANMODIFIKASI KONDISI KERJA MENURUNKAN KELUHAN SUBJEKTIF DAN MENINGKATKAN PRODUKTIVITAS KERJA PADA PEMBATIK CAP DI INDUSTRI BATIK
Authors: Wulan Dhari Ika Fitri , Muliarta I Made , Handari Adiputra Luh Made Indah Sri
Published: June 2019

Characteristics of batik stamp is done by standing working attitude. Equipment used in the form of a work desk height is not in accordance with anthropometric causing work attitude with a bent position and in giving patterns on fabrics monotonous and repetitive. Intervention by designing the working conditions such as repair work desk, a picturesque repair work organization in the form of active rest between working time and rest periods as well as preventive measures in the form of Pilates exercise can reduce the complaints caused by work processes. This study aims to show that the administration of Pilates exercise and modification of working conditions can reduce the subjective complaints and improve productivity on a batik cap in batik industry.

This Study is Experimental research, with treatment by subject design. The first phase (I) subjects treated with conventional working conditions. The second phase (II) subjects treated with application of Pilates exercise and improvement of working conditions in the form of additional altitude work desk and an active break. Among the second stage, given washing out period and adaptation. Normality test data with ShapiroWilk, paired t-test to test the significance difference variables musculoskeletal disorders, fatigue and work productivity.

These results indicate that administration of Pilates exercise and modification of working conditions affect significantly (p <0.05). There was a decrease musculoskeletal 31.6%, 22.1% decrease in fatigue, and increase productivity by 34.56%.

The conclusion that the application of Pilates exercise and modification of working conditions can lower subjective complaints and increase the productivity of batik cap in batik industry. So it is advisable to apply to the batik industry, to minimize complaints due process of batik work.
PENAMBAHAN ALAS MESIN DAN PEMBERIAN PEREGANGAN DINAMIS DI BAGIAN PROSES PEMOTONGAN SINGKONG MENURUNKAN BEBAN KERJA, KELUHAN MUSKULOSKELETAL, DAN MENINGKATKAN PRODUKTIVITAS KERJA PADA INDUSTRI KERIPIK SINGKONG
Authors: Anniza Meiza , Tirtayasa Ketut , Muliarta I Made
Published: June 2019

Cassava cutting machine is a tool to cut the cassava into thin sheets with a thickness of 1 to 2 mm. High base of work cassava cutting machine is under worker’s elbow height. So during the work, the workers took the cassava to put into the machine by means of bending and putting cassava to cutting machine one by one until the cassava is cut off. Ergonomics intervention is making an additional pad on cassava cutting machine. The purpose of this research was to prove the effect of adding pad machines and the provision of dynamic stretching at the cutting process of cassava reduce the workload, musculoskeletal disorders, and increasing work productivity at cassava chips industry.

Research was conducted by the same design subject (treatment by subjects design) with a sample of nine workers. Workload by measured the pulse of the workers. Musculoskeletal disorders measured by nordic body map questionnaire, and productivity is measured by a comparison between the results of cuts cassava production is divided workload multiplied working time. Data analyzed by t - paired with a significant level of p <0.005.

The analysis showed after adding pad machine occurs a significant difference (p <0.05) between before and after treatment: (1) decreases in workload of workers from 102.41 beats per minute become 95.51 beats per minute, (2) decrease musculoskeletal disorders from the average score of 33.56 into 31.56, and (3) increase work productivity from 1.64 to 3.58.

It was concluded that the addition of base support and the provision of dynamic stretching at the process of cutting cassava reduce the workload, musculoskeletal disorders, and increasing work productivity in cassava chips industry. It is suggested in the effort to reduce the workload, musculoskeletal disorders, as well as increasing work productivity in cassava cutting workers so it is suggested to addition of base support and do dynamic stretching movements.
PENGATURAN ORGANISASI KERJA HOUSEKEEPING DENGAN PENDEKATAN ERGONOMI DAPAT MENURUNKAN KELUHAN MUSKULOSKELETAL, KELELAHAN, DAN MEMPERCEPAT WAKTU KERJA
Authors: Tabita Angelin , Adiputra Nyoman , Sutarja I Nyoman
Published: June 2019

This study aims to approve that the reschedule of housekeeping work shifts based on ergonomics may decrease musculoskeletal disorders, decrease fatigue level, and  increase work speed. The reschedule of Housekeeping work shifts conducted by adding more housekeeping workers when cleaning the rooms. The housekeeping formerly was cleaned each room by himself and now scheduled to work by two people, so the task may be shared both. The hotel didn't needed to add new housekeeping workers, just need to reschedule the existing housekeeping, so that the hotel does not need to incur additional costs to conduct work shift with this ergonomic approach.

              The research model is design experimental treatment by subject design. The data of musculoskeletal disorders and fatigue level was collected by using a questionaire. The data of work speed was collected by using direct observation to 10 housekeeping workers in Natya Hotel - Bali, as a sample that randomly selected. The tests were conducted using normality test and significancy test with SPSS for Windows 16th version.

                The results showed that the mean of musculoskeletal disorders in the first period was 57.6 ± 2.59 become 27.1 ± 2.47 in the second period (p < 0.05) or decrease by 36.31%. The mean of fatigue level in the first period was 60.5 ± 2.55 become 27.7 ± 3.23 in the second period (p < 0.05) or decrease by 36.44%. The work speed average in the first period was 21.12 ± 0.06 minutes, while the second period was 13.08 ± 0.03 minutes (p < 0,05) or increase by 23.52%.
APLIKASI ERGONOMI PADA SERAGAM OLAHRAGA DAPAT MENINGKATKAN KENYAMANAN DAN MEMPERBAIKI RESPON SUHU KULIT KETIKA BEROLAHRAGA PADA SISWA SMP DI SMP “KESUMA SARI” DENPASAR BALI
Authors: Ismiyasa Suci Wahyu , Adiputra I Nyoman , Tirtayasa Ketut , Purnawati Susy
Published: June 2019

The choice of sports uniforms should be tailored to the sports activities undertaken. For that reason, the selection of uniforms should be comfortable to use, absorb sweat, and have a circulation between clothing and skin, fit uniform size and at affordable price. The study was conducted to examine the measured application of ergonomic applications on sports uniforms that can make comfort in exercising found on junior high school students.

The design of the study used pretest-posttest control group design involving 2 groups of subjects namely the Control Group and the Treatment Group of respectively 12 samples. The research was conducted at Kesuma Sari Junior High School, Sesetan, Denpasar, Bali. The measured data were age, height, body weight, ambient temperature, dress comfort questionnaire, skin temperature response and pulse recovery response.

The findings of descriptive analysis showed significant differences (p <0.05) on the variables of comfort and surface temperature of the skin, no significant difference (p> 0.05) on the variable of pulse recovery. The mean value of the difference of comfort before and after exercising in the Control Group decreased by (-4.17 ± 4.668) and in the Treatment Group increased by (2.50 ± 3.477). The mean value of the skin temperature difference before and after exercising in the Control Group increased the temperature by (0.57 ° C ± 0.64) and in the Treatment Group there was a temperature increase of (0.01 ° C ± 0.65). The Mean decrease in the pulse recovery in the Control (107.03 ± 15.18) and the Treatment Groups (106.93 ± 16.37) was not much different so there is no influence between the two.

It can be concluded that the ergonomic application of sport uniforms increased the comfort of exercise in the junior high school students of Kesuma sari, the ergonomics application of sport uniform may improve the skin temperature response in exercise on the junior high school students of Kesuma Sari, and the ergonomic application of sport uniform had no effect on the pulse recovery response in exercising on the students SMP Kesuma Sari.
MODIFICATION OF WORKSTATION REDUCE MUSCULOSKELETAL COMPLAINTS AND IMPROVE WORK PRODUCTIVITY DURING THE PROCESS CHICKEN GUT CRACKERS PACKAGING IN DENPASAR
Authors: Prihastini Komang Angga , Sutjana Dewa Putu , Adiputra Indah Sri Handari , Swamardika IB Alit , Purnawati Susy , Sutarja Nyoman
Published: June 2019

Chicken gut crackers are foods that are sold in many restaurants and stalls. The process of making chicken gut crackers is through several stages, such as washing, frying and packing. In those processes, there are some ergonomic problems, especially in the packaging process. The packaging process is done by sitting on the short chair with bent body position and cause discomfort. To overcome these problems then the sitting work attitude is changed based on the anthropometry of workers that refers to the principle of ergonomics.               The study was conducted in March 2017. The design of this study used the treatment by subject design involving 10 samples. Intermediate intervals before treatment and after treatment were given washing out for two days. The study was conducted in home industry located at West Teuku Umar Street. The measured data were the workload seen from the work pulse, enhancement in musculoskeletal complaints recorded with Nordic Body Map questionnaire and work productivity.

               The results showed that decreased of musculoskeletal complaints by 17.30% (p<0.05), and increased of the productivity by 39.35% (p<0.05). The decrease of work intensity and musculoskeletal complaints can increase the quality of workers' health and increase the workers’ productivity.

               Based on the discussion, it can be concluded that the use of chairs and tables according to anthropometry can reduce workload, musculoskeletal complaints, and increase work productivity. So that can be expected to the packaging workers to use the better chairs and tables can minimize the complaints caused by the work process.
REDESIGN WORK STATION CV MASS DIGITAL PRINTING DENPASAR INCREASE PRODUCTIVITY AND REDUCE EMPLOYEE MUSCULOSKELETAL COMPLAINTS
Authors: Adrianto Bagus Arbi , Adiatmika I Putu Gede , Suardana I Putu Ery
Published: June 2019

Less ergonomic computer working condition may cause a variety of complaints among computer operators. The complaint arises due to inappropriate of work load and capacity. Less ergonomic working conditions increase muscle tension of several muscles based on surface electromyography, work load, and subjective complaints based on musculoskeletal complaints, fatigue, and eyestrain. The objective of this study was to analyze improvement of the working conditions based on total ergonomic reduce the electrical activity of muscles, work load, musculoskeletal complaints, fatigue, and eyestrain.

The true experimental study has been conducted with treatment by subject design among design workers of CV. Massa Denpasar with a total 15 subjects. Some data including muscle tension, work load, musculoskeletal complaints, and fatigue were measured when working in conventional working conditions (first Period) and when working with treated working conditions based on total ergonomic (second Period). Data were analyzed by paired samples t test and Wilcoxon signed ranks test.

This study revealed that a decreased of work load was 4,89%, musculoskeletal complaints were 15,45%, fatigue was 33,53%, and eyestrain was 14,32% and productivity was 44,07% (p<0.05). The results showed that the improvement of computer working conditions based on total ergonomic decreased muscle tension, work load, musculoskeletal complaints, fatigue, and eyestrain.

Concluded that the improvement of working conditions based computer ergonomics can reduce the total workload is seen from the decrease in pulse work, as well as lowing the musculoskeletal complaints and fatigue are seen from the increase in productivity, suggested that improvements in working conditions is used as a model computer in designing computer working conditions for the achievement of healthy working conditions, safe, convenient, effective, efficient, and productive with the hope that achieved the highest welfare
DESAIN KURSI ERGONOMIS IBU MENYUSUI MENURUNKAN KELUHAN OTOT DAN MENINGKATKAN MOTIVASI PEMBERIAN ASI EKSKLUSIF
Authors: Santiana I Made Anom , Yusuf M. , Sutapa I Nyoman
Published: June 2019

Pemberian ASI eksklusif merupakan tanggung jawab ibu setelah melahirkan. Suatu kendala tersendiri bagi sang ibu jika selama proses menyusui jika tempat tidak sesuai dengan kondisi fisiologi tubuh. Sikap tubuh saat menyusui yang tidak fisiologis akan menyebabkan timbulnya keluhan bagi sang ibu. Keluhan yang muncul antara lain cepat lelah, sakit atau nyeri pada otot tertentu, dan kondisi kurang nyaman pada tubuh saat menyusui. Disamping itu, bagi ibu yang bekerja dan menyusui sepulang kerja akan mempengaruhi motivasinya dalam memberikan ASI eksklusif dalam enam bulan pertama sejak kelahiran bayi. Untuk mengatasi cepat lelah karena sikap dan posisi menyusui yang tidak fisiologis dilakukan penelitian dengan cara meyesuaikan sarana kerja/kursi termpat menyusui dengan antropometri sang ibu tersebut. Penelitian ini dilakukan menggunakan metode eksperimen dengan rancangan group within treatment (sama subyek). Tempat penelitian di Klinik Bersalin “CB” Kabupaten Badung, Bali. Jumlah sampel 12 ibu menyusui. . Keluhan otot skeletal ibu menyusui diprediksi dengan kuesioner Nordic Body Map, dan motivasi pemberian ASI eksklusif diukur dengan menggunakan kuesioner motivasi dengan 5 skala Liket. Data di analisis secara deskriptif dan inferensial. Untuk mengetahui perbedaan perlakuan, data dianalisis menggunakan uji t-pair. Hasil penelitian diperoleh bahwa ada perbedaan yang siginifikan pada keluhan otot skeletal dan motivasi pemberian ASI Eksklusif antara perlakuan 1 (menggunakan kursi lama) dengan perlakuan 2 (menggunakan kursi perbaikan). Terjadi penurunan keluhan otot skeletal sebesar 32,4% dan peningkatan motivasi pemberian ASI Eksklusif sebesar 29,7%. Disimpulkan bahwa desain kursi ergonomis ibu menyusui menurunkan keluhan otot dan meningkatkan motivasi pemberian asi eksklusif. Untuk itu disarankan kepada ibu menyusui agar menggunakan kursi ergonomis dalam meberikan ASI Eksklusif dan bagi pemerintah agar menyediakan kursi ergonomis pada fasilitas publik ruag ibu menyusui baik di terminal, bandara, maupun fasilitas publik yang lain.
REDESAIN PEGANGAN TABUNG SINAR-X YANG ERGONOMIS DI RADIOLOGI RSUP SANGLAH MENURUNKAN KELUHAN MUSKULOSKELETAL, MENGURANGI KELELAHAN UMUM DAN MENINGKATKAN KECEPATAN PEMERIKSAAN
Authors: Susanta I Putu Adi , Purnawati Susy , Adiatmika I Putu Gede
Published: June 2019

Radiology Installation is a unit of medical support services in a health facility that has a function as a means of patient diagnosis. In RSUP Sanglah there are 5 units of radiology sub-section such as Central Radiology, IRD, Wing Amerta, Central Surgery Room and Cath Lab Room which all have a goal of providing quality diagnostic value to patients and society. Problems occurring within the radiology unit are the incidence of work-related musculoskeletal complaints, increased general fatigue in workers, as well as decreased speed of examination by radiographers in service. This can be caused by a mismatch between the work tool and its users.

Research has been conducted with intervention of redesign of X-ray tube handling through user anthropometry aims to know how big the effect of X-ray tube grip design improvement to musculoskeletal complaints, general fatigue and increased examination speed by radiographer. The subject anthropometry data is used as the basis for redesigning the X-ray tube handle.

The design of the study using Treatment By Subject Designs with a large sample of 12 people who became the control group as well as the intervention group. Subjects were subjected to redesigned X-ray tube handles or grips that have been improved in shape and design more ergonomically adapted to the anthropometry of the subject body. Musculoskeletal complaints were assessed with Nordic Body Map questionnaires from NIOSH Japan, generalized fatigue disorder with 30 general fatigue items, and the examination speed by radiographers was obtained by measuring the time of the radiologic treatment on the number of checks performed. Shapiro - Wilk test was performed to determine the normality of data at significance level (? = 0,05). Differential comparative test between pre-repair and post-design improvement of musculoskeletal complaints, general fatigue and speed of examination using paired t-test at significance level ? = 0.05

It was found that in the intervention group the use of redesigned X-ray tubes could significantly decrease musculoskeletal complaints (p <0.05) by 10.42%, significantly reducing general fatigue by 22.38% (p <0.05 ) and increased the examination rate by 12.50% (p <0.05). Thus it can be concluded that the improved X-ray tube handle design can decrease musculoskeletal complaints, reduce general fatigue and increase the speed of inspection by radiographers at Sanglah Hospital Denpasar.