Search

Introduction: We present a case of late endograft infection that progressed to the left iliac and femoral arteries, leading to left lower extremity gangrene, and the patient's death. Case: A 65-year-old male with a history of endovascular abdominal aortic aneurysm repair (EVAR) developed left acute limb ischemia (Rutherford category III) and abdominal pain. A CT scan showed significant gas formation around the endograft and complete occlusion of the left distal iliac artery to the femoral arteries. Despite undergoing hip disarticulation and wound care, aortic endograft removal was not possible due to a lack of replacement grafts. Microbiological cultures from arterial pus and urine identified multiple antibiotic-resistant extended-spectrum beta-lactamases (ESBL) producing Escherichia coli. Histopathological analysis of the common femoral artery specimen indicated chronic medium-sized arteritis characterized by endothelial erosion, fibrotic myocytes in the tunica media, and fibrosis of the adventitial layer with inflammatory cell infiltration. The patient succumbed in the ICU 6 days later due to uncontrolled sepsis. Discussion: Although the incidence of endograft infection after EVAR is low (20– 75% morbidity and mortality), it poses significant risks. Sources are often hematogenous, stemming from urinary or respiratory tract infections, and infections extending to subsequent arteries are very rare; they could cause chronic arterial inflammation and, in the long term, may lead to thrombosis and limb ischemia. This case highlights a low-grade infection that emerged 3 months post-procedure. Diagnosis typically involves CT angiography to detect periaortic gas or fluid. Management of high-grade infections necessitates complete endograft removal and graft replacement with infection-resistant options. Conclusion: Endograft infections after EVAR, while rare, can have severe outcomes. Early diagnosis based on symptoms and CT-Scan. In high-grade infections, endograft removal is the gold-standard therapy, with ongoing follow-up post-EVAR being essential for prevention. Plain Language Summary: Late stent-graft infection after minimal invasive surgery for aneurysm, which causes acute limb ischemia, is very rare and can spread to subsequent arteries (contiguous arterial infection).Infection of the stent-graft may cause blood vessel obstruction originated from infection.Marfen et al reported that the infected artery is a true vasculitis, with pathological findings showing chronic arteritis with antibiotic resistant Escherichia coli as the cause of stent-graft infection being very rare, and reports are scarce. The stent-graft in a severe stent-graft infection MUST be removed to control the infection. [ABSTRACT FROM AUTHOR]

Background: End-stage kidney disease (ESKD) is associated with a tremendous financial burden. Data in Indonesia shows an increasing number of patients with ESKD taking hemodialysis as a routine procedure every year. Establishment and maintenance of vascular access are important in the management of ESKD. Vascular complications that often arise due to hemodialysis are common and one of the main reasons for hospitalization. Cannulation complications ranged from minor hematomas to acute bleeding from pseudoaneurysms that required emergency surgical procedures. This study aims to assess the different clinicopathological characteristics of ESKD patients with vascular access cannulation complications and the surgical management related to the complications. Materials and Methods: This research is a retrospective observational study. The research subjects in this study were ESKD patients in the vascular and endovascular surgery division of the tertiary hospital in West Java, Indonesia. There were 121 study subjects. Clinicopathological characteristics of vascular cannulation complications and surgical management are extracted from the medical record. Results: Three major vascular complications were ruptured pseudoaneurysms 64/121 (52.9%), impending rupture pseudoaneurysms 28/121 (23.1%), and pseudoaneurysms 21/121 (17.4%). Common surgical procedures were ligation of the draining vein 47/121 (38.8%), arterial primary repair 28/121 (23.1%), and arterial patch repair 18/121 (14.9%). There was a significant relationship between symptoms of bleeding in ruptured pseudoaneurysms and bulging masses in pseudoaneurysms (p = 0.001). There was a significant relationship between the diameter of the vascular mass, vascular defect size, and hematoma and the type of surgical procedure taken (p < 0.010). Conclusion: Ruptured, impending rupture, and pseudoaneurysms are major complications of vascular access in ESKD patients, and there was a significant relationship between the carried-out surgical procedure and the size of the vascular mass, defect, and hematoma. Plain Language Summary: Chronic kidney failure is a particular challenge in terms of health problems in Indonesia. With the increase in kidney failure patients, the number of dialysis patients in this country has also sharply increased because blood dialysis is the main management for end-stage kidney failure. Dialysis treatment does not mean it is 100% safe; various complications can arise from the blood dialysis procedure. Many of the complications that arise are caused by problems with the blood vessels that serve as access to the dialysis machine. In this research, we aim to study the characteristics of blood dialysis complications related to blood vessel access. This study was conducted at one of the largest national hospitals in Indonesia, precisely in West Java province, which is the most populated province in Indonesia. In this study, we involved 121 end-stage kidney failure patients. This study is very important to carry out considering that around 30% of chronic kidney failure patients that were hospitalized have complications from blood vessels. We hope that this research can be used further in determining the best procedure for providing venous access for dialysis with all the limitations faced by developing countries. [ABSTRACT FROM AUTHOR]

Breast cancer is the most prevalent cancer in women and can spread to the lymph nodes in the axilla. The sentinel lymph node is the first lymph node to be targeted for the spread or metastasis of cancer cells involving the lymph nodes. The aim of this study is to compare the accuracy rate of methylene blue injection into sentinel lymph nodes in early-stage breast cancer patients who have undergone incisional and excisional biopsies.Methods: This is a prospective observational study conducted in two general hospitals in West Java, Indonesia. The research subjects in this study were early-stage breast cancer patients with no lymph node metastasis (N0) who had undergone a biopsy. There were 83 study subjects included in this study. The sentinel lymph node biopsy was taken after injection of methylene blue into the peritumoral area. Blue nodes in the axilla were marked as positive lymph node biopsy results and sent for histopathology examination.Results: Patients who underwent excisional biopsy surgery had a sensitivity rate of 85.3% and a specificity of 93.3%, while the accuracy rate in patients who underwent incisional biopsy surgery had a sensitivity rate of 79.2% and a specificity of 80%.Conclusion: There was no difference in the accuracy of SLNB using methylene blue in patients with early-stage breast cancer with N0 who had a history of incisional and excisional biopsy. [ABSTRACT FROM AUTHOR]

The trauma victim is in an emergency phase and needs immediate help. This phase is very sensitive to time, considering that the most common trauma is bleeding. The patient will die if the help is not given immediately. Trauma is comprehended as a degree of severity. Medical treatment is given based on this degree. However, methods to measure the degree currently used require quite some time, which risks the patient’s life. This study proposes a standardized measurement of the degree of trauma and predicts patient mortality based on selected features. We select and discard medical data that does not affect the degree of trauma. The data becomes simple. The primary trauma dataset was collected from the emergency room at Hasan Sadikin Hospital in Bandung, Indonesia. The data has 19 features and two prediction classes for mortality, namely death and life. Data mining techniques were carried out to provide a sufficient dataset so that the algorithm could work optimally. This study performs several steps of data pre-processing as follows: cleaning, correcting, and augmenting the dataset in order to obtain significant results. Then reduce some features in light of the fact that some have overlapped. We implement a long-short-term memory deep learning algorithm to build a mortality prediction model. Although there were inconsistencies in the data and an insufficient amount, the result was promising. Features become concise and comprehensive. It was accurate up to 92% of the time and took less time than the other methods. [ABSTRACT FROM AUTHOR]

Context: The context of this study was epidemiology pediatric thyroid cancer in Bandung, Indonesia. Aims: The aim of this study is to evaluate clinical characteristics and outcome between children and young adult patients with differentiated thyroid cancer (DTC) treated in our hospital. Settings and Design: This was a cohort retrospective study. Materials and Methods: The medical records of 144 patients with DTC who underwent thyroid surgery followed by radioiodine and thyroid hormone suppression were retrospectively reviewed. Thyroid cancers were diagnosed between January 2007 and December 2010. Participants consisted of 43 patients who were younger than 21 years old and 101 young adult patients (older than 21 years old but younger or equal to 40 years). The clinical characteristics and outcomes were analyzed and compared, and then, recurrence-free survival was evaluated using Kaplan-Meier methods. Statistical Analysis Used: Software R 3.3.0 version for Windows was used in this study. Results: Female has higher tendency to have thyroid cancer than male (P = 0.006). Based on histopathology report, classic papillary thyroid cancer is the most common cancer type in children than young adult. However, there was no significant difference between two groups regarding thyroid cancer size and multifocality (P = 0.815 and P = 0.370). The risk of recurrent ratio of children to young adults is 3.88 (95% confidence interval [CI] 1.38; 10.91). A similar result trend has been shown for sex type, histopathology type, number of nodules, surgical technique, and metastasis parameters (adjusted hazard ratio = 7.91, 95% CI 2.11; 29.67). Conclusions: DTC in children shows more aggressive behavior compared to young adult patients. [ABSTRACT FROM AUTHOR]