PROF. OGENGO JULIUS A.

Surface mapping of the liver before invasive procedures depends on a proper understanding of its segmental vasculature. The right portal vein ramification and lengths show marked variations and these mostly involve its right posterior sectoral branch. Their incidence is variable among populations and altogether undocumented among Africans. One hundred livers obtained during autopsies and dissections at the Department of Human anatomy, University of Nairobi, were used in this study. Gross dissection was done to reveal and determine the branching pattern of the right portal vein and the origin of the right posterior sector branch. The lengths of the right portal vein were also measured and recorded. When present, the right portal vein terminated by bifurcation in 61% of the cases, trifurcated in 20.8% and quadrifircated in 18.2%. Its length was between 0.5cm and 4cm. The right posterior sector vein was given off the main portal vein in 34 cases, the common left portal vein trunk in 15 cases, and the right portal vein in 42 cases. In 9 cases, it was not observed at the porta hepatis. We report significant different incidences of the variant anatomy of the right portal vein compared to those found in previous studies and this should be borne in mind when doing surgical interventions

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.

Atrioventricular annuli are important in haemodynamic flexibility, competence, and support for tricuspid and mitral valves. The anatomical features of the annuli, such as circumference, organisation of connective tissue fibres, myocardium, and cellularity, may predispose to annular insufficiency and valvular incompetence. These pathologies occur more commonly in females, although the anatomical basis for this disparity is unclear. Sex variation in the structure of the annuli is important in providing a morphological basis for the patterns of these diseases. This study therefore aimed to determine the sex variations in the structure of human atrioventricular annuli. One hundred and one hearts (48 males, 53 females) obtained from the Department of Human Anatomy of the University of Nairobi were studied. Annular circumferences were measured using a flexible ruler and corrected for heart weight. Results were analysed using SPSS version 17.0 and sex differences determined using student's t-test. A p-value of less than 0.05 was considered significant. For light microscopy, specimens were harvested within 48 hours post-mortem, processed, sectioned, and stained with Masson's trichrome and Weigert's elastic stain with van Gieson counterstaining. Females had significantly larger annular circumferences than males after correcting for heart weight (p ≤ 0.05). Histologically, myocardium was consistently present in all male annuli while this was absent in females except in one specimen. The annuli were more elastic and cellular in males especially in the annulo-myocardial and annulo-valvular zones, respectively. The corrected larger annular circumference in females may limit heart valve coaptation during cardiac cycle and may be a risk factor for valvular insufficiency. The predominance of myocardium, annular cellularity, and elasticity may be more protective against heart valve incompetence in males than in females.

Sternal foramina may pose a great hazard during sternal puncture, due to inadvertent cardiac or great vessel injury. They can also be misinterpreted as osteolytic lesions in cross-sectional imaging of the sternum. On the other hand, variant xiphoid morphology such as bifid, duplicated, or trifurcated may be mistaken for fractures during imaging. The distribution of these anomalies differs between populations, but data from Africans is scarcely reported. This study therefore aimed to investigate the distribution and frequency of sternal foramina and variant xiphoid morphology in a Kenyan population. Eighty formalin-fixed adult sterna (42 males [M], 38 females [F]) of age range 18-45 years were studied during dissection at the Department of Human Anatomy, University of Nairobi. Soft tissues were removed from the macerated sterna by blunt dissection and foramina recorded in the manubrium, body, and xiphoid process. The xiphisternal ending was classified as single, bifurcated (2 xiphoid processes with a common stem), or duplicated (2 xiphoid processes with separate stems). Results were analysed using SPSS version 17.0. Foramina were present in 11 specimens (13.8%): 7 M, 4 F. The highest frequency was in the sternal body (n = 9), where they predominantly occurred at the 5th intercostal segment. Xiphoid foramina were present in 2 specimens (both males) (2.5%), while manubrial foramen was not encountered. The xiphisternum ended as a single process in 64 cases (34 M, 30 F) (80%). It bifurcated in 10 cases (5 M, 5 F) (12.5%), and duplicated in 6 cases (4 M, 2 F) (7.5%). There were no cases of trifurcation. Sternal foramina in Kenyans vary in distribution and show higher frequency than in other populations. These variations may complicate sternal puncture, and due caution is recommended. The variant xiphisternal morphology may raise alarm for xiphoid fractures and may therefore be considered a differential.

Variant origin of lateral circumflex femoral artery (FA) is important during harvesting of anterolateral thigh flaps, aortopopliteal by-pass, coronary artery grafting, and vascularised iliac transplant. The frequencies of variant origins display ethnic variations, but reports from black Africans are scarce. This study, therefore, aimed to describe the variant origins of lateral circumflex FA in a black Kenyan population. Eighty-four (42 right and 42 left) lateral femoral circumflex arteries from 42 cadavers (31 male and 11 female) were exposed by dissection of the femoral triangles at the Department of Human Anatomy, University of Nairobi. The arteries were then traced proximally to their parent trunks. Sites of origin were recorded and representative images of the variations taken using a high-resolution digital camera. Data were analysed using Statistical Program for Social Scientists version 16.0 for Windows and presented in tables and macrographs. The lateral circumflex artery was a branch of the profunda femoris in only 65.5% of cases. Variant origins included from a common trunk with medial circumflex artery (14.3%), with profunda femoris (10.7%), as a trifurcation with profunda femoris and medial circumflex FA (7.1%), and from FA (2.4%). Variant origin of the lateral circumflex FA occurred in nearly 35% of the Kenyan population studied, much lower than in oriental populations. The most frequent variant origin is as a common trunk with medial circumflex femoral and profunda femoris, with a very low prevalence of origin from FA. The unusual origins make the artery more vulnerable to iatrogenic injury during surgery and catheterisation. Preoperative angiographic evaluation of the femoral arterial system is recommended.

Uterine artery undergoes structural modifications at different physiologic states. It is expected that due to its unique course, hemodynamic stresses in the vessel would vary resulting in differences in arterial dimensions. The objective of this study was to investigate regional morphometric changes in the human uterine artery.

Background: Characteristics of Prolapsed Intervertebral Disc (PID) in Africa, reports are scanty and
often disparate.
Objectives: To evaluate the distribution of PID by location, age, gender and predisposing factors among
African patients at our hospital, the largest regional referral and teaching hospital in Kenya.
Patients and Methods: Six hundred and three cases (267 males, 336 females) of prolapsed intervertebral
disc over 11 years between January 1997 and December 2007 were analyzed for location, number of
prolapsed disks, gender, age and predisposing conditions.
Results: Of the determined locations L4/5 was the commonest (42.3%), followed by L5/S1 (25.5%).
Seventy seven (20.9%) of the patients had multiple prolapsed disks. 1.4% were in the cervical region,
and only one in the thoracic. PID was commonest in the 31 – 50 year age group females (M: F is 1:1.26,
p=0.00), with mean age 40.90+13.80 years, (range between 11- 85 years).
Conclusions: PID in Kenya is commonest in the lower lumbar region of young people more in females
and is associated with trauma.

Background: The diversity of benign jaw tumours may cause difficulty in a correct diagnosis and insti-tution of an appropriate treatment. Data on the prevalence of these tumours is scarce from the Afri-can continent. We present a 19-year audit of benign jaw tumours and tumour-like lesions at a University teaching hospital in Nairobi, Kenya. Methods: Histo-pathological records were retrieved and re-examined from the Department of Oral and Maxillofacial pa-thology, University of Nairobi from 1992 to 2011. The jaw tumours were classified according to the latest WHO classification. Results: During the 19-year audit, 4257 biopsies were processed of which 597 (14.02%) were jaw tumours within an age range of between 4 to 86 years. There was greater number of odontogenic tumours 417 (69.85%) than the bone related lesions 180 (30.15%). Of the odontogenic tumours, the epithet- lial and in the bone related types, the fibro-osseous lesions were frequent. Conclusion: Ameloblastoma and ossifying fibroma were the most frequent tumours reported in this audit. The information regarding the prevalence of these tumours is scarce from the conti-nent and can be useful in early detection and man-agement before they cause facial deformity.

A 62 year-old male presented with a progressing three week history of respiratory distress, tachypnoea, right sided chest stony dullness and mediastinal shift to the left. He had no clinical, laboratory or radiological evidence of pulmonary tuberculosis or malignancy and could not remember any history of chest trauma. Chest X ray revealed massive right side pleural effusion. A Computerised Tomography (CT) scan showed six consecutive rib (rib 5- 10) fractures with no callus formation. Chest tube insertion drained 4.7L of straw coloured effusion that did not recur subsequently. We suspect that multiple rib fractures irritated the pleura, resulting in a massive pleural effusion. A review of the literature indicates this to be a rare finding.

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 catheteriz
ation 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.

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

reatment of cervical incompetence by cerclage and other methods has yet to be standardized, as its diagnosis is not uniformly accepted. Its diagnosis, particularly in the African setting, is mostly based on past obstetric history of pregnancy losses, while in developed centres; ultrasound diagnosis is increasingly being used. The mainstay of treatment in developing countries is cervical cerclage, although the indications and contraindications of this mode of treatment are not documented. Our aim was to appraise this practice in terms of patient characteristics, the diagnostic process and management at the Kenyatta National Hospital, Nairobi, Kenya. This was a descriptive retrospective study over 9 years. Predesigned questionnaires were employed to collect data on patient’s socio-demographic profile, presentation, risk factors, diagnosis and management of cervical incompetence. Chisquared test and student’s t-test were used to correlate variables. A total of 199 patients were treated for cervical incompetence, with the patient mean age being 27.97. 87.4% of the patients (p=0.02) were in the 20 to 35 years category. Most of the patients (60.1%) were of low socio-economic status. Cervical cerclage was employed in all the patients, although ultrasound investigation was not employed in 65.8% of them. Diagnosis of cervical incompetence still relies on history of previous pregnancy losses, with the standard transvaginal ultrasound relatively unemployed. There is need to intensify investigations for this condition, standardize the indications for cerclage, and diversify management to other newer modalities.

Branching pattern of middle cerebral artery influences frequency of its aneurysms, and is of potential value in their surgical repair and diagnosis of stroke. This pattern shows inter-population variations but there is paucity of data from Africans. This study aimed at describing branching pattern among black Kenyans. Middle cerebral arteries numbering 288 from 144 formalin fixed brains obtained during dissection and autopsy at Department of Human Anatomy, University of Nairobi, Kenya were studied. Origin of the middle cerebral artery was identified at base of brain and its stem followed by gently separating the fronto-parietal and temporal lobes. Pattern of early cortical, lenticulostriate, and terminal branching was recorded and macrographs taken. Results were analyzed using SPSS version 13.0 for windows and presented using macrographs. All the brains had bilateral middle cerebral arteries which were continuations of the internal carotid artery. Variations of the artery observed included duplication (1.7%), early bifurcation (5.2%), and early cortical branching (47%), predominantly temporal (63.9%). Lenticulostriate arteries arose predominantly from the pre-bifurcation segment as single branches (64.6%), and as common trunks (35.4%). Modes of termination were bifurcation (82.3%), trifurcation (10.8%), primary trunks (6.2%), and quadrifurcation (0.7%). Cortical branching pattern of the middle cerebral artery resembles that of Caucasian and Indian populations suggesting equal vulnerability to aneurysms and stroke. Pattern of origin of lenticulostriate arteries, predominantly from the pre-bifurcation segment and higher percentage of common trunks implies that the population is more prone to ischemia after aneurysm repair. Extra diligence during operation on proximal middle cerebral artery is called for.

Pulmonary thromboembolism (PTE) is a frequent cause of mortality in Kenya, but its characteristics are hardly reported in Subsaharan Africa. To describe the pattern of PTE among black Africans, in a Kenyan referral hospital. Retrospective study at Kenyatta National Hospital (KNH), Nairobi, Kenya. Records of patients seen between January 2005 and December 2009 were examined for mode of diagnosis, comorbidities, age, gender, treatment and outcome. Data were analyzed using SPSS version 15.0 and are presented in tables and bar charts. One hundred and twenty-eight (60 male; 68 female) cases were analyzed. Diagnosis was made by clinical evaluation, a Well's score of >4.0, high D-dimer levels and ultrasound demonstration of a proximal deep venous thrombosis (DVT, 35.9%), lung spiral computer tomography (CT, 50%), multidetector CT (7.8%) and angiography (6.3%). Most frequent comorbidities included DVT (36%); hypertension (18.8%); pulmonary tuberculosis (PTB, 12.5%); HIV infection (10.9%), pueperium, diabetes mellitus and cigarette smoking (9.4% each). Mean age was 40.8 years (range 5-86 years) with a peak between 30 and 50 years. Over 46% of patients were aged 40 years and less. Male:female ratio was 1:1.13. All the patients were treated with anticoagulants and thrombolytics with only one having embolectomy. Ninety-two patients (71.9%) recovered, 18.8% of them with cor pulmonale, while 28.1% died. PTE is not uncommon in Kenya. It affects many individuals below 40 years without a gender bias, and carries high morbidity and mortality. Associated comorbidities include venous thrombosis, lifestyle conditions and communicable diseases. Control measures targeting both are recommended.

The jaws are host to a variety of cysts due in large part to the tissues involved in tooth formation. Odontogenic cysts (OCs) are unique in that they affect only the oral and maxillofacial region. There are few studies from sub-Saharan Africa. This study was aimed at describing the pattern of various types of cysts in the oral and maxillofacial region in a Kenyan population. This was done at the Departments of Oral and Maxillofacial Surgery and Oral Medicine and Pathology, University of Nairobi Dental Hospital. This was a retrospective audit. All histopathologic records were retrieved from 1991 to 2010 (19 years) and were counted. The following information was extracted and recorded in a data sheet: age, sex, and the type of cystic lesions. There were 194 cysts (4.56%) diagnosed of 4257 oral and maxillofacial lesions. Of these, 64.4% were from male and 35.6% were from female patients with an age range of 1 to 70 years (mean, 23.76 [SD, 14.05] years; peak and median of 20 years). The most common OCs (57.2%) were dentigerous and radicular, whereas the most common nonodontogenic cyst (42.8%) was nasopalatine duct cyst. Other soft tissue cysts reported were epidermoid, branchial, thyroglossal, dermoid, and cystic hygroma. Oral and maxillofacial cysts are not uncommon in this population, the majority being the OC, dentigerous cyst, followed by the nonodontogenic cyst, nasopalatine cyst. The cysts are male predominant and occur 10 to 15 years earlier compared with those in the white population.

To determine the mean menarcheal age among urban primary school girls in Kenya.

Aneurysms in the arteries of the upper extremity are rare but important in predicting aortic aneurysms and their potential to thromboembolize and cause limb loss. Their localization, age, and gender distribution vary between countries depending on ethnic background and cause. These data are valuable in the management of aneurysms, but are largely lacking from the Kenyan population.

Knowledge of variant anatomy of the sciatic nerve is important in avoiding inadvertent injury during operations in the gluteal region and interpreting nondiscogenic sciatica. This variant anatomy may cause piriformis syndrome and failure of sciatic nerve block. The variations differ between populations but data from Africans is scarce. This study, therefore, investigated variations of sciatic nerve in a black Kenyan population. One hundred and sixty-four sciatic nerves from 82 cadavers of black Kenyans were exposed by dissection at the Department of Human Anatomy, University of Nairobi, Kenya. The level of bifurcation, relationship to piriformis, and topographic relations between the branches were studied. The results were analysed by SPSS version 16.0 and are presented by macrographs. In 33 (20.1%) cases division occurred in the pelvis, while in 131 (79.9%) it occurred outside the pelvis. A single trunk sciatic nerve exited below the piriformis muscle in 131 (79.9%) cases. In cases of pelvic division, the tibial nerve was always infrapiriformic, while the common peroneal nerve passed below piriformis in 16 (9.8%) cases, pierced the piriformis in 13 (7.9%), and passed above it in 4 (2.4%). For those in which division was extrapelvic, 110 (67.1%) were in the popliteal fossa, 17 (10.4%) in the middle third of the thigh, and 4 (2.4%) in the gluteal region. Where the division was pelvic, in 19 (11.6%) cases they continued separately, in 8 (4.9%) the two nerves reunited, and in 6 (3.7%) they were connected by a communicating nerve. The sciatic nerve in the Kenyan population varies from the classical description in over 30% of cases, with many high divisions, low incidence of piriformic course of common peroneal nerve, reunion, and unusual connection between common peroneal and tibial nerves. These variations may complicate surgery and interpretation of sciatic neuropathy. Preoperative nerve imaging and extra operative diligence in the gluteal region and the back of the thigh are recommended.

The spectrum of cardiovascular diseases varies between countries. Data from east Africa is scarce, but important in formulating disease management strategies. The aim of this study was to describe the spectrum of cardiovascular causes of death in Kenya.

Hypertensive kidney disease is a major cause of morbidity and mortality. Its pattern displays geographical and ethnic variations. Data on these patterns are important for informing management and prevention strategies, but on Kenyans such data are scarce.

Variations in the branching of posterior cord are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of branching show population differences. Data from the African population is scarce.

Background: Accurate evaluation of low back pain is essential for its rational management. The extent of use of clinical and imaging findings in identificationof prolapsed intervertebral disk varies between centers. In Kenya, thediagnostic procedure is obscure.Objective: To assess the evaluation of low back pain patients for prolapsed intervertebral disk at a Kenyatta National Hospital, a teaching and referralhospital in Kenya.Study Design: A retrospective chart studyPatients and Methods: Historical, physical and imaging findings of patients who presented with low back pain and subsequently diagnosed with prolapsed inter-vertebral disk between Jan 1997 and December 2007 were evaluated.Results: Of the six hundred and three patients (267 males, 336 females) whowere evaluated, risk factors were recorded in 39.5% patients, 35.3%patients had sciatica while straight leg raising test was performed in52.2% patients. Investigations performed in these patients included plainroentograms (38.5%), CT scan (9.1%) and MRI (44.1%).Conclusion: The evaluation of low back pain for prolapsed inter-vertebral disk was incomplete. History of sciatica, SLRT, crossed SLRT and MRI use arerecommended for routine evaluation of low back pain for PID.

During routine dissection, we identified a horseshoe kidney arrested inferior to the inferior mesenteric artery in a middle-aged male cadaver. On further dissection, the kidneys were fused inferiorly, both hila were wide and the kidneys had bilateral duplicated renal arteries and ureters. Horseshoe kidneys could be associated with bilateral duplex systems

Position and source of blood supply to the human carotid body displays population variations. These data are important during surgical procedures and diagnostic imaging in the neck but are only scarcely reported and altogether missing for the Kenyan population. The aim of this study was to describe the position and blood supply of the carotid body in a Kenyan populati on. A descriptive cross-sectional study at the Department of Human Anatomy, University of Nairobi, was designed. 136 common carotid arteries and their bifurcations were exposed by gross dissection. The carotid body was identified as a small oval structure embedded in the blood vessel adventitia. Position and source of blood supply were photographed. Data are presented by tables and macrographs. 138 carotid bodies were identified. Commonest position was carotid bifurcation (75.4%) followed by external carotid artery (10.2%), internal carotid artery (7.2%) and ascending pharyngeal artery (7.2%). Sources of arterial blood supply included the carotid bifurcation (51.4%), ascending pharyngeal (21.0%), external carotid (17.4%) and internal carotid (10.2%) arteries. Position and blood supply of the carotid body in the Kenyan population displays a different profile of variations from those described in other populations. Neck surgeons should be aware of these to avoid inadvertent injury.

Atlas bridges are bony outgrowths over the third segment of the vertebral artery. They may exist as incipient, incomplete, or complete bridges, converting the groove into a deep sulcus, incomplete, or complete foramen respectively. These bridges and their associated foramina display bilateral and sex differences in their prevalence and type. Occurrence of these bridges may predispose to vertebrobasilar insufficiency and Barre-Lieou syndrome. The coexistence of lateral and posterior bridges as well as side predilection is not clear in either sex. Their relative occurrence may also point to some evolutionary patterns. We studied the prevalence, side predilection, coexistence, and anatomical features of atlas bridges using 102 dry atlases (49 males and 53 females) obtained from the osteology department of the National Museums of Kenya. Complete posterior bridges occurred in 14.7% and 13.7% on the right and left sides, respectively. A lateral bridge was found in 3.9% of cases on the right side only. There was positive correlation in the coexistence of the bridges. A retrotransverse foramen was found in 13% of cases. This study has found that posterior and lateral atlas bridges occur in association especially on the right side. Complete bridges were more prevalent in females and were more often present on the right side. This pattern seems to mirror the sexual predilection of vertebral artery compression syndromes. Gender roles may have an influence on the occurrence of these bridges and therefore the syndromes as well.

The functional significance of myocardial bridging remains controversial. The bridge morphology and structure of the tunneled vessels may modify its ultimate clinical effects.

We sought to describe the regional, age, and sex distribution; diagnosis; treatment; and outcome of aortic aneurysms in a Kenyan population.

To investigate the uterine artery's origin, branching patterns, and relation to the ureter in a Kenyan population. METHOD: The uterine arteries of the bodies of 53 girls and women were dissected at the University of Nairobi Department of Human Anatomy to study these patterns. Data were analyzed for frequency and the patterns are presented via digital macrographs. RESULTS: The uterine artery consistently originated as a branch of the internal iliac artery. It formed the second or third branch of the anterior trunk in 70.8% of cases; it ascended as a single branch, or from a bifurcation, or from a trifurcation in 76.4%, 17.1%, and 6.7% of cases; and lay posterior to the ureter in 3.8% of cases. In all, 46.2% of the uterine arteries studied varied from the classic description. CONCLUSION: About half of the uterine arteries had a nonclassic origin, branching pattern, or relation to the ureter-as a posterior relation to the ureter had not been previously described. Surgeons operating in the pelvis should be aware of this variant anatomy to avoid injury to the ureter and other organs

Regional differences in the aortic wall are important in explaining the physicomechanical properties and disease distribution in this artery. The goat is a suitable model for studying cardiovascular disease, but the regional features of its aorta are scarcely reported. The purpose of the study was therefore to describe the regional differences in the wall of its aorta. Sixteen healthy adult male domestic goats (capra hircus) were euthanised with intravenous sodium pentabarbitone and specimens obtained from the ascending, arch, each vertebral level of descending thoracic, and various segments of abdominal aorta. The specimens were fixed in 10% formaldehyde solution and routinely processed for paraffin embedding. Seven micron thick sections were stained with Mason's Trichrome and Weigert Resorcin Fuchsin stains. Light microscopic examination revealed that the aortic wall consists of tunica intima comprising endothelium, subendothelial zone and internal elastic lamina, media, and adventitia. Endothelium comprises flat and round endotheliocytes. The population of round cells declines as the internal elastic lamina increases in prominence caudally. Tunica media in ascending, arch, and proximal thoracic aorta comprises two zones: namely a luminal elastic and adventitial musculo-elastic zone, in which muscle islands interrupt some elastic lamellae. These islands progressively diminish caudally until by the eleventh thoracic vertebra they are only patchy. Beyond this point and in the abdominal aorta they are absent and tunica media consists of regular concentric elastic lamellae. Tunica adventitia, on the other hand, increases in thickness and elastic fibre content caudally. Regional variations exist in all three layers of goat aorta. The nature of these differences suggests that they are related to haemodynamic factors. Furthermore, the variations may form the basis for regional differences in physicomechanical strength and disease distribution along the aorta.

The morphology of the suprascapular notch has been associated with suprascapular entrapment neuropathy, as well as injury to the suprascapular nerve in arthroscopic shoulder procedures. This study aimed to describe the morphology and morphometry of the suprascapular notch. The suprascapular notch in 138 scapulae was classified into six types based on the description by Rengachary. The suprascapular notch was present in 135 (97.8%) scapulae. Type III notch, a symmetrical U shaped notch with nearly parallel lateral margins, was the most prevalent type, appearing in 40 (29%) scapulae. The mean distance from the notch to the supraglenoid tubercle was 28.7 ± 3.8 mm. This varied with the type of notch, being longest in type IV (30.1 ± 1.8 mm) and shortest in type III (27.3 ± 2.3 mm). The mean distance between the posterior rim of the glenoid cavity and the medial wall of the spinoglenoid notch at the base of the scapular spine was found to be 15.8 ± 2.2 mm. Type III notch was the most prevalent, as found in other populations. In a significant number of cases the defined safe zone may not be adequate to eliminate the risk of nerve injury during arthroscopic shoulder procedures, even more so with type I and II notches.

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. Student's 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.

Variant anatomy of renal arteries is important in renal transplant, vascular reconstruction, and uroradiological procedures. The variations show ethnic and population differences. Data from Africans are scarce and altogether absent for Kenyans. OBJECTIVE: To describe patterns of origin, trajectories and branching of renal arteries in a Kenyan population. STUDY DESIGN AND SETTING: Descriptive cross-sectional study conducted in the Department of Human Anatomy, University of Nairobi. MATERIAL/METHODS: Three hundred and fifty six kidneys from 178 cadavers and postmortem specimens were used in the study. Aorta, renal arteries and kidneys were exposed by dissection. Number, trajectories, level of branching, number of branches and point of entry into the kidney were recorded. Data was analyzed using SPSS version 16.0, and presented using macrographs, tables, and bar charts. RESULTS: Additional arteries occurred in 14.3% of the cases. In 82.4% of these, there was one additional artery. Fifty nine point five per cent of the double renal arteries were parallel and 7.1% crossed. Of the 305 single arteries, 76.4% showed hilar, 21.6% prehilar and 2% intraparenchymal branching. In the hilar branching, ladder type was present in 65% and fork type in 35%. Bifurcation and trifurcation were present in 59.6% and 33.1% respectively. Polar arteries were present in 16.9% cases. CONCLUSIONS: Over 14% of the Kenyan population may have additional renal arteries while more than 20% show early branching. Several trajectories and hilar branching patterns exist which renal transplant surgeons and radiologists should be aware of to avoid inadvertent vascular injury.

The distribution of congenital neck masses varies between countries and is important in diagnosis and treatment modalities. Data from Africa is scarce, and altogether absent from Kenya.

The pattern of pediatric stroke displays ethnic and geographical variations. There are few reports from black Sub-Saharan Africa, although relevant data are important in prevention, clinical diagnosis, treatment and prognostication.

The superficial temporal artery, one of the terminal branches of the external carotid artery, is used for temporoparietal, parieto-occipital flaps and forehead flaps in reconstructive surgery. The topographic anatomy of this artery exhibits ethnic variations. Therefore, this study aimed to determine the branching pattern of the superficial temporal artery and its relation to specified landmarks in the pericranial region among Kenyans. Sixty superficial temporal arteries from thirty adult cadavers (18 male, 12 female), obtained from the Department of Human Anatomy, were examined during dissection. The number of branches and pattern of branching of the superficial temporal artery was recorded. Specific measurements were taken from the branching point to the lateral canthus, tragus, and midpoint of the arch of the zygoma. Classical bifurcation into a parietal and a frontal branch was seen in 16 (53.3%) cases. Double frontal and double parietal branches were reported in 26.7% and 13.3% of cases, respectively. Only two cases had a trifurcation. The point of origin of the branches in most cases (80%) was above the arch of the zygoma. The mean distance to the midpoint of the arch of the zygoma was 50.8 + or - 20.9 mm, to the lateral canthus 58.6 + or - 24.3 mm, and to the tragus 44.1 + or - 18.5 mm. The branching pattern among Kenyans, therefore, differs from the classical descriptions. A good understanding of the forehead vascularity aids in the design of flaps and minimizes postoperative complications.

The objective of this study was to describe the pattern of acute myocardial infarction in an African country. These data are important for prevention strategies but are scarce from sub-Saharan African countries and altogether absent from Kenya.

The structural organisation of tunica intima in the aorta is important for its integrity, prediction, and diagnosis of atherosclerosis. The goat is a suitable model for cardiovascular studies, but the structure of its tunica intima is scarcely reported. This study, therefore, aimed to describe features of the goat aortic tunica intima by light and transmission electron microscopy. Sixteen healthy male domestic goats (capra hircus) aged between 6 and 24 months were used: 8 for light and 8 for electron microscopy. The animals were euthanised with sodium pentabarbitone 20 mg/mL and fixed with 3% phosphate buffered glutaraldehyde. For light microscopy, specimens from various regions of the aorta were routinely processed for paraffin embedding and 7 mm sections stained with Mason's trichrome. Those for transmission electron microscopy were post fixed in osmium tetroxide, embedded in Durcupan, and ultrathin sections stained with uranyl acetate and counter stained with lead citrate. Endothelium comprises round and squamous cells, linked to the subendothelial material by a simple and sometimes lamellated basement membrane. In the subendothelial zone, a heterogenous population of cells are connected with interlinked collagen and elastic fibres. Both cells and fibres are connected to the internal elastic lamina. The composite structure and interlinkages in the tunica intima permit unitary function and increase mechanical strength, thus enabling it to withstand haemodynamic stress.

With the emerging utilisation of ansa cervicalis in nerve reconstructive surgery, it is important for surgeons to be conversant with the anatomy of these nerves. This descriptive cross sectional study aimed at describing the morphology and topographic anatomy of ansa cervicalis. We examined 38 adult human formalin-fixed cadavers. The superior root was present in 38 (100%) cases and 37 (97%) cases, on the right and left sides, respectively. More than half (56%) of these roots were located superior to the posterior belly of the digastric muscle. The inferior root, on the other hand, was present in 34 (89.5%) cases on the right side and 31 (81.6%) cases on the left side. Of all the inferior roots, 81.5% were located lateral to the internal jugular vein. The loop was seen in all the cases that had the inferior root, and was mostly (64.6%) located above the superior belly of the omohyoid muscle. Knowledge of the anatomy of ansa cervicalis is not only important for nerve reconstruction surgeries, but also for operations in the neck, so as to avoid injuring the great vessels that are closely related to it.

Background: Accurate evaluation of low back pain is essential for its rational management. The extent of use of clinical and imaging findings in identificationof prolapsed intervertebral disk varies between centers. In Kenya, thediagnostic procedure is obscure.Objective: To assess the evaluation of low back pain patients for prolapsed intervertebral disk at a Kenyatta National Hospital, a teaching and referralhospital in Kenya.Study Design: A retrospective chart studyPatients and Methods: Historical, physical and imaging findings of patients who presented with low back pain and subsequently diagnosed with prolapsed inter-vertebral disk between Jan 1997 and December 2007 were evaluated.Results: Of the six hundred and three patients (267 males, 336 females) whowere evaluated, risk factors were recorded in 39.5% patients, 35.3%patients had sciatica while straight leg raising test was performed in52.2% patients. Investigations performed in these patients included plainroentograms (38.5%), CT scan (9.1%) and MRI (44.1%).Conclusion: The evaluation of low back pain for prolapsed inter-vertebral disk was incomplete. History of sciatica, SLRT, crossed SLRT and MRI use arerecommended for routine evaluation of low back pain for PID.

Peripheral aneurysms are important because of concurrence with aortic ones and potential to thromboembolise or rapture. Their distribution shows population variations yet reports from Africa are scarce and altogether absent from Kenya. Objective To describe the pattern of peripheral aneurysms in a Kenyan national referral hospital. Patients and methods Records of in-patients with a diagnosis of peripheral aneurysms at Kenyatta National Hospital between January 1998 and December 2007 were analyzed for presentation, diagnostic method, risk factors, site, age and gender distribution. Only records containing all these data were included. Data were analyzed using SPSS version 13.0 and presented using tables, and bar charts. Results Ninety six cases involved the femoral (24%), common carotid (15.6%); brachial (12.5%); brachiocephalic (11.5%) and popliteal (10.4%) arteries. They presented with pulsatile mass (37.5%), painful swelling (22.9%) and pressure on subjacent structures (13.5%). Diagnosis was confirmed by Doppler ultrasound (37.5%), conventional angiography (30.2%) and plain ultrasound (14.6%). Mean age was 45.6 years (range 13 – 79 years); with 50% of them occurring in individuals aged 40 years and younger. Common risk factors were trauma (39.6%), hypertension (13.5%) and atherosclerosis (9.4%). Male:female ratio was: 15:1 for femoropopliteal, 5:1 for brachial; 1:1 for common carotid and 1:2.6 for brachiocephalic trunk. Conclusion Characteristics of peripheral aneurysms in the Kenyan study population vary from those of Caucasians. They are more widespread, trauma related, and occur in younger individuals. Prudent management of risk factors is recommended.

Characteristics of intracranial aneurysms display ethnic variations. Data on this disease from the African continent is scarce and often conflicting.

Causes of limb amputations vary between and within countries. In Kenya, reports on prevalence of diabetic vascular amputations are conflicting. Kikuyu Hospital has a high incidence of diabetic foot complications whose relationship with amputation is unknown. This study aimed to describe causes of limb amputations in Kikuyu Hospital, Kenya. Records of all patients who underwent limb amputation between October 1998 and September 2008 were examined for cause, age and gender. Data were analysed using the statistical package for Social Sciences (SPSS) for Windows Version 11.50. One hundred and forty patients underwent amputation. Diabetic vasculopathy accounted for 11.4% of the amputations and 69.6% of the dysvascular cases. More prevalent causes were trauma (35.7%), congenital defects (20%), infection (14.3%) and tumours (12.8%). Diabetic vasculopathy, congenital defects and infection are major causes of amputation. Control of blood sugar, foot care education, vigilant infection control and audit of congenital defects are recommended.

The course of the hepatic inferior vena cava (HIVC) has a wide range of variations which are relevant in hepato-vascular surgery and liver transplantation. Eighty livers were studied for hepatic course and axial orientation of the HIVC. The HIVC was found to run in an incomplete tunnel in 43.8% of the cases (n = 35), complete tunnel in 32.5% of the cases (n = 26) while in the rest, it was contained in a shallow groove on the retrohepatic surface. It assumed an oblique course in relation to the longitudinal axis of the liver in 60% of the cases (n = 48). The findings of this study vary to a wide range from those reported previously, and call for extra caution during surgical operations involving the HIVC region.

Background: Accurate evaluation of low back pain is essential for its rational management. The extent of use of clinical and imaging findings in identificationof prolapsed intervertebral disk varies between centers. In Kenya, thediagnostic procedure is obscure.Objective: To assess the evaluation of low back pain patients for prolapsed intervertebral disk at a Kenyatta National Hospital, a teaching and referralhospital in Kenya.Study Design: A retrospective chart studyPatients and Methods: Historical, physical and imaging findings of patients who presented with low back pain and subsequently diagnosed with prolapsed inter-vertebral disk between Jan 1997 and December 2007 were evaluated.Results: Of the six hundred and three patients (267 males, 336 females) whowere evaluated, risk factors were recorded in 39.5% patients, 35.3%patients had sciatica while straight leg raising test was performed in52.2% patients. Investigations performed in these patients included plainroentograms (38.5%), CT scan (9.1%) and MRI (44.1%).Conclusion: The evaluation of low back pain for prolapsed inter-vertebral disk was incomplete. History of sciatica, SLRT, crossed SLRT and MRI use arerecommended for routine evaluation of low back pain for PID.

Background: Accurate evaluation of low back pain is essential for its rational management. The extent of use of clinical and imaging findings in identificationof prolapsed intervertebral disk varies between centers. In Kenya, thediagnostic procedure is obscure.Objective: To assess the evaluation of low back pain patients for prolapsed intervertebral disk at a Kenyatta National Hospital, a teaching and referralhospital in Kenya.Study Design: A retrospective chart studyPatients and Methods: Historical, physical and imaging findings of patients who presented with low back pain and subsequently diagnosed with prolapsed inter-vertebral disk between Jan 1997 and December 2007 were evaluated.Results: Of the six hundred and three patients (267 males, 336 females) whowere evaluated, risk factors were recorded in 39.5% patients, 35.3%patients had sciatica while straight leg raising test was performed in52.2% patients. Investigations performed in these patients included plainroentograms (38.5%), CT scan (9.1%) and MRI (44.1%).Conclusion: The evaluation of low back pain for prolapsed inter-vertebral disk was incomplete. History of sciatica, SLRT, crossed SLRT and MRI use arerecommended for routine evaluation of low back pain for PID.

Background: Prolapsed intervertebral disk (PID) disease can be managed conservatively or surgically with different reported outcomes.Objective: The present study aimed at assessing the management and outcomes of slipped intervertebral disk disease at the Kenyatta National hospital.Study Design: A retrospective cross-sectional study.Setting: Kenyatta National Hospital (KNH) a referral and teaching Hospital in Kenya.Patients and Methods: Consecutive files of all cases of slipped intervertebral disk disease from January1997 to December 2007 were retrieved from the Medical records at the Kenyatta National Hospital. The biodata, management methods and the outcomes of the procedures were recorded. The collecteddata was analyzed using the SPSS 17.0 for Windows.Results: Six hundred and three cases were reviewed. All patients received analgesics and bed rest.Five percent of the patients were put on bilateral traction for two weeks while 4% of the patients had corsets. Thirty five per cent of the patients were surgically managed. Over a third of the surgically managed patients had laminectomies. Microdiscectomy was increasingly popular in the latter half ofthe study period. Of the managed patients 95% reported improvement while 92% were complication free. The rate of reherniation and reoperation was 1.5% and 1.2% respectively.Conclusion: The management of PID at Kenyatta National Hospital is largely successful with few cases of complications. In selected patients both conservative and surgical care are used in tandem. Microdiscectomy is an increasingly popular surgical procedure at the KNH.

To describe the topography and anatomical variations of the carotid arteries among Kenyans.

Background: Prolapsed intervertebral disk (PID) disease can be managed conservatively or surgically with different reported outcomes.Objective: The present study aimed at assessing the management and outcomes of slipped intervertebral disk disease at the Kenyatta National hospital.Study Design: A retrospective cross-sectional study.Setting: Kenyatta National Hospital (KNH) a referral and teaching Hospital in Kenya.Patients and Methods: Consecutive files of all cases of slipped intervertebral disk disease from January1997 to December 2007 were retrieved from the Medical records at the Kenyatta National Hospital. The biodata, management methods and the outcomes of the procedures were recorded. The collecteddata was analyzed using the SPSS 17.0 for Windows.Results: Six hundred and three cases were reviewed. All patients received analgesics and bed rest.Five percent of the patients were put on bilateral traction for two weeks while 4% of the patients had corsets. Thirty five per cent of the patients were surgically managed. Over a third of the surgically managed patients had laminectomies. Microdiscectomy was increasingly popular in the latter half ofthe study period. Of the managed patients 95% reported improvement while 92% were complication free. The rate of reherniation and reoperation was 1.5% and 1.2% respectively.Conclusion: The management of PID at Kenyatta National Hospital is largely successful with few cases of complications. In selected patients both conservative and surgical care are used in tandem. Microdiscectomy is an increasingly popular surgical procedure at the KNH.

Background: Prolapsed intervertebral disk (PID) disease can be managed conservatively or surgically with different reported outcomes.Objective: The present study aimed at assessing the management and outcomes of slipped intervertebral disk disease at the Kenyatta National hospital.Study Design: A retrospective cross-sectional study.Setting: Kenyatta National Hospital (KNH) a referral and teaching Hospital in Kenya.Patients and Methods: Consecutive files of all cases of slipped intervertebral disk disease from January1997 to December 2007 were retrieved from the Medical records at the Kenyatta National Hospital. The biodata, management methods and the outcomes of the procedures were recorded. The collecteddata was analyzed using the SPSS 17.0 for Windows.Results: Six hundred and three cases were reviewed. All patients received analgesics and bed rest.Five percent of the patients were put on bilateral traction for two weeks while 4% of the patients had corsets. Thirty five per cent of the patients were surgically managed. Over a third of the surgically managed patients had laminectomies. Microdiscectomy was increasingly popular in the latter half ofthe study period. Of the managed patients 95% reported improvement while 92% were complication free. The rate of reherniation and reoperation was 1.5% and 1.2% respectively.Conclusion: The management of PID at Kenyatta National Hospital is largely successful with few cases of complications. In selected patients both conservative and surgical care are used in tandem. Microdiscectomy is an increasingly popular surgical procedure at the KNH.

Background: Prolapsed intervertebral disk (PID) disease can be managed conservatively or surgically with different reported outcomes.Objective: The present study aimed at assessing the management and outcomes of slipped intervertebral disk disease at the Kenyatta National hospital.Study Design: A retrospective cross-sectional study.Setting: Kenyatta National Hospital (KNH) a referral and teaching Hospital in Kenya.Patients and Methods: Consecutive files of all cases of slipped intervertebral disk disease from January1997 to December 2007 were retrieved from the Medical records at the Kenyatta National Hospital. The biodata, management methods and the outcomes of the procedures were recorded. The collecteddata was analyzed using the SPSS 17.0 for Windows.Results: Six hundred and three cases were reviewed. All patients received analgesics and bed rest.Five percent of the patients were put on bilateral traction for two weeks while 4% of the patients had corsets. Thirty five per cent of the patients were surgically managed. Over a third of the surgically managed patients had laminectomies. Microdiscectomy was increasingly popular in the latter half ofthe study period. Of the managed patients 95% reported improvement while 92% were complication free. The rate of reherniation and reoperation was 1.5% and 1.2% respectively.Conclusion: The management of PID at Kenyatta National Hospital is largely successful with few cases of complications. In selected patients both conservative and surgical care are used in tandem. Microdiscectomy is an increasingly popular surgical procedure at the KNH.

Background: Prolapsed intervertebral disk (PID) disease can be managed conservatively or surgically with different reported outcomes.Objective: The present study aimed at assessing the management and outcomes of slipped intervertebral disk disease at the Kenyatta National hospital.Study Design: A retrospective cross-sectional study.Setting: Kenyatta National Hospital (KNH) a referral and teaching Hospital in Kenya.Patients and Methods: Consecutive files of all cases of slipped intervertebral disk disease from January1997 to December 2007 were retrieved from the Medical records at the Kenyatta National Hospital. The biodata, management methods and the outcomes of the procedures were recorded. The collecteddata was analyzed using the SPSS 17.0 for Windows.Results: Six hundred and three cases were reviewed. All patients received analgesics and bed rest.Five percent of the patients were put on bilateral traction for two weeks while 4% of the patients had corsets. Thirty five per cent of the patients were surgically managed. Over a third of the surgically managed patients had laminectomies. Microdiscectomy was increasingly popular in the latter half ofthe study period. Of the managed patients 95% reported improvement while 92% were complication free. The rate of reherniation and reoperation was 1.5% and 1.2% respectively.Conclusion: The management of PID at Kenyatta National Hospital is largely successful with few cases of complications. In selected patients both conservative and surgical care are used in tandem. Microdiscectomy is an increasingly popular surgical procedure at the KNH.

Background: Prolapsed intervertebral disk (PID) disease can be managed conservatively or surgically with different reported outcomes.Objective: The present study aimed at assessing the management and outcomes of slipped intervertebral disk disease at the Kenyatta National hospital.Study Design: A retrospective cross-sectional study.Setting: Kenyatta National Hospital (KNH) a referral and teaching Hospital in Kenya.Patients and Methods: Consecutive files of all cases of slipped intervertebral disk disease from January1997 to December 2007 were retrieved from the Medical records at the Kenyatta National Hospital. The biodata, management methods and the outcomes of the procedures were recorded. The collecteddata was analyzed using the SPSS 17.0 for Windows.Results: Six hundred and three cases were reviewed. All patients received analgesics and bed rest.Five percent of the patients were put on bilateral traction for two weeks while 4% of the patients had corsets. Thirty five per cent of the patients were surgically managed. Over a third of the surgically managed patients had laminectomies. Microdiscectomy was increasingly popular in the latter half ofthe study period. Of the managed patients 95% reported improvement while 92% were complication free. The rate of reherniation and reoperation was 1.5% and 1.2% respectively.Conclusion: The management of PID at Kenyatta National Hospital is largely successful with few cases of complications. In selected patients both conservative and surgical care are used in tandem. Microdiscectomy is an increasingly popular surgical procedure at the KNH.

Background: Prolapsed intervertebral disk (PID) disease can be managed conservatively or surgically with different reported outcomes.Objective: The present study aimed at assessing the management and outcomes of slipped intervertebral disk disease at the Kenyatta National hospital.Study Design: A retrospective cross-sectional study.Setting: Kenyatta National Hospital (KNH) a referral and teaching Hospital in Kenya.Patients and Methods: Consecutive files of all cases of slipped intervertebral disk disease from January1997 to December 2007 were retrieved from the Medical records at the Kenyatta National Hospital. The biodata, management methods and the outcomes of the procedures were recorded. The collecteddata was analyzed using the SPSS 17.0 for Windows.Results: Six hundred and three cases were reviewed. All patients received analgesics and bed rest.Five percent of the patients were put on bilateral traction for two weeks while 4% of the patients had corsets. Thirty five per cent of the patients were surgically managed. Over a third of the surgically managed patients had laminectomies. Microdiscectomy was increasingly popular in the latter half ofthe study period. Of the managed patients 95% reported improvement while 92% were complication free. The rate of reherniation and reoperation was 1.5% and 1.2% respectively.Conclusion: The management of PID at Kenyatta National Hospital is largely successful with few cases of complications. In selected patients both conservative and surgical care are used in tandem. Microdiscectomy is an increasingly popular surgical procedure at the KNH.

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy.

Background: The fibula though transmits insignificant force in walking, is an important bone for muscle attachment and significant source of bone grafts.
Objectives: To determine the position, location and number of the nutrient foramina of the fibula among Kenyans.
Design: Cross-sectional descriptive study.
Subjects: Two hundred right and left dry fibulas for male and female Kenyans were obtained.
Setting: Department of Human Anatomy, University of Nairobi and the Osteology Department, National Museums of Kenya, Nairobi.
Methods: The number and position of the nutrient foramina were determined. The distance of the nutrient foramen from the styloid process of the head and the length of the fibula were measured by a tape. The data obtained was analyzed by a computer package, SPSS 11.5.0. The means of each value was compared between right, left and the gender groups.
Results: Five point five percent of fibula did not have any nutrient foramen. Most (53.4%) of the nutrient foramina were located posteriorly. The average length of the fibula was 365±30 mm long while the nutrient foramen was located 153±24mm from the tip of the styloid process of the head of the fibula; it was 3 cm proximal to the mid length of the fibula.
Conclusions: Fibula of 28.6 cm – 41.2 cm is available for grafting among Kenyans. The metric estimation of the position of the nutrient foramen of the fibula could assist in harvesting vascularised graft of the bone.

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

A number of biological risk factors have been implicated for Alzheimer's disease (AD). The investigation of prevalence rates of AD in crosscultural populations has much potential in validating these factors. We previously assessed brain amyloid beta (A beta) protein deposition and other lesions associated with AD as possible markers for preclinical AD in elderly nondemented East Africans. In further analysis, we demonstrate that 17-19% of elderly East African subjects without clinical neurological disease exhibited neocortical A beta deposits and minimal neurofibrillary changes at necropsy that was qualitatively and quantitatively similar to that in an age-matched elderly control sample from Cleveland, OH. A beta deposits varied from numerous diffuse to highly localized neuritic plaques and were predominantly reactive for the longer A beta 42 species. In parallel studies, we evaluated another recently implicated factor in AD, the apolipoprotein E genotype. We found relatively high frequencies of the apolipoprotein E-epsilon 4 allele in elderly nondemented East Africans. The frequencies were comparable to those in other African populations but higher than in subjects from developed countries. Our limited study suggests that elderly East Africans acquire cerebral lesions found in AD subjects but the apolipoprotein E-epsilon 4 allele may not be a highly specific factor for the disease among East Africans.

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

There is little knowledge of the existence of Alzheimer disease (AD) or Alzheimer type of dementia in indigenous populations of developing countries. In an effort to evaluate this, we assessed the deposition of amyloid beta (A beta) protein and other lesions associated with AD in brains of elderly East Africans. Brain tissues were examined from 32 subjects, aged 45 to 83 years with no apparent neurological disease, who came to autopsy at two medical Institutions in Nairobi and Dar es Salaam. An age-matched sample from subjects who had died from similar causes in Cleveland was assessed in parallel. Of the 20 samples from Nairobi, 3 (15%) brains exhibited neocortical A beta deposits that varied from numerous diffuse to highly localized compact or neuritic plaques, many of which were also thioflavin S positive. Two of the cases had profound A beta deposition in the prefrontal and temporal cortices and one of these also exhibited moderate to severe cerebral amyloid angiopathy. Similarly, 2 of the 12 samples from Dar es Salaam exhibited diffuse and compact A beta deposits that were also predominantly reactive for the longer A beta 42 species compared to A beta 40. We also noted that A beta plaques were variably immunoreactive for amyloid associated proteins, apolipoprotein E, serum amyloid P and complement C3. Tau protein reactive neurofibrillary tangles (NFT) were also evident in the hippocampus of 4 subjects. By comparison, 4 (20%) of the 20 samples from randomly selected autopsies performed in Cleveland showed A beta deposits within diffuse and compact parenchymal plaques and the vasculature. These observations suggest A beta deposition and some NFT in brains of non-demented East Africans are qualitatively and quantitatively similar to that in age-matched elderly controls from Cleveland. While our small scale study does not document similar prevalence rates of preclinical AD, it suggests that elderly East Africans are unlikely to escape AD as it is known in developed countries.

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Fluorescence histochemistry discloses that the carotid rete mirabile in the giraffe has a poor sympathetic innervation. In contrast, the efferent artery of the rete (internal carotid artery) and the cerebral arteries show moderate sympathetic innervation. A certain degree of regional variability was noted in which the rostral arteries (anterior and middle cerebral) receive more sympathetic nerves than the caudal (posterior communicating and basilar) arteries. The sympathetic nerves on the giraffe cerebral vessels may constitute part of a host of mechanisms by which regional blood flow to the brain is regulated. Conversely, the paucity of sympathetic innervation of the carotid rete mirabile may indicate that this structure does not play an active role in vasoconstrictor responses during postural changes of the head.

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc