Diagnostic validity of blunt abdominal trauma scoring system (BATSS) on blunt adominal trauma in Sanglah General Hospital, Denpasar, Bali

Background: Abdominal trauma is the third leading cause of death in trauma patients and can be found in about 7-10% of the total number of trauma cases. The Blunt Abdominal Trauma Scoring System (BATSS) provides a high-accuracy score system for diagnosing injury to intra-abdominal organs in blunt abdominal trauma patients based on clinical features, such as patient history, physical examination, and Focused Assesment with Sonography for Trauma (FAST). This study aimed to determine the validity of the diagnostic value of BATSS score in cases of blunt abdominal trauma.Method: This research was conducted at Sanglah General Hospital, Denpasar with a total sample of 44 patients. The subjects were abdominal blunt trauma patients who meet the inclusion and exclusion criteria. This study was a retrospective study to determined the validity of the BATSS score.Result: Of the 44 patients, BATSS score ³12 was found at 34 (77.3%) and BATTS <12 scores of 10 (22.7%). For groups with BATSS score ³12, there were 32 (94.11%) patients. As for the group with BATSS score <12, there were 3 (30%) patients with organ rupture. A validity test of BATSS score obtained showed 91.4% sensitivity, 77.77% specificity, positive predictive value 94.1%, negative predictive value 70%.Conclusion: BATSS can be a tool of early identification and stratification of patients at high risk of the occurrence of intra-abdominal organ injury due to blunt abdominal trauma

Clinical predictors of intra-abdominal lesions in blunt abdominal trauma patients with the conservative treatment

Background: Blunt abdominal trauma has a high rate of morbidity and mortality. Assessment of specific clinical symptoms such as abdominal traces, abdominal pain, gross hematuria, pelvic fracture, systolic blood pressure and pulse rate in blunt abdominal trauma patients can predict the presence of intra-abdominal injury, so the use of CT Scan in diagnostics may be selective. The purpose of this study was to determine the predictors of intra-abdominal lesions in patients with blunt abdominal trauma who were treated conservatively.Material and Method: This study used a cross-sectional design. Samples were taken from the medical records, from January 2015 to December 2016. The total sample was 124 patients, were analyzed using Chi-square and logistic regression. This study has passed ethical clearance from the institutional review board of our UniversityResult: The results showed the mean age of patients was 33 years, the majority of patients were male (74.2%), and a negative CT scan was 39.5%. The clinical predictors of intra-abdominal lesions in CT scan of blunt abdominal trauma patients were: abdominal traces (OR: 11.252; 95% CI: 3.257-38.867; p <0.001), abdominal pain with VAS≥5 (OR : 92.968; 95% CI: 14.604-591,837; p <0.001); and gross hematuria (OR: 9.377; 95% CI: 1.539-57.115; p = 0.015). Pelvic fracture, systolic blood pressure, and pulse rate were not statistically proven.Conclusion: Abdominal traces, abdominal pain, and gross hematuria are clinical predictors of intra-abdominal lesions. Predictors should be taken into consideration in decision making to perform an abdominal CT scan in blunt abdominal trauma patients treated conservatively

Diagnostic validity of Thoracic trauma severity score in patient with blunt thoracic trauma for predicting mortality rate

Introduction: The high incidence of blunt thoracic trauma is still a serious concern in emergency services. Mild to severe cases of blunt thoracic trauma that come to the emergency department are not those that can be considered simple but need to be reviewed for the possibility that can lead to the occurrence of advanced complications. This study aims to predict mortality in patient with blunt thoracic trauma with TTS (Thoracic trauma severity) score.Patients and Methods: This is a retrospective study with 52 subjects of blunt thoracic trauma patients treated at our University Hospital from January 2016 to May 2017. Eligible data were collected from medical record analyzed by receiver operating characteristics curve and cross tabulation. Results: The age of the subjects are 48.03±15.62, with male 42 subjects (80.8%) and female ten subjects (19.2%). The mean point of Thoracic trauma severity score (TTSS) was 8.32 ± SD: 2.69.  The outcome was three patients dead (5.8%) and 49 patients discharged (94,2%). The sensitivity of TTSS 100 %, specificity 89.7%, positive predictive value (PPV) 37.5%, negative predictive value (NPV) 100%, and accuracy rate 90.3%. Highly sensitivity and specificity results for Thoracic Trauma Severity Score is valid for the screening of Blunt Thoracic Trauma.Conclusion: At 11.5 cut-off point, the TTSS was an excellent tool to predict the mortality rate of patients with blunt thoracic trauma. It has a 100% sensitivity and 89.7% specificity, as well as 37.5% PPV and 100% NPV

Surgery of Intramedullary Tumours

Surgery still offers a cure to the majority of intramedullary tumours. The challenge of the surgery is taking out the tumour while preserving the function. Very often the patient has a huge tumour with very minimal symptoms, such as mild numbness. The slow growth of the tumour nature provides enough time for the cord fibres to adapt accordingly.  Usually, the motor function is preserved and most of the pathologies are benign. For this reasons, the majority of cases have good long-term tumour control. The functional outcome is depending on the preoperative functional state, especially for motor function. The patient should be educated prior to surgery, especially to anticipate the post-surgical rehabilitation period. The surgical technique should preserve the motor function, but the fine movement usually gets worst for several months after surgery and slowly recover within 6 months. We share our experience of 45 surgical cases with intramedullary tumour (14F;31M), the pathologies distributions are 20 ependymomas, 8 astrocytomas (1/8 anaplastic astrocytoma), 7 cavernomas, 8 hemangioblastomas, 1 glioblastoma multiforme, and 1 tuberculoma. The location distribution varied from 27 at the cervical cord, 11 thoracal, 4 thoracolumbal, and 3 MO-upper cervical. The surgical outcome for all cases experienced sensory changes and recovered over 6 months. Almost all cases experienced some degree of spasticity and fine movement difficulty and they are improving over 6 months. Motor strength is usually preserved. One case of GBM, improve gradually for the first two months then followed by the disease course regardless of the treatment. The tuberculoma case required one year to recover her neurological function with adequate treatment. 

RISK FACTORS OF HIGH INTRACRANIAL PRESSURE AND THE RELATED OUTCOMES IN SUBJECTS WITH SEVERE HEAD INJURY IN SANGLAH GENERAL HOSPITAL DENPASAR

oai:ojs.nsmc.balijournals.org:article/123Background: Severe head injury management target is to prevent the secondary brain injury characterized by deterioration in the outcome. High intracranial pressure (ICP) and low cerebral perfusion pressure (CPP) could cause unfavourable outcomes which is influenced by many factors, such as hypoxia and haemorrhage lesions pictured on head CT scan. This study analyzes various risk factors that can lead to increased ICP and the influence of high ICP on the outcome.Methods: This study is a prospective cohort, involving 42 consecutive subjects with severe head injury patients from June to October 2016. The subjects underwent examination for blood pressure, blood gas analysis, and head CT scan. ICP monitoring was then performed and the outcome was assessed using the Glasgow Outcome Scale score when the patient was discharged. In this study, risk factors such as hypoxia, hypotension, and subarachnoid haemorrhage (SAH) were analyzed. Statistical analysis was performed with SPSS 27 with a confdence interval of 95%.Result: There were two risk factors that signifcantly influenced the increase of ICP, which were hypotension (RR 0.27; 95CI 0.095-0.775; p<0.001) and hypoxia (RR 0.125; 95CI 0.034-0.457; p<0.001). High ICP value ≥ 20 mmHg was associated with an unfavourable outcome(RR 2.28; 95CI 1.31-3.98; p<0.001).Conclusion: Hypoxia and hypotension were two risk factors that signifcantly influenced the increase of ICP, where high ICP caused the unfavourable outcome

Posterolateral Endoscopic Thoracic Discectomy: Transforaminal Approach

Objective: Symptomatic soft herniated thoracic disc (HTD) before the use of magnetic resonance imaging (MRI) was a rare disease with less than 1% of all spinal disc herniation. The frequency of diagnosis of thoracic disk herniation has increased with the routine use of MRI. To avoid high morbidity and complications associated with conventional approach, the authors applied posterolateral endoscopic technique.Methods: From January 2001 to December 2016, 87 patients with non-sequestrated and soft lateral or central thoracic disc herniation underwent posterolateral endoscopic thoracic discectomy (PLETD). Under local anaesthesia with intravenous sedation, we removed the herniated disc through thoracic intervertebral foramen after foraminoplasty. The enlargement of the foramen by partially cutting the lateral aspect of superior facet with a Reamer or high-speed diamond drills. Clinical outcome was measured by the Oswestry Disability Index (ODI) and the visual analogue scale.Results: Fifty-one males and thirty-six females, aged 21 to 89 years were enrolled in this study. Mean follow-up period was 10 months (1 to 56 months). The mean ODI scores improved from 53.7 before surgery to 16.9 at the final follow-up (p <0.05). Mean VAS scores improved from 7.3 before surgery to 2.1 at the final follow-up (p <0.05). One patient required conversion to an open procedure for recurred disc protrusion in 17 days. Another one patient required repeated PLETD for recurring disc in l year. Three patients experienced transient low extremity paresthesia but all improved. There were no other serious complications associated with this procedure.Conclusion: Conventional treatment of HTD is known for its high morbidity and complications, posing a challenge to physicians. This PLETD technique for symptomatic non-sequestrated and soft HTD is a safe and effective method that provides a direct route to the lesion under local anaesthesia with less morbidity.

MINIMALLY INVASIVE SURGERY: A CONCEPTUAL REVIEW

We are living in an era that performs minimally invasive approaches to many surgical aspects, and spine surgery is not an exception. Nowadays, minimally invasive spine surgery is a routine procedure in many countries around the world. It began in the mid-twentieth century and has now developed into a large field of progressive spinal surgery. This paper will review the philosophy, indications, patient selections, advantages, and disadvantages of minimally invasive spinal surgery

CERVICAL MYELOPATHY AS THE MOST COMMON SYMPTOMS IN PATIENTS UNDERGOING C-SPINE SURGERY IN THE SPINE DIVISION, DEPARTMENT OF NEUROSURGERY, CIPTO MANGUNKUSUMO GENERAL HOSPITAL, FROM JANUARY 2012 TO DECEMBER 2016

Background. Cervical spine disease has the potential to reduce productivity in affected patients because of myelopathy and mood disorder (e.g. depression) which lead to decreasing of the patient’s quality of life. Objective. This study aims to elaborate the most frequent symptoms and pathology of C-spine disease in patients who underwent a surgical procedure over the period time from January 2012 to December 2016. Method. This study is a retrospective, conducted in Spine Division of Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia (FMUI). All patients who underwent surgery for the C-spine disease are included. The data was obtained from the records in our spine database. Result. The total number of surgical procedures for spine disease over the 5 years was 345 procedures, with 127 procedures in the C-spine which are the second most common procedures of spine surgery in Department of Neurosurgery FMUI. The C-spine diseases were more common in males, aged more than 50 years old. The most frequent disease or pathology is degenerative disease, and yet, tumour cases show an increasing number and became the most common pathology in the year of 2016. The most common procedure is anterior cervical discectomy and fusion (ACDF).Conclusion. Our study showed that the most common symptoms and pathology are myelopathies and degenerative disease respectively, which has similarity with another study in the term of the most frequent pathology and surgical procedure. The finding of the more advanced neurological condition by the time of surgery as the most common symptom is found to be contradictory with other studies in western countries

PERCUTANEOUS EPIDURAL NEUROPLASTY (PEN) USING COMBINATION OF HYALURONIDASE AND HYPERTONIC SALINE (NaCl 3%) IN TREATING FAILED BACK SURGERY SYNDROME

Background: Following surgical treatments for low back pain, lower extremity pain or neurologic symptoms would last or recur, this is defined as failed sack surgery syndrome (FBSS). FBSS usually occurs in 5-40% of these surgical patients. The most common cause is an epidural scar adhesion. Percutaneous epidural neuroplasty is the non-mechanical treatment for this condition. Previously, the use of hyaluronidase and hypertonic saline separately is commonly used for epidurolysis but the combination of hyaluronidase and hypertonic saline 3% has not been explored.Objective: To investigate the two-year outcomes of percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% in patients with FBSS.Methods: Twelve patients who experience low back pain, with or without radiculopathy, who have underwent lumbar spine surgery previously were assigned to the study. Parameters, such as the visual analogue scale scores for the back (VAS-B) and legs (VAS-L), and the Oswestry disability index (ODI), were recorded and compared between pretreatment, 1 week, 1 month, 3 months, 1 year and 2 years follow-up.Results: For all 12 patients, the postoperative VAS-B, VAS-L, and ODI were significantly different from the preoperative values in all follow-up periods: 1 month, 3 months, 1 year, and 2 years.Conclusion: Based off this study group, percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% has a favourable outcome in the 2 years follow-u

CERVICAL GUNSHOT INJURY

The incident of cervical spine injury and cervical spinal cord injury is between 2.0% to 5.0%. The advanced trauma life support (ATLS) stated that a patient with multiple traumas should be assumed tohave cervical spine injury especially if the patient loses consciousness when present in the ER. It is stressed that cervical spine injury requires continuous immobilization of the patient’s entire body using a semirigid collar as well as a backboard with tape and straps before and during transfer to a defnitive care facility. The understanding of the mechanism of injury is the most important as the forces transferred are signifcantly different causing different injuries. A serial case reported by Walter and Adkins found that there was no signifcant difference between the patients that have a bullet removed from the neck and patients that have a bullet left in the cervical cord. In both cases, there was no improvement to the neurologic outcome. Kupcha recommends doing selective wound management and observation of retained intracanal bullet fragments in a patient with complete lesion. Surgical decompression after the injury is not recommended. We report a case of 14 year old boy who was treated at Sanglah Hospital referred froman out-of-island Type C Hospital with a spinal cord injury - American Spinal Injury Association A (SCI ASIA A) caused by a gunshot wound in the cervical. Surgical decompression and bullet removal was performedas well as fusion stabilization. He is then treated in the intensive care unit for 48 hours with a slight improvement in motoric of upper and lower extremities