tag:blogger.com,1999:blog-4313933723003403502024-02-20T11:26:22.375-08:00Sense HealSemua tentang bagaimana "kondisi tak menyenangkan" itu di sembuh-kan, Urology, Surgery, Inspirationeko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.comBlogger97125tag:blogger.com,1999:blog-431393372300340350.post-47310034718170252512019-08-20T15:29:00.001-07:002019-08-20T15:31:11.891-07:00UNDESCENDED TESTIS (UDT)<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg38jhrZqadYBGFfiwV6iyS-3v5007TXFZpMZtvHOH3H0aiuQMDREurR9HIlCVhnoiMneEpRlXzzBfNDyo5QXsTY9MCfrBwZ4BC6zgIu4oMeKaLyMr6pBJ9BAprOdD-pDdmIzmcQBaAq0o/s1600/Screen+Shot+2019-08-21+at+5.27.00+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="695" data-original-width="1338" height="166" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg38jhrZqadYBGFfiwV6iyS-3v5007TXFZpMZtvHOH3H0aiuQMDREurR9HIlCVhnoiMneEpRlXzzBfNDyo5QXsTY9MCfrBwZ4BC6zgIu4oMeKaLyMr6pBJ9BAprOdD-pDdmIzmcQBaAq0o/s320/Screen+Shot+2019-08-21+at+5.27.00+AM.png" width="320" /></a></div>
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Undescended testis or cryptorchidism is the absence of one or both testes<br />
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in normal scrotal position and during initial clinical evaluation may refer </div>
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to palpable or nonpalpable testes, which are either cryptorchid or absent.</div>
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<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-33062801891543640672019-07-31T21:55:00.000-07:002019-07-31T21:59:07.858-07:00ERECTILE DYSFUNCTION<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCzYYr7iPMOOFGyXZwKNyDcH9Z2wyd3scN6iPvyxiFHKWsx_xo5FDg32RnBoCh6tyXvCXKdL2bIl6OomWM3Jf8_UQHA1AU-SysMi5gdK39qu4-kkgRukIlsGhITbPgJPPkdeuJOWMynDY/s1600/Screen+Shot+2019-08-01+at+11.51.59+AM.png" imageanchor="1"><img border="0" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCzYYr7iPMOOFGyXZwKNyDcH9Z2wyd3scN6iPvyxiFHKWsx_xo5FDg32RnBoCh6tyXvCXKdL2bIl6OomWM3Jf8_UQHA1AU-SysMi5gdK39qu4-kkgRukIlsGhITbPgJPPkdeuJOWMynDY/s400/Screen+Shot+2019-08-01+at+11.51.59+AM.png" width="400" /></a><br />
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<a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/o7PRHHElBp516U%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/erectile-dysfunction-159634738" title="Erectile Dysfunction" target="_blank">Erectile Dysfunction</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/o7PRHHElBp516U" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a><br />
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The inability to attain and/or maintain an erection sufficient for satisfactory sexual performance and persistent in 3 months.<br />
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(National Institute of Health. JAMA. 1993)<br />
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Massachusetts Male Aging Study (MMAS) reported an overall prevalence of 52% ED in non institutionalized men aged 40-70 years in the Boston area; specific prevalence for minimal, moderate, and complete ED was 17.2%, 25.2%, and 9.6%, respectively.</div>
<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0Jakarta, Indonesia-6.2087634 106.84559899999999-6.4613213999999992 106.5228755 -5.9562054 107.16832249999999tag:blogger.com,1999:blog-431393372300340350.post-15147841102994967632019-07-31T21:49:00.002-07:002019-07-31T21:57:07.316-07:00PREMATURE EJACULATION<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFlIZuQ0oSnuVirU25jVs_CMLB4cJLx3v-BNO3xDoEOPQ-iTjD1qUWRKdb40MXSHnp5Rlb0HwiQxfNeKnioYoc4557EWDXeRD7xm040qgVbMewyIBMl5xiBHaxa2MVTeuQdV4cQn9DrTg/s1600/Screen+Shot+2019-08-01+at+11.47.18+AM.png" target="_blank"><img border="0" height="173" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFlIZuQ0oSnuVirU25jVs_CMLB4cJLx3v-BNO3xDoEOPQ-iTjD1qUWRKdb40MXSHnp5Rlb0HwiQxfNeKnioYoc4557EWDXeRD7xm040qgVbMewyIBMl5xiBHaxa2MVTeuQdV4cQn9DrTg/s320/Screen+Shot+2019-08-01+at+11.47.18+AM.png" width="320" /></a><br />
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Premature ejaculation is male sexual dysfunction characterized by :<br />
• perceived inability to control ejaculation that occurs sooner than desired, or expected, <br />
• either before or shortly after vaginal penetration, and <br />
• causes emotional distress for patient and/or sexual partner<br />
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<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0Jakarta, Indonesia-6.2087634 106.84559899999999-6.4613213999999992 106.5228755 -5.9562054 107.16832249999999tag:blogger.com,1999:blog-431393372300340350.post-72820772085866807772019-07-31T21:44:00.000-07:002019-07-31T21:57:36.030-07:00HYPOGONADOTROPIC HYPOGONADISM<div>
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Hypogonadism is characterised by impaired testicular function, which may affect spermatogenesis and/or testosterone synthesis<br />
The symptoms of hypogonadism depend on the degree of androgen deficiency<br />
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The aetiological and pathogenetic mechanisms of male hypogonadism can be divided into 3 main categories :<br />
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<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0Jakarta, Indonesia-6.2087634 106.84559899999999-6.4613213999999992 106.5228755 -5.9562054 107.16832249999999tag:blogger.com,1999:blog-431393372300340350.post-27032131739666680752019-07-31T21:28:00.000-07:002019-07-31T22:03:28.702-07:00MALE INFERTILITY<span style="font-family: "century gothic";"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTWsD67WkzePSk2ETmhTRFGR-8oy4VXKX1FEp-lvHrDMj-cUIhU3kHkK4J0XJLciEFyoTisfgMOEcOP_QI6UWyHQtvs9GVqT3szcIXmadNAo_hRzgU1JXnSbIEbeFDpHcbzMkQw7Odix0/s1600/Screen+Shot+2019-08-01+at+11.20.15+AM.png" imageanchor="1"><img border="0" height="160" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTWsD67WkzePSk2ETmhTRFGR-8oy4VXKX1FEp-lvHrDMj-cUIhU3kHkK4J0XJLciEFyoTisfgMOEcOP_QI6UWyHQtvs9GVqT3szcIXmadNAo_hRzgU1JXnSbIEbeFDpHcbzMkQw7Odix0/s320/Screen+Shot+2019-08-01+at+11.20.15+AM.png" width="320" /></a></span><br />
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<span style="font-family: "century gothic";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/cYXblrLdu9rJpz%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/male-infertility-159629747" title="Male Infertility" target="_blank">Male Infertility</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/cYXblrLdu9rJpz" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a></span><br />
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<span style="font-family: "century gothic";">“Infertility
is the inability of a sexually active, non-contracepting couple to achieve
spontaneous pregnancy in one year” – WHO</span><br />
<span style="font-family: "century gothic";"><br /></span>
Male
fertility can be impaired as a result of:<br />
<span style="font-family: "arial";">•</span><span style="font-family: "century gothic";">Congenital
or acquired urogenital abnormalities</span><br />
<span style="font-family: "arial";">•</span><span style="font-family: "century gothic";">Malignancies</span><br />
<span style="font-family: "arial";">•</span><span style="font-family: "century gothic";">Urogenital
tract infections</span><br />
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<!--EndFragment--><div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0Jakarta, Indonesia-6.2087634 106.84559899999999-6.4613213999999992 106.5228755 -5.9562054 107.16832249999999tag:blogger.com,1999:blog-431393372300340350.post-59264856201459344952019-07-01T08:28:00.000-07:002019-08-20T08:28:49.317-07:00LASER TECHNIQUE IN URINARY STONE<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiVUS1JHTIfr_y5tNCSio1UUxRnQ6NGYAo6HcvWoNP6A6xJIWHnv98-nP6j3fFM2apEFatb5QmNqCqt-6zVmSmqwFH8HAaThjZvLfBmWw1kZuyvBKW6ts2V53vYUKpVTZvDMVH_8Rhbbc/s1600/Screen+Shot+2019-08-20+at+10.16.38+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="751" data-original-width="1363" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiVUS1JHTIfr_y5tNCSio1UUxRnQ6NGYAo6HcvWoNP6A6xJIWHnv98-nP6j3fFM2apEFatb5QmNqCqt-6zVmSmqwFH8HAaThjZvLfBmWw1kZuyvBKW6ts2V53vYUKpVTZvDMVH_8Rhbbc/s320/Screen+Shot+2019-08-20+at+10.16.38+PM.png" width="320" /></a></div>
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<br /><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/9UmwmwJV6uYqJ8%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/laser-techniques-for-urinary-stones" title="Laser Techniques for Urinary stones" target="_blank">Laser Techniques for Urinary stones</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/9UmwmwJV6uYqJ8" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> <div style="margin-bottom: 5px;">
<strong> <a href="https://www.slideshare.net/Ekoindra4/laser-techniques-for-urinary-stones" target="_blank" title="Laser Techniques for Urinary stones">Laser Techniques for Urinary stones</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>
</a><br /><br /> <br /><br />The holmium:yttriumaluminum- garnet (Ho:YAG) laser is the most widely used laser for URS, with modern systems providing users with a range of settings and parameters that have numerous effects on stone fragmentation<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-84874959695020841542019-05-24T08:43:00.000-07:002019-05-24T08:58:20.594-07:00TURP TECHNIQUE<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7FKdJqn7mLx5rRUXmAdhI2_hmcu2mOqhn33z4B8HtTjzn17BqNCMTotxhxtiHXqSYOGeu36YYz-IueJ5sSlSg9ESeFxsCjrk9rqPuVzNWO3otIkitbKNVONxpEhkPhWV5_tpjh-tfOyc/s1600/Screen+Shot+2019-05-24+at+10.40.05+PM.png" imageanchor="1"><img border="0" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7FKdJqn7mLx5rRUXmAdhI2_hmcu2mOqhn33z4B8HtTjzn17BqNCMTotxhxtiHXqSYOGeu36YYz-IueJ5sSlSg9ESeFxsCjrk9rqPuVzNWO3otIkitbKNVONxpEhkPhWV5_tpjh-tfOyc/s400/Screen+Shot+2019-05-24+at+10.40.05+PM.png" width="400" /></a><br />
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Transurethral resection of the prostate (TURP) is a commonly performed surgical treatment for benign prostatic hyperplasia. This procedure surgically treat moderate- to-severe LUTS in men with prostate size of 30-80 mL. Strong Indications for Surgery are recurrent urinary retention, acute urinary retention, recurrent haematuria refractory to medical treatment with 5-alpha reductase inhibitors, bladder stones, and renal insufficiency.<br />
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Read below slide :<br />
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<a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/41h2MYfd1EhaRv%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/turp-technique" title="TURP TECHNIQUE" target="_blank">TURP TECHNIQUE</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/41h2MYfd1EhaRv" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a><br />
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<a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/41h2MYfd1EhaRv%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/turp-technique" title="TURP TECHNIQUE" target="_blank">TURP TECHNIQUE</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/turp-technique" target="_blank" title="TURP TECHNIQUE">TURP TECHNIQUE</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>
<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0Medan, Medan City, North Sumatra, Indonesia3.5951956 98.672222700000023.0881111 98.026775700000016 4.1022801 99.317669700000025tag:blogger.com,1999:blog-431393372300340350.post-1668151197675919432019-05-01T09:05:00.000-07:002019-05-24T09:22:09.863-07:00TOTAL PENECTOMY<div class="separator" style="clear: both; text-align: center;">
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This is an operation to remove the whole of the penis. The urethra will be surgically reshaped to form a special urinary drainage<br />passage called a perineal urethrostomy. This will mean that men will need to sit down on a toilet to pass urine. The sensation or need to pass urine will not be affected and men will have control of urination.<br />
<a href="https://www.blogger.com/%3Ciframe%20width=%22745%22%20height=%22419%22%20src=%22https://www.youtube.com/embed/KSnI8z0dRXw%22%20frameborder=%220%22%20allow=%22accelerometer;%20autoplay;%20encrypted-media;%20gyroscope;%20picture-in-picture%22%20allowfullscreen%3E%3C/iframe%3E" target="_blank"><iframe allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="419" src="https://www.youtube.com/embed/KSnI8z0dRXw" width="745"></iframe></a><br /><div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-76267105000584690202019-04-16T19:36:00.001-07:002019-04-16T20:06:07.268-07:00Endoscopic Combined Intrarenal Surgery versus Percutaneous Nephrolithotomy for Renal Stones Management: A Meta-analysis<div style="direction: ltr; line-height: 28.8pt; margin-bottom: 0pt; margin-left: 0.25in; margin-top: 0pt; text-align: justify; text-indent: -0.25in; unicode-bidi: embed; word-break: normal;">
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<span style="font-family: "times new roman"; font-size: 12pt; text-indent: -0.25in;"> Endoscopic combined intrarenal surgery (ECIRS) is a novel way to
approach renal cavities antero-retrogradely to remove renal stones since it
combines flexible ureterorenoscopy (fURS) and percutaneous nephrolithotomy
(PCNL). ECIRS is considered useful in managing patients with large stones,
special cases regardless of age and body habitus, and is proven to provide
benefits including minimizing radiation exposure and risk of hemorrhage.</span><br />
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<span style="font-family: "times new roman"; font-size: 12pt; text-indent: -0.25in;"> <b> Read More in Below Slide...</b></span></div>
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<span style="font-family: "calibri"; text-indent: -0.25in;"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/wymUhgpjuBDWQq%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/erirs-vs-pcnl-uro-fair2019-eko-indra" title="Erirs vs pcnl uro fair2019 eko indra" target="_blank">Erirs vs pcnl uro fair2019 eko indra</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/wymUhgpjuBDWQq" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a></span></div>
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<span style="font-family: "calibri"; text-indent: -0.25in;"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/wymUhgpjuBDWQq%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/erirs-vs-pcnl-uro-fair2019-eko-indra" title="Erirs vs pcnl uro fair2019 eko indra" target="_blank">Erirs vs pcnl uro fair2019 eko indra</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/erirs-vs-pcnl-uro-fair2019-eko-indra" target="_blank" title="Erirs vs pcnl uro fair2019 eko indra">Erirs vs pcnl uro fair2019 eko indra</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </span></div>
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<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0Medan, Medan City, North Sumatra, Indonesia3.5951956 98.672222700000023.0881111 98.026775700000016 4.1022801 99.317669700000025tag:blogger.com,1999:blog-431393372300340350.post-54519243482828063482019-04-16T18:51:00.000-07:002019-04-16T20:04:48.647-07:00SIRS, SEPSIS, AND MODS <div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: "arial" , "helvetica" , sans-serif;">SIRS is characterized (1992)
by two
or more of the following : </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">1. Temperature > 38
C
or < 36
C.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">2. Heart rate > 90/minute.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">3. Respiratory rate > 30/minute, or PaCo2 < 32 mmHg.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">4. WBC count > 12000/mm3, < 4000/mm3, or > 10% band forms</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Please read more in below slide...</span></div>
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<div style="direction: ltr; margin-bottom: 6.0pt; margin-left: 0in; margin-top: 5.28pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: 0in; unicode-bidi: embed; word-break: normal;">
<a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/dabzDFMCssaswz%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/sepsis-sirs-mof-and-ards" title="SEPSIS, SIRS, MOF, AND ARDS" target="_blank">SEPSIS, SIRS, MOF, AND ARDS</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/dabzDFMCssaswz" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a><br />
<div style="margin-bottom: 5px;">
<a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/dabzDFMCssaswz%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/sepsis-sirs-mof-and-ards" title="SEPSIS, SIRS, MOF, AND ARDS" target="_blank">SEPSIS, SIRS, MOF, AND ARDS</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/sepsis-sirs-mof-and-ards" target="_blank" title="SEPSIS, SIRS, MOF, AND ARDS">SEPSIS, SIRS, MOF, AND ARDS</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> <br />
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</div>
<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-80487195815447693742019-03-11T17:58:00.001-07:002019-03-11T18:05:19.155-07:00TURBT PROCEDURE<div style="text-align: center;">
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-family: "trebuchet ms";"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnMq7T8M013vnkCjGg7_hLfos7Tf6Up9CG2f50ZUHHLfR-ZMIZw9TSky4lzvcVLlMJsOfbsuHU7BmOkd7MbsW3640bpp8WJXBNQK6XaXQBFYL2Gpxf0eXU3aWdMf8Co-DNugGv_0ak6MM/s1600/Screen+Shot+2019-03-12+at+8.02.09+AM.png" imageanchor="1"><img border="0" height="174" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnMq7T8M013vnkCjGg7_hLfos7Tf6Up9CG2f50ZUHHLfR-ZMIZw9TSky4lzvcVLlMJsOfbsuHU7BmOkd7MbsW3640bpp8WJXBNQK6XaXQBFYL2Gpxf0eXU3aWdMf8Co-DNugGv_0ak6MM/s320/Screen+Shot+2019-03-12+at+8.02.09+AM.png" width="320" /></a></span></span></div>
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-family: "trebuchet ms";"><br /></span></span>
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-family: "trebuchet ms";"><br /></span></span>
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-family: "trebuchet ms";">Tumor
</span><span style="font-family: "trebuchet ms";">buli</span><span style="font-family: "trebuchet ms";"> </span><span style="font-family: "arial" , "helvetica" , sans-serif;">merupakan </span><span style="font-family: "trebuchet ms";">tumor </span><span style="font-family: "trebuchet ms";">genitourinaria</span><span style="font-family: "trebuchet ms";"> </span><span style="font-family: "trebuchet ms";">terbanyak</span><span style="font-family: "trebuchet ms";"> ke-2</span><span style="font-family: "trebuchet ms";">70-75%
tumor </span><span style="font-family: "trebuchet ms";">buli. Mayoritas </span><span style="font-family: "trebuchet ms";">bersifat</span><span style="font-family: "trebuchet ms";"> </span><span style="font-family: "trebuchet ms";">superfisial</span><span style="font-family: "trebuchet ms";"> </span><span style="font-family: "trebuchet ms";">dan</span><span style="font-family: "trebuchet ms";"> </span><span style="font-style: italic;">well
differentiated. </span><span style="font-style: italic;">Recurrence rate mencapai </span><span style="font-family: "trebuchet ms";">70% dengan mortality rate mencapai </span><span style="font-family: "trebuchet ms";">6-10%. Transurethral Bladder Tumor (TURBT) merupakan salah satu pendekatan terapi untuk tumor jenis ini. </span></span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-family: "trebuchet ms";">Tujuan dari TURBT :</span><span style="font-family: "trebuchet ms";"> </span></span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-family: "trebuchet ms";"> - Mengangkat</span><span style="font-family: "trebuchet ms";"> </span><span style="font-family: "trebuchet ms";">lesi</span><span style="font-family: "trebuchet ms";"> </span><span style="font-family: "trebuchet ms";">papiler</span></span><br />
<!--StartFragment-->
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-family: "trebuchet ms";"> - Mengetahui</span><span style="font-family: "trebuchet ms";"> </span><span style="font-family: "trebuchet ms";">seberapa</span><span style="font-family: "trebuchet ms";"> </span><span style="font-family: "trebuchet ms";">dalamnya</span><span style="font-family: "trebuchet ms";"> </span><span style="font-family: "trebuchet ms";">invasi</span><span style="font-family: "trebuchet ms";">
tumor </span><span style="font-family: "trebuchet ms";">atau</span><span style="font-family: "trebuchet ms";">
stadium </span><span style="font-family: "trebuchet ms";">klinis</span><!--EndFragment-->
</span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-family: "trebuchet ms";"><br /></span></span>
<span style="font-family: trebuchet ms;">Pembahasan lengkap pada slide :</span><br />
<br />
<a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/MPLpv6upxk7dIm%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/turbt-procedure" title="TURBT PROCEDURE" target="_blank">TURBT PROCEDURE</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><span style="color: black;"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/MPLpv6upxk7dIm" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </span></a><br />
<div style="margin-bottom: 5px;">
<a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/MPLpv6upxk7dIm%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/turbt-procedure" title="TURBT PROCEDURE" target="_blank">TURBT PROCEDURE</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><span style="color: black;"><strong> </strong></span></a><span style="color: black;"><strong><a href="https://www.slideshare.net/Ekoindra4/turbt-procedure" target="_blank" title="TURBT PROCEDURE">TURBT PROCEDURE</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </span></div>
<span style="color: black;">
</span><div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-90487439950690703412019-01-06T00:58:00.000-08:002019-01-06T01:03:29.637-08:00STONE OR PHLEBOLITH?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh23F1xJOcPLejpxXRAF5_9kaIiICpzUjIbn4j8Oni9Jbe0Y6MbHbyQ_ydcaRp0NbSGb2fgCOAAo5TcKRf_6ZHLFx-Ix_byTt0iGapW37wiU-sjnFBAZRg6N-dsqBYxSIa4z3jbd8nUqm8/s1600/Screen+Shot+2019-01-06+at+3.47.43+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="537" data-original-width="1006" height="170" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh23F1xJOcPLejpxXRAF5_9kaIiICpzUjIbn4j8Oni9Jbe0Y6MbHbyQ_ydcaRp0NbSGb2fgCOAAo5TcKRf_6ZHLFx-Ix_byTt0iGapW37wiU-sjnFBAZRg6N-dsqBYxSIa4z3jbd8nUqm8/s320/Screen+Shot+2019-01-06+at+3.47.43+PM.png" width="320" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtOSQ0fE5EOA6gr9qDAZOLUEQcdqAi0aoTOYgX033qdwLXnbNnXdLPoeCdyQEJ-xoo2RUk0xyT3jmnge8g_7bBJfi46gXq6X_kXcQbNR3fKJX8ggMyBgC5DGZL6StERF0PZINA9ZKTWhw/s1600/Screen+Shot+2019-01-06+at+3.48.05+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="526" data-original-width="929" height="181" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtOSQ0fE5EOA6gr9qDAZOLUEQcdqAi0aoTOYgX033qdwLXnbNnXdLPoeCdyQEJ-xoo2RUk0xyT3jmnge8g_7bBJfi46gXq6X_kXcQbNR3fKJX8ggMyBgC5DGZL6StERF0PZINA9ZKTWhw/s320/Screen+Shot+2019-01-06+at+3.48.05+PM.png" width="320" /></a></div>
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<div style="text-align: justify;">
<span style="color: black; font-family: "corbel";">Stones
in the distal ureter can be difficult to differentiate between pelvic </span><span style="color: black; font-family: "corbel";">calcifications</span><span style="color: black; font-family: "corbel";">. </span></div>
<div style="text-align: justify;">
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<span style="font-family: "corbel";">Needs
</span><span style="font-family: "corbel";">to
look for other signs of obstruction that indicate the presence of a stone
including ureteral dilation, inflammatory changes in the </span><span style="font-family: "corbel";">perinephric</span><span style="font-family: "corbel";"> fat,
</span><span style="font-family: "corbel";">hydronephrosis</span><span style="font-family: "corbel";">, and
a soft tissue rim...</span></div>
<br />
<a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/7yGPouvZBb27Md%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/stone-phlebolith" title="Stone & Phlebolith" target="_blank">Stone & Phlebolith</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/7yGPouvZBb27Md" style="border: 1px solid rgb(204, 204, 204); margin-bottom: 5px; max-width: 100%;" width="595"></iframe></a><br />
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<a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/7yGPouvZBb27Md%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/stone-phlebolith" title="Stone & Phlebolith" target="_blank">Stone & Phlebolith</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/stone-phlebolith" target="_blank" title="Stone & Phlebolith">Stone & Phlebolith</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>
<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-88077853345590177082019-01-01T01:31:00.000-08:002019-01-06T01:36:41.142-08:00ANDROGEN DEPRIVATION THERAPY (ADT)<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxw-FlGWNzMc-5_kjJ9YsoFrIsxEuUVAleRKU4dA0cwNOrdBUVTiaZ3seZq5e_eY_ttOPG85y8DdHxrgpYmkpZ8vkSv1T1_DLUwmm-FpToZ_X4gA_Y8DbHXjfxk38lJkcQ-akjs9ZKCus/s1600/WhatsApp+Image+2019-01-06+at+16.26.42.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="742" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxw-FlGWNzMc-5_kjJ9YsoFrIsxEuUVAleRKU4dA0cwNOrdBUVTiaZ3seZq5e_eY_ttOPG85y8DdHxrgpYmkpZ8vkSv1T1_DLUwmm-FpToZ_X4gA_Y8DbHXjfxk38lJkcQ-akjs9ZKCus/s320/WhatsApp+Image+2019-01-06+at+16.26.42.PNG" width="231" /></a></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">Androgen
deprivation therapy
(ADT),
also called androgen suppression therapy, is an antihormone
therapy whose main use in treating prostate cancer...</span><br />
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<a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/x9evI2NP34VLwR%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/androgen-deprivation-theraphy-on-prastate-ca" title="ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA" target="_blank">ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><span style="color: black;"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/x9evI2NP34VLwR" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </span></a><br />
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<a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/x9evI2NP34VLwR%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/androgen-deprivation-theraphy-on-prastate-ca" title="ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA" target="_blank">ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><span style="color: black;"><strong> </strong></span></a><span style="color: black;"><strong><a href="https://www.slideshare.net/Ekoindra4/androgen-deprivation-theraphy-on-prastate-ca" target="_blank" title="ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA">ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </span></div>
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</span><div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-88960847448195653572018-08-20T07:41:00.000-07:002019-08-20T07:55:45.389-07:00TRANSPLANTASI GINJAL<div class="separator" style="clear: both; text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIKs4hNy6U-KSJ5f7i44dVuIwz604ycy4BjbVv76ALkzMyr6EJY0uCp_FDrAsn2y4Hwd-TlNPSqbUGeTcFwIU1oIZn1enFurq91-EO5Gb3lbzUFMxoh8iWcci2KdScIo-zdG5itgU0bMU/s1600/WhatsApp+Image+2019-08-20+at+21.19.11.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="635" data-original-width="920" height="219" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIKs4hNy6U-KSJ5f7i44dVuIwz604ycy4BjbVv76ALkzMyr6EJY0uCp_FDrAsn2y4Hwd-TlNPSqbUGeTcFwIU1oIZn1enFurq91-EO5Gb3lbzUFMxoh8iWcci2KdScIo-zdG5itgU0bMU/s320/WhatsApp+Image+2019-08-20+at+21.19.11.jpeg" width="320" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHK8X_rfvUSIdmW_ntGXyYehmEmvaqSnFHDqpxvRP3H6xvThfzQOBA-3TIxldlG0XgBiY8Qk_JkjLWVPR-kj3m0X8Lw_Ltq6eoJ5xreXcZlj4ujhRfUnsgQzxf7seiHrv1GaSOVTxZHiY/s1600/WhatsApp+Image+2019-08-20+at+21.18.55.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="768" data-original-width="1024" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHK8X_rfvUSIdmW_ntGXyYehmEmvaqSnFHDqpxvRP3H6xvThfzQOBA-3TIxldlG0XgBiY8Qk_JkjLWVPR-kj3m0X8Lw_Ltq6eoJ5xreXcZlj4ujhRfUnsgQzxf7seiHrv1GaSOVTxZHiY/s320/WhatsApp+Image+2019-08-20+at+21.18.55.jpeg" width="320" /></a></div>
<br /><div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-90891103359945793792018-08-10T18:10:00.001-07:002018-08-11T18:52:08.142-07:00Jelaskan Gamblang, atau Masuk Bui!<div style="text-align: justify;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNFvzVvRKt5olu8BHBbrH8-K2TS8jrL8nk2gQ284k8weFexieuPBhyhH8LWLMVbR0q1jnh_YBmPoAjKxPCu-ucOLhC6sm1uIo-c8VF3VtAz82Vif_thZDeZmH4z5CFwTT-5UO5suPgGF0/s1600/Informed-Consent-e1493302040733.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="534" data-original-width="800" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNFvzVvRKt5olu8BHBbrH8-K2TS8jrL8nk2gQ284k8weFexieuPBhyhH8LWLMVbR0q1jnh_YBmPoAjKxPCu-ucOLhC6sm1uIo-c8VF3VtAz82Vif_thZDeZmH4z5CFwTT-5UO5suPgGF0/s320/Informed-Consent-e1493302040733.jpg" width="320" /></a></div>
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Malas memang untuk sediakan waktu untuk menginformasikan dengan detail tentang prosedur tindakan yang akan kita kerjakan kepada pasien dan keluarga sampai mereka betul-betul mengerti dan tanpa paksaan menyetujui setiap tindakan yang seorang dokter lakukan dengan semua benefit dan resikonya. Seringnya seorang dokter hanya sekelebat saja ditengah kesibukannya untuk memperhatikan hal ini, <i>informed consent </i>biasa disebut dalam dunia medis. </div>
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Berdasar Surat Keputusan Direktur Jenderal Pelayanan Medik Nomor HK. 00.06.3.5.1886 tanggal 21 April 1999 tentang pedoman persetujuan tindakan medik (informed consent) mengatakan bahwa informed consent terdiri dari kata informed yang berarti telah mendapat informasi dan consent berarti persetujuan (ijin). Yang dimaksud dengan informed consent dalam profesi kedokteran adalah pernyataan setuju (consent) atau ijin dari seseorang pasien yang diberikan dengan bebas, rasional, tanpa paksaan (voluntary) tentang tindakan kedokteran yang akan dilakukan terhadapnya sesudah mendapatkan informasi cukup tentang tindakan kedokteran yang dimaksud.</div>
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Informed consent menurut Ketentuan Umum Pasal 1 angka 1 Permenkes No. 290 tahun 2008 yaitu persetujuan yang diberikan oleh pasien atau keluarga terdekat setelah mendapat penjelasan secara<span class="Apple-tab-span" style="white-space: pre;"> </span>lengkap<span class="Apple-tab-span" style="white-space: pre;"> </span>mengenai<span class="Apple-tab-span" style="white-space: pre;"> </span>tindakan kedokteran atau kedokteran gigi yang akan dilakukan terhadap pasien</div>
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Pengalaman buruk akhirnya cuma jadi penyesalan setiap dokter yang akhirnya tertimpa bencana medikolegal terkait hal ini. Versiku, beberapa minggu lalu hampir pecah rasanya kepala ini. Wakil direktur tempatku bertugas sebagai peserta didik menghubungi bahwa seorang pasien mengadukan ketidaksenangannya atas tindakan medis yang diterimanya. Pengakuan pasien, beliau tidak mendapatkan informasi tentang pemasangan <i>Double J</i> (DJ) stent pada ginjalnya. DJ stent merupakan selang pengaman yang digunakan sebagai pelindung saluran kemih, indikasi pada pasien bersangkutan karena setelah dilakukan operasi penembakan batu saluran kemih bagian atas (ureter), terdapat trauma (iritasi) pada ureter, tujuannya untuk memberikan waktu yang cukup pada jaringan ureter untuk menyembuh dan mencegah penyempitan ureter dikemudian hari. Tidak ada yang salah sampai disitu, tujuan cukup gamblang demi kebaikan pasien. Tak sedikitpun terbesit mengambil keuntungan dari tindakan apa yang dilakukan, terlebih adalah seorang peserta didik, hanya menjalankan tugas pelayanan kesehatan sembari menenggak ilmu darinya.</div>
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Pasalnya, pasien ini cukup spesial, punya ambang nyeri yang sangat rendah, jadi rasa tidak nyaman yang dirasakan menjadi sangat mengganggu aktivitasnya. Karena hal tersebutlah pasien mengadu kepada mangement rumah sakit dengan alasan tidak mendapatkan informasi apapun terkait pemasangan selang diginjalnya. Nah, kebetulan pasien tidak dapat menahan emosinya, ancaman untuk membawa permasalahan ke ranah hukum pun tersampaikan. </div>
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Kalau sudah begini, pihak rumah sakit harus ambil langkah cepat mengakomodasi setiap keluhan pasien, adakan pertemuan untuk melakukan pendekatan sosial sehingga tidak meluas dan menjadi gosip umum yang menyudutkan. Saran dari Bapak Wadir, aku menemui pasien dan keluarganya, duduk manis penuh senyum untuk mendengarkan setiap keluh kesah pasien dan memberikan solusi atas masalah yang mereka hadapi. </div>
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Aku penuhi nasehat itu, dibuatlah janji bertemu dengan pasien, ditemani pihak Humas rumah sakit akupun menemui pasien. Yang kulakukan pertama kali jelas membuat pasien nyaman dengan pertemuan saat itu, aku coba menawarkan minuman dingin kepada beliau dan keluarga (berharap isi kapalanya ikut dingin) kemudian membuka pembicaraan dengan <i>persuasive approach </i>yang pernah kudapat pelajarannya selama perjalanan hidup :p. </div>
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Pasien dan keluarga mengaku yakin tidak pernah mendapatkan penjelasan terkait pemasangan selang ginjal, itu konteksnya. Pun sama pikirku, yakin minimal dua kali kujelaskan setiap tindakan yang akan kulakukan kepada pasien. Salahnya, tampaknya hal tersebut tidak terdokumentasikan distatus pasien, terlebih tanda tangan keluarga bahwa mereka mengerti penjelasan dan dengan semua keuntungan serta kerugian tindakan bersedia yang menjalani operasi. Dihadapan pasien aku tidak menunjukkan bahwa aku benar, dan kalian salah, karena hal tersebut hanya akan memperkeruh permsalahan, dan lagi tidak ada manusia manapun yang rela disalahkan. Aku coba menyampaikan permintaan maaf atas ketidaknyamanannya terpasang selang ginjal dan meyakinkan pasien bahwa itu semua demi kebaikan beliau. Kutawarkan solusi untuk pencabutan selang ginjal dengan segera dan dengan pembiusan untuk mencegah nyeri yang timbul saat tindakan. Hasilnya, beliau dan keluarga berkenan. Alhamdulillah... setiap masalah selalu ada jalan keluar.</div>
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Tips singkat jika kita menghadapi permasalahan yang sama :</div>
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- <i>Don't be panic</i></div>
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- Komunikasi hati ke hati</div>
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- Jangan membantah pasien yang sedang emosi, bicara ketika emosi sudah reda</div>
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- Kumpulkan data lengkap sebagai proteksi terakhir untuk justifikasi jika pendekatan sosial gagal</div>
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- Siapkan solusi<br />
- Berdoa sama Pemilik Hati, perbanyak istighfar, mungkin ujian ditimpakan karena dosa kita :)<br />
Yakinlah semua terjadi atas kehendaknya dan semua solusi hanya kembali pada-Nya. </div>
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Tindakan preventif tetap lebih baik. Semua itu gak akan terjadi kalau kita menyediakan waktu dan perhatian cukup untuk pasien. Jelaskan dengan lengkap, pastikan pasien dan keluarga mengerti penjelasan kita lalu tanpa paksaan mengambil keputusan dengan semua resiko dan keuntungan yang dapat terjadi. Terpenting, dokumentasikan apa yang sudah disampaikan kepada pasien lengkap dengan tanda tangan pasien dan saksi keluarga.<br />
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Pertanyaan retoriknya ; Anda pilih mana ?</div>
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<b>JELASKAN GAMBLANG, ATAU MASUK BUI???</b></div>
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<span style="font-size: x-small;">Image Source :</span><br />
<span style="font-size: x-small;"><a href="https://1c01rt250znwm8z6u14bvzy7-wpengine.netdna-ssl.com/images/Informed-Consent-e1493302040733.jpeg">Informed-Consent-e1493302040733.jpeg</a></span><br />
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Semoga bermanfaaat,<br />
Medan, Agustus 2018<br />
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<br /><div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0Medan, Medan City, North Sumatra, Indonesia3.5951956 98.672222700000023.0881111 98.026775700000016 4.1022801 99.317669700000025tag:blogger.com,1999:blog-431393372300340350.post-72338762350720555542018-06-09T17:53:00.003-07:002018-06-09T19:32:14.913-07:00ANAK SERING ISK? HATI-HATI!!!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqDlCepROQfypn-f45YGMpADdcyjLF6EdrY8C-ivYT6ipobaSClk36vB8hNuFcTtK9wIeTYeVjzuL9C8iPoPQGHXMqdE7_wDAD5fIhP-YrGZNLs53xvd62GyxSUScocTamCGr_TyaVs8Q/s1600/INFEKSI+SALURAN+KENCING++PADA+ANAK.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="342" data-original-width="557" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqDlCepROQfypn-f45YGMpADdcyjLF6EdrY8C-ivYT6ipobaSClk36vB8hNuFcTtK9wIeTYeVjzuL9C8iPoPQGHXMqdE7_wDAD5fIhP-YrGZNLs53xvd62GyxSUScocTamCGr_TyaVs8Q/s320/INFEKSI+SALURAN+KENCING++PADA+ANAK.jpg" width="320" /></a></div>
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Dalam pendekatan klinis terhadap penyakit infeksi saluran kemih (ISK) pada anak, ada kalanya kita melakukan underdiagnosis. Tidak jarang pasien anak berulang-ulang bahkan Saya beberapa kali menemukan hingga bertahun-tahun, didiagnosis ISK kronis dan tidak mendapatkan pendekatan yang betul-betul terapeutik, hanya simptomatik. Dokter yang merawat hanya memberikan antibiotik dana analgenik untuk penanganan penyakit ini.<br />
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Tidak sepenuhnya keliru memang, namun pendekatan ideal dan sistematik sebaiknya menjadi perhatian kita bersama untuk penanganan ISK pada anak. Kenapa?</div>
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Ada salah satu etiologi/penyebab pasien anak menderita ISK kronis, yang jika tidak tertangani dengan baik, akan menyebabkan komplikasi yang demikian serius. Ciyus? Hahaha... Berikut penjelasannya :</div>
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<b>DEFINISI</b></div>
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<b>VUR</b> adalah aliran balik abnormal urine yang berasal dari vesica urinaria (buli/kandung kencing) menuju saluran kemih bagian atas (ureter dan ginjal) yang disebabkan oleh abnormalitas dari ureterovesical junction. Insidensinya 0.4-1.8 % pada anak yang mengalami ISK. Biasa terjadi lebih banyak pada anak laki-laki dibandingkan dengan perempuan pada anak usia kurang dari satu tahun.</div>
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<b>PATOFISIOLOGI</b></div>
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Ada dua tipe dari VUR, primer dan sekunder. <b>VUR tipe primer</b> disebabkan karena adanya kelainan anatomi pada vesicoureteric juntion (UVJ), yaitu area yang menghubungkan vesica urinaria dan ureter, dimana terjadi perubahan rasio antara panjang dari ureter intramural dan diameternya, normalnya 4-5:1. Ini terjadi saat perkembangan embrional pada minggu ke-6 kehamilan. Walaupun demikian resolusi spontan masih mungkin terjadi hingga 30%.</div>
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Nah, untuk<b> reflux tipe sekunder</b> disebabkan karena adanya kelainan anatomi atau ketidakseimbangan tekanan dari vesioureteric junction (UVJ) seperti yang terjadi pada disfungsi berkemih (voiding disfuction), posterior urethral valves, divertikel ureter, dan neurogenik bladder.</div>
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<b>DIAGNOSIS</b></div>
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Pendekatan diagnosis diawali melalui anamnesis berupa gejala klinis ISK, seperti nyeri atau menangis saat berkemih, sering berkemih (frekuensi), urgensi, BAK berdarah (hematuria), dan sebagainya. pemeriksaan berikutnya adalah ultrasonografi (USG), <i>voiding cystourethrography (VCUG), dan renal scintigraphy.</i> Dari 3 pemeriksaan ini, yang bisa dilakukan pertama kali tentu adalah USG, sejawat dapat melakukannya sendiri jika terdapat fasilitas ditempat kerja, atau merujuk ke sejawat radiologi. Tentu hal ini dilakukan jika pasien datang dengan ISK berulang, jangan pernah melakukan ketika pasien pertama kali datang. Nanti BPJS marah... hehehe...</div>
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Jika menemukan hidronefrosis, dan kita sudah bisa singkirkan penyebab lain hidronefrosis, seperti batu saluran kemih, massa atau tumor, maka perlu kita curigai adanya VUR. Sejawat dapat merujuk pasien ke dokter Urologi untuk dilakukan VCUG. VCUG merupakan pemeriksaan minimal invasif yang menggunakan teknologi <i>x-ray </i>yang disebut fluoroskopi untuk memvisualisasikan saluran kemih dan vesica urinaria. European Association of urology (EAU) sepakat jika pemeriksaan ini dilakukan jika pada pemeriksaan USG ditemukan adanya kelainan korteks ginjal (lapisan terluar ginjal tipis), hidronefrosis bilateral (bengkak kedua ginjal) dengan grade tinggi, ureterocele, dilatasi ureter, atau abnormalitas vesicaurinaria.</div>
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Gambaran pemeriksaan ini dapat dilihat <a href="http://senseheal.blogspot.com/2018/06/voiding-cystourethrography-vcug.html" target="_blank">disini</a>.</div>
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Sementara ini, pemeriksaan <i>renal scintigraphy </i>jarang dilakukan di negeri tercinta untuk penegakkan diagnosis ini, cukup sampai VCUG saja. Tanya kenapa? Invasif karena pake nuklir dan mahal! hehe...</div>
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GRADING VUR</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVwl5XGUvkAlN_lo2vI8ZBB39MQKFNAGOUIGsXJvUlw3y3VJZlLVwtBg9hKtbYW4uQ28EDQTTB5coj2AJzrYUytrTRdnjai6KjJaKCscdwPH4Rf8gLW7iz0KEdrbIRpX89HF9KzfJB7_Q/s1600/vur.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="280" data-original-width="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVwl5XGUvkAlN_lo2vI8ZBB39MQKFNAGOUIGsXJvUlw3y3VJZlLVwtBg9hKtbYW4uQ28EDQTTB5coj2AJzrYUytrTRdnjai6KjJaKCscdwPH4Rf8gLW7iz0KEdrbIRpX89HF9KzfJB7_Q/s1600/vur.jpg" /></a></div>
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<b>TREATMENT</b></div>
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Tujuan penanganan kasus ini adalah untuk preservasi fungsi ginjal dan mencegah pyelonefritis dan minimalisir morbiditas. Pendekatan primer untuk penyakit ini adalah konservatif (nonsurgical), endoskopi, dan pembedahan konvensional.</div>
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<b>Konservatif</b></div>
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Pendekatan konservatif tetap menjadi pilihan karena teori yang mengatakatan bahwa VUR dapat sembuh spontan, termasuk dengan pendekatan observasional, pemberian antibiotik profilaksis intermiten (intermitten antibiotic prophylaxis) atau continuous antibiotik prophylaxis (CAP), rehabilitas vesicaurinaria dan bowel management pada pasien dengan <i>bladder dan bowel dysfuction.</i></div>
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<i>Tingkat resolusi VUR : </i></div>
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Grade I-II : 80% </div>
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Grade III-V : 30-50% </div>
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Nah, ada yang menarik bicara tentang penyakit ini, banyak penulis yang menghubungkan tingkat kejadian ISK dan VUR dengan sirkumsisi/khitan. Sirkumsisi dianggap sebagai salah satu pendekatan konservatif, karena sirkumsisi dapat menurunkan resiko infeksi saluran kemih. Sirkumsisi terbukti menurukan kolonisasi dari flora bakteri patogen disekitar uretra. American urological Assosiation (AUA) dan EAU merekomendasikan serkumsisi pada anak untuk pencagahan infeksi. </div>
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Pendekatan terapi konservatif ini direkomendasikan untuk anak usia kurang dari 12 bulan, dann pendekatan pembedahan konvensional sebaiknya dihindari untuk anak usia kurang dari 12 bulan.</div>
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<b>Endoskopi</b></div>
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pertama kali diperkenal oleh O'Donnel and Puri tahun 1984. Awalnya dilakukan dengan menginjeksikan Teflon secara subureter. Berkembang lebih lanjut, ada beberapa <i>agent </i>yang dapat digunakan sebagai bulking agent termasuk BOTOX, namun pendekatan ini jarang dilakukan di Indonesia, karena terbatasnya bulking agent yang tersedia. Seringnya digunakan untuk kasus dengan komponen neurogenik (kelainan saraf).</div>
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Bulking Agent yang dapat digunakan dalam pendekatan endoskopi :</div>
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<b>Pembedahan</b></div>
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Ketika teknik endoskopi gagal untuk menjadi solusi maka pembedahan adalah pilihan terapi terakhir dengan angka keberhasilan 95-98%. </div>
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Prinsipnya adalah memperpanjang bagian ureter intramural dengan mengimplantasi submukosa dari ureter untuk mencapai rasio panjang 4-5:1 antara panjang tunnel submukosa dan diameter ureter. Ada dua teknik operasi yang dikenal pada VUR, yaitu <b>intravesical Cohen cross-trigonal reimplantation dan etravesical Lich-Gregoir procedure</b>.</div>
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Pembedahan dapat dilakukan baik secara operasi terbuka, laparoskopi, maupun laparoskopi. Operasi jenis ini,bukanlah sesuatu yang mudah, bahkan tidak semua dokter spesialis urologi melakukannya. ada sub bagian khusus pediatri urologi yang sangat menguasai teknik operasi ini. </div>
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pesannya, sekali lagi jangan anggap remeh jika anak anda berulang-ulang mengalami penyakit infeksi saluran kemih, komunikasikan dengan dokter anak anda untuk konsultasi dengan dokter spesialis urologi.</div>
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<span style="font-size: x-small;">Referensi :</span></div>
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<ol>
<li><span style="font-size: x-small;">Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Campbell-Walsh urology: expert consult premium edition: enhanced online features and print, 4-volume set. Elsevier Health Sciences; 2011 Aug 25.</span></li>
<li><span style="font-size: x-small;">Lopez PJ, Celis S, Reed F, Zubieta R. Vesicoureteral reflux: current management in children. Current urology reports. 2014 Oct 1;15(10):447.</span></li>
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<span style="font-size: x-small;">Image :</span></div>
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<span style="font-size: x-small;">https://www.rumahmedis.com/2018/02/infeksi-saluran-kencing-isk-pada-anak.html</span></div>
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Demikian, semoga bermanfaat, terutama buat yang penasaran... ;) </div>
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Medan, Sebelum bisa libur lebaran 2018</div>
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<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-71071968614656289112018-06-08T18:14:00.000-07:002018-06-09T18:15:45.386-07:00VOIDING CYSTOURETHROGRAPHY (VCUG)<br />
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VCUG merupakan pemeriksaan minimal invasif yang menggunakan teknologi <i>x-ray </i>yang disebut fluoroskopi untuk memvisualisasikan saluran kemih dan vesica urinaria. European Association of urology (EAU) sepakat jika pemeriksaan ini dilakukan jika pada pemeriksaan USG ditemukan adanya kelainan korteks ginjal (lapisan terluar ginjal tipis), hidronefrosis bilateral (bengkak kedua ginjal) dengan grade tinggi, ureterocele, dilatasi ureter, atau abnormalitas vesicaurinaria.<br />
Pada pemeriksaan ini, pasien tidak dibius karena kita akan menilai fungsi dari saluran kemih. Orang tua dapat diikutsertakan dalam pemeriksaan ini.<br />
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Teknik pemeriksaan :<br />
- Pasien posisi terlentang (supine)<br />
- Kosongkan kandung kemih dengan kateter sesuai ukuran uretra anak<br />
- Insersi feeding tube (NGT) no. 5 hubungkan dengan drip kontras (Nacl : Iopamiro 1:1) dengan tetesan secepatnya<br />
- Masukkan kontras dengan maksimal pengisian sesuai dengan kapasitas buli (Umur+2)x30 ml. Pengukuran kapasitas Buli dapat dilihat di <a href="http://senseheal.blogspot.com/2018/05/bladder-capacity.html" target="_blank">sini</a>.<br />
- Perhatikan monitor fluoroscopy/C-arm, apakah terdapat reflux contras (aliran kontras menuju ureter dan ginjal)? pada pengisian berapa ml hal tersebut terjadi? Grading Hidronefrosis?<br />
- Buat tabel pemeriksaan untuk mendokumentasikan pemeriksaan ini.<br />
- Kosongkan kandung kemih, tindakan selesai<br />
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Semoga Bermanfaat,<br />
Medan, Juni 2018<br />
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<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-13191733159315449062018-06-05T15:48:00.000-07:002019-01-05T16:20:37.669-08:00SUBCAPSULAR NEPHRECTOMY TIPS<div style="text-align: center;">
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<span style="font-family: "trebuchet ms" , sans-serif;">Teknik nefrektomi ini dikerjakan apabila konvensional nefrektomi tidak dapat dikerjakan, semisal durante operasi kita menghadapi perlengketan ginjal dengan jaringan sekitar seperti lemak pararenal, intestine, liver, dll.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Tips Teknik Operasi :</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">- Berdoa kepada Allah SWT dengan memohon pertolongan dan kemudahan </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">- Jika kita menghadapi perlengketan yang demikian menghambat untuk membebaskan ginjal, buka kapsul ginjal di daerah termudah dan teraman diantara perlengketan yg ada</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">- Telusuri kapsul dengan membebaskan ginjal yang ada dengan klem 90 (<i>right angle clamp</i>), ambil bagian dalam parenkim ginjal dibagian dlm kapsul dan potong/bakar menggunakan kauter. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">- Perluas pembebasan parenkim dengan cara yang sama hingga mencapai pedikel. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">- Gunakan teknik dua klem dan potong seperti approach pada nefrektomi tumor ginjal, hingga mencapai pedikel</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">- Jika mencurigai menemukan pembuluh darah besar, dapat dilakukan pengikatan dan pemotongan</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">- setelah mencapai pedikel, atau kira-kira semua parenkim dpt diklem, gunakan teknik surginal knot, potong</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">- jika mengalami kesulitan dalam mencapai pedikel, gunakan teknik jahit parenkim dengan teknik jelujur, kemudian angkat atau tarik ke distal, klem kembali dibagian proksimal dst hingga dpt mencapai pedikel, baru kemudian dilakukan klem pedikel dan CUT!</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">- Tempelkan surgisoft atau sejenisnya untuk membantu hemostasis, cukup ditempelkan atau jahit pada daerah yang aman.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">- Peritoneum yang terbuka setelah kita masukkan air cucian maka tidak perlu dilakukan penutupan.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">- Operasi selesai, semoga bermanfaat.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Eko Indra, </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Medan, 6 Januari 2019</span></div>
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<br /><div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-80765309867083483902018-05-29T03:28:00.001-07:002018-05-29T03:34:31.005-07:00Principles of Endourology<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEvXcumIINyybnAhmvWWpZv-QvXRnl4HfIuKDxDR7aKEmVW_DIsvgZRKfuYi5JPCu79Rq3_o-alfiEWynFrwLVNiAwN-UGqb55uLWeec4LQTkMDWWVJgp39KDjejqMT7c-3zWOMjPPjV8/s1600/Screen+Shot+2018-05-29+at+5.25.08+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="205" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEvXcumIINyybnAhmvWWpZv-QvXRnl4HfIuKDxDR7aKEmVW_DIsvgZRKfuYi5JPCu79Rq3_o-alfiEWynFrwLVNiAwN-UGqb55uLWeec4LQTkMDWWVJgp39KDjejqMT7c-3zWOMjPPjV8/s400/Screen+Shot+2018-05-29+at+5.25.08+PM.png" width="400" /></a></div>
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<span style="font-family: "calibri light"; font-size: large; font-weight: bold;">CYSTOURETHROSCOPY</span><!--EndFragment--> <br />
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<span style="font-family: "arial"; mso-special-format: bullet;">•<span style="font-size: large;"> </span></span><span style="font-size: large;"><span style="color: black; font-family: "calibri";">Provides
direct visualization of the </span><span style="color: black; font-family: "calibri";">anterior </span><span style="color: black; font-family: "mangal";">–</span><span style="color: black; font-family: "calibri";"> posterior urethra </span><span style="color: black; font-family: "calibri";">and
bladder</span></span></div>
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<span style="font-size: large;"><span style="font-family: "arial"; mso-special-format: bullet;">• </span><span style="color: black; font-family: "calibri";">Rigid
or flexible</span></span></div>
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<span style="font-size: large;"><span style="font-family: "arial"; mso-special-format: bullet;">• </span><span style="color: black; font-family: "calibri";">Rigid
provides larger </span><span style="color: black; font-family: "calibri";">workshing</span><span style="color: black; font-family: "calibri";">
channels, easier to control, and better visualization...</span></span><br />
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<span style="color: black; font-family: "calibri";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/1F0miL8dIpG3Sw%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/principles-of-endourology" title="Principles of Endourology" target="_blank">Principles of Endourology</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/1F0miL8dIpG3Sw" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a></span><br />
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<span style="color: black; font-family: "calibri";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/1F0miL8dIpG3Sw%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/principles-of-endourology" title="Principles of Endourology" target="_blank">Principles of Endourology</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/principles-of-endourology" target="_blank" title="Principles of Endourology">Principles of Endourology</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </span></div>
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<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-32806811870509402752018-05-22T03:59:00.000-07:002018-05-29T04:00:18.030-07:00BLADDER CAPACITY<span style="color: black;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWzuG-qEV2GRa1eg8FmAFEot3jzUySBFWyQC08vPUFzcY2qFk590vY57OlUReasP4vqCtNtQjxmb0d7Iuq4ZRHVOqeYCMhVVaKj2oUFF7v1kgcuCELQJ09DfcUhu85dy2YoItR8AxrtX4/s1600/Screen+Shot+2018-05-29+at+5.50.42+PM.png" imageanchor="1"><img border="0" height="443" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWzuG-qEV2GRa1eg8FmAFEot3jzUySBFWyQC08vPUFzcY2qFk590vY57OlUReasP4vqCtNtQjxmb0d7Iuq4ZRHVOqeYCMhVVaKj2oUFF7v1kgcuCELQJ09DfcUhu85dy2YoItR8AxrtX4/s640/Screen+Shot+2018-05-29+at+5.50.42+PM.png" width="640" /></a></span><br />
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<ul>
<li><span style="font-family: "arial rounded mt bold"; text-indent: -0.3in;">Koff</span><span style="font-family: "arial rounded mt bold"; text-indent: -0.3in;"> formula (bladder capacity [in
ounces]: </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;">(Age </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;">(in years) + 2) × 30</span></li>
<li><span style="font-family: "arial rounded mt bold";">The ABC formula : </span><span style="font-family: "arial rounded mt bold";">(Age (A) x 30) / 2</span></li>
<li><span style="font-family: "arial rounded mt bold"; text-indent: -0.38in;">Daniel Costa et al : </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;"> </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;">[1.6 × age (months) + 45]</span></li>
<li><span style="font-family: "arial rounded mt bold"; text-indent: -0.38in;">Fairhurst</span><span style="font-family: "arial rounded mt bold"; text-indent: -0.38in;"> formula : </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;">[7 × weight (kg)] </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;">which gives a bladder capacity estimate in </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;">millilitres</span></li>
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<span style="font-family: "arial rounded mt bold";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/9h7VLvc3VYC9N6%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/bladder-capacity" title="Bladder Capacity " target="_blank">Bladder Capacity </a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/9h7VLvc3VYC9N6" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a></span><br />
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<span style="font-family: "arial rounded mt bold";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/9h7VLvc3VYC9N6%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/bladder-capacity" title="Bladder Capacity " target="_blank">Bladder Capacity </a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/bladder-capacity" target="_blank" title="Bladder Capacity ">Bladder Capacity </a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </span></div>
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<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-68339602821875130542018-05-01T17:15:00.000-07:002018-06-01T15:55:22.602-07:00Hati-hati dengan doa Burukmu, Dok!<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_tOQVifhaAU5G9dic0S07cwWL-ciq29-w1Q43PfGFUz6l2KFE2dYILLgmQlKUEnCTG8rxkxLkdC_DQoczGKJt-YGlPb9glrgb0yFSlzupeWZxEk_qF8ayfwDoTy9lrJyDZ1vaRtOmbVk/s1600/Screen+Shot+2018-06-01+at+7.22.19+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="164" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_tOQVifhaAU5G9dic0S07cwWL-ciq29-w1Q43PfGFUz6l2KFE2dYILLgmQlKUEnCTG8rxkxLkdC_DQoczGKJt-YGlPb9glrgb0yFSlzupeWZxEk_qF8ayfwDoTy9lrJyDZ1vaRtOmbVk/s320/Screen+Shot+2018-06-01+at+7.22.19+AM.png" width="320" /></a></div>
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Dalam memberikan pelayanan kesehatan kepada masyarakat, sebagai residen banyak sekali hal menarik yang ditemui, baik suka maupun duka.<br />
Dukanya, pernah satu waktu seorang pasien yang tak sabar menunggu antrian panjang operasi dipoliklinik karena begitu padatnya jadwal operasi di Rumah Sakit kecewa karena antrian operasi yang begitu panjang. Sang Bapak sebagai pasien, lengkap bersama keluarganya tidak berkenan atas apa yang mereka hadapi ; berbulan-bulan tidak mendapatkan jadwal operasi. Pasalnya, sakit yang dideritanya sebetulnya bukan merupakan suatu kegawatdaruratan medik dibidang Urologi, Batu buli, dan pasien telah dilakukan pemasangan kateter. Pasien kemudian memutuskan untuk melanjutkan pengobatan ke RS swasta setelah meninggalkan torehan luka hati cukup dalam ke PPDS (haha - agak lebay sedikit). Lontaran kata-kata yang kurang sopanpun harus ditelan seorang PPDS klo kondisinya seperti ini.<br />
Alhasil karena memang antrian operasi di RS swasta tidak sepadat antrian operasi di RS tipe A, pasien mendapatkan jadwal tindakan operasi lebih cepat. namun berselang dua minggu pasien kembali ke RS tempatku bekerja. Beliau datang dalam kondisi luka operasi bocor dari supra simfisisnya (Red-atas perutnya), dan dirujuk oleh dokter yang melakukan operasi untuk melanjutkan perawatan ke RS tempatku bertugas. Dan lagi-lagi pasien ini bertemu denganku lagi untuk kali pertamanya datang kembali. Aku masih sangat ingat persis wajah pasien dan yang satu ini, dan akupun masih ingat, sedikit sumpah serapahku dalam hati ketika 3 bulan yang lalu kepada pasien ini ketika mengeluarkan kalimat-kalimat menyakitkan untuk kami pelayan kesehatan kemudian memutuskan untuk pindah rumah sakit.<br />
Astaghfirulloh, aku beriftighfar memohon ampun, jangan-jangan karena doa buruk kami beliau mendapatkan komplikasi operasi. Bukankah Allah SWT memang menyatakan bahwa doa orang teraniaya itu sangat makbul. Doa orang teraniaya sangat dahsyat.<br />
Pesan moralnya, jangan pernah, karena kecewa akan sikap dari pasien yang memang dalam kondisi kesusahan dan perasaan yang labil kemudian kita lontarkan sumpah serapah apalagi doa buruk untuk mereka, walaupun mereka menyakiti hati kita. Untuk pasien dan keluarga, maka bersabar dengan tetap bijak berpikir positif bahwa dokter yang merawat akan memberikan yang terbaik untuk pasien harus jadi energi besar yang bisa mengantarkan pasien untuk sampai tuntas melakukan pengobatan di rumah sakit.<br />
Daripada kita melontarkan doa yang buruk, bukankah lebih baik lontarkan doa-doa baik untuk setiap pasien yang kita layani? inshaAllah jadi amal baik. Akhirnya, semoga kita terhindar dari sikap dan doa buruk selama berinteraksi memberikan pelayanan ya... Amiin ya robbal alamin.<br />
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<span style="font-size: x-small;">Image : https://chirpstory.com/li/314348</span><br />
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Semoga Berkenan,<br />
Medan, Indonesia<br />
Mei 2018<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0Medan, Medan City, North Sumatra, Indonesia3.5951956 98.672222700000023.0881111 98.026775700000016 4.1022801 99.317669700000025tag:blogger.com,1999:blog-431393372300340350.post-39493925386406371842018-04-01T16:07:00.000-07:002018-06-01T16:12:37.127-07:00Trabekulasi<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbFoE3XZp9F-ABphI-g3CzHPJxRnDsulB7BiDOSpTLTMoWBNW3K2WClPr2fz2XqPrUQpTMlDv4aPm9atIB-9EzkaKXiZFiryrL7KB9fSNwVX1d94ceCX6BLxU6ZOIpRdm1ACRdFFrg6cc/s1600/bladder-trabeculation.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="326" data-original-width="400" height="162" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbFoE3XZp9F-ABphI-g3CzHPJxRnDsulB7BiDOSpTLTMoWBNW3K2WClPr2fz2XqPrUQpTMlDv4aPm9atIB-9EzkaKXiZFiryrL7KB9fSNwVX1d94ceCX6BLxU6ZOIpRdm1ACRdFFrg6cc/s200/bladder-trabeculation.jpg" width="200" /></a></div>
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Grade 0 : No trabeculation<br />
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Grade 1 : <b><span style="font-family: 'Times New Roman'; font-size: 12pt; line-height: 17.1200008392334px;">≤</span></b> 5 mm </div>
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Grade 2 : 5-10 mm </div>
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Grade 3 : <b><span style="font-family: 'Times New Roman'; font-size: 12pt; line-height: 17.1200008392334px;">≥</span></b> 10 mm </div>
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<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-77428011451270561452018-03-19T09:36:00.000-07:002018-05-31T17:39:42.492-07:00Urologic Ultrasonography<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_xp6U6jBMqpM5CAuNjCyCHBNBoG92aSZ6DNxZQwVHElN9N-rRveO_fULwdUkViJ0YDFyOJE60gOadAfwd8KFvSmoRSX8-8ZnwIWSfDTTfrjdeooxM6k_iIjMi3PcMtedy1Ubn_FuIGjQ/s1600/Screen+Shot+2018-03-19+at+11.24.47+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black;"><img border="0" data-original-height="719" data-original-width="1021" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_xp6U6jBMqpM5CAuNjCyCHBNBoG92aSZ6DNxZQwVHElN9N-rRveO_fULwdUkViJ0YDFyOJE60gOadAfwd8KFvSmoRSX8-8ZnwIWSfDTTfrjdeooxM6k_iIjMi3PcMtedy1Ubn_FuIGjQ/s320/Screen+Shot+2018-03-19+at+11.24.47+PM.png" width="320" /></span></a></div>
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<li><span style="font-family: "calibri"; text-indent: -0.38in;">Interaction
of soundwaves w/ tissues and structures within the human body </span><span style="font-family: "wingdings"; text-indent: -0.38in;">à</span><span style="font-family: "calibri"; text-indent: -0.38in;"> ultrasound imaging</span></li>
<li><span style="font-family: "calibri"; text-align: justify; text-indent: -0.38in;">The
soundwaves are longitudinal waves </span><span style="font-family: "wingdings"; text-align: justify; text-indent: -0.38in;">à</span><span style="font-family: "calibri"; text-align: justify; text-indent: -0.38in;"> the
particle motion is in the same direction as the propagation of the wave. </span><span style="font-family: "calibri"; text-align: justify; text-indent: -0.38in;">The
transducer = a receiver for the returning sound wave reconverting the
mechanical wave to </span><span style="font-family: "calibri"; text-align: justify; text-indent: -0.38in;">electrical energy</span></li>
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<a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/FMloJI7n2OZL0U%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/urologic-ultrasonography-91178538" title="Urologic Ultrasonography" target="_blank">Urologic Ultrasonography</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><span style="color: black;"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/FMloJI7n2OZL0U" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </span></a><br />
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<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com2tag:blogger.com,1999:blog-431393372300340350.post-65327887485756890172018-02-01T16:24:00.000-08:002018-06-01T16:30:45.096-07:00OPEN PYELOLITHOTOMY TECHNIQUE<div class="separator" style="clear: both; text-align: center;">
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<span style="color: #404040; font-family: "cambria"; font-size: medium;">The indications for removing stones surgically</span></h3>
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<span style="font-size: medium;"><span style="color: #404040; font-family: "cambria";">(</span><span style="color: #404040; font-family: "cambria";">1) economy and the personal convenience of the
patient,</span></span></h3>
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<span style="font-size: medium;"><span style="color: #404040; font-family: "cambria";"><span style="color: #404040; font-family: "cambria"; text-indent: -0.25in;">(</span><span style="color: #404040; font-family: "cambria"; text-indent: -0.25in;">2) associated disorders that require open operation,</span></span></span></h3>
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<span style="color: #404040; font-family: "cambria"; text-indent: -0.25in;">(</span><span style="color: #404040; font-family: "cambria"; text-indent: -0.25in;">3) infected cases need- </span><span style="color: #404040; font-family: "cambria"; text-indent: -0.25in;">ing</span><span style="color: #404040; font-family: "cambria"; text-indent: -0.25in;"> definitive and expeditious clearance of calculi</span><span style="color: #404040; font-family: cambria; text-indent: -0.25in;">...</span></h3>
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<span style="color: #404040; font-family: "cambria"; font-size: medium;">Slide down for complete information :</span></h3>
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</div>
<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0tag:blogger.com,1999:blog-431393372300340350.post-86476361096170583882018-01-13T20:27:00.000-08:002018-05-31T17:40:41.810-07:00URETHRAL INJURY & PER<div style="direction: ltr; margin-bottom: 0pt; margin-left: .28in; margin-top: 5.76pt; mso-line-break-override: restrictions; punctuation-wrap: simple; text-align: left; text-indent: -.28in; unicode-bidi: embed; vertical-align: baseline;">
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<span style="font-family: "arial";">INTRODUCTION : </span></div>
• Ormond and Cothran first described in 1934<br />
• The aim is to correct severe distraction injuries rather than to prevent a stricture<br />
• Traditionally, urethral injury is managed with an initial suprapubic cystostomy and urethral reconstruction 3 – 6 months after.<br />
• Endoscopic re-alignment is the preferred technique.<br />
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<div class="blogger-post-footer">jika anda merasa yang telah anda baca memberikan kontribusi terhadap apapun dalam diri anda.. give the comment, dont be embarrased</div>eko indrahttp://www.blogger.com/profile/03300443808789346150noreply@blogger.com0