Hori Hariyanto
Department of Anesthesiology and Critical Care Medicine, Siloam Hospitals Lippo Village, Tangerang

Published : 5 Documents
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Distance between parapatellar portal and intra-articular space for needle positioning in knee osteoarthritis

Medical Journal of Indonesia Vol 22, No 2 (2013): May
Publisher : Faculty of Medicine Universitas Indonesia

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Abstract

Background: Intra-articular injection is a common therapeutic procedure in osteoarthritis (OA) that need high accuracy. This study was aimed to measure the distance between parapatellar skin and intra-articular space as a guidance to choose the length of needle needed to perform intra-articular injection. Methods: Twenty one knees MRI were taken from 16 females with knee osteoarthritis. The length of the needle needed to reach intra-articular space was reconstructed by drawing straight line from skin to intra-articular fluid. Paired t-test was using to analyze the mean difference of measurement of left side compare with right side with significant indicator if p-value < 0.05. Results: The entry point on both medial and lateral parapatellar were more cranial than transverse mid-patellar line. On medial portal, the closest distance from skin to intra-articular space is 27.81 ± 7.58 mm. Mean point of entry is 4.46 ± 2.16 mm cranial to mid-patellar line, and 14.20 ± 4.45 mm posterior to the prominence of medial border of patella. On lateral portal, the closest distance from skin to intra-articular space is 16.84 ± 6.79 mm. Mean point of entry is 11.10 ± 5.94 mm cranial to mid-patellar line, and 8.91 ± 3.83 mm posterior to the prominence of lateral border of patella. Conclusion: MRI knee osteoarthritis study showed that the mean distance between skin and intra-articular joint space of medial portal is 27.81 ± 7.58 mm, and lateral portal is 16.84 ± 6.79 mm. The portals on both sides is cranial to midpoint of patella, lateral appears more proximal than medial. This should be put into consideration in choosing needle length and portal projection to increase intra-articular injection accuracy. (Med J Indones. 2013;22:83-7)Keywords: Needle length, osteoarthritis, parapatellar skin portal

A tale of the broken heart: peripartum cardiomyopathy, a case report

Medical Journal of Indonesia Vol 25, No 1 (2016): March
Publisher : Faculty of Medicine Universitas Indonesia

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Abstract

Progressive dyspnea following childbirth warrants a prompt suspicion into the diagnosis of peripartum cardiomyopathy, PPCM. Pump failure causes an inadequate cardiac output which ultimately contributes to PPCM high mortality rate; however early airway control, vigilant fluid balance and vasoactive support will substantially reduce the incidence of patients falling into decompensated heart failure. More importantly, it is imperative that these patients are cared in a setting where continuous hemodynamic monitoring is available. This case report serves as a reminder not to focus end-point therapy solely on blood pressure readings, but to observe signs and symptoms of hypoperfusion such as cold clammy skin, cool extremities, decreased urine output and mental status.

Association of Cross Linked C-Telopeptide II Collagen and Hyaluronic Acid with Knee Osteoarthritis Severity

The Indonesian Biomedical Journal Vol 5, No 3 (2013)
Publisher : The Prodia Education and Research Institute (PERI)

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Abstract

BACKGROUND: This study was carried out to investigate the association of Cross Linked C-Telopeptide Type I & II Collagen (CTX-I and II) and hyaluronic acid (HA) with knee osteoarthritis (OA) severity.METHODS: Sixty menopause women with primary knee OA were enrolled in this study during their visits to the Outpatient Department. Patients with knee pain during weight bearing, active or passive range of motion, or tenderness with Kellgren-Lawrence (KL) grade of more than I were included. Patients with injury, inflammatory and metabolic diseases were excluded. Patients were put in a 10-hour fasting prior to withdrawal of morning blood samples for examinations of HA, CTX-I, interleukin 1 beta (IL-1β), and high sensitivity C reactive protein (hs-CRP) level. Second void morning urine specimens were taken for CTXII assessment. HA, CTX-I and II levels were measured by enzyme-linked immunosorbent assay.RESULTS: Sixty menopausal female patients were included in this study, 35 with KL grade II, 17 grade III, and 8 grade IV. Means of CTX-II were significantly different between subjects KL grade IV and III (p=0.021). Correlation of KL grade was significant with CTX-II (p=0.001, r=0.412) and HA (p=0.0411, r=0.269). KL grades were not significantly associated with CTX-I (p=0.8364, r=-0.0272); IL-1β (p=0.5773, r=0.0853) and hs-CRP (p=0.2625, r=0.1470).CONCLUSION: CTX-II and HA were associated with severity of knee OA, suggesting that CTX-II and HA can be used as marker for knee OA severity.KEYWORDS: CTX-II, hyaluronic acid, otestoarthritis, knee

Association Between Plasma Beta-endorphin and WOMAC Score in Female Patients with Knee Osteoarthritis

The Indonesian Biomedical Journal Vol 4, No 2 (2012)
Publisher : The Prodia Education and Research Institute (PERI)

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Abstract

BACKGROUND: β-endorphin plays a role in the descending pain control in the central nervous system. Central sensitization may be involved in the generating and maintenance of osteoarthritis (OA) pain. However, the correlation between β-endorphin and pain severity in OA has shown conflicting results. The aim of this study was to investigate the association between plasma β-endorphin and the severity of the disease. METHODS: This study was an observational cross-sectional study carried out on 60 female subjects with knee OA who fulfilled the inclusion criteria. Plasma β-endorphin was measured by a commercial enzyme-linked immunosorbent assay (ELISA) kit. Osteoarthritis knees were classified by the Kellegren-Lawrence (KL) grading (1-4) criteria. The Western Ontario McMaster University Osteoarthritis (WOMAC) scoring method was used to assess self-reported physical function, pain and stiffness. RESULTS: The mean of the participants' ages was 58 years old, ranging from 42 to 83 years. Overall, more than 70% of the participants were overweight with a mean of body mass index (BMI) of 27.59. More than 54% of the participants were diagnosed of having KL grading 3 or 4. Plasma β-endorphin was correlated inversely with the WOMAC subscale of stiffness (r=-0.286, p=0.0311), but no correlation was noted with the WOMAC subscale of pain and physical activity. There was no significant difference of the mean of plasma β-endorphin among the KL gradings. CONCLUSIONS: Plasma β-endorphin is associated with better WOMAC total score and stiffness subscale, but not associated with KL grading of OA. KEYWORDS: knee osteoarthritis, female, β-endorphin, WOMAC, Kellgren-Lawrence

Koksidinia Kronis dengan Keterlibatan Sendi Facet

Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
Publisher : Perdatin Pusat

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Abstract

Koksidinia atau nyeri tulang ekor merupakan sebuah kondisi yang sering dicetuskan oleh subluksasi atau fraktur tulang coccyx. Akibatnya, inflamasi kronis akan menimbulkan nyeri yang sangat hebat pada daerah tersebut. Pada laporan kasus ini, kami menemukan gangguan sendi facet dalam menimbulkan koksidinia kronis. Meskipun literatur menyarankan coccygectomy pada penanganan kasus koksidinia kronik, ada baiknya jika Facet Block dipikirkan sebagai alternatif pengobatan nyeri sebelum beralih pada pembedahan. Laporan kasus ini membahas koksidinia kronis pada pasien wanita berusia 25 tahun dengan riwayat trauma. Terapi Ganglion Impar Block dengan 96% alkohol gagal dalam menghilangkan rasa nyeri. Blok dilakukan lagi dengan menggunakan 96% alkohol, bupivakain 0.25% and Triamcinolone, namun nyeri masih tetap dirasakan. Pasien tetap merasakan sulit untuk berjalan akibat nyeri, maka Facet blok pada L2–L4 kanan dilukakan dengan Radio Frequency (RF). Terapi tersebut menyebabkan nyeri tulang ekor menghilang secara permanen. Kasus ini menunjukkan bahwa nyeri muskuloskeletal kronik tidak berdiri sendiri, nyeri akan menyebabkan gangguan mobilisasi yang mengakibatkan perubahan pada otot, ligamen dan sendi sekitarnya. Kata kunci: Blok ganglion impar, koksidinia kronik, nyeri sendi facet Coccygodynia or tailbone pain is a chronic condition most commonly caused by subluxations and fractures of the coccyx. Intense pain is thought to arise from continuous inflammation within the coccygeal area. In this case report, we have discovered the development of lumbar facetogenic pain syndrome as a sequel to untreated chronic coccygodynia. Treatments should therefore be aimed at eliminating facet pain before resorting to operative procedures of the coccyx. In this report, we present the case of a 25 year old woman with chronic coccyx pain due to trauma. Ganglion Impar block had been given but failed to relieve the patient’s symptoms within one week post therapy. Blocks were later changed to 96% alcohol, bupivacaine 0.25% and Triamcinolone. Nevertheless, the pain continued to recur two weeks post-treatment. Due to presenting complaints of pain at standing and failure of blocks at the coccygeal level, facet blocks at L2-L4 was performed on the basis of lumbar facetogenic pain. This resulted in complete relief of symptoms including a 2 month follow-up report. Coccygodynia pain may not be a single disease entity. Intense chronic musculoskeletal pain will cause problems in mobilization thereby inflicting changes to the musculoskeletal, ligament and joint structures which may extend to other regions in the body. Key words: Chronic coccygodynia, facet joint pain, ganglion impar block Reference Fogel GR, Cunningham PY, Esses SI. Coccygodynia: Evaluation and Management. J am acad orthop surg. 2004;12(1):49 ̶ 54. Maigne JY, Chatellier G, Faou ML, Archambeau M. The treatment of chronic coccydynia with intrarectal manipulation: a randomized controlled study. Spine. 1976;31(18):E621 ̶ 7. Grgic V. Coccygodynia: etiology, pathogenesis, clinical characteristics, diagnosis and therapy. Lijec Vjesn. 2012;134(1-2):49 ̶ 55. Sehirlioglu A, Ozturk C, Oguz E, Emre T, Bek D, Altinmakas M. Coccygectomy in the surgical treatment of traumatic coccygodynia. Injury. 2007;38(2):182 ̶ 7. Mitra R, Cheung L, Perry P. Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician. 2007;10(6):775 ̶ 8. Foye PM, Buttaci CJ, Stitik TP, Yonclas PP. Successful Injection for Coccyx Pain. Am J Phys Med Rehabil.2006;85(9):783 ̶ 410.1097/01.phm.0000233174.86070.63. Ianuzzi A, Little JS, Chiu JB, Baitner A, Kawchuk G, Khalsa PS. Human lumbar facet joint capsule strains: I. During physiological motions. Spine J. 2004;4(2):141 ̶ 52. Cavanaugh JM, Ozaktay AC, Yamashita HT, King AI. Lumbar facet pain: biomechanics, neuroanatomy and neurophysiology. J Biomech. 1996;29(9):1117 ̶ 29. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106(3):591 ̶ 614. Helbig T, Lee CK. The lumbar facet syndrome. Spine. 1976;13(1):61 ̶ 4.