THE TREND AND PROFILE OF THE THORACIC SPINE SURGERY IN NEUROSURGERY DEPARTMENT FACULTY OF MEDICINE UNIVERSITAS INDONESIA – RSUP NASIONAL DR. CIPTO MANGUNKUSUMO 2012 – 2016

Background: Spinal surgery, in general, is increasing in number. The most frequent pathology is degenerative disease, and the most common segment is cervical and lumbar. However, there is limited information concerning the thoracic spine surgeries.Objective: The aim of this study is to describe the trend and profle of the thoracic spine (T-spine) surgeries in the Department of Neurosurgery Faculty of Medicine Universitas Indonesia – RSUP Dr.Cipto Mangunkusumo from 2012 to 2016.Method: This is a retrospective study including all patients who were undergoing T-spine surgery during the period of study from January 2012 to December 2016. The number of T-spine procedureswas recorded and plotted in the trend graph. The data consisting age, gender, indication and procedure of T-spine surgery, and duration of hospital stay were recorded from medical records.Result: In the last fve years, there was an increasing trend of T-spine surgery. A total of 68 surgeries for T-spine performed with 35 female and 33 male subjects. Majority of subjects were aged 41 to 50 years old (28%), with an indication of surgery due to tumours (68%). As many as 76% T-spine surgery was carried out non-instrumented. Duration of hospital stay was 9-13 days.Conclusion: Productive age is the most common age undergoing T-spine surgeries. A spinal tumour is the most frequent indication of the T-spine surgerie

New Predictor of In-Hospital Mortality of The Surgically Treated Haemorrhagic Stroke: Subanalysis

At present there are no specific limits on the level of inflammatory markers which can be used as a boundary between excessive or non-inflammatory responses. We investigate the leukocytes count at hospital admission of spontaneous intracerebral haemorrhage patients to be proposed as a boundary between excessive inflammation and not excessive. This is a subanalysis from the study of the neuroprotective effect of tigecycline on brain injury due to spontaneous intracerebral haemorrhage supratentorial who underwent evacuation of the hematoma. Leukocytosis defined as a leukocyte count ≥ 11.000 cells/mL. The primary outcome was inhospital mortality and the secondary outcome was length of hospital stay (LOS). Statistical analysis conducted by chi-square or Fisher’s exact test and logistic regression. Seventy patients were included. Approximately 79% of the patients had leucocytosis. Leucocytosis was not associated with inhospital mortality or LOS of 15 days or longer. However, a leucocyte count of 20,000 mm3 or higher was associated with in-hospital mortality (odds ratio, 9.09; 95% confidence interval, 1.97 to 42.06; P = 0.005). A leucocyte count of 20,000/mm3 or higher can be proposed as a boundary of the excessive inflammation on spontaneous intracerebral haemorrhage. Prediktor Baru Kematian di Rumah Sakit untuk Pasien Stroke Hemoragik yang Dilakukan Operasi: Hasil Subanalisis Saat ini belum ada penanda khusus untuk menilai suatu respons inflamasi yang berlebihan atau tidak. Penelitian ini bermaksud mengungkap jumlah leukosit tertentu sebagai penanda inflamasi yang berlebihan pada pasien perdarahan otak spontan yang dilakukan operasi evakuasi hematoma intracranial. Penelitian Ini adalah subanalisis dari studi efek neuroprotektif tigecycline pada cedera otak akibat perdarahan intraserebral spontan yang menjalani evakuasi hematoma. Leukositosis didefinisikan sebagai jumlah leukosit ≥ 11.000 sel / mL. Luaran utamanya adalah kematian di rumah sakit dan luaran sekundernya adalah lama perawatan di rumah sakit (LOS= length of stay). Analisis statistik dilakukan dengan chi-square atau uji eksak Fisher dan regresi logistik. Hasil: 70 pasien dilibatkan. Sekitar 79% dari pasien memiliki leukositosis. Leucocytosis tidak berhubungan dengan kematian di rumah sakit atau LOS 15 hari atau lebih. Namun, jumlah leukosit 20.000 mm3 atau lebih tinggi berhubungan dengan kematian di rumah sakit (rasio odds, 9,09; interval kepercayaan 95%, 1,97 hingga 42,06; P = 0,005). Jumlah leukosit 20.000 / mm3 atau lebih tinggi dapat diusulkan sebagai batas peradangan berlebihan pada perdarahan intraserebral spontan.&nbsp

In retrospective, the gentle learning curve of unilateral laminectomy promotes favorable clinical outcomes

Background: The learning curve in implementing a new surgical procedure is often time-consuming and potentially comes with the additional risk of injury associated with an unusual surgical procedure, which may harm the patient. Aim: Evaluate intraoperative burden and neurologic recovery of spinal tumor resection following unilateral laminectomy procedures. Methods: Medical records of patients undergoing surgery for intradural spinal tumors from January 2015 to June 2020 were retrospectively reviewed. Preoperative and postoperative data were collected from medical records and interviews. The intraoperative burden was assessed by duration of surgery, estimated intraoperative blood loss (EIBL), and postoperative leukocyte count. Short-term and long-term outcomes were recorded. Data analysis was performed using descriptive statistics and Fisher's exact test. The neurological recovery rate is calculated by the Hirabayashi method, where a 75–100% score indicates an excellent neurological recovery. Results: Twenty-six records were included in this study. The mean duration of surgery was 180 (120–540) minutes, the mean EIBL was 175 (50 – 1,200) mL, and mean increase in postoperative leukocyte count was 5,670 (2,210 – 13,250) cells/mL, and the mean LOS was 6.5 (4 – 42) days. In 20 of 26 (76.9%) patients, gross total resection was achieved. An excellent neurological recovery rate was achieved in 81% of patients. Conclusion: Unilateral laminectomy procedures are adaptable without additional disadvantages, resulting in satisfactory clinical results

Status Koagulasi Pasien Cedera Kepala Sedang Berdasarkan Tromboelastografi dan Hemostasis Konvensional

 Pasien cedera kepala paling banyak di RSUPN dr. Cipto Mangunkusumo (RSCM), Jakarta adalah cedera kepala sedang (CKS) dan kelainan koagulasi dapat memperburuk luaran pasien cedera kepala. Untuk mengetahui status koagulasi dan luaran pada pasien CKS di RSCM dilakukan studi kohort prospektif pada bulan Oktober 2019 – Januari 2020 dengan subjek 20 pasien CKS. Dilakukan pemeriksaan hemostasis konvensional (trombosit, PT, APTT) dan viskoelastisitas darah menggunakan tromboelastografi (TEG). Dari pemeriksaan konvensional didapatkan gangguan koagulasi pada 5% pasien sedangkan dari pemeriksaan TEG diperoleh 60% subjek dengan gangguan koagulasi (55% hiperkoagulasi dan 5% hipokoagulasi). Median lama rawat inap adalah 7 (3-27) hari dan tidak didapatkan mortalitas. Tidak didapatkan perbedaan bermakna antara pemeriksaan hemostasis konvensional dengan TEG (uji Fisher, p>0,999) serta antara status TEG dengan lama rawat inap (Uji Mann-Whitney, p=0,243). Dari parameter TEG (R time, K time, alpha angle, dan MA) tidak didapatkan perbedaan bermakna dengan lama rawat (uji Mann Whitney dan korelasi Spearman). Terdapat perbedaan bermakna antara parameter TEG, yaitu R time (p<0,001) dan alpha angle (p=0,028) dengan hasil CT scan. Disimpulkan, hiperkoagulasi merupakan kelainan koagulasi yang paling sering pada pasien CKS.   Coagulation Status of Patients with Moderate Traumatic Brain Injury Based on Thromboelastography and Conventional Haemostasis Test   It is known that the majority of traumatic brain injury (TBI) patients in Cipto Mangunkusumo Hospital, Jakarta (RSCM) are comprised of moderate TBI. This prospective cohort study was done in RSCM to evaluate the coagulation status profile of 20 patients with moderate TBI using conventional hemostatic test (platelet count, PT, APTT) and blood viscoelasticity using thromboelastography (TEG) from October 2019 – January 2020. From conventional test, coagulopathy were detected in 5% patients, while from the TEG, coagulopathy were detected in 60% patients (55% hypercoagulopathy and 5% hypocoagulopathy). The outcome of the patients were evaluate using length of stay (LOS) which is 7 days (3-27 days) and mortality (no mortality found in this study). From statistical analysis, the conventional test result and TEG test are not significantly correlated (p>0.999). Thromboelastography test result are not significantly correlated with LOS (p=0.243). From each parameter of TEG (R time, K time, alpha angle, and MA) are not correlated with LOS (Mann Whitney test and Spearman’s correlation test). We found that 2 parameters of TEG, R time (p<0,001) and alpha angle (p=0,028) are significantly correlated with CT scan. In conclusion, hypercoagulopathy is the most coagulation abnormality that occurred in moderate TBI.  &nbsp

Status Koagulasi Pasien Cedera Kepala Sedang Berdasarkan Tromboelastografi dan Hemostasis Konvensional

 Pasien cedera kepala paling banyak di RSUPN dr. Cipto Mangunkusumo (RSCM), Jakarta adalah cedera kepala sedang (CKS) dan kelainan koagulasi dapat memperburuk luaran pasien cedera kepala. Untuk mengetahui status koagulasi dan luaran pada pasien CKS di RSCM dilakukan studi kohort prospektif pada bulan Oktober 2019 – Januari 2020 dengan subjek 20 pasien CKS. Dilakukan pemeriksaan hemostasis konvensional (trombosit, PT, APTT) dan viskoelastisitas darah menggunakan tromboelastografi (TEG). Dari pemeriksaan konvensional didapatkan gangguan koagulasi pada 5% pasien sedangkan dari pemeriksaan TEG diperoleh 60% subjek dengan gangguan koagulasi (55% hiperkoagulasi dan 5% hipokoagulasi). Median lama rawat inap adalah 7 (3-27) hari dan tidak didapatkan mortalitas. Tidak didapatkan perbedaan bermakna antara pemeriksaan hemostasis konvensional dengan TEG (uji Fisher, p>0,999) serta antara status TEG dengan lama rawat inap (Uji Mann-Whitney, p=0,243). Dari parameter TEG (R time, K time, alpha angle, dan MA) tidak didapatkan perbedaan bermakna dengan lama rawat (uji Mann Whitney dan korelasi Spearman). Terdapat perbedaan bermakna antara parameter TEG, yaitu R time (p<0,001) dan alpha angle (p=0,028) dengan hasil CT scan. Disimpulkan, hiperkoagulasi merupakan kelainan koagulasi yang paling sering pada pasien CKS.   Coagulation Status of Patients with Moderate Traumatic Brain Injury Based on Thromboelastography and Conventional Haemostasis Test   It is known that the majority of traumatic brain injury (TBI) patients in Cipto Mangunkusumo Hospital, Jakarta (RSCM) are comprised of moderate TBI. This prospective cohort study was done in RSCM to evaluate the coagulation status profile of 20 patients with moderate TBI using conventional hemostatic test (platelet count, PT, APTT) and blood viscoelasticity using thromboelastography (TEG) from October 2019 – January 2020. From conventional test, coagulopathy were detected in 5% patients, while from the TEG, coagulopathy were detected in 60% patients (55% hypercoagulopathy and 5% hypocoagulopathy). The outcome of the patients were evaluate using length of stay (LOS) which is 7 days (3-27 days) and mortality (no mortality found in this study). From statistical analysis, the conventional test result and TEG test are not significantly correlated (p>0.999). Thromboelastography test result are not significantly correlated with LOS (p=0.243). From each parameter of TEG (R time, K time, alpha angle, and MA) are not correlated with LOS (Mann Whitney test and Spearman’s correlation test). We found that 2 parameters of TEG, R time (p<0,001) and alpha angle (p=0,028) are significantly correlated with CT scan. In conclusion, hypercoagulopathy is the most coagulation abnormality that occurred in moderate TBI.  &nbsp