Kevin Ongeti

Variant origin of the superior thyroid artery in a Kenyan population.

Variant anatomy of the superior thyroid artery is important during surgical procedures, interpretation of angiograms, and interventional radiography in the neck. Pattern of the variations shows population differences but there is no data from the Kenyan population. This study therefore investigated the variations in origin of the superior thyroid artery in a Kenyan population. Forty six necks (36 males and 10 females) from 46 cadavers of black Kenyans in Department of Human Anatomy University of Nairobi, Kenya were bilaterally dissected to expose the origin of the superior thyroid artery. Pattern of origin of the vessel was determined on both sides in males and females. It originated from the external carotid artery common carotid artery and linguo‐facial trunk in 80%, 13%, and 6.5% of the cadavers respectively on the right side. All but one of the superior thyroid arteries were ventral branches. There was asymmetric origin in 6.5% of cases. Origin from the common carotid artery was associated with high carotid bifurcation. Nearly 20% of superior thyroid arteries showed variant origin. Of these, 6.5% arose from the linguo‐facial trunk, much higher than in the Caucasian and Oriental populations. Origin from common carotid artery is substantially lower than prevailing figures from other populations. These findings support ethnic variations. Preoperative angiographic evaluation is recommended. Clin. Anat. 25:198–202, 2012.

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.

Features of atherosclerosis in the tunica adventitia of coronary and carotid arteries in a black kenyan population.

Introduction. Histologic changes which occur in the tunica adventitia during initiation, progression, and complications of atherosclerosis are seldom reported. This study aimed at describing the features of atherosclerosis in the tunica adventitia of two of the commonly afflicted arteries, namely, left anterior descending coronary and common carotid in black Kenyans. Materials and Methods. Specimens from 108 individuals [76 males and 32 females, mean age 34.6] were processed for paraffin embedding. Seven micron thick sections were stained with Masons trichrome and Haematoxylin/Eosin and examined with a light microscope. Results. Features of atherosclerosis were present in the tunica adventitia of 14.8% of left anterior descending arteries and 11.1% of common carotid arteries. Increase in adventitial thickness was associated with increased density of vasa vasora in 8.3% of both arteries. In the left anterior descending and common carotid arteries, 6.5% and 3.7% of cases, respectively, the tunica adventitia thickened without intimal hyperplasia. Conclusion. Features of atherosclerosis occur in the tunica adventitia of coronary and carotid arteries in over 10% of the black Kenyans studied. These features often precede the intimo medial changes. Tunica adventitia should therefore be prioritized in evaluation for atherosclerosis, in individuals at risk. This may enhance early detection and intervention.

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.

Luminal dimensions of left anterior descending coronary artery in a black kenyan population

Luminal diameter and percent stenosis of left anterior descending coronary artery are considered indicators of early atherosclerosis, arterial occlusion, myocardial infarction, and are important in quantitative estimation of coronary disease severity. These parameters show ethnic variation but there are hardly any data from African populations. This study examined luminal diameter and percent stenosis of 108 proximal left anterior descending coronary arteries. The specimens were obtained from adult individuals [72 males, 36 females; mean age 34.8 years (range 18 – 72 years] who had died of non-cardiovascular causes. The specimens were processed for routine paraffin embedding and sectioning. Seven-micron thick sections were stained with Mason’s trichome and examined with light microscope. Luminal diameter and percent stenosis were determined on the microscopic sections using multiscan software. The dimensions were corrected for heart weight and analyzed for age and gender differences. The mean luminal diameter was 2.72 ± 0.018 mm, with insignificant age and gender difference after correcting from heart weight. It increased with number of branches of left coronary artery. Mean percent stenosis was 34.6%. Percent stenosis of over 50% was present in 25% of individuals, all males. Of these, 8% were under 20 years. There was visible and focal intimal thickening. The mean luminal diameter is comparable to those reported from Caucasian and Asian populations, and there is significant percent stenosis in a substantial number of individuals. These findings suggest comparable vulnerability to atherosclerotic occlusion of left anterior descending.

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.