Kirsteen Awori

Spinal cord termination in adult Africans: relationship with intercristal line and the transumbilical plane.

The level of cord termination and level of vertebral intersection of intercristal line and transumbilical plane (TUP), frequently used landmarks, show ethnic variation. The relationship of the spinal cord termination to these lines is vital in spinal surgery and anesthesia, but data on these parameters are scarce in the African population. The purpose of this work is to determine the level of cord termination and establish its relationship with intercristal line and TUP. One hundred and twelve specimens obtained from the department of Human Anatomy at the University of Nairobi were used in this study. The conus medullaris was exposed by laminectomy and its vertebral level together with those of intercristal line and TUP recorded. The distance of conus medullaris from intercristal plane was measured in millimeters. Data obtained were coded and analyzed using Statistical Package for Social Sciences (SPSS) for windows version 16.0 Chicago, Illinois, 2002. Students t‐test was used in the statistical assessment of gender differences. A P value of less than 0.05 was considered significant. The median level of termination of the cord was the upper third of L2, 51.9% of cases terminating below this. There was no statistically significant gender difference in the level of termination of the cord. The intercristal plane passed through L4/L5 disc (70.9%) and below (29.1%). The TUP corresponded with intercristal line in 78.2% of subjects. The mean distance of the spinal cord termination from intercristal line was 99 ± 24 mm. The spinal cord terminates at or below the upper third of L2. Care should be exercised during lumbar punctures and spinal epidural anesthesia among Africans. Intecristal line and TUP are safe landmarks to use in location of conus medullaris. Clin. Anat. 23:563–565, 2010.

Locating the Arcuate Line of Douglas: Is It of Surgical Relevance?

Ventral hernia formation is a common complication of rectus abdominis musculocutaneous flap harvest. The site and extent of harvest of the flap are known contributing factors. Therefore, an accurate location of the arcuate line of Douglas, which marks the lower extent of the posterior wall of the rectus sheath, may be relevant before harvesting the flap. This study is aimed at determining the position of the arcuate line in relation to anatomical landmarks of the anterior abdominal wall. Arcuate lines were examined in 80 (44 male, 36 female) subjects, aged between 18 and 70 years, during autopsies and dissection. The position of the arcuate line was determined in relation to the umbilicus, pubic symphysis, and intersections of rectus abdominis muscle. Sixty four (80.4%) cases had the arcuate line. In most cases (52), this line was located in the upper half of a line between the umbilicus and the pubic symphysis. Most males (93%) had the arcuate line, while more than a third of females did not have it. In all these cases, the line occurred bilaterally as a single arcade, constantly at the most distal intersection of the rectus abdominis muscle. Consequently, the arcuate line is most reliably marked superficially by the distal tendinous intersection of the rectus abdominis muscle. Harvesting of the muscle cranial to this point will minimize defects in the anterior abdominal wall that may lead to hernia formation. Clin. Anat. 23:84–86, 2010.

Variations in the pattern of formation of the abdominis rectus muscle sheath among Kenyans

El patron de formacion de la vaina del musculo recto abdominal humano muestra variaciones, no esta claro si estas variaciones son poblacion-especificas. Este estudio tiene como objetivo describir el patron de formacion de la vaina del musculo recto del abdomen en una poblacion seleccionada de Kenia. La formacion de la vaina del musculo recto del abdomen se analizo en 80 sujetos (47 hombres, 33 mujeres) durante autopsias y diseccion de cadaveres. La pared anterior de la vaina del musculo recto en todos los casos era aponeurotica y firmemente unida al musculo recto abdominal. La pared posterior de la vaina del musculo recto era aponeurotica en 71 (88,5%) casos, las paredes restantes eran musculoaponeuroticas y solo se observaron en varones. En todos los casos, la aponeurosis del musculo oblicuo interno del abdomen se dividio en dos laminas, una lamina profunda que se fusionaba con la aponeurosis del musculo transverso del abdomen en el borde lateral del musculo recto del abdomen y una lamina superficial que se fusionaba con la aponeurosis del musculo oblicuo externo del abdomen a mitad del recorrido entre los bordes medial y lateral del musculo recto del abdomen. El patron de formacion de la vaina del musculo recto del abdomen, entre los kenianos muestra algunas variaciones que no han sido reportadas en trabajos anteriores. El conocimiento de estas variaciones es importante en cirugia ya que esta vaina es seccionada en abordajes abdominales.