kelainan saluran empedu

Dr Herry Setya Yudha Utama SpB. MHKes. FInaCS. ICS: PRINSIP PRINSIP PENGETAHUAN DASAR BEDAH SARAF

Dr Herry Setya Yudha Utama SpB. MHKes. FInaCS. ICS: PRINSIP PRINSIP PENGETAHUAN DASAR BEDAH SARAF: BAB I PENDAHULUAN                                 Saat  ini tejadi  pengembangan teknik pemantauan neurophysiologic intraoperative....

LITERATUR REVIEW : Penatalaksanaan Trauma Spinal dan Cedera Cervikal

Penatalaksanaan Trauma Spinal dan Cedera Cervikal

II. 1. ANATOMI

Tulang belakang manusia adalah pilar atau tiang yang berfungsi sebagai penyangga tubuh dan melindungi sumsum tulang belakang. Pilar itu terdiri atas 33 ruas tulang belakang yang tersusun secara segmental yang terdiri atas 7 ruas tulang servikal (vertebra servikalis), 12 ruas tulang torakal (vertebra torakalis), 5 ruas tulang lumbal (vertebra lumbalis), 5 ruas tulang sakral yang menyatu (vertebra sakral), dan 4 ruas tulang ekor (vertebra koksigea). Setiap ruas tulang belakang dapat bergerak satu dengan yang lain oleh karena adanya dua sendi di posterolateral dan diskus intervertebralis di anterior. Pada pandangan dari samping pilar tulang belakang membentuk lengkungan atau lordosis di daerah servikal, torakal dan lumbal. Keseluruhan vertebra maupun masing-masing tulang vertebra berikut diskus intervertebralisnya bukanlah merupakan satu struktur yang mampu melenting, melainkan satu kesatuan yang kokoh dengan diskus yang memungkinkan gerakan antar korpus ruas tulang belakang. Lingkup gerak sendi pada vertebra servikal adalah yang terbesar. Vertebra torakal berlingkup gerak sedikit karena adanya tulang rusuk yang membentuk toraks, sedangkan vertebra lumbal mempunyai ruang lingkup gerak yang lebih besar dari torakal tetapi makin ke bawah lingkup geraknya makin kecil.

4, 5

Secara umum struktur tulang belakang tersusun atas tiga kolom, yaitu :

1.      Kolom anterior, terdiri atas ligamentum longitudinal anterior, dua per tiga corpus vertebra, dan diskus intervertebralis bagian anterior

2.      Middle column, terdiri atas corpus vertebrae bagian posterior, diskus intervertebralis bagian posterior, ligamentum longitudinal posterior, ligamentum lateral

3.      Kolom posterior, terdiri atas pedikel, lamina dan prosesus spinosus, ligamentum flavum, ligamentum interspinosus, ligamentum supraspinosus, serta kapsul sendi.

KELAINAN KONGENITAL MUSKULOSKELETAL

kelainan kongenital muskuloskeletalblog from yudhasetya01

DIAGNOSA DAN PENATALAKSANAAN FISTULA ANI

FISTULA ANI

I. DEFINISI

            Fistula ani disebut juga fistel perianal atau fistel para-anal¹. Fistula anorektal (Fistula ani) adalah komunikasi abnormal antara anus dan kulit perianal. Kelenjar pada kanalis ani terletak pada linea dentate menyediakan jalur organisme yang menginfeksi untuk dapat mencapai ruang intramuscular².  

II. ETIOLOGI          

            Fistula dapat muncul secara spontan atau sekunder karena abses perianal (atau perirektal). Faktanya, setelah drainase dari abses periani, hampir 50 % terdapat kemungkinan untuk berkembang menjadi fistula yang kronik. Fistula lainnya dapat terjadi sekunder karena trauma, penyakit Crohn. fisura ani, karsinoma, terapi radiasi, aktinomikosis, tuberculosis, dan infeksi klamidia². 

            Hipotesa kriptoglandular menyatakan bahwa infeksi bermula pada kelenjar ani dan berkembang menuju dinding otot dari sfingter ani yang menyebabkan abses anorektal. Setelah pembedahan atau drainase spontan pada kulit periani, biasanya jaringan granulasi dari traktus tertinggal, menyebabkan gejala yang berulang². 

            Dapat disebabkan oleh perforasi atau penyaliran abses anorektum. Kadang fistel disebabkan oleh colitis yang disertai proktitis, seperti TBC, amubiasis, atau morbus Crohn. Infeksi dari kelenjar intersphincter di anal dengan organisme yang ditemukan di traktus gastrointestinal- baik aerob (Cth : E.coli) dan anaerob (Cth : Bacteroides spp.) – adalah penyebab gangguan yang umum terjadi ini.¹

III. ABSES ANOREKTUM

            Biasanya abses perianal terjadi akibat glandula analis terinfeksi yang mengerosi ke dalam jaringan yang mendasari. Biakan dari fistula abses rektum anal memperlihatkan infeksi campuran dengan E.coli dominan. Penggunaan kronis purgatif dan enteritis regionalis merupakan faktor penyebab yang lazim. Infeksi yang tak lazim seperti aktinomikosis, tuberkulosis, dan penyakit jamur lain, penyakit peradangan pelvis, prostatitis dan kanker bisa jarang menyertai³.

PRINSIP PRINSIP PENGETAHUAN DASAR BEDAH SARAF

BAB I

PENDAHULUAN
               

                Saat  ini tejadi  pengembangan teknik pemantauan neurophysiologic intraoperative. Contohnya termasuk pemantauan saraf tengkorak tengkorak selama operasi dasar, menilai perfusi serebral selama kliping atau endarterectomy aneurisma karotis, pemantauan baik naik dan turun jalur selama operasi tulang belakang, dan pemetaan sensorik, motorik, dan bahasa daerah korteks otak. Sebagian besar pusat kesehatan besar sekarang memiliki personil dan perlengkapan yang didedikasikan untuk pemantauan intraoperative, dan ada kelompok-kelompok swasta yang menawarkan layanan pemantauan berdasarkan kontrak untuk rumah sakit kecil nasional. pemantauan spesialis Syaraf sekarang telah sertifikasi nasional yang ditawarkan oleh Dewan Amerika Monitoring neurofisiologis (tingkat pengawasan) dan Dewan teknolog Terdaftar Amerika elektrodiagnostik (tingkat teknolog). pemantauan Neurophysiologic telah menjadi bagian integral dari prosedur bedah saraf banyak serta dari berbagai ortopedi, otolaryngologic, pembuluh darah, pediatrik, dan prosedur radiologi neurointerventional.

BAB II

NEUROSURGERY

PEMBEDAHAN CRANIUM

            Salah satu aplikasi pertama neurofisiologi intraoperative tengah memantau fungsi saraf wajah selama reseksi neuroma akustik, teknik yang benar-benar dirintis di akhir abad 19 yang mulai digunakan secara luas selama tahun 1980. elektroda jarum kecil ditempatkan di dalam otot-otot wajah untuk merekam potensi elektromiografi, dan stimulasi listrik digunakan untuk peta saraf sehubungan dengan tumor oleh eliciting tanggapan elektromiografi ketika saraf dihubungi. Ambang dan amplitudo tanggapan dapat digunakan untuk mengukur fungsi saraf wajah dan memprediksi hasil pasca operasi. tanggapan elektromiografi mungkin juga menimbulkan oleh acara bedah seperti traksi pada saraf dan dapat mengingatkan ahli bedah untuk lokasi saraf di bidang bedah, yang kemudian dapat dikonfirmasikan dengan stimulasi. Sebaliknya, tidak adanya respon terhadap rangsangan suprathreshold menunjukkan bidang yang reseksi dapat melanjutkan dengan aman. Teknik ini telah terbukti secara dramatis menurunkan kejadian saraf wajah lumpuh berikut reseksi Neuroma akustik, dan menggunakan rutin yang telah direkomendasikan dalam laporan Konsensus Konferensi NIH.

Teknik yang sama dapat digunakan untuk memonitor saraf lainnya bermotor tengkorak oleh penempatan yang sesuai dari rekaman elektroda. Untuk operasi dasar tengkorak anterior, seperti penghapusan atau luas tumor prepontine daerah sinus, saraf ke otot extraocular dapat dipantau dengan menempatkan elektroda hookwire halus ke rektus inferior, oblik superior, dan otot-otot rektus lateral. Komponen motor dari saraf trigeminal dapat dimonitor dengan elektroda di otot temporalis atau masseter. saraf kranial rendah dapat diidentifikasi dengan elektroda di muscle dan genioglossus untuk tumor foramen jugularis atau wilayah foramen magnum. Dengan intubating dengan sebuah pipa endotrakeal khusus elektromiografi (Xomed-Treace), elektromiografi dapat direkam dari otot vocalis, innervated oleh komponen laringeus berulang dari saraf kranial kesepuluh. Dalam semua kasus, reaksi elektromiografi untuk manipulasi bedah dapat waspada ahli bedah untuk lokasi saraf tertentu, dan stimulasi listrik dapat digunakan untuk konfirmasi.

Pengembangan teknik untuk pemantauan saraf sensorik telah lebih sulit. Visual potensi membangkitkan (VEP), yang telah lama digunakan dalam klinik diagnostik dan yang merupakan sarana yang jelas dari pemantauan fungsi saraf optik, yang terkenal stabil dengan anestesi. Meskipun upaya ulang dengan agen anestesi yang berbeda, masalah ini tetap keras, dan fungsi saraf optik adalah untuk alasan jarang dipantau. artefak stimulus berlebihan karena respons latency pendek telah membatasi potensi menimbulkan penerapan somatosensori (SEP) untuk memantau fungsi sensorik trigeminus. N. hanya tengkorak indra yang secara rutin dipantau adalah saraf koklea, yang mudah dapat dinilai dengan hanya sedikit modifikasi respon batang otak (ABR) teknik secara rutin digunakan di klinik Audiologi. Namun, respon amplitudo kecil batas utilitas ini, sejak sinyal rata-rata lebih dari 1 atau 2 menit seringkali diperlukan untuk memperoleh tanggapan-terlalu lambat diulangi untuk penggunaan banyak konteks bedah. rekaman langsung dari saraf koklea yang lebih cepat tetapi membutuhkan sebuah elektroda invasif yang dapat sulit untuk tempat sehingga stabil dan tidak di jalan. teknik pemrosesan sinyal digital menunjukkan janji untuk mempercepat koleksi ABR kali, namun belum mulai digunakan secara luas. Meskipun keterbatasan ini, pemantauan ABR memiliki tempat dalam pengelolaan tumor akustik yang lebih kecil dengan sisa pendengaran yang baik. Hal ini juga berguna dalam mendeteksi peregangan berlebihan saraf koklea selama pencabutan cerebellar untuk dekompresi mikrovaskuler atau prosedur fosa posterior.

Persyaratan anestesi untuk memantau saraf kranial adalah jelas: Tidak relaksan otot harus digunakan kecuali untuk intubasi, karena tanggapan elektromiografi harus terpengaruh. Sebaliknya, semua teknik yang diinginkan dapat digunakan, karena ABR hampir tidak terpengaruh oleh konsentrasi normal dari agen yang umum digunakan seperti N2O, halogenasi uap, opioid, barbiturat, atau propofol. Sumsum tulang belakang.

Salah satu aplikasi paling awal dari pemantauan neurophysiologic intraoperative adalah penggunaan potensi menimbulkan somatosensori (SEP) selama koreksi scoliosis. SEP dicatat dengan metode yang serupa dengan yang digunakan di klinik diagnostik: saraf tepi yang tepat (biasanya median, ulnar, peroneal umum, atau tibialis posterior) yang distimulasi listrik dan rata-rata tanggapan diperoleh dari elektroda kulit kepala dekat daerah kortikal somatosensori serta dari lebih perifer situs. Namun, karena SEP ditengahi terutama oleh kolom punggung, adalah mungkin untuk cedera tulang punggung terisolasi anterior atau iskemia untuk tetap tidak terdeteksi. Ada demikian telah minat yang besar dalam pengembangan teknik untuk pemantauan jalur motor juga tulang belakang. Teknik awal terlibat stimulasi kabel itu sendiri melalui jarum perkutan ditempatkan berdekatan dengan lapisan tulang belakang rostrad ke insisi dan rekaman dari elektroda ditempatkan di atas saraf motorik perifer. Ini disebut "motor menimbulkan neurogenik potensial" (nMEP) memiliki keuntungan bahwa pasien dapat dipertahankan pada agen memblokir neuromuskuler untuk mencegah gerakan dalam menanggapi rangsangan.

DEFINITIONS, SYMPTOMS, SIGNS, DIAGNOSIS AND MANAGEMENT ANAL FISTEL/ DEFINISI,GEJALA,TANDA ,DIAGNOSA DAN PENATALAKSANAAN FISTULA ANI

CHAPTER II
Fistula ANI

I. DEFINITION
Fistula ani also called perianal fistula or fistula para-anal1. Anorectal Fistula (Fistula ani) is an abnormal communication between the anus and perianal skin. Glands in the canal lies in linea dentate ani provides a pathway for the infecting organism can achieve intramuscular2 space.

II. Etiology
Fistulas can occur spontaneously or secondary to perianal abscess (or perirektal). In fact, after drainage of the abscess periani, nearly 50% are likely to develop into a chronic fistula. Other fistulas may occur secondary to trauma, Crohn's disease. ani fissures, carcinoma, radiation therapy, aktinomikosis, tuberculosis, and infections klamidia2.
Kriptoglandular hypothesis states that an infection begins in the gland ani and evolve into the muscular wall of the anal sphincter causing anorectal abscess. After surgical or spontaneous drainage periani on the skin, usually of the granulation tissue tract behind, causing symptoms berulang2.
Can be caused by perforation or abscess penyaliran anorektum. Sometimes fistula caused by colitis with proctitis, such as tuberculosis, amubiasis, or morbus Crohn. Infection of the anal glands intersphincter in organisms found in the gastrointestinal tract-either aerobic (Cth: E. coli) and anaerobes (Cth: Bacteroides spp.) - Is a common disorder that causes ini.1

antibiotika

Sekilas tentang  Inflammation, Infection, & Antibiotics

PENDAHULUAN

Untuk memahami tujuan judul diatas maka akan dibahas dulu tentang, Infeksi bedah adalah infeksi yang (1) adalah tidak seperti  respon  pada nonsurgical (itu biasanya harus dipotong atau dikeringkan) dan menempati ruang unvascularized dalam jaringan atau (2) terjadi di sebuah daerah  yang dioperasikan. Contoh umum dari kelompok pertama adalah radang usus buntu, empiema, gangrene gas, dan sebagian besar abses.

Ahli bedah akrab dengan lingkaran setan operasi atau cedera, infeksi, kekurangan gizi, imunosupresi, kegagalan organ, reoperation, gizi buruk lebih lanjut, dan infeksi lebih lanjut. Salah satu seni rupa operasi adalah untuk mengetahui kapan harus campur tangan dengan eksisi, drainase, dukungan fisiologis, terapi antibiotik, dan terapi gizi. Untuk infeksi yang timbul dalam ruang atau di jaringan mati, sejauh ini aspek yang paling penting dari pengobatan adalah untuk membangun drainase bedah.

Tiga unsur yang umum untuk infeksi bedah: (1) agen menular, (2) rentan host, dan (3) spasi, ditutup unperfused.

. Infeksi Agen
Meskipun beberapa patogen penyebab infeksi yang paling bedah, banyak organisme mampu melakukannya. Di antara organisme aerobik, streptokokus dapat menyerang impas kecil di kulit dan menyebar melalui pesawat jaringan ikat dan limfatik Staphylococcus aureus adalah patogen yang paling umum pada infeksi luka dan sekitar benda asing. Klebsiella sering menyerang telinga bagian dalam dan jaringan usus serta paru-paru. organisme enterik, khususnya Enterobacteriaceae dan enterococci, sering ditemukan bersama-sama dengan anaerob. Di antara anaerob, Bacteroides spesies dan peptostreptococci sering hadir dalam infeksi bedah, dan spesies clostridium adalah patogen utama pada jaringan iskemik. .

SYMPTOMS, SIGNS, DIAGNOSIS AND MANAGEMENT oral cancer / GEJALA , TANDA, DIAGNOSA DAN PENATALAKSANAAN KANKER RONGGA MULUT

CHAPTER I
INTRODUCTION

 Diseases of the oral soft tissues has been a serious concern by experts, especially with the increase in cases of deaths caused by cancer in the oral cavity particularly in countries that are developing.
Oral cancer is approximately 5% of all malignancies occurring in men and 2% in women (Lynch, 1994). It has been reported that oral cancer is a major cancer in India, especially in Kerala where the incident was reported at an average height, about 20% of all cancers (Balaram and Meenattoor, 1996).
Although there is progress in the diagnosis and therapy, and death caused by an abnormality of oral cancer is still high and has long been a problem in the world. Some of the reasons put forward for this is mainly due to the lack of early detection and identification of high-risk groups, and the failure to control the primary lesion and cervical lymph node metastases (Lynch, 1994; Balaram and Meenattoor, 1996).
To overcome the problems caused by oral cancer, the WHO has made instructions for oral cancer control, especially for countries that are developing. Control is based on primary prevention where the main principle to reduce and prevent exposure to substances that are carcinogens. The second approach is through the implementation of secondary prevention, in the form of early detection of cancerous lesions and precancerous oral cavity (Subita, 1997). Folson et al, 1972, estimates that 80% of all cases of oral cancer deaths can be prevented with early detection of malignancy in the mouth (Folson et al, 1972).
In general, for the early detection of oral malignancy in the process can be done through anamnesis, clinical examination and confirmed by additional laboratory examinations. In this paper will put forward measures that can be performed by your dentist to detect early malignant processes in the mouth. It is expected to find a dentist lesions suspected of being malignant process early so the prognosis of oral cancer better.



CHAPTER II
Oral cancer

DEFINITION II.1
A. Restriction
Oral cancer is cancer originating from both epithelial mucosa or salivary glands in the walls of the oral cavity and the mouth organ.
 

SEKILAS TENTANG PRINSIP PRINSIP BEDAH PLASTIK DAN REKONSTRUKSI

SEKILAS TENTANG BEDAH PLASTIK DAN REKONSTRUKSI

Operasi bidang bedah plastik, meskipun dianggap sebagai teknik yang berorientasi khusus, sebenarnya bidang pemecahan masalah.  seorang ahli bedah plastik memungkinkan dia untuk melihat masalah bedah dalam kacamata yang berbeda dan memilih dari berbagai pilihan untuk memecahkan masalah bedah.  bedah plastik dengan pelatihan yang luas, dan sebagian besar telah menyelesaikan residensi di bidang bedah umum,.
            Prinsip-prinsip dasar operasi plastik adalah analisis yang cermat dari masalah bedah, perencanaan yang cermat prosedur, teknik yang tepat, dan penanganan atraumatic jaringan. Perubahan, cakupan, dan transfer kulit dan jaringan terkait adalah prosedur yang paling umum dilakukan. Operasi plastik mungkin menangani penutupan luka bedah-luka terutama bandel seperti yang terjadi pasca radiasi atau buruk penyembuhan luka dalam pemindahan pasien immunocompromised-tumor kulit, perbaikan cedera jaringan lunak atau luka bakar, koreksi yang diakuisisi atau cacat bawaan dari payudara, atau perbaikan cacat kosmetik. Operasi di kepala dan leher dan tangan bedah mungkin membutuhkan pelatihan khusus.      

DEFINISI,GEJALA, DIAGNOSA DAN PENATALAKSANAAN HERNIA INGUINAL / DEFINITIONS, SYMPTOMS, DIAGNOSIS AND MANAGEMENT inguinal hernia

BAB I

PENDAHULUAN

Hernia inguinalis merupakan kasus bedah digestif terbanyak setelah appendicitis. Sampai saat ini masih merupakan tantangan dalam peningkatan status kesehatan masyarakat karena besarnya biaya yang diperlukan dalam penanganannya dan hilangnya tenaga kerja akibat lambatnya pemulihan dan angka rekurensi. keseluruhan jumlah operasi di Perancis tindakan bedah hernia sebanyak 17,2 % dan 24,1 % di Amerika Serikat. ¹

Hernia inguinalis sudah dicatat sebagai penyakit pada manusia sejak tahun 1500 sebelum Masehi dan mengalami banyak sekali perkembangan seiring bertambahnya pengetahuan struktur anatomi pada regio inguinal.¹

Hampir 75 % dari hernia abdomen merupakan hernia ingunalis. Untuk memahami lebih jauh tentang hernia diperlukan pengetahuan tentang kanalis inguinalis. Hernia inguinalis dibagi menjadi hernia ingunalis lateralis dan hernia ingunalis medialis dimana hernia ingunalis lateralis ditemukan lebih banyak dua pertiga dari hernia ingunalis. Sepertiga sisanya adalah hernia inguinalis medialis.Hernia lebih dikarenakan kelemahan dinding belakang kanalis inguinalis. Hernia ingunalis lebih banyak ditemukan pada pria daripada wanita, untuk hernia femoralis sendiri lebih sering ditemukan pada wanita.Sedangkan jika ditemukan hernia ingunalis pada pria kemungkinan adanya hernia ingunalis atau berkembangnya menjadi hernia ingunalis sebanyak 50 % Perbandingan antara pria dan wanita untuk hernia ingunalis 7 : 1. Prevalensi hernia ingunalis pada pria dipengaruhi oleh umur. ¹

Hernia merupakan keadaan yang lazim terlihat oleh semua dokter, sehingga pengetahuan umum tentang manifestasi klinis, gambaran fisik dan penatalaksaan hernia penting.

Tehnology Urology CURRENT AFFAIRS / TEHNOLOGI DIBIDANG BEDAH UROLOGI TERKINI

CHAPTER I
INTRODUCTION

Surgery or operation is a treatment that uses all of the follow-invasive way to open or show the body parts that will be addressed. The opening of the body is generally done by making an incision. Once the parts to be handled is displayed, do the corrective action concludes with the closing and sewing.
Urology is the branch of medicine which studies disorders of the urinary tract and genital male and female urinary tract.
In penetalaksanaan urinary tract and genital abnormalities, science and medical aspects of urology explore aspects of the operative.
Some communities do not yet know or are unfamiliar with the doctor of urology (urologist), although these cases are very much urology.
Most of us probably have a complaint:
• urinate so frequently, straining to urinate and not lampias, or dripping at the end of micturition.
• The pain of colic with reddish or bloody urine, pain while urinating
• Urine is cloudy, or had urinary sandy or rocky.
• Frequent urinating or incontinence.
• There is a congenital malformation of the genitals, such as the testes are not one or both sides, the mouth of the urethra is not at the end of the genitalia (hypospadia).
• Abnormalities of erection / erectile dysfunction in a group of sexual dysfunction
• Abnormalities of fertility or infertility in men
The foregoing are some examples of complaints or disorders related to urology. Medical aspects of the intended management of urology urology kelaianan done a preventive or treatment (Medical) that is not surgery, whereas the operative aspects include the start of surgery that is not invasive to the action that is very invasive.
For example: a man in the diagnosis of kidney stones with a stone the size of a small (<0.5 mm) and found no signs of blockage in the radiological treatment may be recommended ekspektatif the waiting for 2 weeks with lots of drinking and exercises, whereas if the rock is quite there may be many choices of action can be started with no or less invasive, such as ESWL (extra-corporal shock wave lithotripsy), PCNL, URS with litotriptor / special stone-breaking or using a laser. Action is the most invasive open surgery.

PERANAN BIOMOLEKULER (BIOLOGI MOLEKULER) DALAM ILMU BEDAH / THE ROLE OF SCIENCE BIOLOGY MOLECULAR IN SURGERY

BAB I

PENDAHULUAN
Saya herry setya yudha utama, mencoba memaparkan pengetahuan biologi molekuler mudah mudahan bermanfaat

Biologi molekuler merupakan kelanjutan dua cabang ilmu yang sudah ada sebelumnya, yaitu Genetika dan Ilmu Biokimia. Biologi molekuler terutama berkutat memahami interaksi antara berbagai sistem sel, termasuk interaksi antara DNA, RNA dan protein biosintesis dan juga belajar bagaimana interaksi ini diatur. Awal Biologi molekuler ditandai dengan adanya penemuanstruktur heliks ganda DNA oleh Watson dan Crick pada tahun 1953. Penemuan lainnya adalah bahwa suatu gen menentukan suatu protein, mekanismenya dirumuskan dalam konsep yang dikenal sebagai dogma sentral yaitu urutan nukleotida dalam DNA menentukan urutan nukleotida dalam RNA yang selanjutnya menetukan urutan asam amino dalam protein.

Perkembangan biologi molekular menjadi lebih dipercepat dengan munculnya rekayasa genetik yang memungkinkan pengandaan dan isolasi gen sehingga struktur dan fungsi gen dapat dipelajari. Peran sentral dalam kehidupan sel dimainkan oleh protein (polipeptida) dan DNA (gen).Selain peran tradisional protein sebagai enzim, protein memainkan berbagai peran lain sepertimembentuk sitoskeleton dan matriks antar sel, reseptor, hormon, antibodi, faktor pertumbuhan,faktor transkripsi, dan berbagai peran lain. Protein tertentu secara langsung maupun tak langsungmengatur proliferasi dan diferensiasi sel, histogenesis, oranogenesis, bahkan ada protein tertentuyang mengatur kematian sel (apoptosis).

Semua sifat yang dimiliki oleh organisme ditentukanoleh gen-gen yang dimilikinya. Gen merupakan bagian-bagian dari urutan asam nukleat yangterdapat pada DNA. Terdapat dua kategori gen, yaitu gen struktural dan gen regulator. Gen-genstruktural mengkode urutan asam amino dalam protein, seperti enzim, yang menentukankemampuan biokimia dari organisme pada reaksi katabolisme dan anabolisme, atau berperansebagai komponen tetap pada struktur sel. Gen-gen regulator berfungsi mengontrol tingkatekspresi gen struktural, mengatur laju produksi protein produknya dan berhubungan denganrespon terhadap signal intra dan ekstraselular. Karena sintesis protein dikendalikan oleh gen,maka gen dapat dikatakan mengatur segala aspek kehidupan sel atau organisme.Di bidang kedokteran perkembangan biologi molekuler memberi dampak pada hampir semua ilmu pre-klinik seperti: genetika, histologi, embriologi, fisiologi, mikrobiologi, parasitologi, patologi, imunologi, dan farmakologi. Salah satu bentuk peranan biologi molekular dalam bidang kedokteran adalah adanya terapi molekular seperti pada pengobatan penyakit SCID(Severe Combained Immuno Deficiency), penanggulangan penyakit keturunan seperti talasemia,fibrosis kistik, hemfilia, dan penyakit kanker.

BAB II

PEMBAHASAN

1.        RUANG LINGKUP

Biologi Molekuler merupakan cabang ilmu pengetahuan yang mempelajari hubungan antara struktur dan fungsi molekul-molekul hayati serta kontribusi hubungan tersebut terhadap pelaksanaan dan pengendalian berbagai proses biokimia. Secara lebih ringkas dapat dikatakan bahwa Biologi Molekuler mempelajari dasar-dasar molekuler setiap fenomena hayati. Oleh karena itu, materi kajian utama di dalam ilmu ini adalah makromolekul hayati, khususnya asam nukleat, serta proses pemeliharaan, transmisi, dan ekspresi informasi hayati yang meliputi replikasi, transkripsi, dan translasi.

Meskipun sebagai cabang ilmu pengetahuan tergolong relatif masih baru, Biologi Molekuler telah mengalami perkembangan yang sangat pesat semenjak tiga dasawarsa yang lalu. Perkembangan ini terjadi ketika berbagai sistem biologi, khususnya mekanisme alih informasi hayati, pada bakteri dan bakteriofag dapat diungkapkan. Begitu pula, berkembangnya teknologi DNA rekombinan, atau dikenal juga sebagai rekayasa genetika, pada tahun 1970-an telah memberikan kontribusi yang sangat besar bagi perkembangan Biologi Molekuler. Pada kenyataannya berbagai teknik eksperimental baru yang terkait dengan manipulasi DNA memang menjadi landasan bagi perkembangan ilmu ini.

Biologi Molekuler sebenarnya merupakan ilmu multidisiplin yang melintasi sejumlah disiplin ilmu terutama Biokimia, Biologi Sel, dan Genetika. Akibatnya, seringkali terjadi tumpang tindih di antara materi-materi yang dibahas meskipun seharusnya ada batas-batas yang memisahkannya. Sebagai contoh, reaksi metabolisme yang diatur oleh pengaruh konsentrasi reaktan dan produk adalah materi kajian Biokimia. Namun, apabila reaksi ini dikatalisis oleh sistem enzim yang mengalami perubahan struktur, maka kajiannya termasuk dalam lingkup Biologi Molekuler. Demikian juga, struktur komponen intrasel dipelajari di dalam Biologi Sel, tetapi keterkaitannya dengan struktur dan fungsi molekul kimia di dalam sel merupakan cakupan studi Biologi Molekuler. Komponen dan proses replikasi DNA dipelajari di dalam Genetika, tetapi macam-macam enzim DNA polimerase beserta fungsinya masing-masing dipelajari di dalam Biologi Molekuler.

Beberapa proses hayati yang dibahas di dalam Biologi Molekuler bersifat sirkuler. Untuk mempelajari replikasi DNA, misalnya, kita sebaiknya perlu memahami mekanisme pembelahan sel. Namun sebaliknya, alangkah baiknya apabila pengetahuan tentang replikasi DNA telah dikuasai terlebih dahulu sebelum kita mempelajari pembelahan sel.

A.  Tinjauan Sekilas tentang Sel

Oleh karena sebagian besar makromolekul hayati terdapat di dalam sel, maka kita perlu melihat kembali sekilas mengenai sel, terutama dalam kaitannya sebagai dasar klasifikasi organisme. Berdasarkan atas struktur selnya, secara garis besar organisme dapat dibagi menjadi dua kelompok, yaitu prokariot dan eukariot. Di antara kedua kelompok ini terdapat kelompok peralihan yang dinamakan Archaebacteria atau Archaea.

THE ROLE OF SURGERY IN DISASTER MANAGEMENT AND DISASTER PLAN

INTRODUCTION Indonesia is geographically located in areas prone to natural disasters, technological failures and human-induced. This is exacerbated by the crisis in the form of multidimensional complex emergencies, including the social nuances of racial unrest, transportation and industrial accidents and outbreaks of work due to outbreaks of infectious diseases. Even the recent terrorist attacks in the form of bombs are also more intense. This situation always raises a broad impact on the health problems of life and livelihood of human disorders, deaths and illness, environmental damage and health facilities etc.. This leads to health as the spearhead of the disaster response, where the first has always found the victim dead and many sick. Hence the need for knowledge of disaster management so well that in any event of a disaster can be overcome by good without having to take more casualties. Disasters can occur unexpectedly at any time and in various forms such as the Tsunami, Earthquake, Fire, explosion, toxic gas leaks or nuclear radiation and other natural disasters that followed. Natural disasters can cause casualties and huge losses if it can not be controlled with a fast and organized. Large-scale disasters also require an integrated management involving a variety of elements and a great resource, planning and proper management and sustainable education. The most fundamental question is whether we have to deal with every possibility of the worst that will happen due to the effect or impact caused by a disaster? REVIEW REFERENCES

Disaster (disaster) is a serious disruption of the functioning of a community, causing widespread loss of human life in terms of material, economic or environmental and are beyond the ability of communities to cope with their own resources. (ISDR, 2004) Disaster is a combination of threats (Hazard) and vulnerability (Vulnerability). Phenomenon, namely the threat, danger or risks, both natural and unnatural that it can (but not necessarily lead to disasters such as floods, landslides, drought, disease, armed conflict etc.. While the vulnerability is a state within a community that makes them susceptible to the harmful effects from threats such as physical vulnerability, social, and psychological / behavior. Handling or Disaster Management (Disaster Management) Disasters are iterative activities undertaken to control and state disaster daruat, while providing a framework to help masyarakt in a state of high risk for DAPT avoid or recover from disasters. The purpose of disaster management are: A. Reduce or avoid physical harm, economic and life experienced by individuals, masyarakt state. 2. Reduce the suffering of disaster victims. 3. Speed ​​up recovery. 4. Perlindunagan give to refugees or displaced people when life is threatened. For purposes of the above required number of stages in an attempt to deal with a disaster A. Emergency Management; the effort to save lives and protect property and handle the problems of damage and other impacts of a disaster. While the emergency conditions caused by extraordinary events that are beyond the ability of people to face him with the resources or capacity exist so it can not meet basic needs and the drastic decline in the quality of life, health or security threats directly to many people in a kominitas or location. 2. Recovery (recovery) is a process through which that basic needs are met. Recovery process consists of: • Rehabilitation: direct repairs needed that are temporary or short term. • Reconstruction: permanent repairs 3. Prevention (prevension); efforts to eliminate or reduce the possibility of a threat. For example: the creation of dams to prevent flooding, biopori, planting crops on the hillside to avoid flooding and so on. But be aware that prevention can not be 100% effective against most disasters. 4. Mitigation (mitigation); the efforts made to reduce the harm of a threat. For example: the realignment of rural land that floods do not cause large losses. 5. Preparedness (preparedness); the preparation of a plan to act when there is (or is likely to happen) disaster. Planning consists of estimates of the needs in emergencies danidentifikasi on existing resources to meet those needs. This planning can reduce the adverse impact of a threat. Some of the principles of preparedness, among others • Development of information networks and systems of Early Warning Systems Network (Early Warning System / EWS) • Planning and preparation for evacuation of the stock of basic needs (food supplies, medicines, etc.) • Improvements to infrastructure can be used in emergencies, such as communication facilities, roads, vehicles, buildings as shelters etc.. Disaster Medicine Disaster health (health disaster) is penurunanstatus overall public health is not able to overcome. Disaster medicine called humanitarianmedicine which is a branch of medical science in the sense of immediate medical assistance (emergency) and health in disaster management activities regardless of political ideology and statehood. According to WHO reports, the number of deaths from the disaster probabilities of each decade from 1951 to 2000 always decreases although the number of disasters and victims has increased. Similarly, the probability of death due to the data of the earthquake from 1960 to 2001 participated decreased. The decrease was probably caused by the development of disaster medicine in the form of increased activity of prevention, mitigation and coordination system, changes in natural variation, or a combination of management and coordination system with the change of natural variation, but can also be due to inadequate reporting of data. The basic principles of disaster management can be done by eliminating the disaster (preventive), eliminating or reducing the damage inflicted on the population and environment bencanatersebut (therapy), or a combination of preventive and therapeutic. For this, the team must understand the pathophysiology or mechanism of the disaster from the beginning of a hazard to the disaster as shown in Figure 1. They should be able mengembangkanketerampilan and disaster medical knowledge in order to achieve proper control or management, effective and efficient. Therefore, the purpose of management after a disaster is the return on the health status of victims as they are for or against the impact of disasters on the health of the victim or prevent the disaster not occurred. Disaster management strategy must be owned by the team are: (1) modify the hazard to prevent disasters or reduce risk factors resulting in the reduction of negative effects on society and the environment, (2) reduce the vulnerability (vulnerability) and the vulnerability of society and the environment for the future; and (3) improve disaster preparedness in order to damage minimal.1, 7 -, 9 It is concluded that the team should be able to do the prevention, mitigation, eliminating the risk factors to prevent disaster or to prepare the public and the environment to prevent or reduce damage to the victim not cause disaster. Therapy Preparation means to prepare community strategies, teams and hospitals to manage post-disaster victims, the ability to mitigate against the victim as soon as possible, the ability to reduce pain and promote healing and rehabilitation. Preparation also includes warning systems, evacuation and relocation of a safe place, food preparation, medicine, clean water, financing, tents for victims, personnel, and simulation exercises by the team, the community and hospitals. Sample preparation areas Mount Merapi in Yogyakarta to evacuate the population and determine the area / relocation in the event of increased activity of Merapi with simulation training at the Hospital Sardjito.1, 7.10 Eliminating risk factors is to free the possibility of negative effects, because of the team should be able to understand how to eliminate risk factors. Risk factors are called risk maker, like a pile of snow at the top of the mountain may be flooding and mudslides when the snow is melting. Several observational studies show changes in behavior or animals in the area of ​​Mt Merapi is a sign or warning of an increase in volcanic activity. The team should be able to eliminate the risk factors established by personal behavior, lifestyle, culture, environmental factors, characteristics of the descendants of people who related to health. For example, bus accidents occur due to the drivers often consume excessive alcohol, because it is necessary to check levels of alcohol in the driver's body on a regular basis so that bus accident can be prevented or reduced. The team needs to determine the category of victims of the disaster management as follows: (a) minor injuries (walkingwounded), (b) serious injuries (severe Wounded) or the victim was pinned under heavy objects or buildings (burieddeeply under rubble), and (c) the victim died. As a triage team should be able to select victims based on the total score. The highest score should be given help and then transferred to a hospital after the victim kegawatannya resolved. Action Surgery / Medicine are carried out in accordance with what we learned from: A. ATLS è A, B, C, D, E & Traige 2. BSS è Sew sewing, debridement and external fixation 3. Damage Control Surgery è DSTC (Stop & Stop Bleeding Contamination), Triad of Death (hypothermia, coagulopathy, and acidosis is never an uncontrolled) & Compartment Syndrome. 4. Peri Operative Critical Care è Total Care Handling a wide range of disaster medicine: a. Lightly Wounded Generally, minor injuries caused by collision or a mild crush of bodies. Victim left the affected areas to safer areas or family and community / volunteer took him to the health services have been provided by the team or the nearest hospital. Lesions are mostly kontusi, lacerations, fractures and dislocations, strains, sprains, minor head injury, compartment syndrome and the presence of foreign bodies in wounds such as wood, sand or broken glass. The team should be able to do the treatment on the victim such as wound care, antibiotics, anti-tetanus or analgesics, immobilization and resuscitation and treatment of comorbid victims themselves. b. Trauma victims or oppressed by the weight of objects or buildings Serious injuries or victims trapped by heavy objects or buildings are in need of immediate resuscitation aid. That is, the team must have the skills to perform resuscitation as life-savingbersamaan with the release of the victims of the crush of heavy objects and bring to a service that has been prepared. Special to the release of the victims who are isolated in the ruins of the earthquake should always be coupled with resuscitation procedures. This procedure has several difficulties such as the position of the victim and the very limited room for maneuver oxygenation. Therefore, the team must have the skills and specialized equipment to free him. Another issue to consider when building is wedged stability of the building, as subject to collapse again. Bantul is the area with the traditional architecture of the system consists of bamboo and wood, some without a reinforced concrete wall. Most of the victims of the fall of materials or the ground floor walls of the house bare soil resulting in inhalation of dust on the victim. The victim's family or neighbors who do not automatically release the victim injured by improvised means and without the knowledge of disaster medicine. The victim was immediately taken to a safer place or to the health care that has been prepared by a team without thinking of resuscitation. As a triage team to send the victim to a hospital that does not fit with or without the knowledge of life saving facilities. Some communities also took the victim to the hospital by using a private vehicle transportation, truck or bus without thinking first aid. There are also issues that resulted in the victim late Lifesaving assistance, such as the issue of tsunami earthquakes in Yogyakarta, so people are not hurt trying to leave the victim to a safer place and the victim died without help. c. Airway and Ventilation Problems The team must immediately secure the airway (airway) and ventilation to the need for oxygen and rehydration in order to avoid complications of hydration. According to the disaster in Kobe in 1995 and the earthquake in Turkey in 1999 found 12.9% -25% of victims with trauma that cause piston pernapasan.Di Yogyakarta in 2006 found 63 victims of trauma piston so that the concentration of oxygen in tissues is reduced. The team should be able to identify the presence of toxic gases, chemical gases, or dust or inhalation of carbon monoxide in volcanic earthquake, tectonic earthquake, buried in the ground or trapped indoors. All these problems can cause damage to lung function or gas exchange impairment. As a result the victim menjadihipoksia, hiperkrabia, respiratory acidosis, shock, and decreased kesadaran.Korban should be given an oxygen mask or intubation and measured concentrations in peripheral oxygen saturation by oximeter. Generally the victim face down position, the victim is limited space for intubation, and usually the victim is unconscious (coma) or semi-conscious team must have the skills and tools specific to the situation. Many drug induction intubation depends on blood pressure and suffered head trauma victims. Teams often use thiopental, etomidate, ketamine and succinylcholine. These drugs should be considered the advantages and disadvantages to the consumption of oxygen in the brain, heart and respiration activity and vascular conditions of the victim. The use of succinylcholine may result in paralysis, therefore the use of these drugs have to be careful. d. Crush Syndrome The team must predict the crush syndrome in victims of the compression in the long term by a heavy object. More than 40% of disaster victims who suffered crush syndrome alive by a falling heavy object. Report of the earthquake in San Francisco, Armenia (1988), Iran (1990), in the Great Hanshin Awaji earthquake, Japan (1995), and Marmara, Turkey (1999) found that there is a crush syndrome in need of dialysis and died There are also reports disastertidak found abnormalities such as an earthquake in Mexico City in 1985 and in the Philippines in 1990.Tim should be able to diagnose the crush syndrome. Increased muscle strain that will affect the permeability sarkolema and the metabolism of extracellular fluid into the sarkolema which would cause cellular swelling and impaired function that ends the death of muscle cells. Swelling of the muscle will cause compartment syndrome. Intracellular death and muscle into the circulation. The end of this process, the victim will experience hyperkalemia, hypocalcemia, hyperphosphatemia, metabolic acidosis, and myoglobinemia ataumyoglobinuria. The victim will die suddenly (cardiacarrest) or acute renal failure (acute renal failure). Victims of the earthquake or a war that uses a powerful explosive devices can cause crush syndrome, severe damage to soft tissue and muscle, hypovolemic shock, and infection. Therefore, the goal is to improve the management of victims crushsyndrome hydration and urine output (diuresis) that the metabolism of toxic and myoglobin do not cause acute renal failure by hemodialysis. Rehydration treatment is to give Ringer fluid with a dose of 20 ml / kg / hour for children and adults, or 10 ml / kg hour for the elderly or 1-1.5 L in the first hour combined with the administration at a dose of 44 meg bikarbonas / per liter and the maximum 300 ml for the victims who suffered anuri. Mannitol is sometimes needed when the urine output (urine output) <200 ml / hour. Provision of 20% mannitol in combination with Furosemide. When the urine starts out, the infusion should be reduced. The team should monitor the urine out of therapy, blood pressure, and check the peripheral oxygen concentration, respiration and chest auscultation. The team should be able to identify the causes of such crushsymdrome massive muscle damage due to trauma, delayed until at referral hospitals, and inadequate resuscitation during transport and at the referral hospital as well as team personnel skills are very minimal. e. Head Trauma Head trauma due to impact or trapped victims bangunanharus predictable though not visible in the crush room will experience hypoxia, hypertension, and dehydration. Clinical signs of head trauma is impairment of consciousness, signs of lateralization, and convulsions. When there is trauma to the head of the team always predicted the existence of spinal trauma to the cervical area, especially not proved in the next examination. The goal of treatment is to prevent head trauma occurs agartidak hypoxemia and lower blood pressure. Prehospital treatment of severe head trauma must achieve an average blood pressure 90-110 mmHg with saturation (SaO2 = 100%). Oppressed victims of a heavy object to the provision of oxygen even if I have to do intubation with hyperventilation procedure with the use of narcotic sedation. If there are symptoms of a seizure, the victim must be given 10 mg diazepam or phenobarbital intravenas more than 10 mg / kg and followed by 1mg/kg / h. Lowering blood pressure is given 25-50 g intravenous Mannitol and Furosemide 20-40 mg every 4 hours. Antikovulsi drug should not be given to victims who are still trapped under buildings or heavy objects. f. Hypothermia Hypothermia victims need to be estimated on the still under the crush of heavy objects or other disaster, because it is difficult even corrected high-temperature environments. Therefore, open the victim's clothing to perform the initial inspection is only done when there are indications of life-saving. Victims should be covered to prevent hypothermia. Hypothermia has the advantage of the victim as the victim increases the body's defense but also have adverse effects on health. Temperature 32o-33o C can reduce neuronal damage after head trauma, but have a negative effect on the metabolism and hemostatic function. Increased oxygen demand, platelet activation and blood clotting action of the enzyme is inhibited. Can be concluded hypothermia is an independent risk factor early death or due to the crush of disaster victims. The use of heating, wrap the victim, and the heated fluid infusion could not prevent the decrease in temperature of the victim. g. Burns and Inhalation of Dust Burns, inhalation of dust, and damage eyesight or the oppressed victims of the disaster caused by explosion of gas and electricity should be a concern. The team should be able to perform debridement of burns and then closes the wound with sterile gauze, antibiotics and tetanus prophylaxis as tetanus toxoid 0.5 ml and life-saving. h. Victim Dead Death of the victim and also the cause of death Meru feed document very beharga for analysis. Generally, the cause of prehospital death can not be determined because the team is only focused on morbidity. According to Coupland 20-24% of sudden death can be prevented at the disaster site with the proper management and directed. The team and the hospital's medical staff must be able to prepare their transport into the space provided in order to reduce the buildup in the disaster site. Summary The team should be able to understand the disaster that patofisologi accurate casualty management. They also had to respond and prepared to perform resuscitation, prophylactic immunization and medical treatment of victims. They also must be able to monitor the required energy, hydration, and clinical signs of stress that would arise on the team. The team should be able to classify the victims were slightly injured. They come to the services provided. ; Most actions can be wound treatment, antibiotics, tetanus, analgesic. Installation of temporary immobilization and then sent to a referral hospital. Most of the victims to seek help because of life-threatening crush syndrome, hypothermia, pneumotorak, abdominal trauma, or pelvic trauma. Do not forget that the treatment of victims of comorbidities such as angina pectoris pain. Severe injuries or crushed by heavy objects need to be performed resuscitation. The team must immediately release the victims from the rubble crush or heavy objects in conjunction with the primary resuscitation and examination and to prevent sudden death due to hyperkalemia or hypothermia. The team should be able to care for the victim to death and cause of death as the documentation to be analyzed in the future. Members of the victim's body parts are detached or separated must be identified and collected by the main body. Then the victims gathered to a place that has been prepared by the team. Coordination between the team and knowledge of disaster medicine is a factor that strongly supports the success of disaster management disaster. Indonesia has a high risk factor happens then the disaster medicine is mandatory and is required curriculum at undergraduate and post graduate education throughout the medical education center REFERENCE 1. Saunder KO, Birnbaum ML. Health disaster Management Guidelines for Evaluation and Research in the Utstein Style. Prehospital and Disaster Medicine, 2003. 2. Gunn SWA. Multilingual Dictionary of Disaster Medicine and International Relief. Boston: Kluwer Academic Publishers, 2000.p. 23-24 3. Last JM. A Dictionary of Epidemiology. New York, Oxford, Toronto: Oxford University Press 1995.p.149. 4. Pan-American Health Organization/World Health Organization (PAHO/WHO): IDNDR impact meeting, San Jose, Costa Rica, 2001. 5. Al-Mahari AF, Keller AZ. Review of disaster definition. J Prehsp Disast Med 1997;12(1):17-21. 6. Perez E, Thompson P. Natural Hazards: Causes and effects. J Prehosp Disast Med.1994;9(1):80-8. 7. Ashkenazi I, Isakovich B, Kluger Y, Alfici R, Kessel B, Better OS. Prehospital Management of Earthquake Casualties Buried Under Rubble. J Prehosp Disast Med 2005.20(2):122-33. 8. Cuny FC. Introduction to disaster management. Lesson 1: The scope of disaster management. J Prehosp Disast Med 1992; 7(4):400-5. 9. Emami MJ, Tavakoli, AR, Alemzadeh H, Abdimejad F, et al. Strategies in Evaluation and Management of Bam Earthquake Victims. J Prehosp and Disast Med 2005.20(5):327-30. 10. Bremer R. Policy development in disaster preparedness and management: Lessons learned from the the January 2001 earthquake in Gujarat, India. J Prehosp Disast Med 2003.18(4):372-84. 11. Tanaka K. The Kobe earthquake: The system response. A disaster report from Japan. Eur J Emer Med 1996: 3(4):263-9. 12. Bar-Dayan Y, Beard P, Mankuta D. An earthquake disaster in Turkey: An overview of the experience of Israeli Defense Forces Field Hospital in Adapazari. Disaster 2000.24(3):262-70. 13. Schultz CH,Koenig KL, Noji EK. A medical disaster response to reduce immediate mortality after an earthquake. N Engl J Med 1996:334((7):438-44. 14. Grande CM, Baskett PFJ, Donchin Y. Trauma anesthesia for disaster: Anything, anytime, anywhere. Critical Care Clinics 1991: 7(2):339-61. 15. Collins AJ. Kidney dialysis treatment for victims of the Armenian earthquake. N Engl J Med. 1989;320(19):1291-2. 16. Oda J, Tanaka H, Yoshioka T.Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake. J trauma 1997;42(3):470-6. 17. Bywaters EGL. 50 years of crush syndrome. Br Med J 1990;301(6766):1412-32. 18. Daniels M, Reichman J, Brezis M. Mannitol treatment for acute compartment syndrome. Nephron 1998;79(4): 492-3. 19. Smith J, Greaves I. Crush injury and crush syndrome: A review. J Trauma 2003;54:S226-S230. 20. Allister C. Cardiac arrest after crush injury. Br Med J Clin Res 1983:287(6391):531. 21. Collin AJ, Burzstein S. Renal failure in disaster. Critical Care Clinics 1991.7(2):421-35. 22. Coupland RM. Epidemiological approach to surgical management of the casualties of war. BMJ 1994; 308: 1693-7. 23. Moede JD. Medical aspects of urban heavy rescue. J Pre Disast Med 1991;6(3):341. 24. Gentilello LM. Advances in management of hypothermia. Surg Clin North Am 1995;75(2):243-56. 25. Nakamori Y, Tanaka H, Oda J. Burn injuries in the 1995 Hanshin- Awaji earthquake. Burn 1997,23(4):319-22. 26. Hooft PJ, Noji EK, Van de Voorde HP. Fatality management in mass casualty incidents. Forensic Sci Int 1989;40(1):3-14.

SEMINAR NASIONAL PENANGANAN LUKA TGL 14 JULI 2012

Seminar wound revise from yudhasetya01

Dr Herry Setya Yudha Utama SpB. MHKes. FInaCS. ICS: DIFFUSE PERITONITIS DUE TO TYPHOID PERFORATION

Dr Herry Setya Yudha Utama SpB. MHKes. FInaCS. ICS: DIFFUSE PERITONITIS DUE TO TYPHOID PERFORATION: CHAPTER I INTRODUCTION Typhoid fever is a systemic disease caused by Salmonella typhi. The disease is characterized by prolonged heat, ...

DIFFUSE PERITONITIS DUE TO TYPHOID PERFORATION

CHAPTER I

INTRODUCTION
Typhoid fever is a systemic disease caused by Salmonella typhi. The disease is characterized by prolonged heat, the prop with bacteremia without getting involved or endokardial endothelial structure and invasion of bacteria into the cell multiplication as well as mononuclear phagocytes of the liver, spleen, lymph nodes and intestinal Peyer's patches. Until now, typhoid fever remains a public health problem, and associated with poor sanitation, especially developing countries.
In developing countries, the estimated incidence of typhoid fever varies from 10 to 540 per 100,000 population. Although the incidence of typhoid fever came down with a sanitary disposal in many developing countries, estimated that each year there are 35 million cases with 500,000 deaths in the world there. Typhoid fever in Indonesia is still an endemic disease with an incidence rate is still high. Among the diseases that are categorized as intestinal infectious diseases, typhoid fever ranks second after gastroenteritis. 1
Gastrointestinal perforation is a complex form of penetration of the wall of the stomach, small intestine, large intestine result from leakage of intestinal contents into the abdominal cavity. Perforation of the colon can potentially lead to the occurrence of bacterial contamination in the abdominal cavity (a condition known as peritonitis). Gastric perforation developed into a chemical peritonitis caused by leakage of stomach acid kedlam abdominal cavity. Perforation in any form of gastrointestinal distress is a surgical case. 3
In children, injury to the small intestine caused by blunt abdominal trauma from a very rare with 1-7% incidence. Since 30 years ago merupakn peptic ulcer perforation in a common cause. Perforated duodenal ulcer incidence is 2-3 times more than a perforated gastric ulcer. Nearly 1/3 of gastric perforation due to gastric malignancy. Approximately 10-15% of patients with acute diverticulitis can develop into free perforation. In the older patients had a mortality rate of appendicitis acuta as much as 35% and 50% morbidity. The main factors that contribute to morbidity and mortality in these patients is a severe medical conditions that accompany such appedndicitis.
Perforation of the gastrointestinal tract is often caused by diseases such as gastric ulcer, appendicitis, gastrointestinal malignancies, diverticulitis, superior mesenteric artery syndrome, trauma. 2

Iskemik Akut Pada Ekstremitas

Iskemik Akut Pada Ekstremitas

Pendahuluan

adanya Iskemia akut pada ekstremitas merupakan keadaan darurat bedah yang membutuhkan penilaian yang akurat dan manajemen mendesak untuk memaksimalkan menyelamatkan ekstremitas. Manifestasi klinis bisa berbagai macam dari yang agak dramatis dengan nyeri yang hebat dan kehilangan jaringan, ke gejala agak lebih berbahaya tetapi keduanya sama-sama mengancam jiwa. Kelompok utama yang terkena iskemik akut pada ekstremitas sudah berusia lanjut dan akan memiliki manifestasi klinik penyakitlain berupa kelainan kardiovaskuler. Fungsi mental sering dapat mempengaruhi, sehingga menyebabkan penilaian menjadi rumit. Namun, jalur manajemen yang jelas dan tepat sangat penting jika penyelamatan ekstremitas dengan morbiditas minimal ingin dicapai. Secara umum, pada ekstremitas yang terkena iskemik terjadi revascularisasi sangat diharapkan. Namun, tidak selalu penting untuk menyediakan revaskularisasi yang segera dan penilaian pra-operasi ekstensif yang lebih luas lebih diperlukan. Hal ini tidak lagi diterima untuk melanjutkan langsung ke embolectomy sebagai manajemen lini pertama sebagai pengobatan yang efektif mungkin memerlukan kombinasi trombolisis, embolectomy, rekonstruksi arteri dan perhatian pada sistem kardiovaskular secara umum. Mengingat sifat multifaset iskemia akut dan pendekatan yang tersedia baru untuk mengelola kondisi ini, pasien ini paling baik ditangani oleh tim multidisiplin termasuk bedah vaskular, ahli radiologi dan dokter. Pendekatan pada pasien dengan iskemia ekstremitas akut yang biasanya memerlukan amputasi primer kurang dari 10%.  

Pada kelompok usia muda iskemia akut mungkin terkait dengan trauma, salah tempat suntikan infus, pemasangan kateter, abrnormalitas bawaan dari vaskular perifer dan, jarang pada penyakit jantung rematik. Pada pasien yang lebih tua, atherosclerosis dan irama jantung abnormal menjadi faktor utama dan iskemia pada kaki mungkin merupakan manifestasi pertama dari masalah sistemik.

Etiologi 
Penyebab umum dari iskemia tungkai akut adalah: emboli arteri, trombosis, dan trauma. Trauma arteri dan embolisasi perifer sering pada penyakit vaskular. Thrombosis, pada sisi lain, sering menjadi episode akut pada sirkulasi aterosklerotik.

Embolisasi 
Embolus dapat didefinisikan sebagai suatu massa abnormal yang dibawa oleh aliran darah dari satu bagian ke bagian lainnya. Mayoritas dari emboli diproduksi dalam aliran darah dan jantung merupakan sumber utama pada sekitar 80% kasus. Fibrilasi atrium, berkaitan dengan penyakit jantung iskemik dan frekuensi ini lebih jarang ditemukan pada penyakit jantung rematik, bagian dari emboli jantung yang utama. Trombus mural sekunder yang terjadi pada infark miokard merupakan sumber penting bagi pembentukan embolus meskipun kejadian embolisasi pada infark miokard relatif rendah. Sumber terjadinya emboli pada jantung yaitu kardiomiopati, katup jantung buatan, aneurisma ventrikel, emboli paradoxic melalui foramen ovale paten dan shunts intercardiac bawaan.

Pembengkakan Akut Pada Ekstremitas

Pembengkakan Akut

Pada Ekstremitas

Keadaan Edema terjadi akibat akumulasi cairan jaringan yang berlebih pada ruang interstitial. Cairan interstitial merupakan sesuatu yang bersifat statis, dimana produksi transudat merupakan hasil dari kandungan arteri dari jaringan kapiler ke ruang jaringan dan diseimbangkan melalui proses reabsorpsi oleh vena dan sistem limfatik. Sistem limfatik merupakan satu-satunya yang bertanggung jawab dalam mengeluarkan sepersepuluh dari cairan yang direabsorpsi tapi cairan ini penting bagi pengeluaran molekul-molekul protein besar dan partikel lain dari ruang intertsitial.

            Faktor-faktor yang berperan terhadap aliran cairan intertitial meliputi: saringan pada dinding kapiler, tekanan osmotik, absorpsi sistem limfatik, tekanan jaringan, tekanan arteri dan vena. Penyebab utama dari peningkatan transudat kapiler yaitu

·         Peningkatan  tekanan kapiler yang disebabkan oleh peningkatan tekanan vena.

·         Peningkatan permeabilitas kapiler

·         Berkurangnya reabsorpsi cairan interstitial

·         Peningkatan tekanan osmotik pada cairan jaringan

·         Obstruksi atau insufisiensi sistem limfatik

 

Diagnosa Banding

 Untuk Mengetahui perbedaan antara pitting dan non pitting edema sangat berguna tapi biasanya jarang dilakukan dalam membedakan limphoedem. Riwayat adanya limphoedem yang lama dapat mempengaruhi kedua ekstremitas bawah dan meningkatkan terjadinya edema, tidak hanya pada kulit tetapi juga pada jaringan subkutan, dimana karakteristik pembengkakan ini yaitu tidak mudahnya terjadi pitting pada saat penekanan. Gambaran ini mudah diketahui pada keadaan kronik, tapi baru-baru ini penegakan diagnosis limphoedema sudah tidak diragukan lagi. Secara sederhana, edema dibagi menjadi tiga kategori yang masing-masing mempunyai diagnosis banding. Diantaranya:

·         Pitting edema bilateral

·         Pitting edema unilateral yang terasa nyeri

·         edema unilateral yang tidak nyeri

Pitting edema bilateral

·         Gagal jantung

·         Penyakit ginjal

·         Proteinuria

·         Sirosis

·         Karsinomatosis

·         Gangguan nutrisi

Dan pada kasus yang jarang

·         Obstruksi vena kava inferior atau

·         Penyakit pada kedua ekstremitas bawah