Handsewn perineal rectosigmoidectomy (Altemeier) for complete full-thickness rectal prolapse: a case study

Rectal prolapse is a condition in which the entire rectal wall layers protrude through the anal canal. This condition rarely occurs, and the management is still a challenge for both clinician and patient. Rectal prolapse management can be done transabdominally or transperineally. Full-thickness rectal prolapse in principle should have more attention to the rectum function and anal sphincter to prevent recurrence and erectile dysfunction. The Altemeier transperineal recto-sigmoid resection has become the most common for surgical management of rectal prolapse.We report four cases of rectal prolapse, two males and two females with chief complaints had lumps out from their anus. All patients displayed comorbidities. We performed the handsewn Altemeier procedure. All surgeries resulted in minimal intraoperative bleeding. Patients experienced neither incontinence, postoperative fistula, bleeding nor infection. One month after surgery, no patients experienced a recurrence of their complaints.Handsewn Perineal rectosigmoidectomy for the treatment of complete full-thickness rectal prolapse in patients who are having comorbidity can be considered to be an alternative treatment because the procedure is relatively more accessible, safe, and has fewer complications

Chronic wound mitomycin-c-induced animal models

ABSTRACT Chronic wound is a problem often encountered, especially in areas that do not have adequate health facilities. Some of the factors that caused the injury are mechanical, chemical, electrical, or heat. Chronic inflammation and bacterial infections are the two major factors that affect the process of wound chronicity. Mitomycin-C (MMC) is widely used as an intravenous, oral, and topical anti-cancer drug. MMC that is applied topically to a wound can cause cross-linking and decrease or stop the process of DNA transcription so that the wound will not develop the healing phase because MMC works as an inhibitor of fibroblast and proliferation that can inhibit wound healing. This study aimed to create animal models of chronic wound using topical MMC compared to those who given exposure of NaCl without topical MMC. This study used eight female Wistar rats aged 70 to 90 days, weighed between 300 to 350 grams. Wounds were made in the hip area with a diameter of approximately two centimeters. The subjects were divided into two groups. The first group, we compressed the wounds using sterile gauze moistened with MMC 0.5 mg/ml for 5 minutes and rinsed with a saline solution as much as 10 ml6. The second group was compressed using sterile gauze moistened with saline for 5 minutes. On day 3, 5, and 15 we observed the wound profile that was consist of diameter (as an indicator of wound healing), necrosis, and the consistency. The wounds that were compressed using MMC showed brownish-black, dry, thick chronic wounds and took longer to heal compared to those with NaCl. Application of MMC topically on the wound after day 15 showed an inhibition of wound healing process. The animal models showed a slower decrease of wound diameter, fewer scar tissue formation, and development of necrotic tissue

Suplementasi Menir Kedelai Terproteksi dan Minyak Ikan Lemuru untuk Meningkatkan Produktivitas Domba Ekor Tipis.

Kebutuhan daging sebagai komoditas pangan menjadi perhatian serius seiring dengan pertambahan jumlah penduduk. Pemenuhan daging selayaknya tidak hanya terfokus pada sapi dan kerbau, namun juga dapat dipenuhi dengan daging ruminan kecil seperti domba. Domba merupakan komoditas ternak yang banyak dipelihara oleh masyarakat pedesaan. Domba beranak lebih dari satu dan mampu beradaptasi dengan baik pada lingkungan kritis dengan memanfaatkan pakan kualitas rendah seperti limbah pertanian menjadi pakan utamanya. Pertambahan bobot badan pada domba dapat ditingkatkan dengan penambahan pakan konsentrat yang lebih mudah dicerna dibandingkan dengan pakan hijauan. Salah satu pakan yang dapat dijadikan sumber protein untuk meningkatkan pertambahan bobot badan adalah menir kedelai. Sedangkan untuk meningkatkan asupan energi dapat menggunakan minyak ikan lemuru yang memiliki kandungan lemak tak jenuh dan asam lemak Ω-3 tinggi dan tersedia cukup melimpah sebagai limbah pengolahan ikan pada industri pengalengan ikan. Pemberian menir kedelai dan minyak ikan lemuru sebagai bahan pakan lemak tak jenuh akan menghasilkan daging domba dengan kolesterol rendah. Namun, pemberian pakan dengan protein dan asam lemak tak jenuh hanya akan menimbulkan masalah pada proses pencernaan domba. Teknologi proteksi pakan bertujuan agar protein dan asam lemak tak jenuh tidak dirombak di dalam rumen tetapi protein pakan baru akan didegradasi dan asam aminonya akan diserap dalam usus halus. Hal ini penting untuk dilakukan agar produktivitas ternak dan efisiensi pakan dapat meningkat. Salah satu proteksi yang dapat dilakukan adalah dengan menggunakan tanin. Tanin adalah senyawa yang yang terdapat pada tanaman legumonisa. Metode yang digunakan dalam penelitian ini adalah metode eksperimen dengan cara memberikan perlakuan pada pakan domba dengan cara memberikan proteksi tanin pada pakan yang berupa menir kedelai dan minyak ikan lemuru. Penelitian ini dilaksanakan di Kandang Percobaan Jurusan Peternakan Fakultas Pertanian UNS di desa Jatikuwung, Gondangrejo, Karanganyar selama 4 bulan. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh proteksi pakan dengan menggunakan tanin terhadap efis iensi pakan dan produktivitas ternak. Hasil penelitian yang diharapkan dapat 1) memberikan informasi tentang proteksi tanin terhadap pakan dengan protein berkualitas tinggi. 2) mengoptimalkan penggunaan protein dalam meningkatkan produktivitas ternak domba. Luaran yang dihaapkan adalah akan dihasilkan produk pakan suplemen berbahan baku limbah pertanian dan limbah pengalengan ikan yang kaya Ω-3 dan Ω-6 yang akan menghasilkan daging kolesterol rendah. Luaran lain yang diharapkan dari adanya penelitian ini adalah publikasi karya ilmiah yang dilakukan oleh peneliti. Kata Kunci : Domba Ekor Tipis, Proteksi Tanin, Menir Kedelai, Minyak Ikan Lemuru

Detecting miRNAs expression as the early prognostic factor for patients with colorectal cancer in Dr. Sardjito Hospital Yogyakarta : A preliminary study

Background: Colorectal cancer (CRC) is the third highest-ranked cancer and causes high mortality in patients with a low survival rate. The lack of sensitivity and specificity of clinical and other diagnostic modalities results in a higher mortality rate. Therefore, the exploration of potential early biomarkers for CRCs is necessary. Objective: We aimed to evaluate the local expressions of potential tumor suppressor and oncogenic miRNAs in CRC patients in Indonesia. Methods: This retrospective cohort study involving thirty-one colorectal carcinoma patients at Dr. Sardjito Hospital Yogyakarta from January 2014-December 2017. Total RNA was isolated, and the expressions of miR-21, miR-92a, miR-96, miR-26b, miR144, and miR-195 were measured by real-time quantitative PCR. The correlation between miRNAs and other predictors was determined by Spearman correlation, and the association of miRNA expression and other clinical parameters used logistic regression. Results: The local expression of miR-195 decreased significantly in the tumor sites. In contrast, miR-21 activity tends to increase in the local tumor. Meanwhile, the expressions for miR-92a, miR-96, miR26b, and miR-144 in the same subjects were non-significant. MiR-195 was also significantly associated to cancer stage (r=-0.570, p=0.001) with significant odds ratio (OR=0.892, 95% CI=0.804–0.990, p=0.031). Conclusion: Our study was the first to report aberrant expressions of miRNA-21, miRNA-195, miRNA-92a, miRNA-26b, miRNA-96, and miRNA-144 in Indonesian CRC patients. The tumor suppressor miRNA-195 expression was superior among others to serve as an early biomarker in detecting and predicting CRC disease progression

Family-centered rehabilitation in high risk infant; A case report

Preterm infants are categorized as a high-risk group in neonatology. Theyare physiologically less mature and have limited compensatory responsesto the extrauterine environment compared with term infants. Preterminfants need long-term evaluation, monitoring, and follow-up to optimizeneonatal care and development through an extensive rehabilitationperiod. However, the COVID-19 pandemic restricted patient care andfollow-up in the outpatient hospital setting. This case report discusses ahigh-risk infant treated with family-centered rehabilitation (FCR). Thepatient's rehabilitation issues included delays in gross motor, fine motor,and language development and preventing complications that may arisein a high-risk premature infant. Considering recent occurrences, ourapproach to rehabilitation programs for high-risk infants needs to bereevaluated and revised, focusing on home programs through familycentered treatment. These techniques may aid in delivering rehabilitationtreatments to children with developmental delays during COVID-19

The role of focused assessment sonography for trauma (FAST) on the outcomes in patients with blunt abdominal trauma following non-operative therapy: A cohort study

Background: The non-operative management of blunt abdominal trauma had a high success rate and is expected to reduce the length of hospitalization and patients' morbidity. Here, we aim to evaluate the outcomes of patients with blunt abdominal trauma after non-operative management and associate them with prognostic factors. Methods: We performed a retrospective analysis on patients with blunt abdominal trauma who received non-operative management (NOM) at our institution from April 2018 to April 2021. Results: Two hundred eleven patients were included in this study who underwent non-operative management. Most of the subjects (73) were males, with male to female ratio of 2.7:1. Most patients aged 20–29 years old (29.4), FAST negative (62.1), minor injured (45), successfully managed nonoperatively (98.6), received no transfusion (38.9), and injured due to traffic accident (80.1). ISS was significantly associated with FAST (p = 0.028), while male gender, NLR, PLR, and blood transfusion did not (p > 0.05). The presence of external injury was associated with FAST results (p = 0.039), while the head, facial, thoracic, pelvic, and skeletal injuries did not (p > 0.05). We also found a significant correlation between blood transfusion and patient survival with NOM outcomes (p = 0.047 and p = 0.041, respectively). Furthermore, external injury significantly correlated with NOM outcomes (p = 0.042). Multivariate analysis showed that external and pelvic injury was significantly associated with NOM outcomes (p < 0.0001 and p = 0.036, respectively). Conclusions: The results of the FAST examination were not associated with the outcome of non-operative therapy. Moreover, the successful outcome of NOM might be affected by blood transfusions, the presence of external injuries, and pelvic injury. © 202

Comparison and impact of associated anomalies on the anal position index in neonates with anorectal malformation

Objective: Some prognostic factors have affected the functional outcomes of patients with anorectal malformations (ARM) after definitive surgery, including the associated anomalies. Moreover, the anal position index (API) study in neonates from developing countries is minimal. We aimed to (1) compare the API between neonates with ARM and controls; and (2) determine the impact of associated anomalies on the API in neonates with ARM. Results: We ascertained 68 subjects: 35 neonates with ARM and 33 controls. The API of neonates with ARM was similar to controls, either male or female neonates (p = 0.51 and 0.90, respectively). Interestingly, the API in ARM males with associated anomalies (0.42 ± 0.07) was significantly lower than in control males (0.48 ± 0.02) (p = 0.005). Moreover, the API of ARM neonates with vertebral anomalies (0.35 ± 0.04) was lower than ARM neonates without vertebral anomalies (0.47 ± 0.07) (p = 0.021). In conclusion, associated anomalies and sex might affect the API in neonates with ARM. These findings should be considered and informed during counseling to the parents regarding the prognosis of functional outcomes in ARM neonates, particularly with associated anomalies

Prognostic factors for persistent obstructive symptoms in patients with Hirschsprung disease following pull-through.

BackgroundAlthough most patients with Hirschsprung disease (HSCR) improve after pull-through, some patients still have persistent obstructive symptoms. Most previous studies reported persistent obstructive symptoms after pull-through in HSCR patients from developed countries. Our study determined the prognostic factors of persistent obstructive symptoms in patients with HSCR following pull-through from a particular developing country.MethodsA cross-sectional study was conducted using medical records of patients with HSCR at our institution from January 2017 to January 2022.ResultsWe ascertained 114 patients with HSCR: 79 males and 35 females. Most of them (90.4%) showed a short aganglionosis and underwent transanal endorectal pull-through (55.3%). Twenty-two percent of patients showed persistent obstructive symptoms following pull-through. Operative technique and age at definitive surgery were significantly associated with the persistent obstructive symptoms after pull-through (p = 0.011 and 0.019, respectively), while sex, aganglionic segment length, presence of global developmental delay, and Down syndrome were not (p = 0.873, 0.525, 0.647, and 0.301, respectively). Multivariate analysis revealed that age at pull-through was a significant independent factor for persistent obstructive symptoms after pull-through, with an odds ratio of 3.41 (95% CI = 1.18-9.91; p = 0.02).ConclusionsOur study shows a moderate frequency of persistent obstructive symptoms after pull-through in our institution. In addition, patients who underwent pull-throughs at a younger age might have persistent obstructive symptoms following a definitive surgery. Our study provides new data on persistent obstructive symptoms after pull-through from a particular population that might be beneficial for pediatric surgeons' consideration before performing definitive surgery on patients with HSCR

Bladder injury in an incarcerated inguinal hernia in a pediatric patient

Bladder injury is a relatively uncommon side effect of inguinal hernia surgery. One of the causes is bladder ears, i.e., protrusions of the urinary bladder across the deep inguinal ring. Here, we presented a case of bladder injury during inguinal hernia surgery that was found intraoperative and successfully repaired without any sequelae for long-term follow up after surgery. A 10-month-old male came to the emergency department with a chief complaint of swelling and pain on the groin and profuse vomiting. Fluid resuscitation and manual reduction was performed but failed. Therefore, we decided to perform emergency surgery. We accidently opened the bladder during the surgery since mimicking the hernia sac. Fortunately, this injury was found intraoperatively. Subsequently, we repaired the bladder injury, followed by hernia repair. The patient was discharged uneventfully on a post-operative day 7. The patient was regularly followed up for approximately two years after surgery. No sequelae were noted. In conclusions, bladder injury is a rare case that might be occurred during an incarcerated inguinal hernia repair. Surgeons, particularly young surgeons or trainees should be aware of the possibility of bladder ears that might mimic the hernia sac and injured during the hernia repair

Integrated Propranolol, Methylprednisolone, And Surgery In Managing A Rare Case Of Infantile Hemangioma With Concurrent Cleft Lip And Palate

Abstract Infantile hemangioma (IH) with concurrent cleft lip and palate is a rare case. Surgical management is often considered as the best management for infantile hemangioma with concurrent cleft lip and palate. However, considering the functionality aspect and aesthetic appearance, a plastic surgeon can also consider non-surgical management without interrupting the surgical timeline for the cleft lip and palate. This case report aimed to describe the role of oral propranolol and oral methylprednisolone for infantile hemangioma with concurrent cleft lip and palate alongside the surgical management for cleft lip and palate. A 2-month-old presented with complaints of swelling in her right upper nose and cheek along with cleft lip and palate. She was treated with oral propranolol and oral methylprednisolone. Labioplasty was performed when she was three months old. Palatoplasty and nasorraphy were done when she was one year old. A significant reduction of the hemangioma was seen and the corrective procedures showed a good result. The use of propranolol and methylprednisolone for infantile hemangioma in our patient shows a good result even when combined with labioplasty, palatoplasty, and nasorraphy for cleft lip and palate. The management of infantile hemangioma with concurrent cleft lip and palate using oral propranolol and oral methylprednisolone shows a good result with no side effects and can be elaborated with labioplasty, palatoplasty, and nasorraphy, and will not interrupt the cleft lip and palate surgical timeline