Errol U. Hutagalung
Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Published : 11 Documents
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Post-irradiation osteosarcoma : A case report Hutagalung, Errol U.; Basuki, Achmad; Susworo, R.
Medical Journal of Indonesia Vol 9, No 4 (2000): October-December
Publisher : Faculty of Medicine Universitas Indonesia

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Metastatic bone disease Hutagalung, Errol U.
Medical Journal of Indonesia Vol 13, No 2 (2004): April-June
Publisher : Faculty of Medicine Universitas Indonesia

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Metastatic bone disease is the most common malignancy of bone, it is estimated that 70% of all malignant bone tumors are metastatic in origin. At autopsy it has been reported between 30 to 85% of patients who die from cancer show occult skeletal metastases. Bone is the third most common site of metastatic process after lung and liver. 80% of metastatic bone disease arise from Ca of breast, prostate, lung, kidney and thyroid. Typical location are thoracolumbal spine, pelvis, ribs, skull and proximal of femur and humerus. Pathogenesis of metastatic bone disease had been explained by Paget’s “Seed and Soil” theory and Ewing’s circulatory theory. Diagnostic procedures include complete laboratory examination, diagnostic bone imaging, chest x-ray, total body scan, CT-scan of chest, abdomen and pelvis and confirmed by histopathological examination. Management of metastatic bone disease is palliative that includes : chemotherapy, radiotherapy, bisphosphonates and surgical treatment for impending / established pathologic fracture to alleviate pain, ease nursing and restore functional activity. (Med J Indones 2004; 13: 127-31) Keywords: bone cancer, metastases
Traumatic hemipelvectomy (amputae): Report of one case Hutagalung, Errol U.; Qomarrudin, Qomarrudin
Medical Journal of Indonesia Vol 10, No 3 (2001): July-September
Publisher : Faculty of Medicine Universitas Indonesia

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Traumatic hemipelvectomy (amputae) is a catastrophic injury resulting front violent shearing forces which avulsed the lower limb at the level sacroiliac joint and symphisis pubis. Patients surviving traumatic hemipelvectomy are rare. One case of a 25 months old girl surviving traumatic hemipelvectomy), is presented. This is the first case reported from Indonesia. (Med J Indones 2001; 10: 169-73)Keywords: Colostomy, skin graft, traffic accident
Outcomes of stage IIB osteosarcoma treated by limb salvage surgery using extracorporeally irradiated (ECI) autograft Kamal, Achmad F.; Ismail, Ismail; Mi’raj, Faisal; Hutagalung, Errol U.
Medical Journal of Indonesia Vol 20, No 2 (2011): May
Publisher : Faculty of Medicine Universitas Indonesia

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Background: Extracorporeally irradiated (ECI) technique is an alternative of limb salvage procedure in treating osteosarcoma regarding limitation of endoprosthesis and allograft. This study evaluated the outcomes of limb salvage surgery using extracorporeally irradiated (ECI) autograft and its correlation with patient’s characteristics.Methods: Retrospective cohort design was performed to study 20 patients with stage IIB osteosarcoma treated by ECI autograft from 1995 to 2008. Survival, local recurrence, metastases, complications, union time and functional score based on Musculoskeletal Tumor Society scoring system-(MSTS) were evaluated. Kaplan-Meier method was used to describe survival, local recurrence free survival, and metastases free survival. The correlation among patient’s characteristics that were age, gender, duration, site of tumor size, type of osteosarcoma, SAP (serum alkaline phosphatase) level, type of biopsy, and type of Huvos were analyzed by Log rank test. Chi-square test was used to analyze the correlation between MSTS score and patient’s characteristics, local recurrence, metastases, complications.Results: Five-year survival was 54.97 ± 9.8 %, five-year local recurrence free survival was 66.5 ± 7.6%, and five year metastasis-free survival was 57.13 ± 10.04%. Six patients died, five were due to lung metastases and one due to complication of chemotherapy. Three underwent amputation after local recurrence. Kaplan-Meier curve showed that a good type of Huvos (III, IV) always gave better survival, local recurrence free survival, and metastases free survival than poor type of Huvos (I,II). Normal SAP level gave better local recurrence free survival compare to increased level of SAP. Mean of union rate was 8.13 months. MSTS mean score was good (70.63%) in patients with no evidence of disease. MSTS score was poor in patients with local recurrence (p = 0.025), metastases (p = 0.01), complications (p = 0.03), and the combined of those three outcomes (p = 0.001).Conclusions: Functional outcome was poor in patients with local recurrence, metastases, and complications. SAP level and type of Huvos could be studied further as predictive factors for the outcomes (survival, local recurrence, metastases). (Med J Indones 2011; 20:131-7)Keywords: extracorporeally irradiated autograft (ECI), osteosarcoma stage IIB, outcomes
Ewing sarcoma of the left big toe with trans-articular skip lesion Kamal, Ahmad F.; Nagieb, Muhammad; Hutagalung, Errol U.; Budiatmoko, Bambang; Gumay, Saukani; Muthalib, Abdul
Medical Journal of Indonesia Vol 18, No 2 (2009): April-June
Publisher : Faculty of Medicine Universitas Indonesia

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We report the case of the patient who had Ewing Sarcoma in whom radiological and hystopathological appearances revealed a tumor mass in the left big toe along with trans-artikular skip lesion on the left diaphysis of tibia. In Cipto Mangunkusomo Hospital since 1995 until 2004 we have found 20 Ewing sarcoma cases, but only one skip lesion Ewing sarcoma was found. The diagnosis of transarticular skip lesion in association of Ewing sarcoma was confirmed in clinicopathological conferrence. The initial evaluation of all patients included the recording of the medical history, physical examination, and hematological studies. Radiographs of the chest and the site of the primary tumor were made routinely. Systemic staging was performed with use of total-body bone scan. Ray amputation of left big toe and open biopsy from mass of mid-shaft of tibia had been done to confirm the diagnosis. The patient underwent induction chemotherapy and above knee amputation. Ten months after diagnosis, he died because of advanced-distant metastasis. (Med J Indones 2008; 18: 139-44)Key words: Ewing sarcoma, trans-articular skip lesion
Periosteal osteosarcoma: A case report Hutagalung, Errol U.; Librianto, Didik; Gumay, Saukani; Muthalib, Abdul; Budiatmoko, Bambang
Medical Journal of Indonesia Vol 12, No 3 (2003): July-September
Publisher : Faculty of Medicine Universitas Indonesia

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Periosteal osteosarcoma is a rare type of malignant bone neoplasm, with predominantly cartilaginous component and arising on the bone surface. Reports of the case in the literature were rare. Last case was reported by Mayo Clinic in 1999. We report a case of periosteal osteosarcoma in a 17-year-old male, who was treated surgically with a limb salvage procedure, neoadjuvant and adjuvant chemotherapy were also given to the patient. There was no local recurrence and lung metastases up to 14 months after surgery. (Med J Indones 2003; 12: 166-70) Keywords: osteosarcoma, periosteal osteosarcoma, limb salvage
Biocompatibility of various hydoxyapatite scaffolds evaluated by proliferation of rat’s bone marrow mesenchymal stem cells: an in vitro study Kamal, Achmad F.; Iskandriati, Diah; Dilogo, Ismail H.; Siregar, Nurjati C.; Hutagalung, Errol U.; Susworo, R.; Yusuf, Achmad A.; Bachtiar, Adang
Medical Journal of Indonesia Vol 22, No 4 (2013): November
Publisher : Faculty of Medicine Universitas Indonesia

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Background: Scaffold (biomaterial) biocompatibility test should be performed in vitro prior to in vivo stem cell application in animal or clinical trial. These test consists of direct and indirect toxicity test (MTT assay [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide]). Those tests were used to identify cell morphological changes, cell-substrate adhesion impairment, and reduction in cell proliferation activity.Methods: The tested scaffolds were hydroxyapatite-calcium sulphate (HA-CaSO4) (scaffold I), nano-particular HA paste (scaffold II), synthetic HA granule (scaffold III), bovine HA granule (scaffold IV), and morsellized bovine xenograft (scaffold V). Direct contact toxicity test and MTT assay [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] were performed on those groups. In direct contact toxicity test, we put granules of various scaffolds within plates and incubated together with mesenchymal stem cells (MSCs). In MTT assay we included phenol 20 mg/mL and 100 mg/mL group as positive control. Morphology, cell adhesion impairment, and cell growth were monitored daily until day-7. Cells counting in the direct contact toxicity test was conducted on day-7.Results: There were no changes on 24 hours observation after direct contact. On day-7, an impairment of cell adhesion to plastic substrates, changes in cell morphology, and cell death were observed, especially in scaffold I, scaffold II, and scaffold V. In MTT assay, only scaffold I, phenol 20 mg/mL, and phenol 100 mg/mL showed more than 50% inhibition at 24-hour and 7-day-observation. Extracts from scaffold II, III, IV, and V did not affect the viability and proliferation of bone marrow MSCs (inhibition value < 50%). Scaffold II, III, IV and V were proven non-cytotoxic and have good biocompatibility in vitro,  no statistical significant differences were observed among the scaffold groups (p > 0.05).Conclusion: We understand which scaffold was nontoxic or the least toxic to MSCs in vitro. Scaffold IV (bovine HA granule) showed the least toxic effect to rat’s bone marrow MSCs on direct contact test and MTT assay. (Med J Indones. 2013;22:202-8. doi: 10.13181/mji.v22i4.600)Keywords: Biocompatibility test, direct contact test, hydroxyapatite, MTT assay, scaffold
Primary malignant giant cell tumor of the patella: report of a rare case Kamal, Achmad F.; Hutagalung, Errol U.; Gumay, Saukani; Prabowo, Yogi; Yanuarso, Yanuarso
Medical Journal of Indonesia Vol 22, No 4 (2013): November
Publisher : Faculty of Medicine Universitas Indonesia

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Primary malignant giant cell tumor (GCT) at the patella bone is a very rare case. It is a high-grade sarcoma characterized by a lesion in which there are areas of synchronous high-grade sarcomatous next to areas of benign GCT. A limb sparing approach is applicable to virtually any bone lesion, whether low grade or high grade. We report a case with primary malignant GCT at the patella, from diagnostic to detailed limb sparing surgery procedure. Fifteen months after surgery, the patient had a good functional outcome without local recurrence and distant metastasis. (Med J Indones. 2013;22:238-42. doi: 10.13181/mji.v22i4.607)Keywords: Limb sparing surgery, primary malignant GCT, total patellectomy
Primary malignant mesenchymoma of bone Hutagalung, Errol U.; Gumay, Saukani; Budiatmoko, Bambang; Anggawidjaja, Suga
Medical Journal of Indonesia Vol 10, No 4 (2001): October-December
Publisher : Faculty of Medicine Universitas Indonesia

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Pimary malignant mesenchymoma of bone (PMMB) is an exceedingly rare neoplasm consisting of two or more unrelated malignant mesenchymal components other than fibrosarcoma or malignant fibrous histiocytoma. Review of the literature reports only 16 cases, most of which were composed of osteosarcoma and liposarcoma. We report a case af PMMB composed of liposarcoma,rhabdomyosarcoma and high grade chondrosarcoma arising within the left distal femur in a 52-year-old male, resulting in the patients death 3 months after presentation. (Med J Indones 2001;10: 235-41)Keywords: Bone tumor-malignancy, liposarcoma, dedifferentiated chondrosarcoma, rhabdomyosarcoma
Venous thromboembolism in 13 Indonesian patients undergoing major orthopedic surgery Tambunan, Karmel L.; Hutagalung, Errol U.; Sukrisman, Lugyanti; Saleh, Ifran; Gunawan, S. B.; Sofyanuddin, Sofyanuddin; Setiawati, Arini
Medical Journal of Indonesia Vol 18, No 4 (2009): October-December
Publisher : Faculty of Medicine Universitas Indonesia

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Aim: To estimate the incidence of VTE in Indonesian patients undergoing major orthopedic surgery and not receiving thromboprophylaxis.Methods: This was an open clinical study of consecutive Indonesian patients undergoing major orthopedic surgery, conducted in 3 centers in Jakarta. Bilateral venography was performed between days 5 and 8 after surgery to detect the asymptomatic and to confi rm the symptomatic VTE. These patients were followed up to one month after surgery.Results: A total of 17 eligible patients were studied, which a median age of 69 years and 76.5% were females. Sixteen out of the 17 patients (94.1%) underwent hip fracture surgery (HFS). The median time from injury to surgery was 23 days (range 2 to 197 days), the median duration of surgery was 90 minutes (range 60 to 255 minutes), and the median duration of immobilization was 3 days (range 1 to 44 days). Thirteen out of the 17 patients were willing to undergo contrast venography. A symptomatic VTE was found in 9 patients (69.2%) at hospital discharge. Symptomatic VTE was found in 3 patients (23.1%), all corresponding to clinical signs of DVT and none with clinical sign of PE. These patients were treated initially with a low molecular weight heparin, followed by warfarin. Sudden death did not occur up to hospital discharge. From hospital discharge until 1-month follow-up, there were no additional cases of symptomatic VTE. No sudden death, bleeding complication, nor re-hospitalization was found in the present study.Conclusion: The incidence of asymptomatic (69.2%) and symptomatic (23.1%) VTE after major orthopedic surgery without thromboprophylaxis in Indonesian patients (SMART and AIDA), and still higher than the results of the Western studies. A larger study is required to establish the true incidence, and more importantly, that the use of thromboprophylaxis in these patients is warranted. (Med J Indones 2009; 18: 249-56)Keywords: venous thromboembolism (VTE), orthopedic surgery, Indonesia