Heart rate (HR) reduction is essential to achieve good image quality for cardiac computed tomography (CCT). We evaluated the efficacy of a bolus injection of landiolol, an ultra-short acting β-blocker, without the administration of oral β-blocker to reduce HR prior to CCT. We enrolled 678 consecutive patients who underwent CCT from December 2011 to March 2012 and divided them into three groups, which were a propranolol group (n = 277), a low-dose landiolol group (n = 188), and a high-dose landiolol group (n = 213). Patients in the propranolol group received oral propranolol (10–20 mg) prior to CCT. Patients in the low-dose and high-dose landiolol groups were administered a bolus injection of landiolol (0.125 mg/kg), while the high-dose group received an additional 3.75 mg of landiolol if the baseline HR was ≥75/min. Although the average HR was significantly lower in the propranolol group (61.6 ± 8.0/min) than in the low-dose landiolol group (64.1 ± 7.4/min, P < 0.001), there was no significant difference in the image quality (P = 0.91). Among patients with baseline HR ≥75/min, the average HR tended to be lower in the high-dose landiolol group (67.2 ± 6.9/min) compared with the low-dose landiolol group (69.0 ± 6.9/min, P = 0.10), and there was a corresponding difference in image quality between these two groups (P = 0.02). In conclusion, Although the decrease of HR was significantly larger in the propranolol group than in the landiolol groups, the image quality was similar. Among the patients who received landiolol, a higher dose was associated with a lower HR and better image quality. Further investigation to assess higher-dose bolus injection of landiolol or bolus injection following oral administration of a β-blocker would be needed.

SummaryPurpose: The aim of this study was to evaluate the impact of wall share stress (WSS) in the carotid artery using a computed fluid dynamics analysis system and adopting open-source software. Methods: The dependence of element number (computation time and analytical accuracy) were considered with simple vessel models. We evaluated WSS and flow velocity using a carotid artery model that was based on the outcome of simple vessel models. Results: When the number of elements was 10 5 or more, the flow velocity error of the outlet decreased to 0.5% or below when using simple vessel models. The carotid bifurcation model showed a whirlpool and a decrease in flow velocity in the carotid bulb part. Conclusion: An analysis system was built using open source software. The results from the carotid bifurcation model suggested that hemodynamics contributes to the development of carotid stenosis.

Background: The internet is technology that developed is very fast in recent years. Development of internet may occur positive and negative effect. Survey that conducted in 2017 in Indonesia, according to gender showed that males (51,43%) are more than females in using the internet. The purpose of this research was to know internet addiction profiles and relationship between internet addiction and gender in SMPN 2 Denpasar students. Methods: The study design was a cross sectional study with total sampling. The data were taken from students by using questionnaire at SMPN 2 Denpasar. The result was analyzed by univariate and bivariate method using chi-square test. Results: There are 366 subjects included in this study. 198 samples were males, and 168 samples were females. Based on the analyzed result, it confirmed that the internet addiction relates significantly with gender (p-value = 0.048) (p < 0.05). Univariate analysis showed that 21,8% were suffer mild internet addiction and 4,3% were suffer moderate internet addiction. Males were suffering internet addiction more than females. Internet was mainly used to play game online and chatting were smartphone are the most device-used to access the internet. Basic needs were the most activities that can stop internet access. The most duration of internet usage are 2-4 hours/day and <40 hours/week. Conclusions: From the result of this study, can be concluded that there is a significant relationship between internet addiction and gender in SMPN 2 Denpasar students.

INTRODUCTION: Insulinoma is congenital hyperinsulinism of infancy (CHI). It is a type of functional neuroendocrine tumor (NET) in the pancreas that manifests with persistent hypoglycemia caused by inappropriately high secretion of insulin (hyperinsulinemia). Comprehensive and multidisciplinary management is required for a better outcome. CASE PRESENTATION: A 2-months-old girl came to the Emergency unit Sanglah Hospital, with a chief complaint of seizure. The patient had a low blood glucose level, high fasting insulin, high LDH, computed tomography of the abdomen result showed isodense heterogeneous lesions border in the cauda pancreas with size 1.32 × 1.24 × 1.35 cm. The anatomy-pathological result showed pancreatic neuroendocrine tumor WHO Grade II, functional, consistent, and clinically to insulinoma on the tail of the pancreas. The patient was treated with hydrocortisone, nifedipine, and octreotide. The patient underwent laparotomy partial pancreatectomy. In post-surgery condition, she had good drink tolerance, no episode of recurrent seizure, and blood glucose was controlled. CONCLUSION: Insulinoma is a rare disease. The diagnosis was challenging. This case report presents the diagnostic work-up and management of a patient with a persistent hypoglycemia condition that was diagnosed as insulinoma.

Background: Hyperglycemic hyperosmolar state (HHS) is a life-threatening rare acute complication of diabetes mellitus (DM). The condition should be distinguished from diabetic ketoacidosis (DKA) as the management differs significantly. HHS is classically associated with type 2 DM, but it has been increasingly reported in type I DM as well. The literature regarding HHS in children is still sparse. The management of HHS in children is extrapolated from the adult study. Cases: The first case was male 5 years old, and the second case was female 15 years old. Both cases were typed 1 DM patient. The first case was newly diagnosed. Both of the patients came with general weakness, mild dehydration, overly high blood sugar, normal blood pH, hypocalcemia, glucosuria and only mild ketonuria. In the second case develop, both patients were rehydrated, given insulin and discharged in 7-10 days without any sequelae. Conclusion: These case series emphasize the importance of recognizing HHS and differ it from DKA. These two cases prove that HHS is increasingly reported in children with clinical symptoms resembling DKA. It is also proven that with early diagnosis and correct management, children with HHS can be discharged home without any sequelae.

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Purpose: It is time‐consuming and might cause re‐planning to check couch‐gantry and patient‐gantry collisions on a radiotherapy machine when using couch rotations for non‐coplanar beam angles. The aim of this study was to develop a computer‐graphics (CG)‐based radiation therapy simulator with physical modeling for avoidance of collisions between gantry and couch or patient on a radiotherapy machine. Methods: The radiation therapy simulator was three‐dimensionally constructed including a radiotherapy machine (Clinac iX, Varian Medical Systems), couch, and radiation treatment room according to their designs by using a physical‐modeling‐based computer graphics software (Blender, free and open‐source). Each patient was modeled by applying a surface rendering technique to their planning computed tomography (CT) images acquired from 16‐slice CT scanner (BrightSpeed, GE Healthcare). Immobilization devices for patients were scanned by the CT equipment, and were rendered as the patient planning CT images. The errors in the collision angle of the gantry with the couch or patient between gold standards and the estimated values were obtained by fixing the gantry angle for the evaluation of the proposed simulator. Results: The average error of estimated collision angles to the couch head side was ‐8.5% for gantry angles of 60 to 135 degree, and ‐5.5% for gantry angles of 225 to 300 degree. Moreover, the average error of estimated collision angles to the couch foot side was ‐1.1% for gantry angles of 60 to 135 degree, and 1.4% for gantry angles of 225 to 300 degree. Conclusion: The CG‐based radiation therapy simulator could make it possible to estimate the collision angle between gantry and couch or patient on the radiotherapy machine without verifying the collision angles in the radiation treatment room.

Backgrounds: Turner syndrome (TS) also called monosomy X or Ulrich, is a congenital disorder caused by one intact X chromosome and the absence of second sex chromosomes. Only females are affected by Turner syndrome, characterized by abnormalities affecting the X chromosomes. Its incidence about 2.5-5.5 per 10,000 live births of girls. Mosaic 47, XXX karyotype is found in 3%-4% of TS patients. Objective: To describe clinical manifestation and examination aspects of mosaicism turner syndrome. Case presentation: An 18-years-old girl came with complaint short stature. This complaint has been noticed since the patient was in elementary school. The patient's parents initiated to have their child checked by pediatric endocrinologist when the patient was 6 years old. The patient was diagnosed with Turner syndrome from the result of chromosomal examination. The patient was given growth hormone by pediatrician with unknown dosage for approximately 1.5 years but the patient has never returned to control. During that period of time, her breast developed when she was 11 years old and the patient had menstruation at the age of 14 but the menstrual cycle was irregular. Physical examination showed the patient with short stature, low hairline, shield-shaped chest and right elbow deformity. The Sexual Maturity Rating score was M4P4. Her anthropometric status was overweight and short stature with height for age < P3rd. The patient's bone age was equivalent with child age 17-years-old. Karyotype examination with G-banding technique, the chromosomes from 40 cells have been studied and the number of chromosomes in each cell studied is mos 47, XXX[30]/45, X[10]. Ultrasonography examination showed the uterus anteflexed below normal size, the right ovary appears below normal size, and the left ovary is not visible. Conclusion: An 18-year-old girl with mosaic Turner syndrome. The diagnosis is established by history taking, physical examination, hormone examination, imaging and karyotyping. Patient was treated with growth hormone.