Background: Herniated nucleus pulposus (HNP) is one of the most common diseases of the spine. For an optimal management and prevention, there's a need for data on factors related to the onset of complaints because this disease lowers the quality of life and increases morbidity. This study is aimed to see the scale and pattern of the HNP in Dr. Hasan Sadikin General Hospital, Bandung. Methods: This is a descriptive study with the design of case series, data was obtained from medical records of patients with the diagnosis of HNP in the inpatient care of Dr. Hasan Sadikin General Hospital in the period of 2007-2011. Results: According to the study on 79 patients, with 43 men and 36 women, the highest incidence was at the age group of 51-60 years old (31.6%) and most common occupation was civil servant (11.4%). The most common clinical symptoms were sciatica (51.9%) and low back pain (51.9%). Most frequent location was in the lumbar vertebrae at the level of L5-S1 (58.2%). Trauma was found to be the highest relatable history in the patients (39.2%). Therapy of choice was primarily conservative (58.2%) and most patients went home after the progression (84.8%). The year 2007 showed the highest prevalence of HNP at 25.3%. The most common clinical symptoms were sciatica (51.9%) and low back pain (51.9%) Conclusions: The most common clinical symptoms were sciatica and low back pain. Most frequent location was in the lumbar vertebrae at the level L5-S1. [AMJ.2015;2(1):

Background: Human papillomavirus (HPV) infections cause a spectrum of clinical disease states, depending on the causative HPV and the characteristics of the infected host, especially the status of cell-mediated immunity. Generalized verrucosis is an unusual clinical presentation of a disseminated HPV infection associated with severe immunodeficiency status. Observations: We present a case of extreme disfigurement associated with an HPV-2 (common wart virus) infection. Virologic studies, immune status of the patient, and treatment(s) are summarized. Conclusions: The severe disfigurement of this patient was a result of an underlying severe immunodeficiency, permissive for a disseminated HPV-2 infection that was allowed to progress for many years before the initiation of therapy. Such a rare case illustrates the natural history of generalized verrucosis in the setting of severe immunodeficiency in the absence of sustained medical interventions. Medical and surgical treatments resulted in marked improvement in the general health of this patient, as well as improvement of the disfigurement that resulted from the generalized verrucosis.

Background: Distal radioulnar joint (DRUJ) instability results from the disruption of the triangular fibrocartilaginous complex consisting of DRUJ's primary and secondary stabilizers. The gold standard of stabilization procedure remains ligament reconstruction that utilizes tendon grafts to reanimate the volar and dorsal radioulnar ligament (RUL) as the primary stabilizers of the joint. The palmaris longus (PL) tendon, the graft of choice in reconstructive surgery, is commonly used in DRUJ reconstruction. However, it can exhibit anatomic variations from agenesis to the variation in morphology, location, and attachment that is rarely encountered other than in cadaveric studies. Case Presentation: We present a case of a 14-year-old boy with ulnar-sided wrist pain and instability following an injury in a boxing match four months before admission. The clinical and radiological results suggested a DRUJ injury with extensor carpi ulnaris (ECU) tendinitis. A ligament reconstruction using the PL tendon graft was planned. Intraoperatively, the PL was found anomalous with dual distal attachments and a short graft length. Results: We performed Adams ligament reconstruction technique with some modifications to the original design. To overcome the under-sized graft, instead of passing it around the ulnar neck, we added one more bone tunnel on the ulna to enhance the construct stability by a tendon to bone healing. Conclusion:In reconstructive surgeries, surgeons should consider the other sources of grafts as graft variations exist. Otherwise, as in our case, modifications to the standard technique can be made.

Reaksi seluler kondrosit osteoartritis pada lutut ditandai dengan peningkatan sitokin tumor necrosis factor-α (TNF-α).TNF-α mengaktifkan fibroblas dan makrofag sinovial untuk menyekresi enzim degradasi dan menekan sintesis proteoglikan rawan sendi sehingga memberikan gambaran histopatologik kartilago yang mengalami perubahan. Osteoartritis sekunder terjadi akibat trauma sendi yang menyebabkan nyeri. Terapi obat seperti non-steroidal anti-inflammatory drugs (NSAIDs) yang digunakan menyebabkan efek samping merugikan jika digunakan dalam jangka panjang. Fraksinasi sarang semut papua (Myrmecodia pendans) diketahui memiliki kandungan salah satunya flavonoid yang berfungsi sebagai anti-inflamasi, antioksidan dan pelindung sel. Berdasar hal tersebut maka ingin diketahui potensi fraksinasi sarang semut papua pada osteoartritis kartilago lutut kelinci dalam menghambat enzim proinflamasi, yaitu TNF-α dan memberikan perbaikan secara histopatologik dibanding dengan kontrol. Penelitian menggunakan uji eksperimental hewan dengan desain experimental comparative menggunakan 8 kelinci ras New Zealand yang dibagi menjadi 2 kelompok, yaitu kelompok kontrol dan kelompok yang diberikan fraksinasi sarang semut papua dengan dosis 2,5 mg/kgBB intra-artikular. Kemudian dilakukan pengukuran kadar TNF-α dan skoring secara histopatologik. Penelitian dilakukan di Fakultas Kedokteran, Universitas Padjadjaran periode Februari-Maret 2017. Pada Uji-t tidak berpasangan untuk TNF-α didapatkan nilai p=0,011; Uji Mann Whitney untuk skoring histopatologik dengan nilai p=0,034 pada kelompok yang diberian fraksinasi sarang semut papua. Terdapat penurunan TNF-α dan perbaikan secara histopatologik pada kartilago osteoartritis lutut kelinci yang diberikan fraksinasi sarang semut papua.

Fibrous dysplasia of the spine in a polyostotic form is very rare, with fewer than 36 cases discussed in the literature and there is no such case in Indonesia that has been reported. The aim of this report is to present a case from Indonesia of polyostotic fibrous dysplasia isolated in the spine. We report a case of a 38-year-old Sundanese man with a 1-year history of progressive back pain and weakness of both lower extremities. There was no history leading to infection and no previous trauma. A physical examination revealed kyphoscoliotic deformity, a caf´e au lait spot, tenderness at the thoracolumbar region, and neurological deficits. Laboratory studies were within normal ranges. Plain radiographs showed lytic lesion and kyphoscoliosis. Magnetic resonance imaging showed an endosteal scalloping, infiltrative process, expansion, and destruction in the vertebral bodies from T2 to L5. The findings of an aggressive destructive process was highly suspicious of a malignant process, relying on differential diagnosis and metastases, plasma cell myeloma, bone tumor and chronic infectious spondylitis. Histology revealed an irregularly oriented osteoid without osteoblastic rimming but surrounded by fibroblastic proliferation with a C-shaped sign. Investigations revealed a diagnosis of polyostotic fibrous dysplasia of the thoracolumbar spine in isolation. The patient underwent T5-S1 stabilization and bone grafting. At 1 year postoperative, the patient was asymptomatic; there was no recurrence and minimal neurological deficit with grade II on the modified McCormick scale. A case of the polyostotic form of fibrous dysplasia of the spine in isolation has never been reported in Indonesia. The extreme rarity of this type of presentation can pose a diagnostic dilemma, and in cases isolated to the spine, surgical treatment with posterior stabilization, decompression, and bone grafting gives a good functional outcome.

Background: Coronavirus disease 2019 (COVID-19) pandemic has affected global health system; in the context of the COVID-19 pandemic, both surgeon and anesthesiologist often dealt with emergency situation, optimal timing of surgery and safety protocol in hospital setting must be implemented with many facets for both patients and health-care providers. Case Description: We reported two cases. Case#1 - A 16-year-old male was referred to our hospital, due to a decreased of consciousness following a motor vehicle accident. Head CT scan revealed an epidural hemorrhage on the left temporoparietal. The patient was suspected for having COVID-19 from the reactivity of his serum against SARS-CoV-2 antigen. Procedures for the confirmation of COVID-19 and surgical preparation caused 12 h delayed from the admission. Nevertheless, the patient was deteriorated clinically before he was transported to the operating room and died after 6 cycles of cardiopulmonary resuscitation. Case#2 - A 25-year-old male was referred to RSHS, due to a decreased of consciousness, diagnosed as bilateral proximal shunt exposed with suspected COVID-19; delay occurred due to unavailability of negative pressure intensive unit for postoperative care. This caused 5760 h (4 days) delayed for bilateral shunt removal and temporary extraventricular drainage. Conclusion: Optimal timing of surgery, a good safety, and health protocol during pandemic in emergency setting are an obligation to protect health providers and patients. A decision-making plan must be organized precisely to maintain alertness, achieve the highest possible standard of care, and outcome in emergency surgical cases. Lack of monitoring must be abated to avoid fatality for patient, especially in emergency surgery setting.

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