AMAÇ: Bu çalışmanın amacı toraks travması nedeni ile kliniğimize müracat eden ve toraks kontüzyonu tespit edilen hastalardaki kontüzyon ile hemotoraks, pnömotoraks ve hemopnömotoraks arasındaki ilişkiyi değerlendirmek.GEREÇ VE YÖNTEM: Çalışmaya alınan olgular 2017 Ocak, 2018 Kasım tarihleri arasında Afyon Sağlık Bilimleri Üniversitesi Göğüs Cerrahisi Kliniğine müracaat eden, toraks kontüzyonu tespit edilen ve kliniğimiz tarafından takip önerilen ya da yatırılarak tedavi altına alınan, 77 künt toraks travmalı hasta dahil edildi. Hastaların cinsiyeti, yaşı, bilgisayarlı toraks tomografileri (BT) ve hastanede yatış süreleri retrospektif olarak incelendi.BULGULAR: Toraks kontüzyonu bulunan 77 hastanın %80.52’i erkek, %19.48‘i bayan, yaş ortalaması 50.57, hastanede ortalama yatış süresi 4.19 gün idi. Hastaların %48.05’inde sağda, %35.07’inde solda, %16.88’inde bilateral toraks kontüzyonu tespit edildi. Olguların %51.95’inde pnömotoraks izlendi. Bunların %24.68’i sağda, %10.39’u solda, %16.88’i bilateral idi. Vakaların %45.45’inde hemotoraks tepit edildi, bunların %24.68’inde sağda, %16.88’inde solda, %3.89’unda bilateral olarak gözlendi. Hastaların %3.89’unda hemopnömotoraks mevcuttu, bunların %2.60’ı solda, %1.30’u bilateral olarak izlendi.SONUÇ: Yaptığımız çalışmada künt toraks travmasına bağlı toraks kontüzyonu sağ hemitoraksta ve erkeklerde daha fazla görülmektedir. Pnömotoraks, hemotoraks, hemopnömotoraks sıklıkla toraks kontüzyonuna eşlik etmektedir. Her bir komplikasyon kendi içinde değerlendirilmeli ve tedavisi ona göre yapılmalıdır.
Abstract: Thoracic trauma is a significant cause of mortality and morbidity. Difficulties in the management of blunt thoracic trauma patients are caused by the late presentation of acute respiratory distress syndrome (ARDS). Thorax trauma severity score (TTSS), introduced by Pape et al. in 2000, includes patient age, physiologic parameters, and thoracic radiological assessment. This study was aimed to assess the ability of TTSS in prediction of the occurence of ARDS in patients with blunt thoracic trauma. Statistical analysis performed was receiver operating characteristic (ROC) curve. In this study, there were 50 blunt thoracic trauma patients (45 males and 5 females), aged ≥18 years old, admitted to Prof. Dr. R. D. Kandou Hospital during August 2016 to July 2017. Patients with penetrating thoracic trauma, history of any lung disease, and blunt thoracic trauma with onset >24 hours were excluded. The patient age range was 18-73 years with a mean of 39.02 years. Overall, 12 patients (24%) developed ARDS, 9 patients (18%) with pulmonary contusion, 20 patients (40%) with rib fracture, 25 patients (50%) with hematothorax, 6 patients (12%) with pneumothorax, and 5 patients (10%) with hypoxemia. TTSS got the most optimal value of sensitivity (100%) and specifity (92.1%) in cut-off point of 6. Conclusion: TTSS can be used as a diagnostic tool to predict ARDS in blunt thoracic trauma.Keywords: thorax trauma severity score, acute respiratory distress syndrome, blunt thoracic traumaAbstrak: Trauma toraks merupakan penyebab mortalitas dan morbiditas yang signifikan. Kesulitan penanganan pasien dengan trauma tumpul toraks disebabkan keterlambatan terdeteksinya acute respiratory distress syndrome (ARDS). Thorax trauma severity score (TTSS) yang diperkenalkan oleh Pape dkk pada tahun 2000 mencakup usia, parameter fisiologik, dan penilaian radiologik toraks. Penelitian ini bertujuan untuk menilai kemampuan TTSS dalam memrediksi kejadian ARDS pada pasien dengan trauma tumpul toraks. Analisis statistik menggunakan receiver operating characteristic (ROC) curve. Dalam studi ini terdapat 50 pasien dengan trauma tumpul toraks (45 laki-laki dan 5 perempuan), berusia ≥18 tahun yang dirawat di RSUP Prof. Dr. R. D. Kandou pada Agustus 2016 s/d Juli 2017. Pasien dengan trauma tembus toraks, riwayat penyakit paru, dan trauma tumpul toraks dengan onset >24 jam tidak diikut sertakan dalam penelitian. Hasil penelitian mendapatkan rentang usia pasien 18-73 tahun dengan rerata 39,02 tahun. Terdapat 12 pasien (24%) dengan ARDS, 9 pasien (18%) dengan kontusio paru, 20 pasien (40%) dengan fraktur kosta, 25 pasien (50%) dengan hematotoraks, 6 pasien (12%) dengan pneumotoraks, dan 5 pasien (10%) dengan hipoksemia. TTSS mendapatkan nilai paling optimal dari sensitivitas (100%) dan spesifitas (92,1%) pada cut-off point 6. Simpulan: TTSS dapat digunakan sebagai alat diagnostik untuk memrediksi kejadian ARDS pada pasien dengan trauma tumpul toraks.Kata kunci: thorax trauma severity score, acute respiratory distress syndrome, trauma tumpul toraks
Amaç: Bu çalışmada amaç travmaya bağlı gelişen kot fraktürü ile hemopnömotoraks ilişkisinin saptanmasıdır. Gereç ve yöntemler: Hastanemiz acil servisine 2014-2017 yılları arasında göğüs travmasıyla gelen ve kot kırığı bulunan 280 hastanın toraks BT filmleri retrospektif olarak taranmıştır. Bulgular: 130 hastada deplase(%46,4) 150 hastada nondeplase (%53,6) kot kırıkları saptandı. Deplase olanların 75 tanesinde (%57,6) travmatik pnömotoraks, 25 inde (%19,2) eşlik eden hemotraks vardı. Nondeplase kırıkların 20 tanesinde (%13,3) pnömotoraks, 7 sinde (%4,) eşlik eden hemotoraks vardı. Geri kalanlarda pnömotoraks hemotoraks izlenmedi. Tüm kırıkların 35’i (%12,5) alt torakal segmentte (9-12. Kotlar), 205’i (%73,2) ise üst torakal segmentteydi (1-8. Kotlar). 40 hastada (%14,3) ise mix tip fraktürler izlendi. Üst torakal yerleşimli olanların 100’ünde ( %79), alt torakal segmentte olanların 4’ünde ( %3) ve mixt tip olanların 23’ünde (%18) hemopnömotoraks saptandı. Sonuç: Kot kırığının lokalizasyonu ve deplase-nondeplase olması eşlik eden olası hemopnömotoraks varlığı ile ilişkilidir.
Pendahuluan: Endometriosis toraks adalah penyakit yang jarang terjadi namun dapat menimbulkan morbiditas dan mortalitas. Deteksi dini dengan anamnesis dan pemeriksaan penunjang yang tepat dapat mengarahkan pilihan terapi dan memperbaiki prognosis pasien.Laporan Kasus: Pada laporan kasus ini seorang pasien perempuan usia produktif dengan gejala nyeri dada kanan dan sesak yang terjadi saat menstruasi.Diskusi: Dari hasil rontgen toraks ditemukan pneumotoraks dextra dan dilakukan pemasangan selang dada. Anamnesis yang menunjang ke arah endometriosis toraks dan hasil CT scan yang menunjukkan terdapat lesi diafragma kanan lalu tatalaksana dilanjutkan dengan pembedahan minimal invasive video-assisted thoracoscopic surgery (VATS). Intraoperasi dilakukan reseksi lesi dan dari hasil patologi anatomi dikonfirmasi terdapat lesi endometriosis. Pasca operasi pasien diberikan tatalaksana hormonal dengan gonadotropin releasing hormone analog.Kesimpulan: Tidak ada kekambuhan gejala pada pemantauan lanjutan sampai 12 bulan setelah operasi.
Evaluasi pengobatan penderita tuberkulosis paru meliputi evaluasi klinis, bakteriologis, dan radiologis. Evaluasi bakteriologis bertujuan untuk mendeteksi ada tidaknya konversi sputum yang merupakan indikator keberhasilan pengobatan. Foto toraks merupakan pemeriksaan yang mudah, cepat dengan biaya yang relatif murah, tetapi belum dijadikan indikator keberhasilan pengobatan. Penelitian ini bertujuan mengetahui kesesuaian antara gambaran foto toraks dan sputum mikroskopis pada evaluasi respons pengobatan penderita tuberkulosis paru setelah enam bulan pengobatan. Penelitian dilakukan pada 246 orang penderita baru dengan diagnosis tuberkulosis paru yang telah mendapat pengobatan tuberkulosis selama enam bulan. Data diambil dari penelitian Proverty Related Infection Oriented Research (PRIOR) di Fakultas Kedokteran Universitas Padjadjaran Bandung yang berlangsung dari September 2000 sampai dengan Desember 2005. Pembacaan hasil foto toraks dilakukan oleh dua orang ahli radiologi. Subjek penelitian berusia 15−67 tahun. Hasil pembacaan kedua ahli radiologi menunjukkan kesesuaian antara penilaian foto toraks dan hasil mikroskopis sputum. Nilai kesesuaian hasil pembacaan oleh ahli radiologi I adalah 0,420 (fair) dan ahli radiologi II adalah 0,446 (fair). Simpulan, terdapat kesesuaian antara penilaian foto toraks dan hasil mikroskopis sputum pada evaluasi respons penderita tuberkulosis paru setelah enam bulan pengobatan. Foto toraks dapat dijadikan alternatif evaluasi respons tuberkulosis paru setelah enam bulan pengobatan. [MKB. 2011;43(3):140–5]. Kata kunci : Foto toraks, sputum mikroskopis, tuberkulosis paru Compatibility between Chest Radiograph and Microscopic Sputum Examination at Response Evaluation of Lungs Tuberculosis after Six Months of Therapy Evaluation of pulmonary tuberculosis treatment include clinical, bacteriological, and radiological evaluation. Bacteriological evaluation aims to detect sputum conversion as an indicator of treatment success. Chest radiograph is simple, quick and relatively low cost, but it has not been used as an indicator of treatment success. This study aims was to compare the compatibility between chest radiograph and microscopic sputum in patients with lung tuberculosis after sixth months of treatment. The study was conducted on 246 new lung tuberculosis patients that had received treatment for six months. Data was taken from Proverty Related Infection Oriented Research (PRIOR) at Medical Faculty of Padjadjaran University in Bandung that was held from September 2000 to December 2005. Assessment of chest radiographs was performed by two expert radiologists. Age of the subjects were 15−67 years old. The study showed that chest radiograph assessment was compatible with sputum microscopy result. The suitability value between them was 0.420 (fair) by the first radiologist and 0.446 (fair) by the second radiologists. In conclusion, there is compatibility between assessment chest radiograph and microscopic sputum examination at the responses evaluation of the lung tuberculosis patients after six months of therapy. Chest radiograph can be an alternative for response evaluation of lung tuberculosis after six months of therapy. [MKB. 2011;43(3):140–5]. Key words : Lungs tuberculosis, microscopic sputum, thorax photo DOI: http://dx.doi.org/10.15395/mkb.v43n3.60
Kanker paru merupakan masalah yang terjadi di Indonesia dan merokok merupakan salah satu penyebab kanker paru. Bedah toraks dapat mengobati pasien yang terkena kanker paru, akan tetapi usia hidup pasien pasca operasi yang menjadi masalah, jika kanker paru yang diderita pasien sudah parah. Usia pasien setelah satu tahun menjalani bedah toraks dapat hidup atau tidak. Dataset thoracic surgery merupakan data yang berisi tentang pasien yang menjalani bedah toraks dan usia hidup pasien setelah pasca operasi. Naive Bayes merupakan algoritma machine learning yang sederhana dan cepat dalam hal klasifikasi, kinerja yang baik dan mudah dalam penerapannya. Banyak penelitian dalam menentukan pasien tersebut hidup atau tidak setelah satu tahun menjalani bedah toraks, salah satunya menggunakan Naive Bayes. Dataset bedah toraks memiliki permasalahan imbalance class (ketidakseimbangan kelas) karena nilai false lebih banyak dibandingkan nilai true. Dataset yang tidak seimbang dapat menyebabkan kinerja pada model yang digunakan menurun, sehingga dibutuhkan metode yang dapat menangani permasalahan tersebut. Bagging merupakan metode yang tepat dalam menangani permasalahan imbalance class dan dapat meningkatkan kinerja dari model yang digunakan. Pada penelitian ini menggunakan model Naive Bayes dan Bagging untuk prediksi model bedah toraks.
Investigations showed that the three insecticides used had the most damaging effect upon hydra immediately after treatment. The tentacles and the hypostome are the parts most often damaged. Inse the affected cells, lesions appear in the intracellular membranes, the nucleus shell and the membranes of the mitochondria, Golgi complex and the endoplasmic reticulum, while the cell membrane is preserved. The damaged parts of the body regenerate within three days. Zymogen cells play a significant role in the course of regeneration. They dedifferentiate into gastrodermal interstitial cells and later into other types of cells of the ectoderm and the gastroderm. Apart from their intense participation in regeneration, these totipotent cells also invariably participate in the formation of new hydra buds. It was observed that Dimiline WP 25 and Torak EC 24 in the concentrations used stimulate asexual reproduction of this animal.
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