W Kaisha

Topography of the recurrent laryngeal nerve in relation to the thyroid artery, Zuckerkandl tubercle, and Berry ligament in Kenyans.

Injury to the recurrent laryngeal nerve (RLN) is an important but avoidable complication of thyroidectomy. This complication may be avoided by the identification of the nerve facilitated by important landmarks found along its course. The setting for this work is the Human Anatomy Laboratory of the University of Nairobi. The aim of this work is to determine the topographic relationship of the RLN with the inferior thyroid artery (ITA), the tubercle of Zuckerkandl (TZ), and the ligament of Berry (LB) in a Kenyan population. The relationship between the nerve and the above landmarks was determined during dissection of 146 right and left thyroid lobes. One right side of the neck had a nonrecurrent nerve. Of the specimens where relationship was determined, the nerve was anterior to the ITA in 37% of cases and posterior in 51.4%. In relation to the LB, 45.3% were superficial (dorsolateral). The TZ was clearly delineated in 86 of the 146 specimens. No nerve traversed the tubercle. The RLN exhibited variations similar to those in other populations. The TZ when present was a reliable landmark to the nerve. Clin. Anat. 24:853–857, 2011.

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.

Palpable discrete breast masses in young women: Two of the components of the modified triple test may be adequate

BACKGROUND Palpable breast masses in young women, though usually benign, are a common source of anxiety. Current practice is assessment using the modified triple test (MTT). This entails clinical breast examination (CBE), ultrasound scans and cytological examination of a fine-needle aspiration biopsy specimen (FNAC). It is unclear whether it is necessary to utilise all three components in most patients. OBJECTIVES We aimed to determine the diagnostic value of the MTT for the evaluation of palpable discrete breast masses in women under 35 years of age, and to assess the performance of its components when used individually or in combinations of two. DESIGN AND SETTING This was a cross-sectional study carried out between August 2010 and October 2010 in the breast and general surgical outpatient clinics at Kenyatta National Hospital, Nairobi, Kenya. PATIENTS AND METHODS Fifty-eight patients presenting during the study period with palpable discrete breast masses satisfying the inclusion criteria were recruited. All patients had a CBE, ultrasound scans and FNAC. A core biopsy was performed as a reference standard. Main outcome measures. The test results of the MTT and its elements (CBE, ultrasonography and FNAC) were compared with the histological findings (the reference standard). RESULTS The age range of the 58 patients was 18 - 34 years (mean 25.5 years, standard deviation 5.1 years). Forty-five patients (77.6%) had concordant MTT results (agreement in all the three components). Concordant MTTs had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100%. Sensitivity, specificity, PPV and NPV were 100%, 92.3%, 60% and 100%, respectively, for CBE; 100%, 94.2%, 66.7% and 100%, respectively, for ultrasonography; and 100%, 98.1%, 83.3% and 100%, respectively, for FNAC. The combinations CBE plus ultrasound and CBE plus FNAC had sensitivities, specificities, PPVs and NPVs of 100%. CONCLUSION Use of the MTT for diagnosis of palpable breast masses in young women (

Prevalence of Abnormal Sternal Angles in a Kenyan Population.

Abnormal sternal angles are unique anatomical variations of major clinical significance. For instance, misplaced sternal angles may cause inaccurate numbering of ribs and thus complicate intercostal nerve blocks and needle thoracostomies. They are also associated with increased risk of sternal fracture in blunt chest trauma. Additional sternal symphyses can be misinterpreted as fracture or lytic lesion in cross-sectional imaging of the sternum. These variations are rarely reported in Africans and lacking in the Kenyan population. We therefore aimed to determine the prevalence of abnormal sternal angles in a Kenyan population. 80 cadaveric adult sterna were studied at the Department of Anatomy, University of Nairobi, after ethical approval. The size of the angle was measured using a sliding protractor (CCKL, U.K). Results were analyzed by SPSS 18.0. The sternal angle was located at the level of the third costal notch in 7 cases (8.8%). It was un-ridged in 8 cases (10%). The angle measured 161.7° ± 4.7 in males and 159.9° ± 4.9 in females (p=0.165). In 9 cases (11.25%), the angle measured less than 150°. An additional sternal symphysis was present in 6 specimens (7.5%). Over 35% of sternal angles in Kenyans showed an abnormality in location, palpability or size. These variations may influence intercostal nerve blocks, interpretation of sternal images and evaluation of chest trauma. Further research is needed to correlate these findings.