Objective: The Nuss procedure is a widely accepted technique for correcting pectus excavatum. Unfortunately, fatal complications such as cardiac perforation and injury of the great blood vessels have been noticed in a few patients.We modified original Nuss technique to be simpler and less
dangerous.

Methods: We modified Nuss procedure with the sternal elevation to improve sternal depression. Modified Nuss procedure was carried out by applying metal lifter raise sterum until the patient starts to raise from the operating table. The space behind sternum is now wider, and surgery
has become safer with less probability of injuries intrathoracic organs. We compared 46 patients operated by the original Nuss method (taking into account the data from the literature on complications of the original method on a large series of patients) with 54 patients operated by a modified Nuss method.

Results: Before lifting the sternum depth of the deformity was between 2.9 and 6.2 cm (mean 5.4 cm), and the increase were between 1.5 and 4.0 cm (mean 2.8 cm). The difference of 2.6 cm is large enough, and the width of introducer and bars are about 3 mm for securely passed along the chest.

Conclusions: A modified method of treating pectus excavatum is safer, better and with fewer complications than the original method of Nuss.

Objective: Refractive disorders are one of the most common causes of visual impairment worldwide and become the second leading cause of blindness that can be cured. This study aims to know the characteristic of refractive errors patients in Sanglah General Hospital in the period of 1st January until 31st December 2011.

Method: This is a retrospective analytical descriptive study. Data were collected retrospectively from patient’s medical records with refractive errors and shown as frequency and
percentage. Visual acuity before and after corrections were investigated and analyzed using McNemar Test.

Results: from 579 patients, the most common diagnosis was astigmatism (40.1%), 63% were woman, 39.7% were older than 40 years old, and 60.2% live in Denpasar. In myopia cases, 69.7% patients were woman and 25.1% were between 11-20 years old. In astigmatism cases, 63.4% were woman, 57% were older than 40 years old. Of the hypermetropic cases, 61,3% were woman, 79.5% were older than 40 years. Among presbyopia cases, 53.2% patients were woman with 84.4% were older than 40 years. In McNemar test, there were a significant difference between visual acuity before and after correction in both eyes (p=0.0001). Most astigmatism was with the rule cases on both eyes. On the right eye 54.3% shows mild astigmatism, whereas on the left eye 50.8% shows moderate astigmatism. In hypermetropic cases 92.4% are mild degrees. While 55.5% presbyopic patients need
additional glasses of +1.00 D up to +2.00 D. About 97.9% patients with refractive error were given glasses prescription.

Conclusion: mostly refractive errors patient are woman and the most common diagnosis is astigmatism. There were significant differences of visual acuity before and after
correction on both eyes (p=0.001).

Objective: Catheter associated urinary tract infection (CAUTI) is the most common complication of short-term indwelling catheters. The risk of this complication is increase along with the length of catheter insertion. There is no complete agreement of intravenous administration of prophylaxis
antibiotic in reducing the incidence of CAUTI. Currently, antibiotic instilation into bladder was developed, however it is still a controversial issue. Therefore in this study we would like to see the effectiveness of this procedure in reducing the risk of CAUTI.

Method: Single blind randomized controle trial was conducted on 40 eligible male patients treated at surgical ward, Sanglah Hospital between March and August 2012. Twenty patients had netilmicin sulfate instilation and anathor 20 patients treated without instilation procedure. Urine culture was taken before and after catheter removal. The number of colonies were analyzed according to the WHO criteria. In this study WHO critirion 3 was used with a significant bacteriuria of more 10 5 CFU / mL. Data were analyzed with Chi-square table and processed statistically with SPSS. Significance was set at p value <0.05 with 95% CI.

Results: The mean age was 50.07 (SD 15.49) years. The avarage length of urinary catheterization was 5 days (range from 4 to 14 days). CAUTI was observed in 18 patients (45%); symptomatic was 11 patients (61.1%) and asymptomatic was 7 patients (38.9%). Statistic nalysis showed that netilmicin sulfate insilation significantly reduced the risk of CAUTI (OR 0.028 ; CI 0.004 - 0.172).

Conclusion: Netilmicin sulfate instilation prior to catheter removal significantly reduced the risk of CAUTI after short-term indwelling catheter.

Objective: Acute appendicitis is the most common surgical emergency encountered compared with other non-traumatic acute abdomens. Sanglah General Hospital recorded there were 470 cases of acute appendicitis in the year 2006. This study aims to determine the effectiveness of a single-dose antibiotic prophylaxis in prevention of surgical site infection in open appendectomy of non-perforated acute appendicitis.

Method: A single blind randomized controlled trial in 110 nonperforated acute appendicitis patients that underwent open appendectomy at Sanglah General Hospital emergency operating theatre from April to June 2012 was conducted. Cefazolin 1 g and Metronidazole 500 mg were administered intravenously prior operation. Samples were divided into
two groups by permuted block. Following operation, the single-dose group was administered placebo, while the multiple-dose group received two additional doses of antibiotics. Surgical site infection (SSI) of both groups in every week for one month was evaluated. Surgical site infection was
determined based on Hulton’s criteria. Risk of surgical site infection of both groups was analyzed with Relative Risk (chi-square).

Results: In the single-dose group 49.1% were males and 50.9% were females with a mean age of 28.71 years old, and in the multiple-dose group 40% were males and 60%
were females with a mean age of 29.07 years old. Risk of SSI in single-dose group was 7.3% and multiple-dose group was 5.5% with Relative Risk (RR) = 1.33% (95% CI RR: 0.31-5.68, p= 1.000).

Conclusion: There is no difference of SSI risk between single and multiple-dose antibiotic prophylaxisinopen appendectomy of non-perforated acute appendicitis.

Objective: our objective was to display the presentation of simple virilizing Congenital Adrenal Hyperplasia (CAH) with genital ambiguity and severe virilization of the external genitalia, influencing growth, height and weight, bone maturation, quality of life and hence undergoing genitoplasty. Surgical treatment was aimed to obtain a more natural psychological and sexual development and the type of surgical repair performed was tailored based on individual patient’s anatomy findings.

Case: we report a case of a 3-year old female with simple virilizing CAH, diagnosed due to genital ambiguity, severe virilization, clitoromegaly, external genital pigmentation, precocious pubic hair, previously was under treatment with glucocorticoid replacement therapy for 2
years since newborn and neglected due to discontinuing the hormonal treatment for one year duration, underwent several clinical studies including chromosomal study for sex determining, pelvic ultrasonography for internal anatomical details and bone age study for skeletal maturation, given
stress dose steroids pre-operatively and followed by genital reconstructive surgery (genitoplasty). A clitorectomy and labioplasty approach were performed. At time of surgery cystoscopy was carried out prior to the surgical repair.

Results: Management of virilizing CAH child with ambiguous genitalia demands multidisciplinary and interdisciplinary approach. The team‘s major challenge is to use the
feasible means to make the least bad choice in order to select a gender able to match the individual
identity, social identity, and behavioral identity. Surgical option should be tailored, one stage surgery,
at early age and performed according to the individual anatomy findings.