Microsurgery techniques are useful innovations towards minimizing the insult of canal stenosis. Here, we describe the trumpet laminectomy microdecompression (TLM) technique, advantages and disadvantages. Sixty-two TLM patients with lumbar disc herniation, facet hypertrophy or yellow ligament or intracanal granulation tissue. The symptoms are low back pain, dysesthesia and severe pain on both legs. Spine levels operated Th11-S1; the patients who had trumpet-type fenestration, 62.9% had hypertrophy of the facet joint, 11.3% had intracanal granulation tissue, 79.1% had hypertrophy of the yellow ligament and 64.5% had disc herniation. The average of procedure duration was 68.9 min and intraoperative blood loss was 47.4 mL. Intraoperative complications were found in 3.2% of patients, with dural damage but without cerebrospinal fluid leakage. The TLM can be performed for all ages and all levels of spinal canal stenosis, without the complication of spondilolistesis. The TLM has a shorter duration, with minimal intraoperative blood loss.
AbstrakCedera servikal merupakan salah satu cedera tulang belakang terbanyak pada penderita trauma. Di Amerika Serikat tahun 2008 dari 100.000 kasus cedera tulang belakang, 2/3 merupakan kasus cedera servikal. Penilaian awal dilakukan berdasarkan American Spinal Cord Injury Association (ASIA) Impairment Score, sedangkan hasil setelah penatalaksanaannya sering diabaikan untuk evaluasi keberhasilan ahli di rumah sakit. Tujuan penelitian untuk mengetahui nilai functional independence measure (FIM) penderita cedera servikal dengan manajemen konservatif dan korelasinya dengan usia, jenis kelamin, jenis trauma, onset trauma, abnormalitas tulang servikal, lesi cervical spine, dan ASIA Impairment Score. Dilakukan studi kohor prospektif pada semua pasien cedera servikal yang memenuhi kriteria inklusi di Departemen Bedah Saraf Rumah Sakit (RS) Dr. Hasan Sadikin Bandung. Subjek dikelompokkan berdasarkan usia, jenis kelamin, trauma tunggal/multipel, akut/kronik, abnormalitas tulang servikal, lesi komplet/inkomplet, ASIA Impairment Score, dan komplikasi awal cedera. Pada penderita dilakukan penilaian FIM di Poliklinik Bedah Saraf. Data dianalisis menggunakan uji-t dan uji chi-kuadrat dengan p<0,05. Terdapat 17 penderita cedera servikal yang dirawat di Departemen Bedah Saraf RS Dr. Hasan Sadikin Bandung periode April 2009-April 2010. Observasi kohor prospektif nilai FIM rata-rata penderita cedera servikal adalah 4+1,63. Analisis chi-kuadrat menyatakan bahwa tidak terdapat hubungan usia (p=0,064), jenis kelamin (p=0,144), jenis trauma penyerta (p=0,959), onset cedera (p=0,220), abnormalitas tulang servikal (p=0,869) dengan besarnya nilai FIM pasien cedera servikal. Terdapat hubungan jenis lesi cervical spine (p=0,037), ASIA Impairment Score (p<0,001) dengan besarnya nilai FIM penderita cedera servikal. Simpulan, jenis lesi cervical spine dan ASIA Impairment Score memiliki hubungan bermakna dengan besarnya nilai FIM penderita 3 bulan pascacedera servikal. [MKB. 2013;45(3):180-6] Kata kunci: ASIA Impairment Score, cedera servikal, functional independence measure Functional Independence Measure in Patients with Cervical Spine Injury AbstractCervical spine injury is one of the most common spinal cord injuries in trauma patients. From 100,000 spinal cord injury cases reported in the United States of America (2008), 2/3 involved cervical spine injury. American Spinal Cord Injury Association (ASIA) Impairment Score is used as an initial assessment but further prognostic outcome of these patients is often not paid enough attention. The objective of this study was to find the value of functional independence measure (FIM) cervical spine injury patients with conservative management and correlation with age, sex, type of trauma, onset of trauma, cervical bone abnormalities, type of spinal lesion and ASIA Impairment Score. A prospective cohort study was performed to all patients with cervical spine injury which fullfil the inclusion criteria treated in Neurosurgery Department of Dr. Hasan Sadikin Hospital Bandung. The subjects were cla...
Acute traumatic subdural hematoma (SDH) is a focal brain injury resulting in alteration of cerebral perfusion and glucose metabolism, which would also results in hyperglicemia-induced-hyperlactatemia. A cross-sectional study was performed to analyze acute traumatic SDH patients by head CT scan and observe the effect on pre-operative blood lactate and blood glucose levels in 40 acute traumatic SDH patients at Dr. Hasan Sadikin Hospital, Bandung, Indonesia during the period of July-September 2013. Somers' D correlation were used in the analysis with a p-value of ≤0.05 considered as significant with 95% confidence interval. The mean values of pre-operative blood lactate and blood glucose levels were 3.16±1.49 mmol/L and 155.85±32.95 mg/dl, respectively with a strong positive correlation between the hematoma thickness and the increase in blood lactate (r= 0.656; p= 0.021) and a moderate positive correlation with increased blood glucose (r= 0.556; p= 0.025). In addition, the compressed cistern also had a very weak positive correlation with increase in blood lactate (r =0.156; p=0.043) and very weak positive correlation with increase in blood glucose (r= 0.139; p=0.056) while the midline shift had a weak positive correlation with increased blood lactate (r=0.353; p= 0.041) and a weak positive correlation with increased blood glucose (r = 0.333; p= 0.046). In conclusion, increased hematoma thickness, compressed cistern, and midline shift seen on head CT scan correlate with increasing blood lactate and glucose levels in acute traumatic SDH. Head CT scan, blood lactate level, and blood glucose level can be considered as one of the routine examinations to determine acute traumatic SDH severity at the macroscopic and cellular level.
Background : Low Back Pain is pain in the lower back which is a sign of disorder that causes a state of discomfort in performing daily activities and is felt in the anatomical area, especially in the fifth lumbal and sacral area. Low Back Pain will increase as gestational ages. This discomfort begins between the fifth and seventh months of pregnancy. Purpose : To find the relationship between body mass index in the third trimester of pregnancy with Low Back Pain incidence. Method : This research is an observational analytical research with cross-sectional approach. The population of this research is pregnant women in the third trimester who visited poly Obstetrics and Gynecology Hermina Padang Hospital with 77 samples by using consecutive sampling technique. Data analysis uses univariate and bivariate analysis with data processing using the computerized SPSS 23.0 version. Results : The most age were 26-35 years which is 44 people (57,1%), the most likely respondents were those who did not work which is 48 people (62,3%), and the most respondents gestational age is > 36 weeks that is 40 people (51,9 %). The average body weight of the respondent is 65.8277 kg with a minimum body weight 51.51 kg and maximum 80.40 kg. The average height of respondent is 157.99 cm with a minimum height 148 cm and maximum 170 cm. The majority of respondents with an overweight body mass index were 50 people (64,9%), the highest level of LBP pain is 2 (a little pain) which is 26 people (33,8%), with respondents experienced LBP of 61 people (79,2%). Based on the bivariate analysis, it is known that there is a relationship between body mass index in the third trimester of pregnancy with Low Back Pain incidence (p=0.022). Conclusion : The third trimester of pregnant women, the most age is early adulthood (26-35 yars), with the most work is not working, and the most gestational age >36 weeks. The average body weight of the respondent is 65.8277 kg and the average height of the respondent is 157.99cm, the most body mass index is overweight, the highest level of LBP pain is 2 (a little pain), and in the third trimester pregnant women experience the most LBP incidence is yes and there is a relationship between body mass index in the third trimester of pregnancy with low back pain incidence.
Pendahuluan. Hematoma subdural merupakan salah satu cedera otak lokal yang menyebabkan defisit neurologis, memiliki gejala sisa bahkan kematian. Hematoma subdural akut traumatik memicu iskemia serebri melalui peningkatan tekanan intrakranial akibat edema yang menyebabkan gangguan perfusi otak. Angka keberhasilan pengobatan dan perawatan hematoma subdural akut traumatik dinilai menggunakan Glasgow outcome scale yang sederhana, cepat dan mudah dilakukan. Metode. Studi akuasi eksperimental dengan one group pre–post test design dilakukan terhadap 40 penderita hematoma subdural akut traumatik yang masuk Unit Gawat Darurat RS Dr Hasan Sadikin Bandung periode Agustus–Oktober 2013. Penelitian ini menggunakan uji t–test berpasangan dan uji korelasi Spearman. Kemaknaan ditentukan berdasarkan nilai p<0,05 dan confidence interval sebesar 95%. Hasil. Hasil penelitian menunjukkan nilai rerata kadar laktat darah pra dan pasca bedah adalah 3,16+1,49 mmol/L dan 2,38+1,23 mmol/L, terdapat penurunan yang bermakna rerata kadar laktat pasca bedah (p<0,001). Uji korelasi Spearman didapatkan bahwa kadar laktat pra bedah memiliki korelasi negatif lemah dengan nilai glasgow outcome scale (r=–0,346; p = 0,026). Kesimpulan. Pemeriksaan kadar laktat darah pra dan pasca bedah dapat dipertimbangkan sebagai salah satu pemeriksaan rutin dalam menentukan kerusakan seluler dan nilai glasgow outcome scale akibat hematoma subdural akut traumatik
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