Background: In obesity, macrophages that infiltrate into adipose tissues create an inflammatory condition.  Besides that, adipose tissues release proinflammatory cytokines such as TNF alpha. These cytokines promote LDL oxydation by ROS, and accelerate NO degradation resulting in endothelial dysfunction. Adiponectin which could prevent endothelial dysfunction is decreased secondarily to TNF alpha’s action. Objectives: To determine the serum levels of TNF alpha and adiponectin, and their correlations with the endothelial dysfunction. Methods: This was an observational, descriptive, and analytic study with cross sectional. Samples were students of senior high schools in Manado.  Sampling method was carried out consecutively until the required number was enough. Data consisted of age, blood pressure, waist circumference, body weight, lipid profile, creatinin, TNF alpha, adiponectin, and albumin creatinine ratio. We used the Spearman Correlation to analyze the data. Result: Over a 4-month period, there were 35 obese male subjects with ages of 16-18 years old. The average of body weights was 83.23 kg, and of waist circumferences was 103.94 cm.  Endothelial dysfunction was found in 5.72% of samples, high levels of TNF alpha in 68.57% of samples, and low levels of adiponectin in 62.8% of samples.  We found a significant positive correlation between TNF alpha and endothelial dysfunction (r=0.554, p<0.000), and an inverse correlation between adiponectin level and endothelial dysfunction (r = -0.349, p=0.020). Conclusion: There were high levels of TNF alpha in 68.57% of samples and low levels of adiponectin in 62.86% of samples. There was a significant correlation between TNF alpha level and endothelial dysfunction. There was an inverse correlation between adiponectin level and endothelial dysfunction. Key words: obesity, adiponectin TNF alpha, endothelial dysfunction.

Coronary angiography is the main component in cardiac catheterization. Its aim is to determine all coronary vessels, whether with original or graft bypass. According to ACC/AHA guidelines, coronary angiography is indicated (class 1) for patients with chest pain that survived after an acute cardiac arrest; chronic coronary disease with clear symptoms or high risks in non invasive tests; or there is clinical evidence of heart failure. There is no absolute contraindication for coronary angiography, so far. Albeit, renal and non-renal disturbances have to be taken care of while analysing the risks and benefits of coronary angiography, which involve the patient, a cardiologist, a nephrologist, and the other competent specialists. Protection of radiation for the patient, staff, and operators has to be considered very carefully by using the principle of as low as reasonably achievable (ALARA). By understanding the indications and contraindications of coronary angiography, and protection from radiation to all the involved people in the catheterization laboratory, coronary angiography can be used safely, precisely, economically, with highly optimal diagnostic results.Key words: coronary angiography, indication, contraindication, radiation, risk and benefitAbstrak: Angiografi koroner merupakan komponen utama dalam kateterisasi jantung yang bertujuan untuk memeriksa keseluruhan cabang pembuluh darah koroner baik pembuluh darah asli maupun graft bypass. Menurut Guidelines ACC/AHA, angiografi koroner diindikasikan (Kelas 1) untuk pasien dengan keluhan nyeri dada yang bertahan hidup setelah henti jantung mendadak; penyakit koroner kronis dengan simtom jelas atau tanda-tanda risiko tinggi pada pemeriksaan non-invasif; serta terdapatnya bukti klinis yang menunjukkan adanya gagal jantung. Sampai saat ini tidak terdapat kontraindikasi absolut untuk angiografi koroner. Walaupun demikian, adanya gangguan renal maupun non-renal perlu diatasi terlebih dahulu dengan mempertimbangkan analisis risiko dan manfaat yang melibatkan pasien, kardiologi, nefrologi, serta para ahli yang berkompetensi menangani pasien tersebut. Proteksi terhadap radiasi perlu dicermati baik terhadap pasien, staf dan operator dengan prinsip as low as reasonably achievable (ALARA). Dengan memahami indikasi dan kontraindikasi dari angiografi koroner serta proteksi terhadap radiasi baik bagi staf maupun pasien dalam laboratorium kateterisasi maka pemanfaatan angiografi koroner dapat dicapai dengan aman, tepat, ekonomis, dan disertai keberhasilan diagnostik yang optimal.Kata kunci: angiografi koroner, indikasi, kontraindikasi, radiasi, risiko dan manfaat

Pseudoaneurysm is an accumulation of blood extravascularly in a space or cavity related to an artery, associated with disruptions of vessel layers. We reported a 51-year-old male with a pseuudoaneurysm of the left femoral artery. A lump in the left inguinal region occured due to a instrument wound during his fifth hemodialysis. The 6x5 cm-sized lump was hard, fixed, and painful in palpation, and had a bluish red center. A bruit was detected on auscultation. Diagnosis was based on the occurence of the lump in the inguinal region after the fifth hemodyalisis, a bruit on the lump, and a USG doppler examination that showed an aneurysm of the left femoral artery. The patient was operated on, and a pseudoaneurysm of the left femoral artery was found during the exploration. On day 36, the patient’s physical condition was improved and he was permitted to leave the hospital. From the pseudoaneurysm aspect, the prognosis of this patient was good, but in general the prognosis was dubia ad malam.Key words: pseudoaneurysm, femoral arteryAbstrak: Pseudoaneurisma atau aneurisma palsu adalah akumulasi darah ekstravaskuler dalam suatu rongga yang terhubung dengan arteri, disertai disrupsi lapisan pembuluh darah. Kami melaporkan kasus seorang laki-laki berusia 51 tahun dengan pseudoaneurisma arteri femoralis. Diagnosis ditegakkan berdasarkan gejala dan tanda klinis dimana ditemukan benjolan di lipat paha kiri yang timbul akibat tusukan pada saat menjalani hemodialis kelima, pemeriksaan fisik adanya bruit pada benjolan, dan USG doppler memperlihatkan adanya aneurisma arteri femoralis kiri. Pasien dilakukan pembedahan, dan pada saat eksplorasi ditemukan adanya pseudoaneurisma arteri femoralis kiri. Setelah perawatan hari ke-36, keadaan pasien membaik dan bisa dipulangkan. Prognosis pseudoaneurisma pada pasien ini baik, tetapi secara keseluruhan dubia ad malam.Kata kunci: pseudoaneurisma, ateri femoralis

No abstract

Abstrak: Walaupun merupakan pengukuran sederhana dan non-invasif, ankle brachial index (ABI) menunjukkan sensitifitas dan spesifisitas yang tinggi dalam mendiagnosis penyakit arteri perifer pada nilai ABI ≤0,9. ABI juga merupakan indikator yang kuat untuk mengetahui penyakit aterosklerosis pada area vaskular lainnya. Penelitian ini bertujuan untuk menentukan perbandingan antara ABI pada pasien dengan atau tanpa sindroma koroner akut (SKA). Penelitian ini menggunakan analisis analitik observasional dengan desain potong lintang. Subyek penelitian ialah pasien dengan SKA dan pasien tanpa SKA yang datang ke Departemen Kardiologi dan Pembuluh Darah RSU Prof. Dr. R.D Kandou, Manado bulan September-Desember 2012. Nilai normal ABI yaitu >0,9 dan <1,4, sedangkan ABI <0,9 perlu dipertimbangkan abnormal. Nilai ABI >1,4 dipertimbangkan tidak valid dan diekslusi. Hubungan antara variabel dievaluasi menggunakan SPSS. Hasil penelitian memperlihatkan 33 pasien SKA (72,8% laki-laki) dan 33 pasien tanpa SKA (81,8% laki-laki) sebagai subyek penelitian. Rerata usia pasien SKA 57 tahun dan tanpa SKA 52,3 tahun. Angka kejadian pasien SKA dengan ABI abnormal lebih tinggi, yaitu 82,1% vs 17,9% (P < 0,001). Uji chi-square menunjukkan terdapatnya hubungan antara SKA dan peningkatan risiko ABI abnormal (OR 12, P < 0,05). Simpulan: Sindroma koroner akut berhubungan dengan peningkatan risiko dari ABI abnormal. Kata kunci: Ankle brachial index, sindroma koroner akut.   Abstract: Although the ankle-brachial index (ABI) is a simple and non-invasive measurement, it shows a high sensitivity and specificity in the diagnosis of peripheral arterial disease (PAD) when its value is ≤0.9. Moreover, ABI is a powerful indicator of atherosclerotic diseases in other vascular areas. This study aimed to determine the comparison between ankle brachial indices (ABI) in patients with or  without acute coronary syndrome (ACS). This was an analytical observational study with a cross sectional design. We measured ABI indices in 33 patients with ACS and 33 patients without ACS admitted to the Department of Cardiology and Vascular Medicine, Prof. Dr. R.D. Kandou Hospital, Manado. The normal ABI is >0.9 and <1.4. However, ABI <0.9 was considered as abnormal. On the other hand, ABI >1.4 was considered invalid and then excluded. The association of variables was evaluated by SPSS software. The results showed that there were 33 ACS patients (72.8% male) and 33 patient without ACS (81.8% male). ACS patients were older (57 vs 52.3 years). ACS patients had more prevalent abnormal ABI (82.1% vs 17.9%; P < 0.001). Chi square test showed that ACS was associated with an increased risk of abnormal ABI (OR 12, P < 0.05). Conclusion: ACS was associated with an increased risk of abnormal ABI. Keywords: ankle brachial index, acute coronary syndrome.