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BACKGROUND: Breast cancer (BC) is the most common cancer among women worldwide and a leading cause of death in Indonesia. The primary treatment of locally advanced BC is neoadjuvant chemotherapy (NAC). The rapid proliferation of tumor cells in a neoplastic microenvironment is largely due to hypoxia, which also encourages the development of chemoresistant BC. The master regulator of the hypoxia response is hypoxia-inducible factor-1α (HIF-1α). The response evaluation criteria in solid tumors (RECIST) is an objective response metric that demonstrates the efficacy of a NAC based mostly on the size of the tumor. Ca15-3 is the protein product of the MUC1 gene and is the most widely used serum marker in BC. The purpose of this study is to investigate the relationship between HIF-1α and RECIST and between Ca15-3 and RECIST and to assess the relationship among all of them in BC. METHODS: This observational study used the prospective cohort method included 11 patients with histopathologically confirmed BC, specifically invasive ductal carcinoma. We evaluated the changes in HIF-1α and Ca15-3 serum levels using ELISA and measured tumor lesions with RECIST. The procedure was carried out twice. Serum levels were measured at baseline, and after receiving two cycles of NAC (5 weeks). RESULTS: Among the 11 patients included in this study, HIF-1α, Ca15-3, and RECIST decreased significantly after NAC. The changes in RECIST correlated with Ca15-3: each unit decrease in RECIST score was associated with a 0.3-unit decrease in Ca15-3 levels (p = 0.019). CONCLUSIONS: There was a decrease in HIF-1α, followed by a decrease in Ca15-3 and RECIST in response to chemotherapy. There was a statistically significant correlation between Ca15-3 and response to chemotherapy. This study evidences the relationship between factors that shape the local tumor microenvironment.

Mendy Hatibie Oley,1– 3 Maximillian Christian Oley,3– 5 Ferra Olivia Mawu,6 Deanette Michelle R Aling,3 Muhammad Faruk7 1Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia; 2Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery, R. D. Kandou Hospital, Manado, Indonesia; 3Hyperbaric Centre, Siloam Hospital, Manado, Indonesia; 4Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia; 5Division of Neurosurgery, Department of Surgery, R. D. Kandou Hospital, Manado, Indonesia; 6Department of Dermatology and Venereology, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia; 7Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, IndonesiaCorrespondence: Mendy Hatibie OleyPlastic Reconstructive and Aesthetic Surgery Division, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Jalan Raya Tanawangko No. 56, Malalayang Satu Barat, Malalayang, Manado, 95162, IndonesiaFax +62431-863786Email mendy.hatibie@unsrat.ac.idIntroduction: Minimally invasive aesthetic procedures such as filler injections and thread lifts have gained popularity recently. Complications from these aesthetic procedures are difficult to avoid. This increasing public health concern requires a combination of effective therapeutic modalities. Hyperbaric oxygen therapy (HBOT) has generated favorable results in treating a diversity of wounds, inflammation, and infection.Case Presentations: Three cases with complications arising from aesthetic procedures were described in this report. The patients were all female, with ages ranging from the late-twenties to mid-fifties. Two patients experienced complications from filler injections, one of which progressed to a parotid gland infection due to a placental extract filler while the other was caused by a hyaluronic acid filler. The third patient had notable excoriations and inflammation on both cheeks following a thread lift procedure. Alongside antibiotics and other symptomatic therapies, the patients received multiple, 90-minute HBOT sessions at 2.4 ATA over the course of one to two weeks. The wounds were frequently monitored to evaluate the healing progress.Discussion: Complications from facial rejuvenation procedures can be disastrous. They expose the patient to the risk of developing vascular occlusions and skin infections that require prompt and effective treatment. Multiple treatment options (eg, frequently massaging the affected area, warm compresses, aspirin, and antibiotics) have been used to treat these complications. HBOT serves a valuable purpose in restoring adequate tissue perfusion in cases of filler-induced vascular occlusion and infection. Moreover, HBOT assists in restoring tissue injury and reducing inflammation following thread lift procedures.Conclusion: HBOT has proven helpful as a treatment adjunct toward counteracting the effects of minimally invasive aesthetic procedures in several cosmetic-related cases.Keywords: hyperbaric oxygen therapy, filler injection, thread lift, complications, aesthetic procedures

Introduction: The unique anatomy of the ear makes the reconstruction more challenging. Microtia and auricula hematomas are deformities or defects that can occur in the ear. Treating traumatic injury and congenital malformations of the ears needs some technique and expertise. Hyperbaric Oxygen Therapy is an additional therapy that makes a significant contribution and is effective in wound healing. Case Series: In our first case, a 52-year-old man presented with a traumatic right cauliflower ear due to a traffic accident two weeks before hospital admission. The second case involves a boy 14-year-old who has a Microtia in the right ear with total ear construction performed using autologous costochondral cartilage techniques in a two-stage. Results: Both cases following hyperbaric oxygen therapy, yield good results with good scars, no sign of infection nor tissue necrosis Summary: The combination therapy of reconstructive surgery and administration of oxygen therapy gave satisfactory results in both cases. Five sessions of hyperbaric treatment showed promising results. There is no infection, rapid wound healing, and cessation of flap compromise.

Introduction Limb injury is a major health concern that imposes a direct danger to both life and limb viability. At Kandou Hospital Manado, hyperbaric oxygen (HBO) therapy has been performed as an adjunctive treatment for crush injury although no study has yet directly compared outcomes of HBO versus conventional therapy. Documentation of the association between HBO therapy and the healing process of crush injury is necessary to reduce the gaps in the literature and to establish an evidence-based clinical use of HBO therapy. Methods In this study, we assessed the changes in the vascular endothelial growth factor (VEGF) serum levels and VEGF mRNA expression as biomarkers of wound healing using ELISA and qRT-PC at four different measurement times: at baseline, after receiving initial treatment (debridement and limb-salvage surgeries), 2 h after the first session HBOT, and after a full 10 HBOT sessions. A randomized controlled trial (RCT) was used to enroll patients subjected to crush injury who were admitted to the Surgical Emergency Department (ER) of Kandou Hospital Manado, Indonesia. Results VEGF serum levels increased significantly in patients suffering from crush injury who received HBO therapy versus the control group. The increased VEGF serum is expected to result in an acceleration time of wound healing and a reduction in amputation rate. Conclusion There was a significant difference between crush injury patients who received conservative therapy versus those receiving HBO therapies; thus, there was an increased likelihood of an accelerated wound healing and a reduction in the risk of amputation.

Introduction Ischemia-Reperfusion Injury (IRI) is a complication following the reperfusion of ischemic tissues; it requires immediate treatment, as it can lead to severe infection and tissue death. The purpose of this study was to demonstrate the ability of Hyperbaric Oxygen Therapy (HBOT) to treat SIRS (Systemic Inflammatory Response Syndrome) caused by IRI and to provide long-term functional assessment for a period of up to 5 years. Case presentation Two cases of avulsions of the hand at the levels of the wrist joint and the medial third forearm, severed by machetes. Both patients were male and in their twenties. Hand replantation was carried out after 30 minutes (medial third forearm case) and 11 hours (wrist joint case) of ischemic time. A couple of days after surgery, both patients experienced SIRS as a result of IRI. The patients were brought to the hyperbaric chamber and received 3 consecutive 90-min sessions of HBOT at 2.4 ATA 3 days in a row. The outcomes were compared in a table with each patient's vital signs and laboratory results, both before and after HBOT. A significant improvement was seen at the follow-ups in vital signs and laboratory results for both patients after HBOT administration. Long-term follow-up also showed satisfying results for hand function, proven by low DASH (Disabilities of the Arm, Shoulder, and Hand) scores. Conclusion HBOT was able to treat SIRS in both patients. Favorable long-term hand function results signify successful extremity replantation., Highlights • Ischemia-Reperfusion Injury (IRI) is a complication following the reperfusion of ischemic tissues. • Two cases of avulsions of the hand that had underwent hand replantation had experienced systemic inflammatory response syndrome (SIRS) due to IRI. • Administration of HBOT has been proven to be an effective treatment for post-hand replantation SIRS.

Trauma to the extremities is a common major health problem that requires special attention because it can have a dangerous impact on both the viability of the limb and the patient's life. Hyperbaric oxygen therapy is an alternative therapy hypothesized to improve the prognosis in lower extremity trauma.We present a series of 7 cases of lower extremity trauma treated with hyperbaric oxygen therapy: soft tissue loss, neglected chronic burn injury, high-voltage electrical burn, gas gangrene, crush injury, chemical burn, and excoriation with skin loss.Hyperbaric oxygen therapy involves giving 100% oxygen in a chamber at pressures above atmospheric pressure (2-3 atm absolute [ATA]). It can increase oxygen delivery to peripheral tissues with vascular compromise, cytogenic and vasogenic edema, and cellular hypoxia caused by limb trauma.Hyperbaric oxygen therapy has many benefits in lower extremity trauma for wound recovery, preventing complications, and helping patients return to daily activities.

Burn injuries are frequently encountered in emergency cases and often become the port of entry for pathogens. More than 450,000 burn injuries occur annually causing nearly 3,400 deaths in the United States. The prevalence of burn injury in Indonesia is 0.7% in 2013. More than half of these According to several studies on the use of patients were treated for bacterial infections, some of which were resistant to certain antibiotics. Using hyperbaric oxygen therapy (HBOT) to treat burns has several positive effects including managing bacterial infections, as well as accelerating the wound healing process. Therefore, this study aims to prove the effectiveness of HBOT in inhibiting bacterial growth.This is an experimental research study in rabbits using a post-test control group design. 38 rabbits were given second-degree burns on the shoulder region with a metal iron plate that has been previously heated for 3 min. Bacterial cultures were taken on days 5 and 10 after exposure to the burns. The samples were divided into two groups, HBOT and control. Statistical analyses were performed using the Mann-Whitney U method.Gram-negative bacteria were the most frequently found pathogen in both groupsHBOT administration can significantly reduce bacterial growth in burn injuries.

Background The scalpel was once the gold standard for surgical incisions. Electrosurgery has started to supplant scalpels but is not yet acceptable for skin incisions due to the risk of burns and deeper injury relative to the scalpels' neat incision with less tissue damage. The unnecessary burden of excessive scar formation makes comparing these two methods challenging. Therefore, this study aims to compare post-incision skin scarring created after monopolar electrosurgery and scalpel surgery, and evaluate the Patient and Observer Scar Assessment Scale (POSAS) suitability for assessing skin incision scars by comparing patients' and observers’ scores. Methods This self-controlled study involved patients undergoing elective and emergency skin surgery procedures. A singular wound site was created using two incision methods (monopolar electrosurgery and scalpel) simultaneously. Post-incision scar tissue formation was evaluated using the POSAS, a subjective scar assessment tool that involved patients self-reporting on pain, itching, color, thickness flexibility, and surface relief. Observer-rated vascularity, pigmentation, thickness, flexibility, and surface relief both using a 5-point Likert-type scale. We performed this assessment three months post-surgery, and the results were analyzed by a battery of statistical tests and linear mixed models. Results Twenty patients were included in this study. Data analyzed using the paired t-test or Wilcoxon rank-sum test indicated no statistically significant differences between the scar tissue created by monopolar electrosurgery and scalpels according to both the patients and the observers. Correlation analyses between the patients' and observers’ total POSAS scores indicated these followed a moderate linear relationship (r = 0.51; p, Highlights • The scalpel was once the gold standard for surgical incisions. • Electrosurgery has started to supplant scalpels but is not yet acceptable for skin incisions due to the risk of burns. • The Patient and Observer Scar Assessment Scale (POSAS) is a subjective scar assessment. • Our results show that electrosurgery was not inferior to the scalpel technique. • The POSAS instrument is an acceptable means of assessing scar formation on the skin.

Tujuan: Membuktikan bahwa terapi oksigen hiperbarik (TOHB) dapat mempercepat proses penyembuhan ulkus kaki diabetik (UKD) melalui peningkatan kadar IL 6 serum dan dapat memperkecil ukuran serta kedalaman luka dinilai melalui skor PEDIS. Metode: 20 pasien UKD dibagi menjadi dua kelompok. Kelompok kontrol menjalani penanganan holistik UKD tanpa TOHB, kemudian dilakukan dua kali pemeriksaan kadar IL 6 serum dengan selisih waktu 1 hari, sedangkan kelompok TOHB menjalani penanganan holistik UKD dengan TOHB dan dilakukan pemeriksaan kadar serum IL 6 dua kali yaitu satu hari sebelum TOHB dan 2 jam sesudah TOHB hari pertama. Hasil: Perubahan kadar IL 6 serum terlihat lebih besar pada pasien dengan TOHB dibandingkan pasien kontrol (b=5,82 pg/mL; p=0,025). Sementara untuk skor PEDIS dan ukuran luka, kelompok TOHB jelas lebih kecil dibanding pasien kontrol; Skor PEDIS (p

Introduction Hyperbaric oxygen therapy (HBOT), a procedure that involves the patient inhaling 100% oxygen gas under pressure, is currently used as an adjunctive treatment option for certain inflammatory conditions. HBOT can improve wound healing by increasing the rate of angiogenesis in injured tissue by increasing levels of vascular endothelial growth factor (VEGF). VEGF causes re-epithelialization, the migration of endothelial cells, and the formation of granulation tissue, which are involved in the wound healing process. Methods This study contains secondary data analyses of information previously collected in two separate studies, each concerning the effects of HBOT on diabetic foot ulcers and crush injury fractures at Prof. Dr. R. D. Kandou Hospital Manado and Siloam Hospital Manado from 2019 to early 2020. Results Based on the classification tree analysis, the predictors of HBOT success were leukocytes level (34%), platelet count (32%), and age (26%). The conditional inference tree analysis also indicated significant leukocyte levels, age, and platelet counts (p, Highlights • Hyperbaric oxygen therapy (HBOT) as an adjuvant or complementary therapy is widely applied today. • The antimicrobial effect of HBOT is a reaction to the formation of reactive oxygen species. • HBOT is also believed to bolster the immune system. • HBOT acts synergistically with several anti-microbial agents and it is useful against various infections. • The success of HBOT based on significant contributing factors such as age, leukocyte levels, and platelet counts.

Introduction Pneumocephalus (PNC) is the presence of air in the intracranial cavity. The most frequent cause is craniofacial trauma, though there are many etiologies, including surgical procedures. PNC with compression of the frontal lobes and widening of the interhemispheric space between the tips of the frontal lobes results in the characteristic radiological finding of the “Mount Fuji sign”. Presentation of case A 57-year-old man presented to the A&E with loss of consciousness due to a motorcycle collision 9 h prior. He had a GCS of E4M6V5, and a head CT scan revealed minimal PNC forming in both hemispheres. After discharge, severe headaches and rhinorrhea developed. A second CT scan revealed a massive PNC. An operation was then performed via a bicoronal incision to drain the PNC and seal the cranial defect. A burr hole in the calvarium was created, and the cranial defect was closed using a pericranial rotational flap. Post-operation, the patient's headache and rhinorrhea decreased; neither symptom was present at 1-month post-operation. The wounds healed with minimal scarring, and the cosmetic outcome for the craniofacial fracture was acceptable. Discussion Although the patient may at first present with a mild head injury, this can progress into something much more serious. PNC is difficult to diagnose clinically. Rarely, patients describe a splashing sound upon moving the head (termed bruit hydro-aerique), which can also be auscultated. A head CT scan is the gold standard in the diagnosis of PNC. Pericranial flaps are widely used for dural repair because they are easily accessible and have a lower rate of infection than artificial grafts on expanding PNC. Conclusion Tension PNC may be slow-growing and increase intracranial pressure to high levels before clinical signs are present. The pericranial rotational flap technique is the best way to close a dura mater defect in cranial base fractures with tension PNC., Highlights • Pneumocephalus (PNC) is the presence of air in the intracranial cavity. • Craniofacial trauma is the most frequent cause of PNC. • We report a male with expanding PNC who required a pericranial rotational flap. • Tension PNC may be slow-growing and increase intracranial pressure to high levels before clinical signs are present.

Introduction: Post-concussion syndrome is common in young adults and can greatly interfere with the quality of daily life. It has a wide range of symptoms that require prompt and well-targeted treatment to avoid further brain impairment. Hyperbaric oxygen therapy (HBOT) is a promising regenerative treatment option for these patients to help prevent the progression of post-concussion syndrome. This study aims to determine whether HBOT accelerates the healing process and reduces symptoms in patients with post-concussion syndrome. Methods: 20 patients with post-concussion syndrome participated in this randomized controlled trial study. After receiving standard mild traumatic brain injury treatment in accordance with the Advanced Trauma Life Support guidelines, the patients were divided into HBOT and control groups. Matrix metallopeptidase 9 (MMP-9) levels and Rivermead Post-Concussion Symptoms Questionnaire (RPQ) scores were used to compare the two groups (before HBOT & after 1st, 3rd, and 5th week). Results: The study sample was predominantly male (65%) with an average age of 60 years old. HBOT reduced serum MMP-9 levels by nearly 20 ng/mL (p < 0.001) compared with the control treatment. The efficacy of HBOT was also reflected in the RPQ scores, which were significantly lower in the HBOT group than the control group (before HBOT & after 1st, 3rd, 5th week) (-3.80 on RPQ-3, p = p Conclusion: HBOT ameliorated the symptoms associated with post-concussion syndrome through a mechanism that involves MMP-9 activity. The accelerated recovery observed in the present study supports the use of HBOT to treat post-concussion syndrome and potentially other forms of traumatic brain injury.

Background Viral infection can compound the severity of pre-existing inflammation caused by underlying diseases. For those with a chronic, immune-related condition such as diabetic foot ulcers (DFUs), the coronavirus disease (COVID-19) serves to exacerbate the inflammatory burden. Serum levels of intracellular adhesion molecule-1 (ICAM-1), a primary mediator of cell adhesion express in the inflammatory process, are often used to indicate the gravity of all inflammatory conditions. Therefore, the purpose of this study was to investigate serum ICAM-1 levels before and after debridement in patients with DFUs who were also diagnosed as COVID-19 positive compared with those who were COVID-19 negative. Methods 20 patients with DFUs were screened for COVID-19 and then divided into COVID-19 positive and negative groups according to the results. Before debridement, chest x-rays and blood analysis, including ICAM-1 serum levels, were performed in both groups. Only ICAM-1 serum levels were measured after debridement. Results Of the 20 patients included in this study, 55% were male (n = 11) and 45% were female (n = 9). The mean age was 52.9 ± 1.9 years. ICAM-1 levels in patients with DFU in the COVID-19-positive group were significantly higher than those in the COVID-19-negative group (median 317.2 vs 149.2, respectively; p

Introduction The surgical removal of an intraoral tumor and preventing intraoral wound dehiscence are constant challenges faced by surgeons today. Hyperbaric oxygen therapy (HBOT), the inhalation of 100% oxygen at a greater atmospheric pressure, is often used in cases of wounds to induce a faster wound healing process, alongside other treatment modalities. We report a rare case of squamous odontogenic tumor (SOT) treated with HBOT after being surgically removed to foster an accelerated wound recovery. Case presentation A 39-year-old Asian male presented with an intraoral 3 × 4 cm tumor, accompanied by acute pain on the maxillary region. Biopsy results showed a solid, brown parenchyma with islands of mature squamous epithelial cells, confirming the diagnosis of an SOT. An intraoral surgical approach was performed to remove the tumor. The patient was then treated with prophylactic antibiotics and 5 consecutive, daily sessions of HBOT at 2.0 ATA as an adjuvant therapy. No further complaints and no abnormalities were found at the 2-week follow-up evaluation. Discussion In our case of SOT, HBOT plays a role to inhibiting the bacterial growth which could lead to post-operative wound infections. A number of studies have incorporated HBOT as an adjuvant therapy for post-operative intra oral wounds which has resulted in minimal wound complications. Conclusion The use of HBOT as an adjunctive therapy in managing possible wound complications after the resection of an intraoral tumor enables a faster angiogenesis process, reduces tissue hypoxia and minimizes the risk of post-operative wound infections; hence fostering the wound healing process., Highlights • Squamous odontogenic tumors (SOT) are very rare tumors. • SOTs are local infiltrating lesion described as aggressive, odontogenic, and epithelial. • HBOT can be used as supportive therapy in SOT. • Hyperbaric oxygen therapy (HBOT) can accelerate wound healing and minimize the possibility of postoperative infection.

Introduction Angiosarcoma is a very rare malignancy, which varies based on the location and organ affected. A clinicopathological form of cutaneous angiosarcoma (CAS) involves the head: scalp, face, and neck. We report a 59-year-old female patient with CAS on the temporoparietal region of the scalp. Case presentation The patient presented with lesions in the head area, which appeared suddenly in the last 6 months, (before her surgery). Excision was performed under general anesthesia for bleeding as indicated on the right temporal region. The excision procedure was carried out three times at various stages, and then closed with skin grafts. Pathological examination of the three excised tissues showed progression, leading to CAS. Based on the clinical picture and anatomical assessment, a consultation with the surgical oncology department was necessary for further treatment. Discussion Angiosarcoma has a high rate of progression. The onset of lesions, which are difficult to detect, does not often lead to progression. Other macroscopic features appear as bluish macules, which can be perceived as bruising. Wide surgical resection is the optimal treatment and is usually combined with radiotherapy and/or chemotherapy. This patient underwent gradual excision, based on bleeding in the right temporal lesion, along with progressive pain. Conclusion Surgical is the preferred management for our patients. Determination of multimodality therapy as treatment for CAS requires assessment of all factors related to age and patient condition. Follow-up evaluation is carried out after palliative therapy – to observe the general condition of the patient, tumor progression, tendency for metastases, and excision of any remaining lesions., Highlights • Angiosarcoma is a very rare malignancy, which varies based on the location. • Cutaneous angiosarcoma (CAS) is a malignancy with a high rate of progression. • Scalp, head, or neck are common sites of CAS. • Surgical management is the best treatment for our patients. • Multimodal therapy for CAS requires consideration of age and patient condition.

Highlights • Trichilemmal carcinoma (TC) is a rare malignancy originating in hair follicles. • TC usually occurs in photo-exposed areas. • We report a rare case of TC in a non-sun-exposed area of the nose. • Surgical excision with wide margins prevents local recurrence., Introduction Trichilemmal carcinoma (TC) is a rare, low-grade, cutaneous malignant lesion that originates from hair follicle cells. It usually occurs in photo-exposed areas, especially on the face, scalp, neck, and dorsal part of the hand. We report a case of an adult female with TC in an unexposed area of the nose, which completely obstructed the right nasal cavity. Case presentation An 82-year-old female presented with TC in a non-sun-exposed area of the nasal cavity, which grew progressively over one year and caused nasal obstruction. The mass had dimensions of 15cm × 8cm, and it was removed surgically with a wide and deep excision. Histopathological examination confirmed the diagnosis of TC. A follow-up at three years post-surgery revealed no signs of recurrence. Conclusion Surgical excision with wide margins improved the treatment outcome by preventing local recurrence and providing satisfying cosmetic results.

Background: Deep burn wound with exposed underlying structures such as muscle or moreover in this case, bone, may increase morbidity in the terms of infection. Therefore careful planning of reconstruction is needed. Patient and Method: We report one case of neglected burn wound with exposed tibia and muscle contracture on bilateral knee joint that was reconstructed in our Plastic Surgery Division of Prof RD Kandou Hospital. Data was taken from medical and surgery record. Result: We managed the muscle contracture of the left knee joint by sedated gradual stretching and splinting. We also utilized hyperbaric treatment in order to maximize granulation process. A medial gastrocnemius muscle flap followed by split thickness skin graft is used to reconstruct the missing tissue at upper tibia, and another split thickness skin graft to cover another wound at opposite upper leg. The result was satisfying without any complication. Conclusion: In managing a neglected burn wound with bone exposed and muscle contracture, it is compulsory to have a careful reconstruction planning. Our objectives are to release the muscle contracture and to provide an adequate coverage to the bone-exposed wound by using many modalities we have.

Hypospadias is a congenital abnormality. In hypospadia the urethra meatus is located ventral position and proximally from its normal position at the tip of glans penis. Hypospadia present with a wide array of meatal position and curvature. Surgery to repair anatomical defect is the only one treatment for hypospadias. Urethrocutaneous fistula is the most frequent complication of hypospadias. There is not yet research about hypospadias in Prof. Dr. R. D. Kandou Hospital. That’s motivated me make research about hypospadias. This research is retrospective descriptive with the medical record in Prof. Dr. R. D. Kandou Hospital Manado period January 2009 to October 2012. This research was two month from November 2012 to Desember 2012. The incidence of hypospadias has been found by 17 cases. The most frequent is in 2011 and 2012. Penoscrotal hypospadia is the most frequent in this research. There are many patient have uretroplasty and chordectomy. Fistula in this research have been found two cases. Keywords : hypospadias, incidence, type, manajemen, fistula Abstrak : Hipospadia merupakan salah satu kelainan kongenital saluran kemih. Pada hipospadia meatus uretra eksternus terletak di permukaan ventral penis dan lebih ke proksimal dari tempatnya yang normal pada ujung penis. Hipospadia dibagi menurut posisi meatus dan derajat kelengkungan penis. Koreksi bedah untuk memperbaiki kelainan anatomi merupakan satu-satunya penanganan untuk hipospadia. Fistula uretrakutaneus merupakan komplikasi dengan frekuensi yang paling banyak pada koreksi hipospadia. Juga dilaporkan adanya fistula uretra kongenital yang timbul bersama-sama hipospadia. Penelitian mengenai hipospadia di RSUP Prof. Dr. R. D. Kandou Manado belum pernah dilakukan. Hal tersebut mendorong penulis untuk melakukan penelitian tentang hipospadia.Penelitian ini bersifat deskriptif retrospektif dengan menggunakan data rekam medik di RSUP Prof. Dr. R. D. Kandou Manado periode Januari 2009 hingga Oktober 2012. Penelitian ini dilakukan selama 2 bulan yaitu pada bulan November hingga Desember 2012. Ditemukan angka kejadian hipospadia sebanyak 17 kasus. Angka kejadian hipospadia paling tinggi ialah pada tahun 2011 dan 2012. Tipe penoskrotal merupakan tipe hipospadia yang paling banyak frekuensinya. Penderita hipospadia paling banyak mendapat penanganan uretroplasti dengan chordectomi. Fistula yang ditemukan sebanyak dua kasus. Kata kunci: hipospadia, angka kejadian, tipe, penanganan, fistula.

Introduction Diabetic foot ulcers (DFU) is a major social issue in terms of treatment cost. DFU has a high risk of infection with morbidity and an increased risk of lower-extremity amputations. Currently, there are no satisfactory treatments for DFU. This motivates a search for methods that can stimulate the acceleration of wound healing; one of these methods is the use of hyperbaric oxygen therapy (HBOT). This study attempts to prove the ability of HBOT to accelerate the healing process of DFU by increasing levels of both serum Interleukin 6 (IL-6) and Vascular Endothelial Growth Factor (VEFG), assessed by the perfusion, extent, depth, infection and sensation (PEDIS) score. Methods Twenty DFU patients were divided into two groups. The control group underwent a holistic DFU treatment without HBOT and was tested twice for serum IL-6 and VEGF levels, 1 day apart. The HBOT group underwent a holistic DFU treatment with HBOT and was also tested twice for serum IL-6 and VEGF levels: one day before HBOT and 2 h after the first day of HBOT. Results The changes in serum IL-6 and VEGF levels were greater in patients with HBOT than in control patients (p = 0.025 and p = 0.004). As for PEDIS score assessment, the HBOT group had significantly lower PEDIS scores than the control group (p Conclusion HBOT can help accelerate the wound healing process, which was proven by increased serum IL-6 and VEGF levels and a lower PEDIS score.