Background The success of the micro-surgery procedure for the treatment of postganglionic brachial plexus injury was influenced by several factors, including the surgical timing and also the viability of the proximal stump. This study evaluates the evidence of apoptosis in the brachial plexus proximal stump and its correlation with the surgical timing. Methods Proximal stump biopsy of postganglionic brachial plexus injury patients were obtained during nerve procedure surgery. The samples were grouped based on the surgical timing, before six months post-trauma (early group) and after six months post-trauma (late group). The apoptosis of motorneurons was evaluated by immunohistochemistry expression of Caspase-3, TNF-α, Caspase-8, and Caspase-9. Results Immunohistochemistry findings showed higher expression of Caspase-3 in the late group compared to the early group, as well as the expression of Caspase-8 and Caspase-9 (p < 0,05), and with a positive correlation between Caspase-8 and Caspase-9 to Caspase-3. Meanwhile, TNF-α expression was higher in the early group than the late group (p < 0,05) and with no correlation between TNF-α to Caspase-3. Conclusion Apoptosis of proximal stump motorneuron plexus brachialis on more than six months post-trauma is higher than on less than six months post-trauma.

Background:The fatality rate of unstable pelvic fracture is still high (20-50%) due to acute phase hemorrhage or late multiple organ failure. The assurance for 100% survival in acute phase had been reported if the emergency room team have the right technique, right timing, and right protocol. The aim of this study was to evaluate and to date factors that influence the nonsurvival unstable pelvic fracture within 2x24 hours.Methods: This retrospective study was conducted in emergency unit of Dr. Soetomo General Hospital Surabaya during 2012-2016 for unstable pelvic fracture with unstable hemodynamic, without concomitant head or thoracic injury and admitted within 4 hours after the incident. All patients were handled according to the protocol for resuscitation and C-clamp insertion immediately. X-ray was taken after the insertion to check the C-clamp position and to confirm the diagnosis. The 2x24-hour data were taken whether the patient survive or not survive, including mean arterial pressure (MAP) pre-and post, heart rate (HR) pre-and post, and initial hemoglobin and platelet count. Data were analyzed with independent t-test and multiple regression analysis.Results: Twenty two patients were recorded as the inclusive criteria, separated into 17 survivors and 5 non-survivors. They were comprised of 14 males and 8 female patients, with an average of 31.9±15.3 years old. The MAP post, HR pre-and post, and platelet count were significantly different. The factor that influenced the survival within 2x24 hours was the MAP post C-clamp (>70 mmHg) (p<0.05). Conclusion:The acute phase 2x24-hour outcome after C-clamp insertion and resuscitation was significantly influenced by MAP post C-clamp and resuscitation.

Background: Streeter dysplasia is a term to describe fetal congenital syndrome which mainly characterized by constriction band on appendages, prenatal amputations of extremities, and acrosyndactyly. This syndrome has wide range of clinical manifestation between patients, as reflected by many other terms to describe this syndrome. Case: The author reported five cases of Streeter dysplasia with constriction band on different locations of the body, with a patient having a constriction band around pelvic and other multiple anomalies, patient with constriction around leg and caused acute limb ischemic, and several cases of acrosyndactyly around hand and foot. Result and Conclusion: Constriction band release surgery, as well as correction surgery for other abnormality was performed, either by direct closure or Z-plasty with satisfactory result in functional and aesthetic.