Anne Pulei

Unusual formation of the median nerve associated with the third head of biceps brachii

We read with interest the recent paper by Ongeti et al. (2012). The authors reported the presence of a third head of biceps brachii in dissected upper limb of male cadaver and concluded that this supernumerary head of biceps muscle may compress the proximal median nerve. However, it seems hard to accept that the muscle shown in the figure of this article is biceps brachii. The normal two heads of biceps muscle are not dissected and still covered by deep fascia. In addition, the distal attachment of the claimed third head of biceps as well as its nerve supply is not shown. As this third head of biceps is medial in position, it will be important to show a dissection of the coracobrachialis muscle which is attached to the medially located short head of biceps. Moreover, the musculocutaneous nerve supplying the biceps muscle is not shown. What is (8) in the figure legend? No indication for (8) in the figure. Entrapment or compressive neuropathies are widespread clinical problems caused by compression of a nerve such as median nerve when it passes through fibro-osseous or muscular tunnels as Gantzer’s muscle or deep to aponeurotic and vascular channels (Eid and Otsuki, 2009; Eid et al.,2011). We would like to mention that Clinical Anatomy is one of the leading journals in gross and clinical anatomy; therefore, the quality of dissection as well as photographing a carefully dissected specimen is extremely important for anatomists and medical doctors.

Variations in the attachments of the medial meniscal anterior horn: a descriptive cadaveric study

PurposeMeniscal tears are common in Kenya, with prevalence rates ranging from 45 to 78% of intracapsular knee pathology. Diagnosis of these injuries relies on the use of both clinical signs and symptoms as well as radiological investigations. In a few instances, radiological detection could be difficult, partly because of variant attachment patterns of the medial meniscal anterior horn. Some of these unusual attachments of the anterior horn of the medial meniscus could even be mistaken for meniscal tears. There is also evidence that these variations differ from population to population. This study, therefore, aimed to determine the variant bony and ligamentous attachments of the medial meniscal anterior horn in a sample Kenyan population.MethodsThe study was conducted at the Department of Human Anatomy, University of Nairobi. Thirty-one male and female unpaired medial menisci were obtained from cadaveric specimen. The bony and ligamentous attachments were identified and recorded and photomacrographs taken.ResultsThe bony attachments different from the classical textbook attachment accounted for 54.8% of the medial meniscal anterior horns. The anterior intermeniscal ligament was present in 62.3% while 16.2% showed attachment to the anterior cruciate ligament. Twenty-nine percent (29%) of the medial menisci studied did not have any ligamentous attachments.ConclusionsThe bony and ligamentous attachments of the medial meniscal anterior horn are highly variable presenting unique diagnostic and therapeutic challenges. A new classification of ligamentous attachments is thus proposed.

Periduodenal Tuberculosis masquerading as Annular Pancreas

Background: Perforations complicate up to 5-10% of peptic ulcer diseases. Mortality following peptic ulcer perforation can peak 29%. Of the factors that influence the outcome of peptic ulcer perforation, treatment delay is most important and modifi able. This study reviewed delay and how it affected outcome in patients treated for perforated peptic ulcers at the Kenyatta National Hospital. Methods: Patient’s files for the period January 2002 to December 2007 were reviewed and direct interviews carried out for patients seen from January to December 2008. Data sought included patient demographics, clinical presentation, time from symptom onset to presentation at casualty, time from presentation at casualty to surgical treatment and the treatment outcomes. Data was entered using a structured data sheet /questionnaire. The effect of delay as a determinant of outcome was evaluated using univariate analysis. Results: One hundred and ninety three patients were evaluated. Twenty four patients (12.4%) died. Sixty one patients (31.6%) developed complications post-operatively. Thirty patients were reoperated for the complications. No patient treated within 24 hours died. Complications rate was 0 %, 1.5% and 29.5% for patients treated within 24 hours, 24-48 hours and after 48 hours respectively. Delay >48 hours was significantly associated with increased mortality (p value <0.001), morbidity (p value <0.001), and surgical site infections (p value <0.001). The mean length of hospital stay for patients with delay <48 hours and over 48 hours was 7.22 (+ 1.9) and 19.7 days (+ 19.1) respectively (p<0.001). Conclusion: Delay of more than 48 hours is associated with high morbidity and mortality. Efforts should be made to reduce the amount of pre-treatment delay to less than forty eight hours.

Surgical significance of brachial arterial variants in a Kenyan population

Background: Perforations complicate up to 5-10% of peptic ulcer diseases. Mortality following peptic ulcer perforation can peak 29%. Of the factors that influence the outcome of peptic ulcer perforation, treatment delay is most important and modifi able. This study reviewed delay and how it affected outcome in patients treated for perforated peptic ulcers at the Kenyatta National Hospital. Methods: Patient’s files for the period January 2002 to December 2007 were reviewed and direct interviews carried out for patients seen from January to December 2008. Data sought included patient demographics, clinical presentation, time from symptom onset to presentation at casualty, time from presentation at casualty to surgical treatment and the treatment outcomes. Data was entered using a structured data sheet /questionnaire. The effect of delay as a determinant of outcome was evaluated using univariate analysis. Results: One hundred and ninety three patients were evaluated. Twenty four patients (12.4%) died. Sixty one patients (31.6%) developed complications post-operatively. Thirty patients were reoperated for the complications. No patient treated within 24 hours died. Complications rate was 0 %, 1.5% and 29.5% for patients treated within 24 hours, 24-48 hours and after 48 hours respectively. Delay >48 hours was significantly associated with increased mortality (p value <0.001), morbidity (p value <0.001), and surgical site infections (p value <0.001). The mean length of hospital stay for patients with delay <48 hours and over 48 hours was 7.22 (+ 1.9) and 19.7 days (+ 19.1) respectively (p<0.001). Conclusion: Delay of more than 48 hours is associated with high morbidity and mortality. Efforts should be made to reduce the amount of pre-treatment delay to less than forty eight hours.