Kiki Lukman
Departemen Ilmu Bedah Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung
Articles
7
Documents
Perbandingan Penyembuhan Luka Bakar Derajat Dua antara Rebusan Daun Sirih dan Moist Exposed Burn Ointment

Majalah Kedokteran Bandung Vol 44, No 2 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar

Abstract

Penggunaan obat topikal merupakan salah satu faktor utama dalam terapi luka bakar. Moist exposed burn ointment (MEBO) menjadi standar pengobatan luka bakar di Rumah Sakit Dr. Hasan Sadikin Bandung, tidak setiap tempat di Indonesia dapat mempergunakannya. Daun sirih sudah menjadi obat tradisional untuk pengobatan luka, termasuk luka bakar. Penelitian eksperimental membandingkan penggunaan rebusan daun sirih, MEBO, dan NaCl fisiologis (kontrol) dalam penatalaksanaan luka bakar derajat dua. Masing-masing kelompok terdiri atas 10 ekor tikus (Wistar sp.). Penelitian dilakukan selama 14 hari (25 Agustus–8 September 2009) di laboratorium hewan Departemen Farmakologi Fakultas Kedokteran Universitas Padjadjaran. Variabel yang diukur berupa diameter luka, timbulnya pus, cairan serosa, dan eritema pada hari ke-4, 7, dan 14. Pemeriksaan histopatologik dilakukan pada hari ke-14 untuk melihat jumlah fibroblas, kolagen, dan epitel. Berdasarkan variabel diameter (kelompok daun sirih 17,4 mm) lebih kecil bermakna (p<0,001) daripada kelompok lainnya. Timbulnya pus kelompok kontrol bermakna dibandingkan dengan kelompok lainnya (p=0,043). Pemeriksaan patologi anatomi memperlihatkan kelompok kontrol dalam fase inflamasi, kelompok rebusan daun sirih dalam fase proliferasi, dan kelompok MEBO dalam fase remodeling (skor epitelisasi kelompok MEBO 1,9) berbeda bermakna (p<0,001). Simpulan, penggunaan rebusan daun sirih pada luka bakar derajat dua memberikan proses penyembuhan luka yang lebih baik dibandingkan dengan penggunaan NaCl fisiologis, tetapi tidak sebaik penggunaan MEBO. [MKB. 2012;44(2):63–9].Kata kunci: Luka bakar, moist exposed burn ointment, sirihThe Comparison of Second Degree Burn Injury Wound Healing between Boiled Piper Betle Leaves and Moist Exposed Burn OintmentThe use of topical agent is one of the main strategies in management of burn injury. At Dr. Hasan Sadikin Hospital, moist exposed burn ointment (MEBO) is the first line topical agent for treating burn injury, not all places in Indonesia able to use it. Piper betle is one of the traditional agent to treat wound including that caused burn injury. Our experimental study was to compare the second grade burn injury healing process by using Wistar sp. for boiled piper betle leaves, MEBO and as control physiologic sodium chloride for fourteen days (August 25th–September 8th 2009) at Animal Pharmacology Laboratory of Faculty of Medicine Padjadjaran University. The variables which measured were diameter of injury, pus development, evidence of serous and erythematous skin, at 4th, 7th and 14th day of studied. Histopathologic examination was conducted at day 14 to determine the amount of fibroblast, collagen and epithelial. The results according to the measurement of diameter (piper betle leaves group 17.4 mm) was smaller than other groups (p<0.001). In pus development control group was higher than other groups (p=0.043). In pathological findings, the control group was at inflammation phase, while in boiled piper betle leaves group was at proliferation phase and in MEBO group at remodeling phase (with epithel score 1.9 which higher than other groups (p<0.001)). In conclusions, application of boiled piper betle leaves in treating second degree burn injury gives a better result than physiologic sodium chloride, although MEBO is better for second degree burn injury healing process. [MKB. 2012;44(2):63–9].Key words: Moist exposed burn ointment, piper betle, second degree burn injury DOI: http://dx.doi.org/10.15395/mkb.v44n2.81

HUBUNGAN STATUS INSTABILITAS MIKROSATELIT DAN EKSPRESI P53 DENGAN ETIOPATOLOGI ADENOKARSINOMA KOLOREKTAL PADA ORANG INDONESIA DI KELOMPOK USIA KURANG DARI 40 TAHUN

Indonesian Journal of Applied Sciences Vol 2, No 1 (2012)
Publisher : Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar

Abstract

Epidemiologically, the percentage of colorectal adenocarcinoma (CRC) in the age group ≤40 years old in Indonesia is higher than in the West European, North American and other developed Asian countries with different clinico-pathological features. In the afromentioned countries, the carcinogenesis pathway of this group is hereditary which show high microsatellite instability (MSI), whereas the age group >40 years old is sporadic of which show chromosomal instability (CIN) with the mutation of p53 gene. To elucidate the carcinogenesis pathway with its molecular characteristics of this group among Indonesians, a cross sectional study was conducted by performing the immunohistochemical detection of MLH1 and MSH2 expression (MSI status), and mutated p53 gene expression (CIN) in the CRC group ≤40 years old and >40 years old at Dr. Hasan Sadikin Hospital, Bandung, from May 2008 until November 2009. Thirty nine CRC patients, consisting of 22 patients of  ≤40 years old and 17patients >40 years old, were eligible for this study. The CRC patients of ≤40 years old showed 4 MSI high,  1 MSI lowand 17 MSS (microsatellite stable), associated with 10 p53 positive and 12 p53 negative status. In the CRC group of >40 years old, there was no MSI high, but 4 MSI low and 13 MSS were found, associated with 11 p53positive and 6 p53negative status. There was no significant difference with regards to the association between MSI status and p53 expression in both groups (p MSI=0.95, p p53=0.23).

Hubungan Lama Obstruksi Usus, Warna dan Kejernihan Cairan Peritoneum dengan Kontaminasi Bakteri pada Hernia Inkarserata

Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar

Abstract

Hernia inkarserata merupakan salah satu kasus abdomen akut yang diakibatkan obstruksi usus karena jepitan cincin. Penelitian eksperimental pada hewan coba membuktikan bahwa terjadi kerusakan barier mukosa setelah 4 jam obstruksi total usus dan kerusakan total setelah 12 jam, sehingga terjadi translokasi bakteri ke luar lumen usus. Untuk menentukan kontaminasi bakteri dalam kantung hernia akibat translokasi kuman, dilakukan pemeriksaan kultur dalam cairan peritoneum. Tujuan penelitian untuk mengetahui hubungan lama gejala obstruksi, warna, dan kejernihan cairan peritoneum dengan kontaminasi bakteri sebagai akibat translokasi kuman pad penderita hernia inkarserata. Waktu penelitian bulan Oktober 2009–Juli 2010 di Instalasi Gawat Darurat Bedah Rumah Sakit Dr. Hasan Sadikin Bandung. Dilakukan penelitian potong lintang yang menganalisis hubungan lama obstruksi usus, warna dan kejernihan cairan peritoneum dengan positivitas kultur bakteri. Penelitian dilakukan pada 40 penderita, 36 laki-laki dan 4 perempuan. Lama inkarserasi rata-rata adalah 7 jam. Terdapat 11 kasus dengan kultur positif, dengan jenis bakteri terbanyak Staphylococcus (27%). Analisis statistik dengan metode chi-kuadrat dan analisis regresi logistik berganda menunjukkan hubungan lama obstruksi dan perubahan warna cairan peritoneum dengan kontaminasi bakterial (p=0,015; p=0,001) dengan rasio prevalens lama obstruksi >7 jam sebesar 3,63, namun tidak terdapat hubungan dengan kejernihan cairan peritoneum (p=0,078). Penelitian ini tidak dapat menentukan cut-off time karena tidak mengikuti perjalanan penyakit, namun belum dapat dibuktikan translokasi bakteri karena kultur yang didapat adalah kuman komensal kulit. Simpulan, terdapat hubungan lama obstruksi usus dan perubahan warna cairan peritoneum dengan kontaminasi bakteri pada hernia inkarserata, tetapi tidak terdapat hubungan dengankejernihan cairan peritoneum dan kultur bakteri positif dengan kuman kontaminan kulit tidak dapat membuktikan translokasi kuman pada penderita hernia inkarserata. [MKB. 2012;44(4):199–204].Kata kunci: Hernia inkarserata, kontaminasi bakteri, lama obstruksi usus, warna dan kejernihan cairan peritoneumRelationship Bowel Obstructions Color and Clarity of Peritoneal Fluid with Bacterial Culture in Incarcerated HerniaIncarcerated hernia is an acute abdominal case caused by bowel obstruction due to incarceration of hernia ring. An experimental study on animals proved that there was mucosal barrier damage after 4 hours of total bowel obstruction and total damage after 12 hours causing bacterial translocation. In order to determine contamination due to bacterial translocation in the hernia sac, culture was taken from the peritoneal fluid. A cross-sectional study in Dr. Hasan Sadikin Hospital Bandung was done during October 2009 to July 2010 to analyze the relationship between duration of obstruction, color and clarity of peritoneal fluid, and bacterial culture. There were 40 patients, 36 males and 4 females involved in this study. Mean incarceration time was 7 hours. There were 11 positive culture cases, mostly Staphylococcus species (27%). Statistical analysis with chi-square and multiple logistic regression test showed that there was correlation between duration of obstruction and color and clarity of peritoneal fluid with bacterial contamination (p=0.015, p=0.001) with prevalence ratio of >7 hours length obstruction was 3.63, but not with clarity (p=0.078). In this study we could not obtain exact cut-off time of bowel obstruction’s period with bacterial translocation because it did not follow the pathologic event. In conclusions, there is correlation between duration of obstruction, color and clarity of peritoneal fluid with bacterial contamination, but bacterial translocation can not be proven because only commensal bacteria of the skin was obtained from the culture. [MKB. 2012;44(4):199–204].Key words: Bacterial contamination, color and clarity of peritoneal fluid, duration of obstruction, incarcerated hernia DOI: http://dx.doi.org/10.15395/mkb.v44n4.175

Efek Oksigen Konsentrasi Tinggi Pascaoperasi Laparotomi pada Peritonitis terhadap Tingkat Infeksi Luka Operasi

Majalah Kedokteran Bandung Vol 44, No 3 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar

Abstract

Metode sederhana untuk menambah tekanan oksigen secara adekuat pada perfusi jaringan yaitu dengan menambah konsentrasi oksigen yang diinspirasi pada penderita pascalaparotomi. Untuk melihat efektivitas oksigen konsentrasi tinggi tersebut dilakukan uji klinis di Rumah Sakit Dr. Hasan Sadikin Bandung. Dilakukan uji klinis secara random pada 102 penderita yang menjalani laparotomi karena peritonitis lokal atau difus serta membagi penderita dalam dua grup masing-masing 51 penderita untuk mendapatkan oksigen 30% dan 80% selama 2 jam pascaoperasi. Oksigen 30% didapat dari nasal kanul dengan oksigen 3 liter, sedangkan oksigen 80% diperoleh dari nonrebreathing mask dengan oksigen 10 liter. Penanganan anestesi dilakukan standar dan semua penderita mendapat antibiotik profilaksis. Dengan menggunakan protokol single blind, luka dievaluasi saat penderita pulang atau hari ke-7 jika masih dirawat dan 2 minggu pascaoperasi. Uji klinis dilakukan di subbagian Bedah Digestif RSHS selama periode Oktober 2009–Mei 2010. Dari 51 penderita yang diberi oksigen 80%, terdapat 2 (4%) penderita mengalami infeksi luka operasi dibandingkan dengan 9 dari 51 penderita (18%) yang diberi 30% oksigen. Durasi perawatan di rumah sakit sama pada kedua grup penderita. Simpulan, pemberian terapi oksigen konsentrasi tinggi pascaoperasi dapat menurunkan insidensi infeksi luka operasi. [MKB. 2012;44(3):165–9].Kata kunci: Infeksi luka operasi, laparotomi, oksigen, peritonitisEffect of Laparotomy Post-Operative High Concentration Oxygen in Peritonitis to Surgical Wound Infection Level A simple method to improve oxygen pressure to tissue perfusion adequately is by increasing the concentration of inspired oxygen.We therefore tested the hypothesis that the supplemental administration of oxygen during the post-operative period decreases the incidence of wound infection.We randomly assigned 102 patients at Dr. Hasan Sadikin Hospital who underwent exploratory laparotomy due to local and diffuse peritonitis to receive 30 percent or 80 percent inspired oxygen for two hours post-operation. The 30% oxygen was obtained from the nasal canule and 3 litres of oxygen whereas 80% oxygen was obtained from non-rebreathing mask and 10 litres of oxygen. Using the single-blind protocol, wounds were evaluated before the patients were discharged or 7 days post-operative and then two weeks after surgery. The clinical trial was performed at Dr. Hasan Sadikin Hospital Bandung between October 2009–May 2010. From the 51 patients who received 80% oxygen, 2 (4%) had surgical-wound infections, whereas from the 51 patients given 30 percent oxygen, 9 (18%) had surgical-wound infections. The length of hospital stay for both groups were the same. In conclusion that post-operative administration of high concentration ofoxygen can reduce the incidence of surgical-wound infections. [MKB. 2012;44(3):165–9]. Key words: Laparotomy, oxygen, periotonitis, surgical wound infection DOI: http://dx.doi.org/10.15395/mkb.v44n3.83

Sepsis-induced acute kidney injury in oral and maxillofacial infection with upper airway obstruction due to retropharyngeal abscess a case report

Journal of Dentomaxillofacial Science Vol 1, No 3 (2016)
Publisher : DiscoverSys Inc

Show Abstract | Original Source | Check in Google Scholar

Abstract

Left untreated or not properly managed odontogenic infection can cause spreading into facial spaces. Severe oral and maxillofacial infection can spread systemically and cause sepsis.1 Sepsis can induce unfavorable condition for the kidney, which is Acute Kidney Injury (AKI).2,3 The aim of this paper is to report a rare case of an oral and maxillofacial  infection with sepsis-induced AKI and upper airway obstruction which have high mortality rate. The standard treatment consists of proper monitoring of vital function, fluid resuscitation, drainage of accumulated purulence, empirical use of antibiotics chosen to cover the spectrum of potential pathogens until culture results are available, and supplemental oxygen.1,4 This is a case report of  a 48 year old female patient with oral and maxillofacial infection suffers sepsis-induced AKI and upper airway  obstruction. This patient was diagnosed as right submandibular abscess  which has extended into right buccal space, with sepsis, stage I AKI, and upper airway obstruction due to retropharyngeal abscess. We managed this patient with oxygenation, fluid resuscitation, antibiotics and analgesic administration, incision and drainage, and also extraction of mandibular right third molar. Tracheostomy, incision and drainage of retropharyngeal abscess were supposed to be performed by ENT department, but the patient refused. However the patient still survived. In case of oral and maxillofacial infection, the involvement of distant organ should be investigated, because this conditions result in high mortality rate. Early diagnosis and prompt treatment are important and able to lead to a better survival. 

HUBUNGAN STATUS INSTABILITAS MIKROSATELIT DAN EKSPRESI P53 DENGAN ETIOPATOLOGI ADENOKARSINOMA KOLOREKTAL PADA ORANG INDONESIA DI KELOMPOK USIA KURANG DARI 40 TAHUN

Indonesian Journal of Applied Sciences Vol 2, No 1 (2012)
Publisher : Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar

Abstract

Epidemiologically, the percentage of colorectal adenocarcinoma (CRC) in the age group ≤40 years old in Indonesia is higher than in the West European, North American and other developed Asian countries with different clinico-pathological features. In the afromentioned countries, the carcinogenesis pathway of this group is hereditary which show high microsatellite instability (MSI), whereas the age group >40 years old is sporadic of which show chromosomal instability (CIN) with the mutation of p53 gene. To elucidate the carcinogenesis pathway with its molecular characteristics of this group among Indonesians, a cross sectional study was conducted by performing the immunohistochemical detection of MLH1 and MSH2 expression (MSI status), and mutated p53 gene expression (CIN) in the CRC group ≤40 years old and >40 years old at Dr. Hasan Sadikin Hospital, Bandung, from May 2008 until November 2009. Thirty nine CRC patients, consisting of 22 patients of  ≤40 years old and 17patients >40 years old, were eligible for this study. The CRC patients of ≤40 years old showed 4 MSI high,  1 MSI lowand 17 MSS (microsatellite stable), associated with 10 p53 positive and 12 p53 negative status. In the CRC group of >40 years old, there was no MSI high, but 4 MSI low and 13 MSS were found, associated with 11 p53positive and 6 p53negative status. There was no significant difference with regards to the association between MSI status and p53 expression in both groups (p MSI=0.95, p p53=0.23).

Hubungan Faktor Risiko, Status Instabilitas Mikrosatelit, dan Ekspresi P53 dengan Karsinogenesis Adenokarsinoma Kolorektal pada Orang Indonesia

Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar

Abstract

Berbeda dengan berbagai negara lain, karakteristik molekuler adenokarsinoma kolorektal (AKK) pada orang Indonesia di dalam kelompok usia ≤40 tahun memiliki kesamaan dengan kelompok usia >40 tahun, dan keduanya berada pada jalur karsinogenesis sporadik. Untuk mengetahui hubungan karakteristik molekuler dengan berbagai faktor risiko AKK, dilakukan penelitian potong lintang yang mempelajari hubungan berbagai faktor risiko, status instabilitas mikrosatelit (IM), dan ekspresi P53 (instabilitas kromosom=IK) pada 39 penderita AKK yang memenuhi kriteria inklusi di Rumah Sakit Dr. Hasan Sadikin Bandung dalam periode Maret 2009−Maret 2010. Diperoleh masing-masing 21 dan 18 penderita AKK laki-laki dan perempuan, serta 17 dan 22 penderita berusia >40 dan ≤40 tahun. Dilakukan pemeriksaan imunohistokimia ekspresi gen MLH1, MSH2, dan p53 untuk menentukan status IM dan IK. Hasilnya adalah penderita AKK ≤40 tahun menunjukkan 4 IM tinggi, 1 IM rendah, dan 17 IM negatif, serta 10 status P53 positif dan 12 P53 negatif. Penderita AKK >40 tahun menunjukkan 4 IM rendah, dan 13 IM negatif, yang disertai oleh 11 status P53 positif dan 6 status P53 negatif. Pada kedua kelompok tersebut tidak didapatkan perbedaan yang bermakna (p>0,05) dalam pola hubungan berbagai faktor risiko AKK dengan karakteristik molekulernya. Pola diet tinggi lemak dan protein, rendah serat, overweight, merokok, dan aktivitas fisik rendah ditemukan sebagai faktor risiko yang berperan pada kedua kelompok tersebut. Simpulan, mayoritas penderita AKK pada orang Indonesia memiliki klasifikasi molekuler berupa status IK tinggi dan status IM rendah, serta berhubungan dengan faktor risiko diet tinggi lemak dan protein, rendah serat, overweight, merokok, dan aktivitas fisik rendah. [MKB. 2012;44(4):245–52]Kata kunci: Ekspresi P53, faktor risiko, instabilitas mikro-satelit, karsinogenesis adenokarsinoma kolorektalThe Association of Risk Factors, Microsatellite Instability, and P53 Expression in the Carcinogenesis of Colorectal Adenocarcinoma among IndonesianDifferent from developed countries, molecular characteristic of colorectal adenocarcinoma (CRC) among Indonesians in the age group of ≤40 years old is mostly similar compared to the CRC of the age group of >40 years old, and both are sporadic cancers. To know the association of molecular characteristic with the risk factors of CRC, a cross sectional study was conducted to analyze the association of risk factors, microsatellite instability (MSI) and P53 expression (chromosomal Instability=CIN) status in 39 consecutive CRC patients who were eligible for this study at Dr Hasan Sadikin Hospital, from March 2009 until March 2010. They consisted of 21 male and 18 female patients. Of them, there were 17 and 22 patients with>40 and≤40 years of age, respectively. The immuno-histochemistry examinations for the expression of mutated MLH1, MSH2 and p53 genes were conducted to determine the CIN and MSI status. The results showed that the CRC ≤40 years of age had 4 MSI high, 1 MSI low, and 17 MSI negative, associated with 10 P53 positives and 12 p53 negatives. By contrast, in the CRC >40 years of age the MSI was low and negative in 4 and 13 cases, respectively. They were associated with 11 and 6 of p53 positive and negative status, respectively. Between the two groups, there were no significant differences with regards to the association pattern between the risk factors and their molecular characteristics (p>0.05). Conclusions, majority of CRC patients among Indonesian show a molecular classification of high CIN and low MSI, and is associated with risk factors of high fat and protein, low fiber dietary intake, overweight, smoking, and low physical activitis. [MKB. 2012;44(4):245–52]Key words: Carcinogenesis of colorectal carcinoma, expression of P53, microstallite instability, risk factors DOI: http://dx.doi.org/10.15395/mkb.v44n4.216