Introduction: Traumatic Brain Injury is a case that is often encountered in emergency care installation and is one of the leading causes of death in the productive age range. Globally, the Traumatic Brain Injury incident increased sharply, mainly due to the increase in motorized vehicle use. In 2020,  the WHO estimated that traffic accidents would be the third-largest cause of disease and trauma in the world. In Indonesia, at Cipto Mangunkusumo Hospital Jakarta shows that the mortality rate is high in patients with severe head injuries with a percentage of 35% -50%. This figure is higher than the international literature standard. This study aims to describe the traumatic brain injury case in Wahidin Sudirohusodo Hospital from January 2016 - December 2017.

Methods: This descriptive study report the evaluation of cases of traumatic brain injury patients at Wahidin Sudirohusodo Hospital Makassar, from January 2016 - December 2017. The population and sample are 1217 patients (total sampling).

Result: From  1217 samples, most are men (70%), and 30% are women, with age 11-20 years are the most (30%). The most common causes of traumatic brain injury are caused by traffic accidents (89%). The largest group of patients (50%) had a mild head injury (GCS 14-15). From a Head CT scan, the most lesion was epidural hemorrhage (EDH) (26-34%) followed by intracerebral hemorrhage (ICH) (23-28%). About 36% patients were treated by operations and the rest were conservative. Based on the outcomes, about 77% were discharged from a hospital in life and 23% died.  

Conclusion: The highest mortality was in severe head injury, about 87% was died (161 of 186 patients with a severe head injury). From the Head CT Scan, about 95% (19 of 20 patients) with IVH lesions were died and followed by ICH lesions as 39% (122 died from 309 patients). Based on the therapy given both surgery and conservative, patients who were discharged from the hospital in life at 77-79% and died 21-23%.

Introduction: Intestinal anastomosis is carried out with the continuous and simple interrupted sutures technique. Simple interrupted suture is the standard technique in intestinal anastomosis nowadays^1,2. Continuous suture has better serosal apposition, shorter processing time and triggers the formation of hypoxia-inducible factor (HIF) which can stimulate the production of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) that stimulate migration and proliferation of mesenchymal cells, especially fibroblast cells which support the synthesis and increasing collagen density in anastomosis tissue. The aim of current study is to compare the anastomosis technique with continuous and simple interrupted sutures reviewed from fibroblast count and collagen density score in rabbit intestines.

Method: This study is an experimental study. The sample of this study consisted of 36 rabbits divided into two groups continuous and simple interrupted sutures. Randomization is done by permuted randomization block. The inclusion criteria in this study were rabbit strain Oryctolagus cuniculus aged 8-9 months, weighted 2000-2500 grams, healthy and active. The independent variable in this study is the ileal anastomosis technique and the dependent variable is the fibroblasts count and the collagen density score formed on the anastomosis tissue assessed histopathologically.

Results: This study found the average age of the rabbit was 8 months, with an average weight of 2400 grams, the number of fibroblasts in the group of rabbits which received continuous suture was 47 ± 12.679 fibroblasts per visual field with collagen score was 1.88 ± 0.781, whereas in rabbits with interrupted sutures, the fibroblasts count was 42.76 ± 12.47 fibroblasts per visual field with collagen score was 1.82 ± 0.728. However, from the analytic testing showed that the rabbits treated with continuous suture were not significantly different in fibroblast count and collagen density score compared to simple interrupted group (p>0.05), but in continuous rabbit group have higher collagen density scores and fibroblasts count than rabbits who get simple interrupted suture

Background: Breast cancer is cancer, with the highest incidence in women worldwide. It also has a very high mortality due to late treatment. The immunohistochemical examination is an important factor in determining breast cancer subtypes and subsequent therapy. However, neoadjuvant chemotherapy (NACT) has been reported to change the expression of immunohistochemical examinations of Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor-2 (HER-2), and Ki-67. This study aims to determine the relationship between hormonal, HER-2, and KI-67 changes after NCAT.

Method: The immunohistochemical examinations were conducted on ER, PR, HER-2, Ki-67 and histopathological grading from 59 cases of stage III breast cancer after NACT administration. We analyzed the relationship between the changes in the expression of immunohistochemical examinations on the biopsy tissue specimens before NACT administration and from the tissue mastectomy after NACT administration associated with its histopathological grading with spearman correlation analysis using SPSS version 25 for Windows.

Results: There were changes in the results of the expression of immunohistochemical examinations of ER, PR, HER-2, KI-67 and histopathological grading by 23.7%, 22.03%, 32.2%, 32.2% and 40.68% in stage III breast cancer patients who received NACT. There was a relationship with a weak correlation between the changes in immunohistochemical examinations of ER, PR, HER-2 and KI-67 with the changes in histopathological grading. The correlation coefficients between ER, PR, HER-2, Ki-67 and the histopathological grading were r=0.265, r=0.317, r=0.352 and r=0.335.

Conclusions: Patients with stage III breast cancer who were treated with NACT experienced changes in the expression of immunohistochemical examinations of ER, PR, HER-2 and KI-67 and would experience changes in histopathological grading, causing changes in the breast cancer subtypes.

 

Background: Gastric perforation covers 25-30% of acute abdomen in the ER and has high mortality and morbidity rate. Surgery is the primary treatment of gastric perforation. The omental patch is commonly used to close the gastric perforation. One method is to use bioabsorbable material glued with fibrin glue. This study aims to determine the effect of bioabsorbable material as a sutureless technique in wound healing of gastric perforation.

Method: A true laboratory experimental post-test only control group design using a single-blind technique was conducted among 20 Wistar rats. They were divided into 2 random groups, 10 fibrillar and fibrin glue group and 10 omental patch group. Perforation was made by forming a small hole with a diameter of 0.5 cm using a punch biopsy. The microscopic examination with Hematoxylin-eosin staining was carried out for the number of macrophages and fibroblasts from the gastric perforation site. Data were analyzed using SPSS version 16 for Windows.

Result: The average number of fibroblasts produced by the fibrillar and fibrin glue group was 7.5 and 5.4 in omental patch group. Based on the result of  T-test (fibroblasts), it was obtained that there was a significant difference (H1 is accepted) in the number of fibroblasts produced using fibrillar and fibrin glue compared to the omental patch method (P<0.001). The average number of macrophages in fibrillar and fibrin glue group was 4 and 3 in omental patch group. Based on T-test, it was found a significant difference in the number of macrophages produced using fibrillar and fibrin glue compared to the omental patch method (P<0.05)

Conclusion: The administration of fibrillar and fibrin glue biomaterials in the closure of gastric perforation increased the number of macrophages and fibroblast cells better than the omental patch method.

Introduction:  Maxillofacial fractures were caused most by traffic accidents. This study aims to know about concomitant trauma in maxillofacial fractures.

Method: Observational descriptive study to evaluate maxillofacial fracture patients in Head and Neck Division of Surgery Department, Dr Sutomo Hospital between 2015 – 2016.

Result: Distribution of maxillofacial fracture patients in 2015 - 2016 based on sex, data on male patients was 77.52%. In 2015 male compared to female 70.5%, increased in 2016 male compared to female 83.82%. The side of fracture found midface fracture 48%, lower face 30.2% and combination mid and lower face 21.7%. Data on maxillofacial trauma with concomitant trauma were 46.5%. Concomitant injury in 2015 was 36.06% and in 2016 as many as 55.88% where there was an increase in cases of concomitant trauma. In 2015 there were 63.63% of the accompanying brain injuries, while in 2016 there were 42.1% brain injuries, where the trauma outside the brain injury also increased.

Conclusion: Incidence of concomitant injuries in maxillofacial fractures is 46,5 %, and head injury found 50 % in concomitant injuries. The cause of traffic accidents were motorcycles. 

Introduction: Traumatic radial nerve palsy is a condition that need surgical management. Patients who neglect their symptoms or under diagnosed on examination, cause delays to their surgery treatment. Direct nerve repair with epineural microsutures is still the gold standart of surgical treatment for severe axonotmesis and neurotmesis injuries. In this article, we reported a case of nerve repair with epineural microsutures in traumatic radial nerve palsy.

Case presentation: A 14-year-old male complained cramps, tingling, and numbness of his left arm and he was unable to extend his left wrist and fingers after he got a left arm injury 3 months ago. The electromyography (EMG) shown that left radial nerve lesion at left radial sulcus. Direct nerve repair is performed by epineural microsutures.  Two weeks after surgery, we found improvement on the sensory process, but no improvement on the motoric process.

Conclusion: Direct nerve repair with epineural microsutures is an effective treatment for radial nerve injury, but the timing for surgery influencing the result of operation.

Introduction: Hemorrhoidal artery ligation (HAL) combined with recto-anal repair (RAR), is an alternative technique for the treatment of hemorrhoid disease from grade I to IV. HAL-RAR involves anoscope with a Doppler to identify the position and depth of rectal arterial, which can be selectively ligated 3-4 cm above the dentate line. This technique has been proposed as a practical, easy to learn, minimally invasive, and safe.

Case: 5 cases in Husada Hospital Central of Jakarta with hemorrhoid grade IV underwent HAL-RAR. The initial result, 14^th day post-operative follow up, early benefits, and postoperative complications that most affected by HAL-RAR technique will be analyzed. Treatment confirmed 5 cases showed less postoperative pain measured by visual analog scale (VAS), fewer complications, on the 14^th day follow up the main complication there was only one case with residual protrusion in initial follow up resolved four weeks later, and well-controlled of manifestation. All patients were satisfied with the result.

Conclusion: HAL-RAR is an easy to learn technique, useful to perform, less post-operative pain, and gives fewer complications as treatment of advanced hemorrhoid disease. But, needed more cases and a longer follows up to analyze the late complications and recurrence.

Background: A penetrating injury is due to the mechanical force which is piercing in nature and caused by sharp-pointed objects. Penetrating trauma from the inguinal region to the thoracic region is a case with high morbidity and mortality when not sufficient early surgical assessment and good management. The penetrating injury needs early medical assessment and proper management, and this can be done in type B hospital.

Case Description: Twenty-two years old male came to the emergency department in Jombang Public Hospital District after fell from 4 meters height in a construction project. We found 12 mm metallic foreign body has stabbed from right groin projected to left anterior axillary line ICS 4, and patient hemodynamically was stable without any signs of peritonitis. External genital examination showed bloody urethral discharge. We performed chest X-Ray, FAST sonography, prone and lateral KUB X-Ray, urethrographic and emergency exploratory laparotomy for foreign body extraction.

Conclusion: Penetrating injury management involved supportive and surgical management toward damaged organs and extracted foreign body. The recommendation of penetrating injury is to keep the foreign body not to be manipulated since the foreign body can create a tamponade effect that can prevent massive bleeding.