Validation of simplified predictive score for postoperative mortality after pancreaticoduodenectomy

Background: Pancreaticoduodenectomy has long been associated with high rates of morbidity and mortality. The key to a better postoperative outcome is a good patient selection. The aim of this study was to develop a simplified preoperative predictive score for postoperative mortality after pancreaticoduodenectomy.Methods: Patients who underwent elective pancreaticoduodenectomy from 1995 to 2012 were identified from the Division of Digestive Surgery database. Bivariate analysis and multivariate logistic regression analysis identified prediction of morbidity and mortality. ROC curve estimation is use to determined the cut-off value of the predictive score.Results: Of 138 patients who underwent pancreaticoduodenectomy, 27 patients (19.6%) died. The predictor of mortality are serum total bilirubin ≥ 10 mg/dL, serum  creatinin ≥ 1.3 mg/dL, hematocrit ≤ 30%, serum albumin ≤ 3.0 g/dL and ASA status ≥ 3, with assign score 1, 1, 2, 1, 1, respectively. The cut-off value was 4 with 96% sensitivity and 91% specificity. The area under the receiver operator characteristic curve was 0.974 (SE 0.011; p &lt; 0.001), which demonstrated a reasonable predictive value for the score.Conclusion: A total score of 4 or more is associated with increased postoperative mortality in patients underwent pancreaticoduodenectomy.</p

Pancreaticoduodenectomy for periampullary tumors at Dr. Cipto Mangunkusumo Hospital, Jakarta

<p>We reported our experience on 31 pancreaticoduodenectomy out of 141 periampullary tumors during 1994 until 2002; 16 of them were female, and age average 17-68 years. Jaundice was the most common presenting sign; 14 patients showed plasma albumin lower than 3.5 g/dl, and 10 patients had bilirubin level more than 10 mg/dl. We performed classical Whipple technique in 17, pyloric preserving pancreaticoduodenectomy in 11, and total pancreaticoduodenectomy in 3 patients. The mean of operative time was 436 minutes (290-570 minutes). The patients were grouped into 2 periods, between 1994-1999 and thereafter. With experience, the amount of blood loss has decreased from 2000 ml to 400 ml. Histopathologic results showed adenocarcinoma of the pancreas head in 11, adenocarcinoma of the ampulla of Vater in 11, carcinoma of duodenum in 4, head of pancreas benign cyst in 2, and benign tumor in 3 patients. The surgical mortality was 4 in the first 12 patients, in contrast to only 1 in the last 19 patients. The most serious complication was pancreatic leakage in 14 patients, in 4 of them it was responsible as the cause of death. The length of stay after operation varied between 12 and 47 days. Until the end of this report 7 patients are still alive, and 4 patients lost of contact. Recurrence was detected in 13 out of 22 survivors, occurring between 4 to 24 months after operation and 12 patients died 2-3 months later. Three patients died due to other causes. We conclude that pancreoticoduodenectomy is an effective technique, and the operative mortality is decreasing. Furthermore, morbidity especially from pancreatic leakages can be treated in our hospital. <em><strong>(Med J Indones 2004; 13: 166-70) </strong></em></p><p><strong>Keywords:</strong> <em>operative outcome, Whipple technique, pancreatic leakage</em></p

Pre operative radiation for icteric type hepatocellular carcinoma A case report

<p>Hepatocellular Carcinoma (HCC) is still a leading health problem worldwide, due to its correlation with HBV and HCV infection and its management which is strongly dependent on patient’s condition and tumor extension. Surgery, with liver resection or liver transplantation offer a good survival rate as a primary management of such cancer. But since liver resection must consider some aspect of liver function and tumor size, and liver transplantation was not a choice in Indonesia, many treatment modalities has been developed which can be used to overcome this problem, such as tumor ablation, transarterial chemo embolization (TACE), chemotherapy and radiotherapy. With the development of conformal radiotherapy, the hepatitis induced radiation therapy could be minimized. This paper present a case of conformal radiation therapy utilization in icteric type HCC in Dr. Cipto Mangunkusumo Hospital, Jakarta. Hepatic resection was planned for this patient. <em><strong>(Med J Indones 2008; 17: 255-8)</strong></em></p><p><strong>Keywords:</strong><em> Hepatocellular Carcinoma, icteric type, radiation therapy, conformal radiotherapy</em></p

Kualitas Hidup Donor Transplantasi Hati pada Resipien Hati Nonsintas

&nbsp;Kualitas pelayanan transplantasi yang baik dinilai berdasarkan kualitas hidup donor dan resipien hati. Evaluasi kualitas hidup pasien donor hati sintas dan nonsintas merupakan hal penting untuk pusat pelayanan transplantasi hati. Penelitian ini bertujuan untuk mengevaluasi kualitas hidup donor hati serta membandingkan kesintasan resipien dengan kualitas hidup donor. Penelitian menggunakan desain potong lintang di Rumah Sakit dr. Cipto Mangunkusumo (RSUPNCM), tahun 2020. Penilaian kualitas hidup dilakukan pada semua donor hati di RSUPNCM mengunakan World Health Organization Quality of Life questionnaire abbreviated version (WHOQoL-BREF). Terdapat 59 donor hati di RSUPNCM; 3 subjek tidak dapat dihubungi dan 1 subjek menolak menjadi subjek penelitian. Kualitas hidup donor hati memiliki median domain kesehatan fisik 69 (44- 100), psikologis 69 (50-94), hubungan sosial 65 (44-100) dan domain lingkungan 69 (31-94). Tidak terdapat perbedaan bermakna antara kualitas hidup donor hati sintas dan nonsintas pada domain kesehatan fisik (p=0,466), psikologis (p=1,0), hubungan sosial (p=0,77) dan domain lingkungan (p=0,13). Disimpulkan subjek donor transplantasi hati di RSUPNCM memiliki kualitas hidup baik. &nbsp; &nbsp; Quality of Life for Donor of Deceased Recipient in Living Donor Liver Transplantation &nbsp; The quality of liver transplantation is assessed based on the quality of life of donors and recipients. Evaluation of the quality of life of liver donors with surviving and non-surviving recipients is important for liver transplant centers. This study aims to evaluate the quality of life of liver donors and compare recipient survival with donors&rsquo; quality of life. This cross-sectional study was performed in National Hospital dr. Cipto Mangunkusumo (NHCM) in 2020. Quality of life was assessed in all of liver donors in NHCM using World Health Organization Quality of Life questionnaire abbreviated version (WHOQoL-BREF). There are 59 liver donors in NHCM. Three subjects could not be contacted, one subject refused to participate in this research. Donors&rsquo; quality of life physical domain median was 69 (44-100), psychological domain median was 69 (50- 94), social relation domain median was 65 (44-100), and environmental domain median was 69 (31-94). There were no significant differences between the quality of life of donors with surviving and non-surviving recipient in physical domain (p=0,466), sychological domain (p=1,0), social relation domain (p=0,77), and environmental domain (p=0,13). In conclusion, liver donors in NHCM have good quality of life&nbsp

Comparison of the efficacy and safety of isepamicin plus metronidazole and amikacin plus metronidazole in intra-abdominal infections

Intra-abdominal infections due to penetrating wound through the abdominal wall or rupture of the gastrointestinal tract are acute conditions requiring prompt surgical intervention and the use of appropriate antimicrobial agents. Isepamicin is an effective aminoglycoside against various Gram-negative pathogens causing intra-abdominal infections. The objective of the present study is to compare the efficacy and safety of isepamicin (15 mg/kgBW IV o.d.) with amikacin (7.5 mg/kgBB b.i.d.), in conjunction with metronidazole for both drugs. An open, randomized, parallel design was applied in this trial. The subject allocation ratio for isepamicin: amikacin is 2:1. Out of 50 patients enrolled in this study, 27 fuffilled the criteria for safety and efficacy population, and 46 for intent-to-treat population. In the safety and efficacy population, the clinical success rare for isepamicin and amikacin group did not differ significantly (i.e., 95% and 100%, respectively). In the intent-to-treat population, the clinical success rates for isepamicin and amikacin group were also insignifficantly different (i.e., 97% and 100%, respectively). The rates of bacteriological elimination for isepamicin and amikacin, were 95% and 100%, respectively in the efficacy and safety population, and 90% and 93%, respectively in the intent-to-treat population. Streptococci and staphylococci were the most frequent (40%) pathogens isolated from pus, and Acinetobacter anitratus (55%) was the most common one isolated from blood. In the efficacy and safety population, the mean (± SD) length of hospital stay in the isepamicin and amikacin groups was 10.7 ± 3.9 and 11.1 ± 3.8 days, respectively, while in the intent-to-treat population, the mean (± SD) length of hospital stay in the isepamicin and amikacin groups was 10.1 ± 3.4 and 10.5 ± 3 days, respectively. In the present study, both aminoglycosides were well tolerated and there was no patient withdrawal associated with side effect. It is concluded that for intra-abdominal infections, intravenous isepamicin given once daily is as effective as intravenous amikacin given twice daily in combination with metronidazole. (Med J Indones 2001; 10: 88-94) Keywords : Isepamicin, amikacin, inta-abdominal infection