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All Journal Medical Journal of Indonesia The New Ropanasuri Journal of Surgery Jurnal Ilmu Bedah Indonesia
Dedy Pratama
Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology

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Journal : The New Ropanasuri Journal of Surgery

 1 
Comparison of Wells Score, D–Dimer and Combination of Wells Score and D–Dimer with Venous Duplex Ultrasonography in Diagnosis of Acute Deep Vein Thrombosis in Lower Extremity Lesmana, Andy; Pratama, Dedy; Wangge, Grace
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Diagnosis of acute deep vein thrombosis (DVT) of lower extremity using available diagnostic tools such as venous duplex ultrasonography (VDUS) encountered problems including cost, time consuming and the operator. A simple and practical tool is required. Thus, we run a study aimed to evaluate the efficacy of Wells score, D–Dimer, or combination of both, compared to VDUS in early detection of acute DVT of lower extremity. Method. A diagnostic study was run using cross–sectional design in Department of Surgery enrolling all adult subjects of which suspected to acute DVT of lower extremity managed in period of January 2014 –December 2015 who met the criteria. The diagnosis was confirmed by VDUS. Those data of medical record were analyzed statistically with diagnostic study to find out the sensitivity and specificity. Results. The study enrolled of 85 subjects. The prevalence of acute DVT of lower extremity was 65.88%. Sensitivity and the highest negative predictive value of 100.00% were found in score combination of II and IV. While as the highest specificity of 89.66% and the highest positive predictive value of 92.68% were found in score combination of III. The score with balanced diagnostic value (sensitivity of 87.50% and specificity of 72.41%) was found in Wells score 3 level I. Conclusion. Wells score and VDUS showed comparable efficacy in detection of acute DVT of lower extremity. Thus, a score could be used as a diagnostic tool.
Risk Factors Associated with Limb Amputation in Necrotizing Fasciitis at dr. Cipto Mangunkusumo General Hospital Jakarta Pratama, Dedy; Harisandi, Sandra
The New Ropanasuri Journal of Surgery
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Introduction. Early diagnosis and management of necrotizing fasciitis of the extremities has an impact on mortality and morbidity. Studies have shown a correlation of risk factors (e.g. gender, gangrene, and comorbid) with increased risk of amputations in necrotizing fasciitis. Method. A cross sectional study conducted on subjects diagnosed as necrotizing fasciitis managed at dr.Cipto Mangunkusumo General Hospital during January 2012 to December 2015. The subject characteristics i.e. gender, age, comorbid, wound presentation, pulse, respiratory rate, temperature, serum creatinine level, hemoglobin content, sodium, and leukocytes level were the variables subjected to statistical analysis. Results. There were 70 subjects enrolled; fifty percent were males. and 60% were less than 60 years old. The most comorbid found were hypertension (34.3%), diabetes mellitus (28.6%). and kidney disease (22.9%). Amputation occurred in 24.28% subjects. Female was shown to have a greater risk of amputation than male (p = 0.012). Diabetes mellitus, skin necrosis, gangrene and serum creatinine level ≥1.6 mg/dL were significantly associated as an amputation risk factor (p <0.005). Based on modified LRINEC scoring, 45 subjects were of high risk and 25 were of medium risk. Multivariate analysis showed three strong predictors for amputation were diabetes mellitus (risk ratio 7.685; 95% CI 1.898– 31.122; p = 0.004), gangrene (risk ratio 6.151; 95% CI 1.539–24.584; p = 0.010), and serum creatinine level >1.6 mg/dL (risk ratio 4.098; 95% CI; 0.937–17.255; p = 0.054). Conclusion. Diabetes mellitus, gangrene, and serum creatinine level >1.6 mg/dL referred as risk factors associated with limb amputation in necrotizing fasciitis .
Intraoperative Blood flow Rate as a Predictor for Maturity of Radiocephalic Arteriovenous Fistula Pratama, Dedy; Darwis, Patrianef; Yang, Andrew Jackson
The New Ropanasuri Journal of Surgery
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Introduction. Arteriovenous fistula (AVF) is the best access for hemodialysis. The failure of arteriovenous fistula maturation is currently a major problem faced today. This study aims to assess whether an intraoperative blood flow rate measured with Doppler ultrasound can be a predictor of the maturity ofradiocephalic AVF. Method. Subjects were patients to be made radiocephalic AVFwith USG mapping according to the standard. Shortly after, the anastomosis blood flow rate was measured with a linear probe Doppler ultrasound. This study used a cross-sectional analytic design to obtain radiocephalic AVF maturation relationship with intraoperative blood flow rate. Results. Radiocephalic AVF (n = 71) in 71 patients were made and evaluated in 6 weeks. The mean intraoperative blood flow rate in mature fistulas was significantly higher than those which did not mature (201.85 and 141.96 mL/min; p 165.5 mL/min has a good predictor value for radiocephalic AVF maturation. Thus, it can be used as a reference to determine whether the surgeon needs for further assessment and revision intraoperatively, which in turn is expected to decrease the maturation failure rate of arteriovenous fistula.
Recanalization After Radio-frequency Ablation (RFA) in Limb Varices at Dr. Cipto Mangunkusumo and Fatmawati General Hospitals from 2015- 2017 Hermansyah, Rudi; Pratama, Dedy; Irfan, Witra
The New Ropanasuri Journal of Surgery
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Introduction. Ligation in upper location and stripping of the varicose veins, enfacing high incidence of failure, recanalization. Endovascular surgery is a modality used to treat limb varicose. However, the recanalization following the procedure was never evaluated. Method. We ran a cohort study on subjects with reflux of the great saphenous vein treated by RFA. Following the RFA procedure, the evaluation proceeded using ultrasound within the first three weeks. Results. A total of 77 subjects were analysed for recanalization post-RFA. Recanalization was found in one subject (1.3%), partial recanalization in 6 subjects (7.79%), and no recanalization in 70 subjects (90.9%). No significant difference between the diameter of the great saphenous vein with the procedure (p <0.001). Conclusion. We concluded that RFA is effective in treating limb varicose. In addition, we found there is no association between recanalization and age, sex, and body mass index statistically.
CO2 Contrast as Alternative Media Contrast for Renal Insufficiency Patient in Angiography: An Evidence Based Case Report Bermana, Frengky; Pratama, Dedy
The New Ropanasuri Journal of Surgery
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The use of iodine contrast, which is more commonly used, is associated with systemic effects in nephrogenic systemic fibrosis, contrast-induced nephropathy (CIN) in patients with kidney function disorders, geriatric, hypertension, and patients with comorbid diabetes mellitus and hypersensitivity reactions. An evidence-based case report was carried out in the Medical Department of Surgery, FKUI-RSCM. The study indicated that the safety of CO2 angiography did not cause CIN to manifest and showing CO2 contrast proved to be safe for patients who have impaired renal function
Co-Authors Alfa Firdaus Anindya P. Susanto Bermana, Frengky Charles Krisnanda Darwis, Patrianef Doreen S-Y. Tan Grace Wangge, Grace Harisandi, Sandra Hean-Ye Ong I Gusti Agung Bagus Krisna Wibawa Irfan, Witra Lesmana, Andy Rasjid Soeparwata Rudi Hermansyah, Rudi Yang, Andrew Jackson