ABSTRACT
INTRODUCTION:Jejuno gastric intussusception as a complication following gastrectomy occurs at an incidence of 0.1%. It follows several types of gastric surgeries like Billroth 2 and gastro jejunostomy. The mortality of the patient usually confirms to the 10% range but a high mortality of 50% has been reported in cases of delayed diagnosis paired with late intervention. In order to bypass the morbidity of the condition timely surgical invervention is the rule of the day. Though the history of gastric surgery may point towards the diagnosis, preoperative anticipation or the same has proven to be difficult in most of the cases AIMS AND OBJECTIVES: To study the incidence of jejunogastric intussusception following gastric surgery in KAPV medical college Tiruchirappalli during 10 years period from 2006 to 2016.The need for early intervention to prevent mortality and investigations needed to diagnose intussusception. METHODS AND MATERIALS: 50 patients who underwent gastrojejunostomy in KAPV medical college Tiruchirappalli during the period 2006 to 2016 were taken up for study. . Patient demographics, clinical presentation, diagnosis, investigations, operative notes, management and histopathology reports were reviewed and data was collected from case records from medical records department. RESULTS AND OBSERVATIONS: There were 5 cases of JGI. All were males. The mean age at presentation was 54.69 years (range 46–62). All patients presented with hematemesis or coffee ground vomiting. In addition, 3 patients had pain abdomen and 2 patients had malena. . All patients underwent surgical management. Most common type was Type II (efferent loop) seen in 3 patients. Type III (combined type) was seen in 1 patient. One patient had Type I (afferent loop). CONCLUSION: JGI is a rare complication after gastrojejunostomy. Upper gastrointestinal endoscopy is diagnostic. Ultrasound and computed tomography of abdomen can of additional help. This complication can occur years after surgery. High index of suspicion is required for diagnosis. Prompt surgical intervention, still remains the main stay of treatment.
ABSTRACT
Blindness is a devastating condition with psychosocial and economic effects. The shortcomings result in a burden to the blind person, the family and society. Rehabilitation of the blind can transform their lives. The aim of this study was to assess the "change-readiness" of the blind to undergo a "change-management." The study was a semi-structured pre-tested questionnaire-based study of 50 blind subjects in a medical college hospital. The blind participants were assessed for depression using the Beck Depression Inventory II, for the perceived effect of blindness on family, social life and occupation. The participants were counseled to undergo psychiatric management, vocational training, use blind aids and learn Braille. The willingness of the participants with reasons was assessed using a verbal analogue scale. Pearson Chi-square test, ANOVA and the t-test were used for statistical analysis. Over two-thirds of the subjects were depressed. Family life, social life and occupation were perceived to be affected by 44%, 66% and 74%, respectively. Change-readiness scores were low for low vision and blind aids, vocational training, psychiatric management, change of job and learning Braille. The low score was due to the associated taboo, dependence, lack of skills, embarrassment, etc., The most valuable feature was the family cohesiveness. The results suggest that there is a need to modify health policy to include blind rehabilitation, to improve visibility of blind rehabilitation centers, to include family members and co-professionals while managing the blind so that we treat the "blind person" and not a "pair of blind eyes."