Background: Obstructive sleep apnea (OSA) is a disease characterized by periodic upper airway collapse during sleep, which could result in either apnea, hypopnea or both. OSA is very often undetected but it is strongly associated with variety of medical complication, among others cardiovascular diseases.Purpose: To inform ENT specialists about the pathogenesis and pathophysiology of OSA and its complications. Literature review: Recent data from several studies has documented the association between OSA and cardiovascular disorders such as hypertension, heart failure, arrhytmia and atherosclerosis. The undetectable cardiovascular complication that lead by OSA could make the management of cardiovascular disorders uneffective. Conclusion: A good understanding can help physicians to diagnose, manage and prevent cardiovascular complication that caused by OSA. Keywords: obstructive sleep apnea, apnea, hipopnea, cardiovascular disease Abstrak : Latar belakang: Obstructive sleep apnea (OSA) adalah suatu penyakit yang ditandai dengan peristiwa kolapsnya saluran napas bagian atas secara periodik pada saat tidur yang mengakibatkan apnea, hipopnea atau keduanya. Gejala klinis OSA sering tidak terdeteksi, namun diduga dapat meningkatkan risiko berbagai macam komplikasi medis antara lain kelainan kardiovaskuler. Tujuan: Agar para ahli THT dapat mengerti mengenai patogenesis dan patofisiologi OSA dan komplikasinya. Tinjauan pustaka: Beberapa penelitian telah menyatakan tentang adanya hubungan antara OSA dengan penyakit kardiovaskuler seperti hipertensi, gagal jantung, aritmia dan arteriosklerosis. Patofisiologi OSA pada komplikasi kardiovaskuler yang sulit dideteksi dapat menyebabkan penatalaksanaan penyakit kardiovaskuler menjadi kurang efektif. Kesimpulan:Pemahaman yang baik dapat membantu menegakkan diagnosis dan melakukan tatalaksana yang tepat untuk mencegah komplikasi kardiovaskuler yang berhubungan dengan OSA.Kata kunci: obstructive sleep apnea, apnea, hipopnea, penyakit kardiovaskuler
Background: Nasal polyps is an inflammation process effecting in epithelial natrium hiperabsorptionand decreased of chloride ion secretion. Purpose: To find out the role of nasal seroprotein in increasingthe hydraulic effect and improving cellular integrity in balancing the natrium hyperasborption in nasalpolyps patients following protocol treatment of endoscopic simple polypectomy and 6 weeks intranasalglucocorticoid. Method: Twenty-nine patients with naive bilateral nasal polyps were undergone protocoltreatment of endoscopic simple polypectomy followed by 6 weeks intranasal glucocorticoid. There were16 responder subjects and 13 non-responder subjects. Increased expresions of statherin (STATH) and prolactin-induced-protein (PIP) were obtained by microarray examination on the best five responder of paired samples pre and post treatment, and validated by real-time RT-PCR for 22 pairs samples (44nasal polyps tissue). Result: Increasing expression (foldchange) of STATH and PIP based on microarray were 115.33 (FDR 8.81) dan 26.45 (FDR 12.20) and the validation by real-time RT PCR demonstratedthe foldchange expression of 186.59 (95% CI 6.22–1024.97) in STATH expression and 17.64 (95% CI3.37–32.75) in PIP expression. Responder group showed higher transcription activity in gen STATH300.42 (95% CI 1.34–1257.32) compared to non-responder group of 72.76 (CI 95% 21.81–1285.91),while PIP in responder group showed 19.56 (CI 95% 1.75–130.70) and in non-responder group of 15.71(CI 95% 3.84–29.79). Conclusion: Gene expression comparison analysis by microarray, real-time RTPCR from the result of this study showed that STATH and PIP had a function for the improvement innasal polyps treatment protocol. Keywords: epithelial ion transport, nasal polyps, prolactin-induced-protein, statherin Abstrak : Latar belakang: Polip hidung adalah proses inflamasi yang mengakibatkan terjadinya hiperabsorpsiion natrium dan berkurangnya sekresi ion klorida. Tujuan: Untuk mengetahui peran nasal seroproteinyang meningkatkan efek hidraulik dan memperbaiki integritas sel untuk mengatasi hiperabsorpsi ionnatrium, akan dilakukan penelitian pada pasien polip hidung sebelum dan sesudah protokol pengobatandengan polipektomi sederhana endoskopik dan glukokortikoid intranasal selama enam minggu. Dua puluh sembilan pasien polip hidung bilateral yang dapat dievaluasi, dikelompokkan berdasarkankriteria klinis menjadi 16 subjek responder dan 13 subjek non-responder. Peningkatan ekspresi statherin(STATH) dan prolactin-induced-protein (PIP) diperoleh melalui pemeriksaan microarray pada 5 sampeldengan respons terapi terbaik. Selanjutnya 22 pasang sampel (44 jaringan) menjalani pemeriksaauntuk mengetahui ekspresi gen STATH dan PIP pada tingkat mRNA dengan pemeriksaan real-time RTPCR. Hasil: Penelitian ini mendapatkan peningkatan ekspresi (foldchange) STATH dan PIPberdasarkanpemeriksaan microarray 115,33 (FDR 8,81) dan 26,45 (FDR 12,20) dan setelah divalidasi ulang denganpemeriksaan real-time RT PCR didapatkan peningkatan ekspresi 186,59 (IK 95% 6,22–1024,97) (IK 95% 3,37–32,75). Kelompok responder menunjukkan aktivitas transkripsi yang lebih tinggi ermakna pada gen STATH sebesar 300,42 (IK 95% 1,34–1257,32) dibandingkan dengan kelomresponder 72,76 (IK 95% 21,81–1285,91) sedangkan PIP kelompok responder 19,56 (IK 95% 1,75–130,70)dan kelompok non-responder 15,71 (IK 95% 3,84–29,79). Kesimpulan: Analisis perbandingan gen berdasarkan pemeriksaan microarray, real-time RT PCR dari hasil penelitian ini menunjukkan bahwaSTATH dan PIP mempunyai peran untuk respons kesembuhan dalam protokol pengobatan polip hidung. Kata kunci: transpor ion epitel, polip nasi, statherin, prolactin-induced-protein
Background: Risk factors of chronic rhinosinusitis include epithelial disease related to disturbanceof mucociliary transport system, anatomical variations obstructing the ostiomeatal complex anddysfunction of neural regulation.Purpose: To find the prevalence of deviated septum, concha bullosa andlateral deflection of the uncinate process in ipsilateral chronic rhinosinusitis.Methods: A retrospectivestudy of computed tomographic (CT) scans of chronic rhinosinusitis patients who were not cured by6 weeks of maximal medical treatment of rhinosinusitis. Pneumatization of the middle turbinate anddeviation of the septum were evaluated on coronal slices, while lateral deflection of the uncinate processwas also assessed by calculating the angle using Osirix software (Pixmeo, Geneva, Switzerland).Results:One hundred ninety-three CT scans comprising 386 nasal sides were analyzed. The prevalence of thecombination of deviated septum, concha bullosa and lateral deflection of the uncinate process occurringconcurrently with ipsilateral maxillary sinusitis was found to be 32,9% (p=0.01, OR=9.1, 95% CI=1.2-69.7). The prevalence of deviated septum with concha bullosa was found in 40.9% with ipsilateral maxillarysinusitis (p=0.03, OR=3.8, 95% CI=1.1-13.3). One single anatomical variation of lateral deflection ofthe uncinate process had a proportion of 71.5% in ipsilateral maxillary sinusitis (p=0.03, OR=2.7 95%CI=1.1-6.9).Conclusion: Deviated septum, concha bullosa and lateral deflection of the uncinate processwere frequently present in the existence of ipsilateral chronic maxillary rhinosinusitis. It suggested greaterassociation compared to one or a combination of two anatomical variation in the role of local factorscontributing to sinonasal epithelial dysfunction.Keywords: chronic rhinosinusitis, deviated septum, concha bullosa, lateral deflection of uncinate process ABSTRAKLatar belakang: Rinosinusitis kronis adalah penyakit inflamasi yang mengakibatkan gangguankeseimbangan homeostasis fungsi hidung dan sinus paranasal. Patofisiologinya terjadi melalui kombinasigangguan transpor sistim mukosiliar, variasi anatomi yang menyempitkan kompleks ostiomeatal sertagangguan regulasi persarafan sensorik, simpatis dan parasimpatis. Tujuan: Untuk mengidentifikasiprevalensi septum deviasi, konka bulosa dan prosesus unsinatus defleksi lateral, serta hubungannya denganrinosinusitis kronik yang terjadi pada sisi yang sama (ipsilateral). Metode: Penelitian retrospektif potonglintang pada tomografi komputer (TK) pasien dengan rinosinusitis kronik yang tidak sembuh dengan terapimedikamentosa maksimal selama 6 minggu. Pneumatisasi konka media dan deviasi septum dievaluasipada potongan koronal, sedangkan defleksi prosesus unsinatus ke lateral dinilai dan diukur sudutnyadengan menggunakan piranti lunak Osirix (Pixmeo, Geneva, Switzerland). Hasil: Analisis dilakukanpada 193 TK yang terdiri dari 386 sisi hidung. Prevalensi kombinasi septum deviasi, konka bulosa danprosesus unsinatus defleksi lateral yang terjadi bersamaan dengan sinusitis maksila ipsilateral adalah 32,9% (p=0,01, OR=9,1, 95% CI=1,2-69,7). Prevalensi septum deviasi dengan konka bulosa ditemukanpada 40.9% sinusitis maksila ipsilateral (p=0,03, OR=3,8, 95% CI=1,1-13,3). Variasi anatomi tunggalyaitu prosesus unsinatus defleksi lateral memiliki proporsi 71,5% pada sinusitis maksila ipsilateral.(p=0,03, OR=2,7 95% CI=1,1-6,9). Kesimpulan: Septum deviasi, konka bulosa dan prosesus unsinatusdefleksi lateral sering ditemukan bersamaan dengan kejadian sinusitis maksila ipsilateral. Kombinasitiga variasi anatomi yang menyempitkan kompleks ostiomeatal (KOM) lebih kuat daripada hanya satuvariasi anatomi atau kombinasi 2 variasi anatomi, sebagai faktor lokal yang berkontribusi terhadapdisfungsi epitel sinonasal serta gagalnya resolusi inflamasi kronik.Kata kunci: Rinosinusitis kronis, septum deviasi, konka bulosa, prosesus unsinatus defleksi lateral
Background: Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign, but locally invasive neoplasm occurring most often in adolescent males. These tumors are highly aggressive andare associated with significant morbidity and mortality due to its tendency to bleed. Purpose: To presentevidence based case-report on endoscopic removal of JNA as an alternative technique besides the openapproach. Cases: Three cases of JNA managed endoscopically of their removal and the difference ofclinical symptoms based on the histopathological variation and radiological description analysis, givingbenefits in endoscopic surgical planning. Management: The classical treatment for JNA is surgery,however there are cases in which may indicate radiotherapy or even hormone therapy and gamma knifesurgery. Recent advances in technology enable ENT surgeons to use the endonasal technique as analternative in treating JNA patients. Conclusion: Endoscopic removal of JNA was successfully performedfor T1 and T2 tumor based on Fisch classification. To support a good management for JNA casesendoscopically, carefull considerations should be made to determine accesses toward the predominant attachment of the tumor to sphenopalatine foramen and pterygoid plate. Rhinologists and OncologyHeadandNecksurgeonsshouldhavedeepunderstandingofendoscopicanatomyoflateralnasalwalland mastering the art of four-hand technique of endoscopic sinonasal surgery. Keywords : angiofibroma, endoscopic surgery, sphenopalatine artery, pterygoid plate of sphenoid bone. Abstrak : Latar belakang: Angiofibroma nasofaring belia (ANB) merupakan tumor jinak secara histologis,namun bersifat ganas secara lokal yang terjadi terutama pada anak laki-laki usia remaja. Tumor jenis inibersifat sangat agresif dan sering dihubungkan dengan tingginya angka morbiditas dan mortalitas karenakecenderungan tumor yang mudah berdarah. Tujuan: Mempresentasikan 3 kasus dengan diagnosis klinisANB yang dilakukan ekstirpasi secara bedah sinonasal endoskopik. Telaah literatur terstruktur dilakukanuntuk menganalisis keputusan dan aplikasi pemilihan teknik bedah ini. Kasus: Tiga kasus ANB yangtelah dilakukan ekstirpasi dengan bedah endoskopik dianalisis berdasarkan variasi gejala klinis, gambaranhistopatologi dan gambaran radiologiknya yang berguna untuk perencanaan pembedahan sinonasalendoskopik. Penatalaksanaan: Tatalaksana utama ANB adalah dengan pembedahan, namun pada kasuskasustertentudapat dipilih modalitas radioterapi, terapihormon dan pembedahan dengan pisau gamma.KemajuanteknologimemudahkanparaahlibedahTHTuntukmenggunakanpendekatanendoskopisebagaialternatif pendekatan bedah pada pasien ANB.Kesimpulan:Bedah sinonasal endoskopikANBdapatdilakukanuntuktumorberukuranT1danT2berdasarkanklasifikasiFisch.Faktorlainyangharusdiperhatikanuntukkeberhasilantindakanadalahpemahamananatomiendoskopikhidungdansinusparanasal untuk penetapanakses secara sentripetalmenujuperlekatanutamaANBpada foramensfenopalatinadanlempeng pterigoid, serta kerjasama antaraahli Rinologi dengan ahli Bedah KepalaLeherOnkologi dalam teknik bedah sinonasal endoskopik 4 tangan (four-handtechnique). Kata kunci : angiofibroma, bedah endoskopik, arteri sfenopalatina, lempeng pterigoid os sfenoid.
Background: In old traumatic multiple facial fractures, connective tissue and fibrosis were formedwhich make them difficult to be repaired. Purpose: To illustrate to ENT- Head and Neck surgeons asreconstructive surgery could restore the aesthetic and function in facial deformity. Case: Two cases ofold multiple facial fracture were reported. One case was a 32 years old man with history of falling froma tree three years ago and second case was 41 years old man with history of car accident two years ago. Case management: Those two cases were managed with facial reconstruction and malar augmentation using rib cartilage, plate and screw andsilicon implant. Conclusion: Facial reconstruction using rib cartilage autograft, plate and screw or silicon implant could be repair malar asymmetry. Facial analysisin facial reconstruction is important in determining the site of implantation precisely.Keywords: old multiple facial fracture, facial reconstruction, rib cartilage autograft, silicone implant. Abstrak : Latar belakang: Fraktur multipel wajah akibat trauma lama, telah membentuk jaringan ikatdan fibrosis sehingga sukar untuk dilakukan perbaikan. Tujuan: sebagai ilustrasi untuk ahli THT-KL,bagaimana bedah rekonstruksi dapat memperbaiki estetika dan fungsi pada deformitas wajah.Kasus:Dua kasus fraktur lama wajah yaitu, pertama laki-laki berusia 32 tahun dengan riwayat jatuh dari pohon 3 tahun yang lalu dan kasus kedua laki-laki berusia 41 tahun dengan riwayat kecelakaan lalu lintas 2tahun yang lalu.Penatalaksanaan: Pada kedua pasien dilakukan rekonstruksi wajah dengan augmentasimalar menggunakan kartilago iga,plate and screw dan implan silikon. Kesimpulan: Rekonstruksiwajah menggunakan tandur autologus kartilago iga dan plate and screw atau implan silikon dapatmengurangi asimetri malar. Analisis wajah pada saat rekonstruksi penting untuk menentukan posisitandur atau implan dengan tepat.Kata kunci: fraktur multipel lama wajah, rekonstruksi wajah, tandur autologus kartilago iga, implansilikon.
Background: Functional Endoscopic Sinus Surgery (FESS) is only indicated for nasal polyps (NP) cases which not responsive to maximal medical treatment. Objectives: To find proportion of NPs responsive to maximal medical treatment protocol consisted of office based endoscopic simple polypectomy followed by a 6-week intranasal steroid. Subjects who failed the treatment protocol underwent FESS and followed up until 12 months. The difference of gene expression profile was also evaluated based on their different clinical responses. Method: An experimental study of pre and post self-control to evaluate patients with naïve bilateral nasal polyps who had underwent endoscopic simple polypectomy under local anesthesia followed by intranasal steroid for six weeks. Microarray examination validated by real time RT-PCR was performed to determine the difference of gene expression profile before and after protocol treatment. Result: There were 16 responsive subjects (55.17%) to protocol treatment and 13 unresponsive subjects (44.83%) that subsequently underwent FESS. Twelve months follow up showed recurrent nasal polyps in 5 subjects (17.24%) and no recurrence in 8 subjects (27.6%). F5 gene expression was the determinant in response to protocol treatment, with Exp B=0.042 and p=0.04. Nagelkerke R square value of 49.9% showed the equation of F5 as determinant of reponsiveness.Conclusion: Clinical research of endoscopic simple polypectomy followed by intranasal steroid before FESS intervention in bilateral NP obtained evidence in biomolecular level to gain deeper understanding of how resolution of chronic inflammation happened. Keywords: nasal polyps, endoscopic simple polypectomy, functional endoscopic sinus surgery, F5 gene Abstrak : Latar belakang: Indikasi Bedah Sinus Endoskopik Fungsional (BSEF) pada polip hidung adalah kegagalan respons adekuat setelah terapi medikamentosa maksimal. Tujuan: Mengetahui proporsi penderita polip hidung yang responsif terhadap protokol terapi medikamentosa maksimal dengan polipektomi sederhana endoskopik serta terapi steroid intranasal selama 6 minggu. Pasien yang tidak responsif, menjalani terapi BSEF dan ditindak-lanjuti selama 12 bulan. Juga dievaluasi perbedaan profil ekspresi gen yang mempengaruhi perbedaan respons klinis tersebut. Metode: Desain penelitian adalah eksperimental dengan kontrol sendiri pra dan pasca intervensi polipektomi sederhana endoskopik dan terapi steroid intranasal selama 6 minggu pada penderita polip hidung bilateral. Pemeriksaan microarray yang divalidasi dengan pemeriksaan real time RT-PCR, dilakukan untuk mengetahui perbedaan profil ekspresi gen sebelum dan sesudah protokol terapi. Hasil: Sesudah protokol pengobatan terdapat 16 subjek (55,17%) menunjukkan respons terapi baik, dan 13 subjek (44,83%) dengan tanda klinis menetap atau memburuk, dan selanjutnya menjalani terapi BSEF. Tindak-lanjut selama 1 tahun pasca BSEF pada 13 subjek, didapatkan polip rekurens pada 5 subjek (17,24%) dan tidak ada polip 8 subjek (27,6%). Ekspresi gen F5 adalah variabel yang bermakna dengan nilai Exp B = 0,042 dan p = 0,04. Nilai Nagelkerke R square sebesar 49,9% menunjukkan kekuatan gen F5 sebagai determinan respons kesembuhan. Kesimpulan: Penelitian klinik dengan melakukan tindakan polipektomi sederhana endoskopik dilanjutkan terapi steroid intranasal sebagai terapi lini pertama pada polip hidung sebelum intervensi BSEF, mendapatkan bukti pada tingkat molekuler untuk dapat lebih memahami terjadinya proses resolusi inflamasi kronik. Kata kunci: polip hidung, polipektomi sederhana endoskopik, bedah sinus endoskopik fungsional, gen F5,
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