Achmad Fauzi Kamal
Departmen Orthopaedi dan Traumatologi Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo/Fakultas Kedokteran Universitas Indonesia,Jakarta

Published : 8 Documents
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Epiphyseal Preservation Surgery in Distal Femur Osteosarcoma

Journal of the Indonesian Medical Association Vol. 59 No. 3 March 2009
Publisher : Journal of the Indonesian Medical Association

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Abstract

Conventional osteosarcoma is a primary intramedullar high grade malignant tumour in which the neoplastic cells produce osteoid Early diagnostic and accurate preoperative assessment of the extent of the tumor is crucial when a limb salvage procedure is being considered. More recent studies described the accuracy of magnetic resonance imaging for evaluation epiphyseal extension of osteosarcoma. With development of modern chemotherapy regimens, limb salvage procedure was developed. Most of surgical technique presently used to treat high grade metaphyseal osteosarcoma include resection of one or both epiphysis. If an osteoarticular allograft is used to reconstruct the joint, the epiphysis of the affected bone is lost, potentially creating anatomical mismatching or joint instability. Preservation of the epiphysis technique was potentially to maintain a nearly normal joint for several decades. The aim of this case is to report a case of a female, 12 years old, with osteosarcoma of distal femur to whom a Limb Salvage Surgery with Epiphseal Preservation technique was performed. After two years of follow up, no evidence of any metastasis was detected but the graft was fracture due to excessive load. Preservation of the epiphysis in distal femur osteosarcoma is an alternative surgery for tumor that does not extend to epiphysis. Extracorporeally irradiated autograft is a methode that can be used for reconstruction of distal femur osteosarcoma.Keywords: osteosarcoma, epiphyseal preservation, extracorporeally irradiated autograft

Solitary Synovial Osteochondroma of the Knee

Journal of the Indonesian Medical Association Vol. 59 No. 5 May 2009
Publisher : Journal of the Indonesian Medical Association

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Abstract

Synovial osteochondroma is a benign condition in which synovial membrane proliferation and metaplasia result in cartilaginous or ossified synovial fragments in the joint space. This solitary manifestation is not connected to bone and occurs almost exclusively in the vicinity of the joints. It is monoarticular and typically affects large joints, such as the knee, hip, elbow, and shoulder. A solitary synovial osteochondroma, is an extremely uncommon entity; few reports are available in the literature. We report one case with solitary synovial osteochondroma of the right knee. This patient presented with a slowly growing retropatellar bony tumor of 6 years duration following a minor trauma and underwent excisional biopsy at Cipto Mangunkusumo Hospital.Keywords : solitary synovial osteochondroma.

Simple Bone Cyst Management: Percutaneous Steroid Injection Versus Curettage With Hydroxiapatite

Indonesian Journal of Cancer Vol 11, No 2 (2017): April - June
Publisher : Indonesian Journal of Cancer

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Abstract

ABSTRACT The main goals of the therapy of simple bone cyst (SBC) are to get the bone healing, prevent pathological fractures, and management of pain symptom. There are various methods of the SBC treatments, however they still remain controversial because of their healing rate and invasiveness of surgery. A total of 10 SBC patients were divided into two groups namely curretage with hydroxyapatite (HA) and decompression and percutaneous steroid injection (PSI). PSI was performed three times at intervals of each month. The mean followup of 12-26 months. Evaluation of functional outcome by Musculoskeletal Tumour Society (MSTS) score and supported with radiologically based on Chang criteria. There were 5 patients (proximal femur 2; proximal humerus 2, radius 1) performed curretage with HA therapy. Remaining 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1) were performed PSI therapy. PSI group had better MSTS score, particulary at month 3 (55%) and month 6 (84%) than curettage with HA therapy (47% and 69.3%). Complete bone healing was found in both group at month 12 follow up, however solid union occurred faster in PSI group. PSI tends to have faster and better functional outcome than curettage and HA. Curettage with HA and PSI have similar complete bone healing at month 12 follow up. ABSTRAKTarget utama penalaksanaan simple bone cyst (SBC) adalah mencapat penyembuhan tulang yang sempurna, mencegah fraktur patologis dan mengatasi gejala nyeri. Ada beberapa metode penatalaksanaan SBC, namun demikian masih menjadi perdebatan dikarenakan perbedaan angka penyembuhannya dan jenis pembedahan yang invsif. Sepuluh pasien yang didiagnosis SBC dikelompokkan menjadi kelompok yang mendapat tindakan curretage dan pengisian defek dengan hydroxyapatite (HA) dan kelompok dekompresi dan percutaneous steroid injection (PSI). Prosedur PSIdilakukan sebanyak 3x dengan interval waktu satu bulan. Follow up dilakukan selama 12 – 26 bulan. Evaluasi luaran fungsional menggunakan Musculoskeletal Tumour Society (MSTS) score dan secara radiologi sesuai criteria Chang. Terdapat 5 pasien (2 femur proksimal, 2 humerus proksimal, dan 1 radius) yang dilakukan prosedur curretage dan pengisian defek dengan HA. Lima pasien sisanya ( 3 fenur proximal, 1 humerus proximal dan 1 calcaneus) dilakukan prosedur PSI. Luaran fungsional Kelompok PSI memiliki MSTS score yang lebih baik, khususnya pada bulan ke- 3 (55%) dan bulan ke-6 (84%) daripada kelompok curettage dengan HA (47% dan 69.3%). Penyembulan tulang sempurna menunjukkan hasil yang sama pada evaluasi bulan ke-12, tetapi solid union didapatkan lebih cepat pada kelompok PSI. Kelompok PSI memiliki kecenderungan solid union dan luaran fungsional yang lebih cepat daripada kelompok curettage dengan HA. Kedua kelompok mencapai penyembuhan sempurna pada bulan ke-12 follow up

Pengaruh Autoclave terhadap Properti Fisik dan Histopatologi Tulang: Sebuah Penelitian Dasar Rekonstruksi

Indonesian Journal of Cancer Vol 8, No 1 (2014): Jan - Mar 2014
Publisher : "Dharmais" Cancer Center Hospital

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Abstract

Background: Autoclave autograft is a promising alternative procedure in surgical treatment of bone tumors. A minimum effective autoclaving time of 15 minutes at 134°C to devitalise tumour cells. This study aims to know the effect of autoclave to physical properties and histopathology of bone.Methods: We performed experimental study in 28 femoral bone of goat (Capra Aergagus circus) at age 1?2 year old. We divide into two groups with simple random sampling to be 14 autoclave and 14 control group. Autoclaving was performed to the bone at 134°C for 15 minute. We examined physical properties each 7 autoclave group to axial and bending force compared with physical properties of the control group. We also examined histopatology of the bone both groups. Independent t-test statistical analysis to evaluate the difference of axial and bending force between autoclave and control group.Results: There were significant difference between autoclave and control group in axial force (p = 0.000) and bending force (p = 0.03). Physical properties of autoclave bone decreased 58.58 % in axial force and 20.33% bending force to control group. Histopathology examination revealed that all osteocytes were death in autoclave group but without matrix changes.Conclusion: Autoclave at 134°C for 15 minute caused physical properties of bone decrease and statistically significant difference. It also made all osteocytes died but without matrix disturbance.

A Modified Buttockectomy as a Limb Salvage Procedure in Ischium Osteosarcoma: A Case Report

Indonesian Journal of Cancer Vol 9, No 2 (2015): April-Juni 2015
Publisher : "Dharmais" Cancer Center Hospital

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Abstract

Osteosarcoma, which rarely originates from the axial bones such as pelvis, presents a major challenge in limb preservation. We report a 9-year-old girl with osteosarcoma on her buttock. She underwent wide excision “modified buttockectomy” to resect the tumour with sciatic nerve involvement. One year after surgery, she was able to walk and no recurrence was found. Keywords: buttockectomy, osteosarcoma ABSTRAKOsteosarkoma, tulang aksial seperti pelvis jarang sekali ditemukan, dan menjadi tantangan besar dalam upaya penyelamatan ekstremitas. Kami laporkan satu kasus osteosarkoma pada tulang panggul-daearah bokong pada seorang anak perempuan berusia 9 tahun. Pasien menjalani eksisi luas “buttockectomy” yang dimodifikasi untuk mengangkat tumor beserta nervus ischiadikus yang terlibat. Pada pengamatan satu tahun pasca pembedahan, pasien dapat berjalan dan tidak ditemukan tanda-tanda rekurensi. Kata Kunci: buttockectomy, osteosarkoma

Sacral Tumor: Experience in a Single Institution

Indonesian Journal of Cancer Vol 9, No 1 (2015): Jan - Mar 2015
Publisher : "Dharmais" Cancer Center Hospital

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Abstract

ABSTRACTIntroduction. Sacral tumors are rare, and experience of these tumors is usually limited to a small number of patients. Inthis study, we evaluated profile, survival rates, and functional outcome in a series of sacral tumor treated in our institution.Method. We retrospectively reviewed the records of 22 sacral tumor patients from January 1995 to February 2014 inCipto Mangunkusumo National Central Hospital, Jakarta, Indonesia. Kaplan-Meier method was used to describedsurvival and functional outcome. Their correlation with clinical profile, histological type, level of sacral involvement,treatment, and complication were analyzed by Log rank test.Results. From 22 patients, 5 of them were excluded from this study. Thus, there were 17 cases of sacral tumor, 16 ofthem were malignant and one case was benign. In Kaplan-Meier Analysis, there were no significant difference insurvival found between sex, age group, biopsy type, level of sacral involvement, treatment, and complication. There wassignificant difference in survival found between histopathology result (p=0.012), and giant cell tumor GCT showed thehighest survival, followed by chordoma, metastatic lession, and Ewing Sarcoma. Sacral tumor at the level of S2 andbelow had better functional outcome compared to the one above S2 (p=0.001). There were no difference in functionaloutcome found between histopathology type and treatment (p=0.137 and p=0.210).Conclusion. The majority of primary tumors of sacrum are chordoma which present with nonspecific early signs andsymptoms. Survival rate and functional outcome of the sacral tumor patients were determined by histopathology resultand level of sacral involvement. Lower level of sacral involvement lead to better survival and functional outcome.Keyword: sacral tumors, chordoma, giant-cell tumor, metastasis, survival, functional outcomeABSTRAKPendahuluan. Tumor sakrum sangat jarang ditemukan; dan pengalaman mengenai tumor sakrum biasanya terbataspada sejumlah kecil pasien. Dalam studi ini, kami mengevaluasi profil, tingkat kesintasan, dan luaran fungsional dariserangkaian tumor sakrum yang dirawat di institusi kami.Metode. Kami telah mengevaluasi 22 pasien tumor sakrum dari Januari 1995 sampai Februari 2014 secara retrospektif diRumah Sakit Umum Pusat Nasional Cipto Mangunkusumo Jakarta Indonesia. Metode Kaplan-Meier digunakan untukmenganalisis angka kesintasan dan luaran fungsional. Hubungan antara kesintasan dan luaran fungsional dengan profilklinis, jenis histopatologi, level sakrum yang terlibat, penatalaksanaan, dan komplikasi dianalisis dengan Log rank test.Hasil. Dari 22 pasien, hanya 17 pasien tumor sakrum yang dimasukkan ke dalam studi ini (5 kasus diekslusi), 16 kasusdengan tumor ganas dan 1 kasus dengan tumor jinak. Hasil analisis Kaplan-Meier menunjukkan tidak ada perbedaanyang bermakna pada angka kesintasan terhadap jenis kelamin, kelompok umur, jenis biopsi, level sakrum yang terlibat,penatalaksanaan, dan komplikasi. Hasil uji statististik menunjukkan perbedaan yang bermakna antara kesintasandengan hasil histopatologi (p = 0,012), giant cell tumor menunjukkan kesintasan hidup tertinggi, diikuti oleh Chordoma,lesi metastasis, dan Ewing Sarcoma. Tumor sakrum setinggi S2 ke bawah memiliki luaran fungsional yang lebih baikdibandingkan dengan level di atas S2 (p = 0,001). Hasil uji statistik menunjukkan tidak ada perbedaan yang bermakna antara luaran fungsional dengan jenis histopatologi dan penatalaksanaan(p = 0,137 dan p = 0,210). Kesimpulan. Mayoritas tumor primer pada tulang sakrum adalah chordoma yang muncul dengan gejala dan tanda-tanda awal yang tidak spesifik. Angka kesintasan dan luaran funsional pasien tumor sakrum dipengaruhi oleh jenis histopatologi dan level sacrum yang terlibat. Semakin rendah level sacrum yang terlibat, semakin baik kesintasan dan luaran fungsional.Kata Kunci: Tumor sakrum, Chordoma, giant cell tumor, metastasis,kesintasan, luaran fungsional

Schwannoma Nervus Ulnaris

Indonesian Journal of Cancer Vol 9, No 3 (2015): Jul - Sept 2015
Publisher : "Dharmais" Cancer Center Hospital

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Abstract

Ulnar nerve schwannoma is a rare peripheral nerve tumor. Accurate preoperative diagnosis is very important to evaluate the involvement of certain peripheral nerve and surgical planning. MRI is very important investigation for diagnosis before surgery. Surgical management principle in this case is to remove the tumor mass and preserve main ulnar nerve. Schwannoma nervus ulnaris merupakan tumor saraf tepi yang jarang ditemukan. Diagnosis yang akurat sebelum pembedahan sangat penting untuk menilai keterlibatan saraf tepi tertentu dan merencanakan tindakan pembedahan. MRI merupakan pemeriksaan penunjang yang sangat bermanfaat untuk menegakkan diagnosis sebelum pembedahan. Prinsip penatalaksanaan bedah pada kasus ini adalah mengangkat massa tumor dan mempertahankan serabut utama nervus ulnaris.

Pengaruh Autoclave terhadap Properti Fisik dan Histopatologi Tulang: Sebuah Penelitian Dasar Rekonstruksi

Indonesian Journal of Cancer Vol 8, No 1 (2014): Jan - Mar 2014
Publisher : Indonesian Journal of Cancer

Show Abstract | Original Source | Check in Google Scholar | Full PDF (612.906 KB)

Abstract

Background: Autoclave autograft is a promising alternative procedure in surgical treatment of bone tumors. A minimum effective autoclaving time of 15 minutes at 134C to devitalise tumour cells. This study aims to know the effect of autoclave to physical properties and histopathology of bone.Methods: We performed experimental study in 28 femoral bone of goat (Capra Aergagus circus) at age 1?2 year old. We divide into two groups with simple random sampling to be 14 autoclave and 14 control group. Autoclaving was performed to the bone at 134C for 15 minute. We examined physical properties each 7 autoclave group to axial and bending force compared with physical properties of the control group. We also examined histopatology of the bone both groups. Independent t-test statistical analysis to evaluate the difference of axial and bending force between autoclave and control group.Results: There were significant difference between autoclave and control group in axial force (p = 0.000) and bending force (p = 0.03). Physical properties of autoclave bone decreased 58.58 % in axial force and 20.33% bending force to control group. Histopathology examination revealed that all osteocytes were death in autoclave group but without matrix changes.Conclusion: Autoclave at 134C for 15 minute caused physical properties of bone decrease and statistically significant difference. It also made all osteocytes died but without matrix disturbance.