Comparison Between Carotid Intima-Media Thickness and Coronary Artery Calcification in the Prediction of Atherosclerosis in Diabetic Patients

BACKGROUND: Cardiovascular disease is one of the atherosclerosis etiologies that can lead to death. Diabetes mellitus increases the risk of atherosclerosis. Screening tool is very beneficial for detecting atherosclerotic plaque, especially in subclinical atherosclerotic cases. Carotid intima-media thickness (CIMT) and coronary artery calcification score (CACS) are two kinds of tools that are widely used, and each of these tools has its own superiority. This study was aimed to investigate the sensitivity and specificity of both of these tools as screening tools.METHODS: The study was conducted with a cross sectional design involving 43 diabetic and 68 non-diabetic male subjects aged above 45 years old. All subjects fulfilled inclusion criteria. Carotid artery ultrasonography and CACS measurement were performed.RESULTS: Fischer exact test was used to show a significant correlation between CIMT and CACS (p<0.05). Diagnostic test was used to assess the sensitivity of CIMT toward CACS in above 75 percentile. The left common carotid artery (LCCA) showed the highest sensitivity either in diabetic (76.4%) or non-diabetic male subjects (90%).CONCLUSION: CIMT has the same sensitivity with CACS. CIMT can be used as the preferred screening tool for high risk patients and as a substitution tool to CACS for low risk patients in subclinical atherosclerosis detection

Intra Arterial Heparin Flushing Increases Cereberal Blood Flow in Chronic Ischemic Stroke Patients

BACKGROUND: Recently, stroke therapy is focused on reperfusion therapies for restoring cerebral blood flow (CBF) and minimizing the undesired effects of neuron ischemia. However, the thrombolytic therapy to restore CBF was restricted with narrow time window. On other hands, not many patients can reach the treatment immediately after the onset of stroke. A wider time window therapy that might increase CBF would probably helpful. This study aims to investigate the CBF improvement after intra arterial heparin flushing (IAHF) therapy in chronic stroke patients.METHODS: A clinical trial was conducted with time sampling. We collected chronic ischemic stroke subjects (with stroke onset ≥30 days) within periods February-September 2015. We investigated CBF before and after IAHF treatment in 75 chronic stroke patients. The difference before and after IAHF treatment in subgroup which is classified with infarct size and lesion area was tested. CBF was measured using MRI Quality Arterial Spin Labeling (qASL) with region of interest around infarct lesion.RESULTS: We found a significant CBF improvement (p<0.001) around infarct area after IAHF treatment with average 10.39mL/100g/min raised. CBF improvement was found in lacunar infarct (p<0.001) and non lacunar (p<0.001), also in infarct in cortical (p<0.05), subcortical (p<0.001) and both area (p<0.05).CONCLUSION: IAHF is associated with increased CBF around infarct area and IAHF probably offers some benefit for chronic stroke

Gastrointestinal Stromal Tumors: a Rare Neoplasm Presenting with Gastrointestinal Bleeding

Gastrointestinal stromal tumors (GIST) are rare tumors of the gastrointestinal (GI) tract that arise from primitive mesenchymal cells. GISTs occur throughout the GI tract but are usually located in the stomach and small intestine. GISTs are known with myoid, neural or mixed features of differentiation. Clinical findings are gastrointestinal bleeding, abdominal pain, and weight loss. GISTs express a heterogeneous clinical course not easily predicted. The histologic features that correlate best with development of recurrence and metastasis are mitotic activity, tumor size and the presence of tumor necrosis and most recently, mutation in the c-kit gene. Some authors specifically use the term GIST to refer to only those mesenchymal tumors that express CD117, whereas others believe that the diagnosis can be made in the absence of CD117 positivity based on clinical and morphologic features. Surgical resection remains the treatment of choice, since chemotherapy and radiation are ineffective. Long-term follow-up is imperative and recurrence rates are high. We report the case of a 60 years old female patient who presented with intermittent melena, chronic dyspepsia, and anemia. Upper digestive tract endoscopy showed a submucosal tumor, broad-based, centrally ulcerated, projection of &gt;5 cm in the gastric corpus-antral wall as the cause of the upper gastrointestinal bleeding. Endoscopic biopsies were negative for neoplastic changes. After triple eradication therapy of Helicobacter pylori and treatment continued with proton pump inhibitor agent, the patient underwent distal gastrectomy with Billroth-I reconstruction. Histopatological studies on the surgical resection specimen revealed a GIST of smooth muscle with spindle cell, no evidence of mitotic activity but of uncertain biological behavior. One year after surgery the patient is was improved with no signs of residual Malignancy. However, metastases were found later in the liver in the next two year

Nilai Diagnostik Usg Color Doppler dan Elastografi Dibandingkan dengan Hasil Biopsi Aspirasi Jarum Halus dalam Menentukan Limfadenopati Leher Jinak dan Ganas

Limfadenopati didefinisikan sebagai sebuah abnormalitas ukuran dan konsistensi dari limfonodus yang bisa terjadi akibat proses infeksi dan inflamasi lainnya. Penelitian ini bertujuan menjelaskan nilai diagnostik USG color Doppler dan Elastografi dalam menentukan limfadenopati leher jinak dan Ganas dibandingkan dengan hasil Bajah. Penelitian ini dilaksanakan di Bagian Radiologi RS Universitas Hasanuddin, Makassar yang dimulai pada bulan Februari-Maret 2018. Desain penelitian menggunakan uji diagnostik. Sebanyak 50 sampel dengan klinis limfadenopati leher. Dilakukan pemeriksaan ultrasonografi color Doppler untuk melihat pola, lokasi vascular serta nilai resistive index, kemudian dilakukan elastografi untuk menentukan elastisitas jaringan. Dilanjutkan dengan melakukan pemeriksaan Bajah untuk menentukan limfadenopati leher jinak dan Ganas sete. Analisis data menggunakan statistik melalui uji diagnostik. Hasil penelitian menunjukkan bahwa dari uji diagnostik, didapatkan pola vaskuler memiliki sensitivitas 72%, spesifitas 92%, akurasi 84%, NPP 88%, NPN 81%. Lokasi vaskuler memiliki sensitivitas 59%, spesifitas 86%, akurasi 80%, NPP 92%, NPN 75%. Nilai resistive indeks didapatkan cut 0ff 0,795 dengan nilai sensitivitas 95,5%, spesifitas 75%, akurasu 84%, NPP 75% dan NPN 95,5%. Apabila dibandingkan dengan USG color Doppler dan elastografi, maka elastografi jauh lebih unggul dalam menentukan limfadenopati leher jinak dan Ganas dengan sensitivitas 95,4%, spesifitas 96,4%, akurasi 96%, nilai prediksi positif 95,4% dan nilai prediksi negatif 96,4%. &nbsp; Lymphadenopathy is defined as an abnormality in the size and consistency of the lymph nodes that can occur due to other infections and inflammatory processes. This study aimed to determine the diagnostic value of ultrasound color Doppler and Elastography in determining the benign and Malignant cervical lymphadenopathy compared with the results of the elephant Research method. This research was conducted in Radiology Department of Hasanuddin University Hospital, Makassar which started in February-March 2018. The research design used the diagnostic test. A total of 50 samples with clinical cervical lymphadenopathy. The color Doppler ultrasound examination was conducted to find out the pattern, vascular location and resistive index value, then the elastography was performed to determine the elasticity of the tissue. After that, a FNA examination was done to determine benign and Malignant cervical lymphadenopathy. The data analysis used the statistic through the diagnostic tests. The research results indicated that the diagnostic test revealed the vascular pattern of 72% sensitivity, 92% specificity, 84% accuracy, NPP 88%, NPN 81%. The vascular site had a sensitivity of 59%, specificity 96%, accuracy of 80%, NPP of 92%, NPN of 75%. The resistive values index obtained 0ff 0.795 with 95.5% sensitivity, 75% specificity, 84% accuracy, 75% NPP, and 95.5% NPN. When compared with Doppler ultrasound and elastography, the elastography was superior in determining benign and Malignant cervical lymphadenopathy with 95.4% sensitivity, 96.4% specificity, 96% accuracy, 95.4% NPP and NPN of 96.4 %. Thus, Doppler ultrasound and elastography had high diagnostic values, which could be used to determine both benign and Malignant cervical lymphadenopathy

Korelasi Ukuran Ketebalan Korteks dan Resistive Index Ginjal Berdasarkan Pemeriksaan Ultrasonografi pada Pasien Hidronefrosis

Hidronefrosis dapat terjadi pada satu atau kedua ginjal yang menyebabkan aliran urine menjadi lemah dan mengganggu fungsi dari ginjal itu sendiri.Penelitian ini bertujuan mengetahui korelasi ketebalan korteks ginjal dan resistive index ginjal berdasarkan pemeriksaan ultrasonografi pada pasien hidronefrosis. Penelitian ini dilakukan di bagian Radiologi Rumah Sakit Umum Pusat Dr. Wahidin Sudirohusodo Makassar dari Mei sampai dengan Agustus 2018. Desain penelitian yang digunakan adalah observasional dengan rancangan potong lintang.Sampel penelitian sebanyak empat puluh orang yang memiliki klinis hidronefrosis. Pemeriksaan ultrasonografi grayscale terhadap pasien dilakukan untuk mengukur ketebalan korteks ginjal yang dilakukan di bagian tengah ginjal pada potongan longitudinal dan diukur dari puncak piramid tegak lurus ke arah kapsul, kemudian dilanjutkan pemeriksaan ultrasonografi doppler di arteri interlobar atau arcuata pada pole superior, median, dan inferior ginjal untuk menilai&nbsp; renal resistiveindex. Data dianalisis dengan analisis statistik melalui uji korelasi Spearman dan Pearson.Hasil penelitian menunjukkan bahwa rerata sampel penelitian mengalami hidronefrosis derajat ringan. Mean tebal korteks ginjal kanan pada penelitian ini 0,9 cm (0,26-1,79cm) dan ginjal kiri 0,84 cm (0,22-1,57cm). Terdapat korelasi yang bermakna antara derajat hidronefrosis dengan ketebalan korteks ginjal kanan dan kiri dengan arah korelasi negatif (p=0,0001). Kecenderungan peningkatan derajat hidronefrosis, meningkatkan nilai resistive index meskipun secara statistik tidak bermakna. Tidak terdapat korelasi antara ketebalan korteks dan resistive index&nbsp; ginjal berdasarkan pemeriksaan ultrasonografi. &nbsp; Hydronephrosis can occur in one or both kidneys which causes the flow of urine to become weak and interfere with the function of the kidney. This research aimed to investigate the correlation between the cortex thickness and the resistive index of kidney based on the ultrasonography examination in hydronephrosis patients.&nbsp; The research was conducted in Radiology Department of Dr. Wahidin Sudirohusodo General Hospital, Makassar from May through August 2018. The research design used was observational using the cross sectional design. The total samples comprised 40 samples with clinical hydronephrosis. The examination of ultrasonography grayscale was carried out in order to measure the cortex thickness of the kidneys in the central parts of kidneys and the longitudinal cut was measured from the pyramid top straight down the capsule, then it was continued with the Doppler ultrasonography examination in the interlobare artery or arcute at superior pole, median and inferior kidney in order to evaluate the renal resistive index. The data were analyzed using the statistical analysis through the correlation tests of Spearman and Pearson. The research results indicated that the mean research samples had experienced the light hydronephrosis. The mean cortex thickness of the right kidney was 0.9 cm (0.26 - 1.79 cm), and that of the left kidnet was 0.84 cm (0.22 - 1.57 cm). There was a significant correlation between the degree of hydronephrosis and the cortex thickness of the right and the left kidneys, with the direction of the negative correlation (p=0.0001). There was a tendency of the increase of hydronephrosis degree to increase the value of resistive index, though statistically it was insignificant. There was no correlation between the cortex thickness and the resistive index of kidney based on the ultrasonogrphy examination. &nbsp