Characteristics Of Patients Of Descending Necrotizing Mediastinitis Thoracic, Cardiac And Vascular Surgery Subsection Thoracic In Dr. Mohammad Hoesin From 1 November 2019 To 30 November 2020

Background: Acute mediastinitis is an infection of the connective tissue of the interpleural mediastinal space. The infection may spread through the cervical spaces to the mediastinum, via negative intrathoracic pressure and gravity.1 Management of DNM with minimally invasive drainage, namely video-assisted thoracic surgical drainage (VATS),6 mediastinoscopy,7 and percutaneous catheter drainage,8,9 have been widely used. During early 1920s, data showed subsequent to broad-spectrum antibiotics, the mortality rate was about 40%.12 Furthermore, without prompt diagnosis and aggressive surgery, the mortality rate can reach up to 60%.13 Methods: This retrospective study has a descriptive research design. The number of samples is 19 subjects. Results: From January 1, 2019 to November 30, 2020 there were 19 DNM patients. In this study, most DNM patients were male, average age of 39 years, dental abscesses as the most common source of infection, neck exploration and sternotomy were the most common treatment option, most common outcome death, and the most common result of culture was Acinetobacter baumannii. Conclusion: Good non-operative and operative management can reduce mortality rate.

Effectiveness of Preoperative Incentive Spirometry in Patients Following Elective Thoracotomy for Prevention of Postoperative Pulmonary Complication

Background: Thoracotomy can cause postoperative impairment of respiratory function and highly risk turns as Postoperative Pulmonary Complication (PPC). One of strategies to decrease risk of PPC in preoperative evaluation is lung expansion maneuvers include Incentive Spirometry (IS). Incentive Spirometry was breathing technique that sustained maximal inspiration, using device which give visual feedback. This study aims to know effectiveness of using preoperative IS in reducing incidence of PPC in thoracotomy patients. Methods: Experimental study with post test only design. Comparing emerged PPC with Melbourne Group Scale Version 2 (MDG-2) criteria in elective posterolateral thoracotomy patients who given IS and non IS preoperative. Data were analyzed using chi square test. Results: Total samples was 32 patients. There was 11 patients had PPC, which 6 recieved IS preoperatively. There was no relation between PPC with age, sex, height, smoking history proportion (p value>0,05). Chi square test showed there was no relation between using IS preoperative and PPC incidence(p>0,710). Conclusions: IS preoperative was not effective in preventing PPC in elective thoracotomy patients.

Chest Trauma Score of Thoracic Trauma Patients in Dr. Mohammad Hoesin Palembang January-June 2020

Introduction: Thoracic trauma has mortality rates varying from 10% to 60%. Various scoring frameworks have been created for prognostic value in thoracic trauma patients, including the chest trauma score (CTS). This has not been studied in Indonesian patients. The authors decided to study the picture of CTS in thoracic trauma patients in the Indonesian subpopulation, especially in our hospital. Methods: This research is an analytical observational study at dr. Mohammad Hoesin (RSMH) Palembang in January-June 2020. Our research variables are age, lung contusions, number of rib fractures, bilateral rib fractures, and Chest Trauma Score (CTS). 37 cases could be analyzed with the length of stay, ICU care, mortality, and surgery option. Results: The most common thoracic trauma occurred at the age between less than 45 years, the highest degree of lung contusions was unilateral minor lung contusions. The most common rib fractures were <3 rib fractures. Chest Trauma Score in this study were less than 5. The CTS score had a significant relationship with length of stay and the need of ICU, but was not significantly associated with mortality and surgery option. Conclusion: Chest trauma score can be used to consider the length of treatment and priority needs of the ICU which will be prepared for the management of thoracic trauma patients, especially the young who are accompanied by lung contusions and rib fractures.

Characteristics of Upper Extremity Trauma Patients from Division of Orthopedics and Traumatology in Department of Surgery RSUP Dr. Mohammad Hoesin Since Januari 1 st - December 31 st 2019

Background: Upper extremity trauma is one of the most frequent of trauma that leads to emergency department visitation in every health care facilities. A wide range of manifestations could differently be present from one area to another. Thus, the statistical prevalence number of upper extremity trauma is very important for designing and optimizing the health care service for the purpose of preventive and curative. This study aims to understand the charachteristics of patient with upper extremity trauma that admitted at RSUP Dr. Mohammad Hoesin Palembang emergency department in the period of January to December 2019. Method: This research was an observational descriptive study. Using secondary data from the medical records of Mohammad Hoesin Hospital, Palembang. Performed in the from January 2019 to December 2019. Samples were all upper extremity trauma patients who were admitted at RSUP Dr. Mohammad Hoesin Palembang emergency department in the period of study. Result: There were 54 subjects participated who met the study’s criterias. Most of them were male (76%) with the average of age around 34 years old. It is also dominated with the group of age 25-44 years old (39%), 80% of among all patients have closed and hard tissue trauma. Regio humerus is the most frequent area impacted (16 patients). Most of the patients have worked as private employees (13 patients) with education background till senior high school (38 patients). The etiology of majority trauma is traffic accident (29 patients) that lived outside Palembang area (16 patients). Conclusion: Majority of the upper extremity trauma cases of this study have characteristics as male in productive group of age and the cause of trauma is traffic accident.

3 Years Expeimental Study on Abdominal Aortic Aneurysm Patients Who were Treated with Endovascular Aneurysm Repair at Dr. Mohammad Hoesin Hospital Palembang During 1st of January 2018 – 31st of December 2020

Abdominal aortic aneurysm (AAA) is a focal dilatation of the aortic segment with an increase of 1.5 times the normal value or ≥3 cm. The risk increases in old age and requires alternative surgery such as EVAR. EVAR is more useful in AAA therapy than surgery with wide incisions. This research was descriptive in RSMH Palembang for 5 years in 1st of January 2018 - 31st of December 2020 with variables of patient clinical characteristics and patient CTA results. The results showed that AAA was more common in men, aged 60-69 years with high school education, risk factors such as a history of CHF, hypertension, CAD, and smoking habits. Angiographic CT result showed proximal diameter > 2 cm, PAU, calcification, iliac aneurysm, and lowest renal artery on the left side. All AAA patients had inferior limb thrombus and angulation > 600. The average of aneurysm is 5.8 cm in diameter and 9.23 cm in length. The mean diameter of the right iliac artery differs from the mean diameter of the left iliac artery. The diameter of the right femoral artery also differs from the diameter of the left femoral artery. AAA patients mostly had no history of CKD, COPD, and DM. The patients were hospitalized for an average of 7 days, especially in the ICU for 2 days.

The Relationship Between Onset Time and Outcome Patients Intra Cerebral Ganglia Basalis EC Stroke Hemorrhagic Operations at Dr. Mohammad Hoesin General Hospital Palembang

Background: Spontaneous intracerebral hemorrhage is the second most common stroke subtype defined as non-traumatic hemorrhage to the brain parenchyma, which can extend to the ventricles and into the subarachnoid space. Advances in innovations in the field of surgical intervention compared to conservative therapy are more beneficial in preventing disability in patients. The surgical methods that are often used in nontraumatic intra cerebral bleeding interventions are craniotomy and craniectomy. Many factors influence postoperative patient outcome. The level of patient awareness, the extent of the hematoma are the main predictive factors for patient outcome. Glasgow Outcome Scale is often used to measure the outcome of intracranial bleeding patient care. Method: The study is a case series studies which was conducted by tracing 70 medical records of patients with intra-cerebral ganglia basal hemorrhage due to stroke hemorrhagic who had met the study inclusion criteria from January 2018 to December 2020 who were operated on at the Neurosurgery Installation of RSUP Dr. Mohammad Hoesin Palembang. Results: The mean ICH age in the study was 40 - 60 years (54.23 ± 13.09), male gender were 41 samples (58.6%), mean GCS was 10.93 ± 2.48 (3-15), pressure systolic blood 171.33 ± 24.09 (120 - 240), diastolic blood pressure 98.8 ± 13.46 (70 - 140), most patients ICH with a history of hypertension 68 people (97.1%), 60 people (85.7%) without a history of DM, 57.1% with craniotomy, 59 people with a bleeding volume of 30-60 cc (84.3%), surgery onset ≥ 8 hours (68.6%), uncal herniation (57.1%). Craniotomy and craniectomy were not significantly associated with the prognostic assessment of GOS on ICH (p value = 0.502). Uncal herniation was significantly associated with the incidence of ICH (p value = 0.000). The correlation was strong between time of onset and patient prognosis (p 0.000). Conclusion: There was a significant relationship between onset time and patient outcomes, meaning that the correlation between onset time and patient outcomes was quite strong. The longer the onset time, the more likely it is to have a bad outcome (GOS score 4-5), whereas the faster the onset time, the more likely it is to have a good outcome (GOS score 1-3).

Characteristics of Varicose Vein Patients Underwent Endovenous Laser Ablation (EVLA) in Vascular and Endovascular Surgery Sub-Division of Dr. Mohammad Hoesin General Hospital Palembang Between January 2019 - December 2019

Background: Chronic venous disease is often overlooked by health care providers because it has mild symptoms and low mortality. The most common manifestations of chronic venous disease are varicose veins. Risk factors for varicose veins are multifactorial. We aim to determine the characteristics of varicose vein patients who underwent endovenous laser ablation (EVLA). Method: This research is a retrospective descriptive study and was conducted in January 2019 - December 2019 at the Vascular and Endovascular Surgery Sub-division of the General Hospital dr. Mohammad Hoesin Palembang. The samples were all of varicose vein patients who underwent EVLA and was collected with total sampling. The variables used include age, gender, level of severity/grading, and management. The data obtained were processed descriptively and were presented in tabular and narration. Result: There were 24 subjects meeting research critera. The highest age group for varicose veins was in the age group 55 to 74 years as many as 11 people (45.8%). The most varicose vein patients were found in male as many as 14 people (58.3%). Based on the grading of severity, most were in grade C5, namely 14 people (58.3%). In varicose vein patients based on the type of intervention, the most cases occurred with EVLA and phlebotomy as many as 22 people (91.7%). Most subjects did not experience postoperative recanalization, namely 22 people (91.7%). Conclusion: Male patients aged 55 to 74 years old, with severity grade of C5, treated with EVLA and phlebotomy, and without post-operative complication of recanalization are all the most common characteristics of varicose veins patients in dr Mohammad Hoesin General Hospital Palembang.

Sociodemographic Profile of Encephalocele Patients in Department of Surgery, Neurosurgery Division, Dr. Mohammad Hoesin General Hospital From 2015-2019: A Retrospective Study

Background: Encephalocele is a collection of congenital diseases characterized by protrusion of brain tissue with or without protrusion of the meninges through a defect in the skull.1 Incidence of encephalocele is found in 1 in 35.000 live births in North America and Europe. Five Types of encephalocele based on anatomical location have different patterns, where in western countries it is reported that it is more often located in the occipital area, whereas in Southeast Asia the frontoetmoidal type is more frequently reported. geographic.3 On this basis, this study was carried out. Method:This research is a retrospective study with a descriptive design. Data taken from January 1st, 2015 to December 31st, 2019. Result: There were 27 encephalocele patients with complete medical record data with the most distribution being women, age range 1 month to 1 year, work of self-employed parents, ethnic Sumatran parents, region of occipitocervical lesions, onset of action 1 month to 1 year, and the most complications. is a cele rupture Conclusion: The level of parental awareness and appropriate management of all medical personnel determine the prognosis of encephalocele sufferers.

Characteristics of Peripheral Arterial Disease Patients in Vascular and Endovascular Surgery Department Dr. Mohammad Hoesin General Hospital between January 2018 - December 2019

Background: Peripheral artery disease (PAD) is a chronic occlusive arterial disease of the extremities caused by atherosclerosis leading to stenosis or occlusion characterized by decreased blood flow to the limb, due to obstruction or narrowing of the blood vessels. PAD often underdiagnosed and poorly understood. ​​Median annual expenditure per individual for patients with PAD was $ 11.553 to $ 42.613 in the United States. The lack of data on PAD in South Sumatra was the based for investigators to conducting this study. Methods: This research is a retrospective descriptive study. The purpose of this study was to describe the characteristics of PAD patient based on the Rutherford classification. There are 33 cases in this study. Result: The dominant patient was male, the youngest age was 28 years old and the oldest age was 71 years, with a mean age of 55.8 years. Diabetes mellitus, stage 1 hypertension, LDL more than 100 mg/dL, ABI results that showed PAD, and stage 2 Rutherford were the dominant cases in the sample of this study. Conclusion: Early prevention and treatment from vascular and endovascular surgery can be considered as the most important for the management of peripheral arterial disease patient.

Accuracy of a Novel Scoring System for Prediction of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer Patients

Background: Neoadjuvant chemotherapy (NAC) has become a widely accepted treatment option for locally advanced breast cancer (LABC). Furthermore, response to NAC is considered to be a predictor of favorable outcomes. It is known that some predictors are associated with NAC response. Objectives: To assess the accuracy of scoring system for prediction of response to neoadjuvant chemotherapy in LABC. Methods: Medical record of 50 patients received NAC at Mohammad Hoesin Hospital were retrospectively analysed between July 2019 to July 2020. Response of NAC in LABC was determined with Response Evaluation Criteria in Solid Tumours (RECIST). Variables of the scoring system are risk factors of breast cancer, immunohistochemical subtype, CD4+, CD8+, CD4+/CD8+ ratio, and neutrophil to lymphocyte ratio. Results: A total of 50 patients with LABC received and completed NAC. The mean age was 48.2 ± 11.0 at the time of diagnosis. Good response to NAC was achieved in 38 patients (76.0%). This scoring system shows a sensitivity of 77.8%, a specificity of 83.3%, a positive predictive value of 18.4%, and a negative predictive value of 24.4% with the Youden index of 66.1. The combination between less than three parity and positive estrogen receptor demonstrated better accuracy with a sensitivity of 96.3% and specificity of 77.7% and Youden index 74. Conclusion: This pilot study suggests that this scoring system is potentially useful for predicting response to neoadjuvant chemotherapy in LABC patients and warrants further investigation in a larger population to validate this finding.