Publications

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2012
Ongeti K, Pulei A, Ogeng'o J, Saidi H. "Unusual formation of the median nerve associated with the third head of biceps brachii." Clin Anat. 2012;25(8):961-2. Abstract

Unilateral variations in the formation of the median nerve, with the presence of the third head of the biceps brachii entrapping the nerve are very rare. These variations were observed on the right side, of a 30-year-old male cadaver during routine dissection at the Department of Human Anatomy, University of Nairobi. The median nerve was formed by the union of three contributions; two from the lateral cord and one from the medial cord. An additional head of the biceps brachii looped over the formed median nerve. On the left side, the median nerve was formed classically by single contributions from the medial and the lateral cords. These variations are clinically important because symptoms of high median nerve compression arising from similar formations are often confused with more common causes such as radiculopathy and carpal tunnel syndrome.

K O, A P, P M, undefined. "Periduodenal Tuberculosis masquerading as Annular Pancreas." Annals of African Surgery. 2012;9. Abstract

Periduodenal Tuberculosis masquerading as Annular Pancreas
K Ongeti, A Pulei, P Mandela, P Kimpiatu

Abstract

Gastrointestinal tuberculosis is common in Africa. Nonetheless, isolated duodenal involvement is rare, and is more likely to mimic other causes of duodenal obstruction. We report a patient who succumbed to an isolated mid duodenal tuberculosis, diagnosed at laparatomy, whose clinical presentation, endoscopy and computerised tomography scans resembled annular pancreas. The limitations of clinical evaluation, endoscopy and radiology are highlighted as the importance of diagnostic laparoscopy is emphasized.

AN P, KW O, MI I, JA O'o. "SURGICAL ANATOMY OF THE PROFUNDA BRACHII ARTERY." Anatomy Journal of Africa. 2012;1(1):20-23. Abstract

SURGICAL ANATOMY OF THE PROFUNDA BRACHII ARTERY Anne Pulei, Kevin Ongeti, Martin Inyimili, Julius Ogeng’o
Correspondence: Dr. Anne Naipanoi Pulei, Department of Human Anatomy, University of Nairobi. P.O. Box 30197 00100 Nairobi, Kenya. Email: anmunkush@yahoo.com
SUMMARY
Variations in the origin and termination of the profunda brachii artery (PBA) are rarely described in literature. Knowledge of this unusual anatomy is important during brachial artery catheterization and harvesting of lateral arm flaps. One hundred and forty four arms from 72 cadavers of black Kenyans were dissected and examined for the origin and termination of PBA at the Department of Human Anatomy, University of Nairobi, Kenya. The patterns of origin and termination of the PBA were observed and recorded. The PBA was present in all the cases. It arose from the brachial, axillary and a common stem with the superior ulnar collateral arteries in 96.9%, 1.4% and 1.7% of the cases respectively. It displayed duplication and early branching in 11.1% and 16.7% of the cases respectively. The high incidence of duplication and early branching makes it vulnerable to inadvertent injury during fractures of the humerus, brachial artery catheterization and may complicate lateral arm flaps. Preoperative angiographic evaluation is therefore recommended.
Key words: Profunda brachii arteries, variations.

A P, M O, K O, P K, M I, J O'o. "Surgical significance of brachial arterial variants in a Kenyan population." Annals of African Surgery. 2012;9. Abstract

Surgical significance of brachial arterial variants in a Kenyan population
A Pulei, M Obimbo, K Ongeti, P Kitunguu, M Inyimili, J Ogeng’o

Abstract

Background: Knowledge of the variant anatomy of the brachial artery is important in radial arterial grafts for coronary bypass, percutaneous trans-radial approach to coronary angiography, angioplasty and flap surgery. These variations show ethnic differences but data from black populations are scarce. This study therefore describes the course in relation with median nerve, level and pattern of termination of brachial artery in a black Kenyan population.
Methods: This was a cadaveric dissection study of 162 upper limbs at the Department of Human Anatomy University of Nairobi, Kenya. The brachial artery was exposed entirely from the lower border of teres major to its point of termination. The course in relation to the median nerve and the level of termination were recorded. The results were analyzed using SPSS version 17.0 for Windows.
Results: 72.2% of the brachial arteries followed the classical pattern described in Gray’s Anatomy. Superfi cial brachioradial and superficial brachial arteries were present in 12.3% and 6.1% of the cases respectively. Brachial artery terminated at the radial neck in 79% of the cases, radial tuberosity (8.6%), and proximal arm (11.1%), mid arm (1.2%). Pattern of termination was either a bifurcation into the radial and ulnar arteries (90.1%) or trifurcation into radial, ulnar and common interosseous arteries (9.3%). We also report a case of trifurcation of the brachial artery into the profunda brachii, radial and ulnar arteries (0.6%).
Conclusion: Variations of the brachial artery in its relationship with the median nerve, level and pattern of termination are common. These may complicate arm surgical exposures, fl ap and vascular surgery. Pre-operative angiographic evaluation is recommended.

Keywords: brachial artery, bifurcation, trifurcation, superficial brachioradial artery

2011
W O, A N, A K. "The femoral collodiaphyseal angle amongst selected Kenyan ethnic groups." Journal of Morphological Science. 2011;28(2):129-131. Abstract

The femoral collodiaphyseal angle amongst selected Kenyan ethnic groups
Otsianyi, WK.*, Naipanoi, AP. and Koech, A.
University of Nairobi (Human Anatomy), Nairobi, Quénia *E-mail: wyksa2000@uonbi.ac.ke
Background: There is evidence suggesting that there is inter-populational differences of the femoral neck- shaft angle which has been attributed to disparity in the economic and physical activity levels. As knowledge of the collodiaphyseal angle (CDA) is important to orthopaedic surgeons, there is need to elucidate whether there is significant variation of this angle among the diverse ethnic groups in Kenya. Objectives: Describe the variability of the CDA among the different ethnic groups (whose economic and physical activity differ) in the Kenyan population. Setting: The study was conducted at the radiology department of Kenyatta National Hospital. Materials and methods: Normal pelvic radiographs of patients seen at Kenyatta National Hospital were grouped into five major ethnic groups and were used in this study. Three readings of the CDA were then measured using goniometry and the average recorded. Results: Four hundred and thirty-two femora were studied, 133 were female while 299 were male, and the age ranged from 16-95 years. The average CDA angle was found to be 127.56° + 3.75 (the range being 104-145°, the mode 130°). The CDA was 126.11° + 3.22 and 128.21 + 3.79 in females and males respectively. This angle was largest among the nomadic group (129.72 + 4.76) and smallest (127.25 + 4.15) among the highland Bantu (ANOVA revealed an F of 2.022, level of significance of 0.09). Conclusions: The average CDA described here is lower compared to what has been presented in other populations. Interethnic differences were observed and these differences could be explained by the varying activities of the different groups in their day to day life.

K A, A P, G G. "Pattern of Inner- vation of the Upper Gluteus Maximus Muscle: Implication in Prosthetic Hip Dislocation." Annals of African Surgery. 2011;8(2):28-30. Abstract

Gluteus Maximus Muscle: Implication in Prosthetic Hip Dislocation
Awori K.O. MBChB, MMed (Surgery), Dip. (SICOT), FCS (Orth) ECSA, Anne N. Pulei A.A. Bsc, MBChB, Gikenye G. MBChB, MMed,FCS(ECSA) Affiliation: Department of Human Anatomy, University of Nairobi, P.O. Box 30197 00100 Nairobi, Kenya. Correspondingauthor: KirsteenO.Awori,Tel.254-722812499,Email: karsto2005@yahoo.com
Abstract
Background: Dislocation is one of the most common complications after total hip arthroplasty. The posterolateral approach avoids disruption of the abductor mechanism but may denervate gluteus maximus as a basis for associated higher dislocation rates.
Objective: To determine the pattern of innervation of gluteus maximus Study design: Descriptive cross-sectional study
Materials and methods: Twenty four cadavers for routine dissection in the Department of Human Anatomy, University of Nairobi were used. Having exposed the gluteus maximus, the muscle was transected close to its distal attachment and reflected superiorly to expose the entry of the neurovascular structures into it from the greater sciatic foramen. The pattern of distribution of the inferior gluteal nerve to the muscle was
Introduction
Gluteus maximus (GM) is a powerful hip extensor inner- vated by the inferior gluteal nerve (IFN) and an impor- tant muscle in rising up from squatting position, climb- ing (1) and running (2). Its functions during running are to control flexion of the trunk on the stance-side (3) and to decelerate the swing leg. Low levels of GM activity may contribute to hip extension during stance, and to re- strain hip flexion during swing. During loading response of the gait cycle, in the frontal plane, activity in the up- per portions of the gluteus maximus, hip abductors and tensor fascia lata control drop of the contralateral pelvis, which is relative hip adduction (4).
Risk factors in prosthetic hip dislocation include patient- related ones such as neuromuscular disease (5) and sur- gical ones. Of the surgically-related factors, the approach has generated a lot of controversy. In the Moore posteri- or approach to the hip the incision starts 10 centimetres from the posterior superior iliac spine, is directed later- ally and distally to the back of the greater trochanter and extends for 10 or more centimetres, parallel to the shaft of the femur. The deep fascia is exposed and the iliotibial band is incised from the trochanter to the distal end of
noted and the left and right in the same cadaver compared
Results: In all the 48 cadaver sides, the inferior gluteal nerve exited
the pelvis via the infra-piriformic compartment of the greater sciatic foramen. In majority (43, 89.6%) of gluteal regions this nerve funned out in multiple equal branches to the GM. Only one branch crossed the upper border of piriformis muscle. In 5 cases, this single branch that crossed the upper border of piriformis was a major trunk almost equal in size to the parent nerve. One such case was bilateral.
Conclusion: A major branch of the inferior gluteal nerve to the upper part of GM, when present, could be injured in the posterior approaches to the hip to significantly weaken the upper part of this muscle increasing the risk of prosthetic hip dislocation.

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