PROF. OGENG'O JULIUS A.

bstract
Background: Anatomical variations of lumbar arteries predispose them to iatrogenic injury during endovascular intervention or surgery. Due to limited morphological data on lumbar arteries in our setting, we aimed to determine their variant anatomy among Kenyans.

Methods: We performed the study on 90 cadaveric specimens and 120 computed tomography (CT) scans. Cadavers were dissected to expose the aorta and the lumbar arteries emerging from them. The number, origins, location relative to the vertebral bodies, and relations to aortic bifurcation were determined in cadavers and CT scans. Data were analyzed using SPSS (version 21.0).

Results: On average, 3 (3/90 [3.3%]), 4 (63/90 [70%]) or 5 (24/90 [26.7%]) pairs of lumbar arteries were observed among the cadaveric specimens, whereas 4 (100/120 [83.3%]) or 5 (20/120 [16.7%]) pairs were observed in CTs. Differences in the number of pairs observed in the cadaveric versus CT study were not statistically significant (P = .542). There were no sex differences in the number of lumbar artery pairs observed in CT scans (P = .178). The first 3 lumbar artery pairs had a single-origin, whereas the fourth lumbar artery had a common-stem origin. The first, second, and third lumbar arteries mostly originated at the upper third of their respective vertebral bodies. The fourth lumbar artery predominantly originated at the lower third.

Conclusion: Our study's findings show unique variation in the lumbar arteries' relation to the vertebral bodies and the distances between artery pairs.

Level of evidence: IV (cross-sectional study).

Clinical relevance: Variations in the anatomy of the lumbar arteries should be taken into consideration, especially in surgical or interventional procedures to avoid inadvertent injury of the vessels.

Abstract
BACKGROUND: The anatomy of the radial artery draws great interests among anatomists for its frequent involvement in variations. Equally, these variations have gained significant attention from clinicians because of the preference to use the radial artery for catheterization. The commonest of radial artery variations involve its site of origin. In published literature, data on this variations exist, but the prevalence of such variations in a Kenyan population has hitherto been unknown.
METHODS: Sixty-two upper limbs from 50 formalin-fixed cadavers were studied during dissection in the Department of Human Anatomy, University of Nairobi.
RESULTS: Fifty-four (87.1%) radial arteries arose within the cubital fossa, while eight (12.9%) had a high origin. Out of the eight high arteries, two (3.2%) branched off from the axillary artery, another two (3.2%) were branches of the proximal third of the brachial artery and four (6.5%) arose from the middle third of the brachial artery. The high origin radial arteries were more common on the right upper limbs (5 out of the 8 cases). Both axillary and brachial origins were seen bilaterally.
CONCLUSION: The present study details important variations in the anatomy of the radial artery in a Kenyan population. With the radial artery being utilized during clinical, surgical and radiological interventions so frequently, an increased understanding and anticipation of such topographic variances is paramount.

Abstract
Hemorrhage is the main cause of Maternal Mortality (MM) (27%) followed by hypertensive disorders and sepsis (12%). Septic abortion is considered an intermediate risk factor for the development of Massive Obstetric Hemorrhage (MOH). The algorithm for the management of postpartum hemorrhage due to uterine atony that includes systematic pelvic devascularization has been described, but this management is really planned for resolution of the pregnancy after the 20th week of gestation, since an HMO due to abortion is un usual. We present the case of a 21-year-old patient who self-medicates a prostaglandin analog at 2 months of pregnancy, achieving only a threat of abortion, goes to the emergency room 3 months later with a diagnosis of septic shock, USG and MRI are performed with altered results, only of hepatomegaly, delayed abortion of 8 weeks of evolution and gestational trophoblastic disease. Emergency MVA was performed due to profuse bleeding, placement of a Bakri balloon and clamping of the uterine arteries without results, for which an emergency exploratory laparotomy (LAPE) was performed with ligation of the anterior trunk of the internal iliac artery, being a successful procedure, without the need for Obstetric Hysterectomy (HO). The patient is managed in intensive care and in the end the diagnosis of TSG is ruled out. Bilateral Hypogastric Artery Ligation (BHAL) in the case of Massive Obstetric Hemorrhage (MOH) secondary to delivery or cesarean section is commonly used, however it is not a technique to report when bleeding is secondary to abortion. In these cases, it is also a viable, successful, fertility-preserving surgical procedure, and an alternative to Obstetric Hysterectomy (OH) when other less invasive methods such as uterine artery clamping or Bakri balloon have failed.

Abstract
Keloids are fibroproliferative disorders characterized by high recurrence rates, with few factors known to influence the same. We conducted a study to determine whether keloid histology influences recurrence. This was a prospective longitudinal study to determine whether histopathological parameters of keloid influence recurrence. Patients with keloids managed by surgical excision were followed up at Kenyatta National Hospital between August 2018 and July 2020. The excised keloids were processed for histology using hematoxylin,/eosin, Masson, and trichrome stains. The slides were analyzed for inflammatory cells, fibroblasts, and capillary density using the hot spot technique and correlated to keloid recurrence. Postoperative follow-up was for a minimum of 1 year. A total of 90 patients with 104 keloids were recruited in the study. Overall keloid recurrence rate was 28.6%. There was a correlation between the absolute count of more than 50 per High power field of lymphocytes, fibroblasts, and macrophages with recurrence of the disease. The sensitivity and specificity for the above parameters were lymphocytes 48% and 81%, macrophages 57% and 83%, mast cells 32% and 33%, and fibroblasts 41% and 91%, respectively. There was no correlation between mast cells and vascularity status with recurrence. Routine histology should, therefore, be performed to determine these parameters. Close monitoring and second-line therapy should be considered for patients with elevated macrophages and/or lymphocytes so as to reduce the risk of recurrence.

Abstract

Background: Endometriosis is enigmatic clinical entity which is described as the location of the endometrial tissue external of the uterine cavity. Endometriosis constitutes a serious health issue due to its high affliction of 10% of reproductive women. With limited resources in Africa, it is essential to assess whether diagnosis of endometriosis by laparoscopic visualization can be used as a substitute for histology. Objective: To correlate the diagnosis of endometriosis by laparoscopic visualization and the histological confirmation of the biopsy taken. Methods: A prospective cross sectional study with a sample size of 443 was undertaken in the diagnosis of endometriosis among Africans in Nairobi, Kenya from March 2019 to March 2021. Women undergoing laparoscopy were screened for endometriosis by visualization and a biopsy was taken for histopathology. Diagnosis of endometriosis by visualization was correlated with histological confirmed endometriosis. Results: Women with a diagnosis of endometriosis through laparoscopic visualization were found to be 77 (17.4%) and 30 (6.8%) had positive histology for endometriosis. Laparoscopic visualization diagnosis had a low positive predictive value of 39%. Conclusion: Laparoscopic visualization diagnosis had a low positive predictive value of 39% and this did not correlate with histopathologic diagnosis. It is essential to perform biopsy with histopathology for the confirmation of endometriosis.

Abstract
Background: There are still concerns over the safety of laparoscopic surgery in coronavirus disease 2019 (COVID-19) patients due to the potential risk of viral transmission through surgical smoke/laparoscopic pneumoperitoneum.

Methods: We performed a systematic review of currently available literature to determine the presence of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) in abdominal tissues or fluids and in surgical smoke.

Results: A total of 19 studies (15 case reports and 4 case series) comprising 29 COVID-19 patients were included. The viral RNA was positively identified in 11 patients (37.9%). The samples that tested positive include the peritoneal fluid, bile, ascitic fluid, peritoneal dialysate, duodenal wall, and appendix. Similar samples, together with the omentum and abdominal subcutaneous fat, tested negative in the other patients. Only one study investigated SARS-COV-2 RNA in surgical smoke generated during laparoscopy, reporting negative findings.

Conclusions: There are conflicting results regarding the presence of SARS-COV-2 in abdominal tissues and fluids. No currently available evidence supports the hypothesis that SARS-COV-2 can be aerosolized and transmitted through surgical smoke. Larger studies are urgently needed to corroborate these findings.

Abstract
Background: Inflammation seems to play a major role in the pathophysiology of keloids. However, the role of cytokines in keloid pathophysiology has not been fully evaluated with only a few cytokines studied. We undertook this study to compare various cytokines in patients with keloids and a control group of patients without keloids nor family history of keloids so as to determine which cytokines are elevated and could thus be critical in keloid formation.

Methods: This was a cross-sectional study of patients with keloids and a control group of those without. Patients in both groups were matched for age, sex and body mass index. Their plasma was analyzed for both inflammatory and anti-inflammatory cytokines using the Bio-flex ElisaTM method. Comparisons of cytokines means in both groups were done using Student's t-test.

Results: A total of 84 participants with 42 participants in each group were followed during the study. Male to female ratio was 1:2. Age ranges were similar with a mean of 29.6 years. A total of 28 cytokines were assayed. Statistically significant differences were noted in 15 of the 28 cytokines assayed with 11 being elevated more in keloid patients with only four in the non-keloid forming group. Among elevated cytokines in keloid patients were granulocyte colony-stimulating factors, granulocyte-monocyte-colony-stimulating factors, interleukins 4, 6 and 13.

Conclusion: Patients with keloids have significantly higher cytokines compared with non-keloid forming patients. This finding suggests that keloid formation could be influenced by multiple inflammatory cytokines, an indication that the patient's immune system could play a role in keloid formation akin to auto-inflammatory disease.

Abstract
Background: Endometriosis is enigmatic clinical entity which is described as the existence of the endometrial tissue external of the uterine cavity. Endometriosis constitutes a serious health issue due to its high affliction of 10% in reproductive age women and its clinical manifestation of infertility and chronic pelvic pain. Despite of years of research, the causative factor and understanding of ambidextrous endometriosis pathology remains elusive, perplex and disconnected. Worldwide, there is clear documentation of prevalence of endometriosis in the development countries, however, the prevalence of endometriosis in most of black Africa is unknown. The current perspective is that indigenous African are rarely affected by endometriosis. Objective: To determine the prevalence, pattern and clinical presentation of endometriosis in indigenous African women with the primary outcome measure being the prevalence of laparoscopic visually diagnosed, histologically confirmed endometriosis and clinical presentation. Methodology: This was a prospective analytical cross-selection study in 2 hospitals in Nairobi city, Kenya. The sample size was 443 women and the duration of the study was from March 2018 to March 2021. The inclusion criteria was women aged at least 18 years up to 49 years undergoing laparoscopic surgery and willing to take part in the study. The patient’s history, clinical and laparoscopic findings and histological diagnosis were recorded and analysed using Social SPSS version 22.0. Results: The mean age of the 443 patients recruited was 33 years. The prevalence of histological confirmed endometriosis in indigenous Africans was 6.8%. Laparoscopic visualization diagnosis had a positive predictive value of 39%. Dysmenorrhoea, chronic pelvic pain scale 8-10 and dyspareunia were significant symptoms of endometriosis P<0.001. Nulliparous patients significantly had a risk of having endometriosis p<0.001. The patients with menarche at 13 years and below had a significant risk of having endometriosis p=0.001. Physical findings on clinical examination of adnexal tenderness and findings of nodules in the pouch of Douglas were significant in relation to endometriosis p<0.001. The most common site of the histological endometriosis implants were on the Pouch of Douglas (30%) and the most common form of endometriosis was superficial (43%). Conclusion: The prevalence of endometriosis in Indigenous Africa is 6.8%. Laparoscopic visualization diagnosis had low a positive predictive value of 39%. Nulliparity, menarche at the age of 13 and below, dysmenorrhoea, chronic pelvic pain scale 8-10 and dyspareunia were significantly associated with endometriosis. The most common site for endometriosis is the of Pouch of Douglas whilst the most common form of endometriosis was superficial.

Abstract

Africa is the world's most genetically diverse, second largest, and second most populous continent, with over one billion people distributed across 54 countries. With a 23% lifetime risk of stroke, Africa has some of the highest rates of stroke worldwide and many occur in the prime of life with huge economic losses and grave implications for the individual, family, and the society in terms of mental capital, productivity, and socioeconomic progress. Tackling the escalating burden of stroke in Africa requires prioritized, multipronged, and inter-sectoral strategies tailored to the unique African epidemiological, cultural, socioeconomic, and lifestyle landscape. The African Stroke Organization (ASO) is a new pan-African coalition that brings together stroke researchers, clinicians, and other health-care professionals with participation of national and regional stroke societies and stroke support organizations. With a vision to reduce the rapidly increasing burden of stroke in Africa, the ASO has a four-pronged focus on (1) research, (2) capacity building, (3) development of stroke services, and (4) collaboration with all stakeholders. This will be delivered through advocacy, awareness, and empowerment initiatives to bring about people-focused changes in policy, clinical practice, and public education. In the spirit of the African philosophy of Ubuntu "I am because we are," the ASO will harness the power of diversity, inclusiveness, togetherness, and team work to build a strong, enduring, and impactful platform for tackling stroke in Africa.

Abstract
Objective

To describe the relationship between number and distribution of valves.
Methods

Sixty-six popliteal vein specimens were used for the study after routine dissection at the Department of Human Anatomy, University of Nairobi. The extents of the popliteal vein were identified at the adductor hiatus and soleal arch, cut at these points and then longitudinally sliced open. The number and distribution of valves were then recorded. Data were presented using photomacrographs and tables.
Results

The median number of valves was 1 (mean 0.8; range 0–2), with the lower part of the popliteal vein as the most consistent valve position. Most striking was the valve absence noted in 27 (41%) of the veins.
Conclusion

These findings suggest that a significant proportion of popliteal veins do not have valves thus providing a credible structural link that may predispose the popliteal vein to deep venous thrombosis in the study population.

Introduction Knowledge of anatomical variations in the origin and in the course of the dorsal metatarsal arteries (DMTAs) is valuable for many procedures, including reconstructive surgeries and flap selection. However, there is a paucity of data on these arteries among black Africans. Materials and Methods The present study studied the origin and the location of DMTAs in 30 formalin-fixed cadaveric feet of adult black Kenyans at the Department of Human Anatomy of the University of Nairobi, Nairobi, Kenya. Results Dorsal metatarsal arteries were present in all of the cases. Of the right dorsalis pedis artery (DPA), in the majority of the cases, the 1st DMTA arose as the continuation of the DPA, while the 2nd to 4th DMTAs were given off as branches from the arcuate artery (AA). On the left feet, in the majority of the cases, the 1st DMTA arose as the continuation of the DPA, while the rest were given off as branches from the AA. In relation to the dorsal interossei muscles, all of the the arteries were either within the muscle fibers (53%) or beneath them (47%), on the right side. On the left side, the 1st DMTA was above the muscles in 40% of the cases; within the muscles in 53%; and beneath the muscles in 7%. The 2nd and 3rd DMTAs were above the muscles in 57% and in 53% of the cases, respectively. Conclusion These results reveal that the DMTAs show variation in their origin and position relative to the dorsal interossei muscles. These variations display bilateral asymmetry.

Knowledge of the anatomical pattern of dorsalis pedis artery is important during evaluation of peripheral
circulation, peripheral vascular disease, microvascular flap, ankle and foot surgery. Reports from other
populations on the pattern show wide disparity suggesting ethnic and geographical differences. Data
from black African populations is scanty. This study therefore examined the anatomical pattern of dorsalis
pedis artery among adult black Kenyans. The cadaveric dissection study on 30 formalin fixed specimens
evaluated the origin, position, course and branching pattern of the dorsalis pedis artery. The data were
analysed using SPSS for means, frequency and standard deviation. Student t – test was used to determine
side differences at 95% confidence interval where P – Value of <5% was taken as statistically significant.
The artery was consistently present, as a continuation of the anterior tibial artery. It ran 4.6 mm ± 2.1
mm from the medial malleolus, and about 2.5 ± 0.3mm from the medial border of the base of the first
metatarsal bone. The mean was 4.76 mm on the right, and 4.56 mm on the left. The difference was
statistically significant (P<0.05). Three branching patterns were observed. The conventional pattern was
observed in only 47% of cases. The extensor hallucis longus tendon most frequently crossed the artery
above the ankle joint. There were no cases of crossing below the ankle. These observations reveal that
the dorsalis pedis artery is consistently present, high, relatively medialised, and displays an atypical
branching pattern. Due care should be taken during surgery. Preoperative ultrasound evaluation is
recommended.

Background
The pattern of stroke in rural population differs from that in urban ones. Although there are many studies on this condition in sub-Saharan Africa, few studies about stroke pattern in a Kenyan rural area exist.. This study therefore aims at describing the characteristics of stroke in a rural Kenyan hospital.
Patients and Methods
The study was conducted on 227 consecutive patients admitted with a World Health Organization (WHO) diagnosis of stroke in Kangundo Hospital, a level IV facility in Machakos, Eastern Kenya, between April 2015 and September 2016. The sub-type and anatomical distribution of stroke as well as the age, gender of the patients were recorded prospectively. Diagnosis was made through physical neurological examination and confirmed by Computerized Tomography (CT) scan imaging. Only those with complete bio-data, past medical and social history, clinical and physical findings of the patients and imaging results were included. The data were entered into a pre-formatted questionnaire, analysed for means, standard deviations and frequencies, and are presented in tables and bar charts.
Results
Out of 3200 medical admissions, 227 (7.09%) had a confirmed diagnosis of stroke. Ischaemic stroke was more common (67.4%) than haemorrhagic stroke (32.6%). It affected mainly the anterior circulation, especially the middle cerebral artery (39%). The mean age of patients was 68.8 years, (Range 32 – 96). It was more common in females (62%) than in males (38%). Hypertension was the most common (74%) risk factor followed by alcohol abuse (63%), tobacco smoking (48%) and diabetes mellitus (42%).
Conclusion
Ischaemic stroke was the more common major cause of morbidity in the rural hospital studied in Kenya. It occurred most commonly among elderly females, with the most frequent comorbidities being hypertension. In addition, modifiable lifestyle factors like alcohol abuse and cigarette smoking contributed to the prevalence; hence we recommend the control of blood pressure and glucose as well as lifestyle modification to reduce the scourge in our studied population.

Background: Preterm birth (PTB) is a major cause of infant
morbidity and mortality in developing countries. Recent data suggest
that in addition to Human Immunodeficiency Virus (HIV) infection,
use of antiretroviral therapy (ART) increases the risk of PTB. As the
mechanisms remain unexplored, we conducted this study to
determine whether HIV and ART were associated with placental
changes that could contribute to PTB.
Setting: We collected and evaluated placentas from 38 HIVpositive
women on ART and 43 HIV-negative women who had
preterm deliveries in Nairobi, Kenya.
Methods: Anatomical features of the placentas were examined at
gross and microscopic levels. Cases were matched for gestational
age and compared by the investigators who were blinded to maternal
HIV serostatus.
Results: Among preterm placentas, HIV infection was significantly
associated with thrombosis (P = 0.001), infarction (P = 0.032),
anomalies in cord insertion (P = 0.02), gross evidence of membrane
infection (P = 0.043), and reduced placental thickness (P = 0.010).
Overall, preterm placentas in both groups were associated with
immature villi, syncytial knotting, villitis, and deciduitis. Features of
HIV-positive versus HIV-negative placentas included significant
fibrinoid deposition with villus degeneration, syncytiotrophoblast
delamination, red blood cell adhesion, hypervascularity, and reduction
in both surface area and perimeter of the terminal villi.
Conclusions: These results imply that HIV infection and/or ART
are associated with morphological changes in preterm placentas that
contribute to delivery before 37 weeks. Hypervascularity suggests
that the observed pathologies may be attributable, in part, to hypoxia.
Further research to explore potential mechanisms will help elucidate
the pathways that are involved perhaps pointing to interventions for
decreasing the risk of prematurity among HIV-positive women.
Key Words: preterm birth, term birth, placenta, HIV, ART

The late Prof. Hassan Saidi (rest in peace) was a father, husband, an administrator and a surgeon. To many in the medical fraternity, he was a teacher and a mentor. As a mentor, many know of the impact he had on resident surgeons in training, but his contribution to shaping the minds of young anatomists and trainee doctors is often underestimated (1). Prof. Saidi taught in the Department of Human Anatomy, University of Nairobi, for 28 years (7 of which he was the chairman). He had also served previously as the coordinator for the Bachelor of Medicine and Surgery (MBChB) and Intercalated Bachelor of Science, Human Anatomy programs (BSc Anat) (2).

With increased numbers of older people a higher burden of neurological disorders worldwide is predicted. Stroke and other cerebrovascular diseases do not necessarily present with different phenotypes in Africa but their incidence is rising in tandem with the demographic change in the population. Age remains the strongest irreversible risk factor for stroke and cognitive impairment. Modifiable factors relating to vascular disease risk, diet, lifestyle, physical activity and psychosocial status play a key role in shaping the current spate of stroke related diseases in Africa. Hypertension is the strongest modifiable risk factor for stroke but is also likely associated with co-inheritance of genetic traits among Africans. Somewhat different from high-income countries, strokes attributed to cerebral small vessel disease (SVD) are higher >30% among sub-Saharan Africans. Raised blood pressure may explain most of the incidence of SVD-related strokes but there are likely other contributing factors including dyslipidaemia and diabetes in some sectors of Africa. However, atherosclerotic and cardioembolic diseases combined also appear to be common subtypes as causes of strokes. Significant proportions of cerebrovascular diseases are ascribed to various forms of infectious disease including complications of human immunodeficiency virus. Cerebral SVD leads to several clinical manifestations including gait disturbance, autonomic dysfunction and depression. Pathological processes are characterized by arteriolosclerosis, lacunar infarcts, perivascular spaces, microinfarcts and diffuse white matter changes, which can now all be detected on neuroimaging. Except for isolated cases of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy or CADASIL, hereditary arteriopathies have so far not been reported in Africa. Prevalence estimates of vascular dementia (2–3%), delayed dementia after stroke (10–20%) and vascular cognitive impairment (30–40%) do not appear to be vastly different from those in other parts of the world. However, given the current demographic transition in both urban and rural settings these figures will likely rise. Wider application of neuroimaging modalities and implementation of stroke care in Africa will enable better estimates of SVD and other subtypes of stroke. Stroke survivors with SVD type pathology are likely to have low mortality and therefore portend increased incidence of dementia.

Variant anatomy of the testicular artery is important for safe surgery in the retroperioneal area, and
accurate diagnosis of testicular and renal disease. The pattern of origin, number, course and branching
display ethnic and geographical variations. Data from black African populations and especially Eastern
Africa is scarce. The objective of this study was, therefore, to describe the topography of the intraabdominal
part of testicular artery in a sample of the Kenyan population. This was a descriptive crosssectional
study on one hundred (100) testicular arteries at the Department of Human Anatomy, University
of Nairobi. The samples were obtained from autopsy cases and cadaveric specimens. Standard midline
abdominal incisions were made, flaps of the anterior abdominal wall reflected and the intestines,
mesentery and pariental peritoneum retracted systematically to expose the testicular arteries. Their site
and level of origin, number, course and branching were examined. Macrographs of representative
variations were taken using a high resolution digital camera. The results were analysed using SPSS
version 21, and are presented using macrographs and frequency tables. Thirty three (33%) of the arteries
displayed a variant anatomy, with regard to their site of origin (8%), number (4%), course (14%) and
branching pattern (7%). Among the 14 cases of aberrant course, five (5%) arched over the left renal
vein, eight (8%) were retrocaval and one (1%) had a retroureteric course. Seven (7%) bifurcated within
the abdomen. The level of origin along the aorta varied from 1 centimetre above the renal arteries to 5.5
centimetres below them while the vertebral level of origin ranged from T12 to L4. This shows that the
testicular artery among Kenyans displays a high prevalence of variant anatomy characterized by origin
from the accessory renal artery, high level of aortic origin, duplication, retrocaval course and
intraabdominal; division. Preopertaive evaluation of renal and gonadal vasculature is recommended to
minimize misdiagnosis and inadvertent injury retroperitoneal surgery.

SUMMARY: Geometric features of vertebrobasilar system influence occurrence of posterior circulation atherosclerosis,
aneurysms, stroke and neuroradiological procedures. These features show ethnic variation, but data from black Africans in Sub Saharan
Africa are scarce. This study aimed to describe geometric features of vertebrobasilar system in a black Kenyan population. It was a
descriptive cadaveric study at Department of Human Anatomy, University of Nairobi. One hundred and seventy three formalin-fixed
adult brains of individuals (99 male; 74 female; Age range 20 - 79) who had died of non cerebrovascular causes were studied. Level and
angle of confluence of vertebral artery; diameter, length and bifurcation angles of basilar artery were measured. Data were analysed by
SPSS version 21 for windows. The student t – test was used to determine the sex differences at 95 % confidence interval. Data are
presented in macrographs, tables and bar charts. Confluence of vertebral arteries occurred at the sulcus bulbopontinus in 79.8 %; rostral
to it in 11.5 % and caudal to it in 8.7 % of cases. Mean angle of vertebral artery confluence was 46.7º and 68.9º in males and females
respectively (p£0.042). Mean length of the basilar artery was 26.8 mm; 26.3 mm in males and 27.1 mm in females (p=0.465). Mean
diameter was 3.52 mm; 3.32 mm in males and 3.72 mm in females (p=0.002). The mean angle of basilar artery bifurcation was 120.3º ±
15.2; 99.3º ± 32.9 in males and 140.3º ± 16.1 in females (p=0.024). It was wider than 90º in 82.9 % of males and 95.9 % females
(p=0.032). In 85 (49.1 %) it was wider than 120º. The vertebrobasilar system in the Kenyan population has geometric features that
constitute risk factors for atherosclerosis. These features display sex dimorphism which may explain differences in prevalence of
atherosclerosis and aneurysms. Neurosurgeons and neurologists should be aware of these differences. Individuals with risk prone geometric
features should be followed up for atherosclerosis.

The tunica adventitia is an active vascular compartment that actively participates in modulation of
vascular structure, function and pathophysiology. Adventitial thickness has recently been accepted as a
surrogate marker of atherosclerosis. The effects of salt and chemicals that ameliorate those effects are
important in understanding vascular structure, function and pathology. There are few studies on
hibiscus and high salt induced vascular pathology. This study, therefore, investigated the effects of
hibiscus on salt induced vascular changes on rat carotid artery. The experimental animals were divided
into 3 groups of 8 animals each – (i) controls; (ii) high salt diet alone and (iii) high salt + hibiscus
extract for a period of eight weeks. At ages 2, 5 and 8weeks 2 – 3 animals were sacrificed for study.
They were anaesthetized with ether and perfused with formal saline. Specimens were then obtained
from the middle of common carotid artery, fixed in 5% formaldehyde solution, processed routinely for
paraffin embedding and 5-micron thick sections stained with Hematoxylin / Eosin and also with Mason’s
Trichome/ Aniline blue. Adventitial thickness and volumetric densities of collagen were measured using
morphometric techniques. High salt consumption induced statistically significant increase in adventitial
thickness from 297.45μm at week 2 to 659.4μm in week 8. In hibiscus fed rats, this increase
progressively reduced to 482.55μm in week 8. Volumetric density of collagen was 57% in high salt fed
rats but reduced to 45.66% in hibiscus fed rats (p<0.001). The increase in tunica adventitial thickness
and collagen density which is induced by high salt can be mitigated by hibiscus extract. This implies
that hibiscus has potential to restore salt induced vascular injury. Further studies are recommended to
refine the extract.

Background: Pregnancy increases susceptibility to and severity of infections caused by certain microbes and
parasites. The presence of these infectious agents at the maternofetal interface may lead to adverse pregnancy
outcomes including preterm birth either via direct action of the microbes or indirectly via alteration of the placental
microenvironment.
Objective: To summarize the literature regarding the role of various infectious agents in alteration of placental
microenvironment and predisposition to preterm birth.
Method: A review search using Google scholar, PubMed, Cochrane Library and Trip database was conducted at the
University of California San Francisco. A total of 880 abstracts were reviewed and a total of 95 studies were included.
Studies were included if they reported any information on infection during pregnancy, effect on placenta or fetal
membranes or risk of preterm birth.
Results: The current evidence indicates that various infectious agents affect pregnancy and alter placental
microenvironment at the maternofetal interface. Severity of these infections increases with gestation. Additionally,
these infections are associated with the risk of adverse obstetric outcomes including preterm birth.
Conclusion: Prevention, early detection and treatment of these infections including those that are asymptomatic is
important in maintaining integrity of the placenta and in reducing the burden of preterm births.

Introduction Urinary incontinence (UI) is the involuntary urine loss, with the
prevalence of 17% to 24% in women over 65 years-old. It has a multifactorial cause,
being a condition that affects many people in all ages mainly postmenopausal women,
it is also found in athlete women who have a high level of training associated mainly to
high impact activities.
Objective The aim of this study is to conduct a literature review that relates the
influence of physical activity on functional performance and on UI among women on
the stage of aging.
Method The bibliographical review was done in Medline, Scielo, Pubmed and Sports-
Disco databases using the keywords physical activity or exercise, postmenopause or
aging and urinary incontinence and stress urinary incontinence.
Conclusion Elderly women engaged in a regular exercise program have a lower
incidence of UI.

The spinal accessory nerve (SAN) exhibits variant anatomy in its relation to the internal jugular vein (IJV) as well as the sternocleidomastoid muscle (SCM). These variations are important in locating the nerve during surgical neck procedures to avoid its inadvertent injury. These variations, however, are not conserved among different populations and data from the Kenyan setting are partly elucidated. This study, therefore, aims to determine the variant anatomical relationship of the SAN to the SCM and IJV in a select Kenyan population. Forty cadaveric necks were studied bilaterally during routine dissection and the data collected were analyzed using SPSS version 21. Means and modes were calculated for the point of entry of the SAN into the posterior triangle of the neck as well as for its relation to the SCM. Side variations for both of these were analyzed using Student's t -test. Data relating the SAN to the IJV were represented in percentages and side variations were analyzed using the chi-square test. The SAN point of entry into the posterior triangle of the neck was 5.38 cm (3.501-8.008 cm) on the left side and 5.637 cm (3.504-9.173 cm) on the right side ( p  = 0.785) from the mastoid process. The nerve perforated the SCM in four cases (10%) on the left side and in eight cases (20%) on the right ( p  = 0.253). The SAN lay predominantly medial to the IJV on both sides of the neck, 87.5% on the left side of the neck versus 82.5% on the right ( p  = 0.831). In conclusion, the variant relation of the SAN to the IJV and SCM as observed in this setting is an important consideration during radical neck procedures and node biopsies.

Knowledge of sex differences in the histomorphology of the carotid body is important in understanding observed differences in respiratory function and disorders. There are few studies on sex differences in the carotid body. This study therefore aimed at describing these differences in the histomorphology features of the human carotid body.
Thirty six random carotid bodies from cardiovascular disease free individuals (20 male, 16 female) obtained during autopsy at the Department of Human Anatomy, University of Nairobi were studied. Specimens obtained within 48 hours of death were fixed in 10% formaldehyde solution and processed routinely for paraffin embedding. Seven micron thick serial sections were stained with H&E, Mason’s trichrome and examined with light microscope. Stereology was done to determine area occupied by parenchyma, stroma and vasculature. Data were analyzed using SPSS version 13.0. The student’s t test was used to compare sex differences. The data are represented using tables and macrographs.
The human carotid body is highly cellular with two varieties of cells namely; chief and sustentacular. It is heavily vascularised and densely innervated. Females showed higher concentration of chief cells, more profuse vascularization and denser innervation when compared with their aged matched male counterparts. The aging changes characterized by fibrosis, cellular degeneration vascular and neural attenuation are less severe in females.
Sex histomorphological differences in the human carotid body characterized by higher population of chief cells, density of vascularity, innervation and blunted age related morphological attenuation underpin differences in its function and disease.
Keywords: gender differences, carotid body, cells, vascularization

Objectives: Iron deficiency anaemia causes adverse pregnancy outcome. There are few studies on effects of anaemia on the
structure of trophoblastic cells which are important in placental function. These data are important for understanding the
function and disorders of the placenta. The aim of this study was to investigate the ultrastructural cellular changes associated
with iron deficiency anaemia in rat placenta.
Methods: Forty-nine female Sprague-Dawley rats were randomly separated into experimental and control groups. The
experimental group was rendered anaemic by removing 1.5 ml of blood per bleed on five alternate days, and the placentas
were collected on gestational days 17, 19 and 21. For light microscopy, five cubic millimeter segments were fixed in 10%
buffered formaldehyde solution; dehydrated in ethanol and embedded in paraffin wax. Five micron thick sections were cut,
deparaffinized and stained with Hematoxylin and Eosin. For transmission electron microscopy, 1 mm3 sections were fixed in
2.5% phosphate buffered glutaraldehyde, post fixed in 2% osmium tetroxide, dehydrated in ethanol, cleared in propylene
and embedded in epon resin. Ultrathin sections stained with uranyl acetate and lead citrate were examined with JEOL electron
microscope.
Results: Cytotrophoblast, syncytiotrophoblast and giant trophoblastic cells of placentas of anaemic rats showed cytoplasmic
and nuclear vacuolation with loss of cell margins. In addition, there was atrophy of microvilli on the cell surface, as well
nuclear chromatolysis, nucleolar degeneration and appearance of dark bodies.
Conclusion: Chronic anaemia causes trophoblastic cell degeneration. This may undermine the functional integrity of the
cells and constitute part of the mechanism for poor fetal outcome.

Iron deficiency anaemia causes adverse pregnancy outcome. Studies reveal its generalized effects on
histomorphometry of the placenta, without details on specific zones nor effect of gestational age. These data are
important for planning intervention. This study was, therefore, designed to describe the histomorphometric changes
associated with iron deficiency anaemia on placenta of albino rat. Fourty nine (49) Sprague – Dawely albino rats
were randomly separated into experimental and control groups. The experimental group was rendered anaemic by
removing 1.5 ml of blood per bleed on five alternate days. Placentas were collected on gestational days 17, 19 and
21. Five cubic milimetre segments were fixed in 10 % buffered formaldehyde solution; dehydrated in ethanol and
embedded in paraffin wax. Five micron thick sections were cut, deparaffinized and stained with Hematoxylin and
Eosin. Micrographs were taken using Leica ICC 50 digital photomicrographic camera attached to a computer at
magnification x40 and the thickness of the labyrinth and junctional zones measured. Student t- test was used to
compare values for the experimental and control groups. The labyrinth in the chronic anaemia group was thinner
than in the control group at gestational days 17, 19 and 21. The junctional zone, on the other hand, was consistently
thicker in anaemic than in the control animals. The difference in thickness of junctional zone varied with gestational
age. At gestational day 17, the zone was significantly thicker in the anaemic group (628.9 μ) than in the control
(381 μ). On day 19 and 21, however, the difference was not statistically significant. In conclusion, the effects of
chronic iron deficiency anaemia on the labyrinth differ from those on the junctional zone of the placenta. This
differential effect appears to depend on the function and gestational age. The decrease in thickness of the labyrinth
may be designed to maintain placental diffusion capacity while increased thickness of the junctional zone constitutes
a compensatory physical and nutritional adaptation to hypoxia.

Introduction: Data on the features of atherosclerosis of common carotid artery are important for informing strategies against ischaemic stroke in Subsaharan Africa, but are scarce. Materials and Methods: This study therefore investigated, by light microscopy, the presence of features of atherosclerosis in the left common carotid artery among 108 black Kenyans [76 males; 32 females; Mean age 36.4, range 22-82 years] who suffered violent death. Specimens from the distal segment of the artery were prepared for routine paraffin embedding, and 5μ sections stained with Mason’s Trichome. Results: At least one feature of atherosclerosis was observed in 22 (20.4%) cases. Intimal hyperplasia alone was present in all the 22 cases followed by Intimal hyperplasia and degeneration of internal elastic lamina 19 (17.6%); Intimal hyperplasia combined with disintegration of internal elastic lamina and medial degeneration 17 (15.7%). Thickening of tunica adventitia with neovascularization were present in 8 (7.4%) of cases. All the features were more frequent in males than females (1.4:1) and those over 40 years old. Eight of the cases (36.4%) were in individuals aged below 40 years. Conclusion: Multiple features of atherosclerosis in common carotid artery are present in over 20% of the asymptomatic black Kenyans studied. They occur more frequently in males, and affect individuals younger than 40 years. These features appear in all three layers of the vessel wall, suggesting that the disease has attained several stages of severity in this population. We recommend early screening for the disease in individuals at risk.

Gallstone disease (GSD) is a major global health problem that causes high morbidity and mortality constituting a significant
economic burden in developed countries (Shaffer, 2006; Stinton and Shaffer, 2012; Njeze, 2013). It was previously
considered rare in sub-Saharan Africa (Stinton and Shaffer, 2012; Njeze, 2013). Its prevalence, however, is steadily rising
and has already attained considerable proportions in a number of countries perhaps consequent to epidemiological and
demographic transitions (Eze et al., 2016). This condition is important for several reasons – First, it is one of the most
common causes of upper gastrointestinal morbidity and may mimic / be associated with gastritis, peptic ulcer disease, hiatal
hernia, esophagitis, gastroesophageal reflux disease, duodenitis; acute and chronic pancreatitis, hepatitis and portal vein
thrombosis among others (Sabitha et al., 2016). Secondly, it is a predisposing / risk factor for overall mortality and other
diseases including various gastrointestinal cancers, non-alcoholic fatty liver disease; cardiovascular diseases (CVD)
especially coronary heart, cerebrovascular, peripheral vascular diseases, arterial stiffness and heart failure (Yu et al., 2017).
The risk for CVD is independent of age, gender and other comorbidities (Olaiya et al., 2013). Thirdly, patients with GSD
appear to have a higher prevalence of cardiovascular risk factors such as obesity, type 2 diabetes mellitus; dyslipidemia,
hyperinsulinemia, sedentary life style and gut microbiota dysbiosis (Lv et al., 2015).

The pattern of coronary artery atherosclerosis is valuable in informing mitigation strategies for coronary
heart disease. Histomorphological data on this disease among Africans living in Sub Saharan Africa are,
however, scarce. The left anterior descending is one of the most commonly afflicted arteries. This
study, therefore, examined the left anterior descending artery of 213 black Kenyans [Mean age 36.8
years, range 5 – 82 years] who had died of non cardiovascular causes for features of atherosclerosis.
The individuals were divided into male and female, then into 10-yr age groups. Specimens were
obtained from the proximal segment of the artery during autopsy at the Department of Human
Anatomy University of Nairobi, Kenya. They were processed routinely for paraffin embedding and
sectioning. Five micron sections were stained with Haematoxylin/Eosin and Mason’s trichrome and
examined with light microscope. Micrographs of representative features were taken using a high
resolution digital camera. At least one feature of atherosclerosis was present in 54 (25.4%) of the
individuals. The features observed included severe intimal hyperplasia (34; 63%), disintegration of the
internal elastic lamina [30; 55.6%]; atherosclerotic plaque (20; 37%), adventitial thicknening (14;
26%) and mural neovascularization (10; 18.5%). The mean age of those with features of
atherosclerosis was 38.4 years, range 6 – 62 years with 25 (46.3%) being aged 40 years and below. Of
these, the male: female ratio was 1.7:1. In conclusion, features of atherosclerosis are present in over
25% of the population studied. The disease affects young people, including women. Proactive
preventive measures including follow – up should commence early, and involve both men and women

Morphometric properties of the gallbladder such as length, diameter and volume are determinants of gallbladder
function. These parameters are altered with age and may explain the age-related reduction in gallbladder
contractility associated with gallstone formation. Ninety-two gallbladder specimens of subjects aged between 21
and 84 were sourced from City mortuary and the Department of Human anatomy during autopsy. For each
gallbladder specimen, measurements of length and circumference were taken to the accuracy of 0.1millimetres
(mm) and used to calculate the gallbladder volume. These measurements were standardized using
measurements of liver length and weight. Data were recorded by age categories in age groups of 21-30, 31-40,
41-50, 51-60 and 61 or more years. The mean gallbladder volume was 47.948 (±19.080) cm3 and showed a
statistically significant increase with age (p <0.001). There was also a significant increase of gallbladder length
(p =0.01) and diameter (p <0.001). A positive correlation was observed between gallbladder length, diameter
and volume; 0.282, 0.485 and 0.480 respectively (p = 0.01). The gallbladder volume which is a function of
length and diameter, shows a statistically significant increase with age. Notably, there is a marked increase in
these parameters after the fifth decade. This could explain the exponential increase in prevalence of cholelithiasis
by 4 to 10 times after the fifth decade of life.

Atherogenesis is a multicellular event. Early reports concentrated on the role of endotheliocytes, monocyte -
macrophages and smooth muscle cells. Recognition of the immuno-inflammatory nature of the process,
however, expanded the scope of cellular involvement and more recent reviews emphasize the role of immune
and inflammatory cells. In addition, recent studies reveal that other cells are also involved. Elucidation of all
the types of cells involved is valuable to inform therapeutic interventions for this disease, but most accounts
concentrate on cells which are the target of the study and may fail to include other cells. This review therefore
aimed at consolidating information on the various cells involved in atherogenesis. Review of contemporary
literature was done for cells in the vessel wall and in blood to check for their potential role in atherogenesis.
It has been shown that atherogenesis involves all the cells present in the various coats of the vessel wall –
endotheliocytes, smooth muscle cells, fibroblasts, stem cells, pericytes, mast cells, dendritic cells,
macrophages and immigrant cells usually found in blood, namely monocytes, neutrophils, lymphocytes,
platelets and red blood cells. These cells promote atherogenesis by secreting several products which influence
inflammation, migration, proliferation and secretory activity of each other in a manner that synergises their
activities. Therapeutic interventions should target the various cell types.

Unilateral tubal twin pregnancy illustrates and amplifies fundamental phenomena in developmental and
reproductive anatomy. Knowledge of this condition is also important to practicing obstetricians and
gynaecologists because it may constitute a diagnostic challenge, management dilemma, complex ethical
issues and increased risk for maternal morbidity and mortality (Benn et al., 2016). Previously considered
a rare occurence, recent data suggest that the condition is not uncommon (Svirsky et al., 2010). Indeed,
there are many reports (Vohra et al., 2014), including several from Sub-Saharan Africa (Makinde and
Ogunniyi, 1990). The case reported by Pulei et al., in Anat J Afr 2017; 6 (1) reveals several unique
features in the profile of risk factors, location, chorionicity and amnionicity, mode and time of
presentation, condition of the tube, diagnosis and fetal viability. There was no evidence of the
conventional risk factors (Sivalingam et al., 2011). This is consistent with several other reported cases
where it occurred spontaneously (Abi Khalil et al., 2016). In the present case, however, the patient had
multiple intramural and subserosal leiomyomata. Intramural myomata are known to disrupt uterine
contractility which may interfere with transport of the ovum and hence predispose to ectopic pregnancy
(Ajibade et al., 2012). It is probable, therefore, that this was the predisposing factor. Accordingly, it may
be useful to monitor patients with uterine fibroids for potential to suffer ectopic pregnancy. Family
history of twinning may have been useful, and is advocated, in view of the fact that it is one of the major
predisposing factors.

Knowledge of the anatomy of median arteries is important in the diagnosis and management of carpal tunnel and pronator teres syndromes, reconstructive surgery in the forearm, minimizing inadvertent vascular injury as well as in limiting operative complications due to unexpected bleeding. The anatomical pattern displays ethnic differences but there are few studies on black Africans. This study therefore sought to describe the anatomy of median arteries in an adult black Kenyan population. A total of sixty two (62) upper limbs from thirty one (31) formalin-fixed cadavers were studied at the Department of Human Anatomy, University of Nairobi, Kenya. The prevalence, origin, types, relationship with median nerves and termination were determined. Median arteries were observed in 37 (59.7%) cases. Of these, the palmar type comprised 12 (32.4%) and antebrachial type 25 (67.6%) cases. It occurred bilaterally in 14 (45.2%) cases. The most common origin was the common interosseous artery (21; 56.8%) followed by anterior interosseous (13; 35.1%) and ulnar 3 (8.1%) arteries. The artery pierced the median nerve in 7 (18.9%) cases. The palmar type terminated by uniting with the ulnar artery to form a median-ulnar type of superficial palmar arterial arch in 8 (21.6%) cases and directly gave rise to the first, second and third common digital arteries in 4 (10.8%). In conclusion, the median artery occurs in nearly 60% of the population, much higher than in prevailing literature reports. Prevalence of the palmar type of median arteries and that of median arteries piercing median nerves are also higher than in other populations. Accordingly, presence of median artery and consequently other vascular and median nerve variations should be considered in the differential diagnosis of forearm entrapment neuropathies and due caution taken during forearm surgical procedures. We recommend preoperative ultrasound evaluation of the forearm and hand vascular system.

Tunica adventitia was previously considered an inert fibrous layer only involved in nutritional and physical
support of the arterial wall. Recent studies reveal that it is an important dynamic layer actively involved
in the regulation of vascular structure, function, response to injury and disease processes especially
atherosclerosis. Many anatomical studies on arteries, however, still make only peripheral reference to it,
without elucidating its detailed structure. Knowledge of the latter is important in understanding
pathobiology and interventional approaches to atherosclerosis. This review, therefore, aims at
consolidating contemporary literature on the structure and clinical significance of the arterial tunica
adventitia. Google literature search was done using the key words tunica adventitia combined with:
artery, aorta, cells, cell types, collagen, elastic fibres, vasa vasora, lymphatics, nerves, atherosclerosis.
There is overwhelming evidence that the tunica adventitia comprises multiple types of collagen and
elastic fibres arranged in various directions, a wide variety of cells including fibroblasts, smooth muscle,
pericytes, myofibroblasts, leukocytes, mononuclear phagocytic, defence, mesenchymal stem and mast
cells; vasa vasora including microvasculature, lymphatics and neural elements. The exact cellular, fibre
composition and orientation vary between various arteries and regions of the same vessel. Its
components are involved in the initiation, progression and complications of atherosclerosis. In conclusion,
the tunica adventitia is an active dynamic layer which, besides mechanical and nutritive functions; has
metabolic, regulatory and defence roles that are critical in arterial homeostasis and atherosclerosis.
Vascular studies should always include detailed analysis of the biology of the tunica adventitia.

Diameter of the coronary sinus ostium is important in the designing of cannulation devices used in cardiac
resynchronization therapy and percutaneous mitral valve annuloplasty. Population variation of the
diameter may account for the failure rate of these procedures. Studies of the coronary sinus ostium from
African populations are scarce and altogether absent for Kenya. Therefore, this study aimed at
determining sex differences in the diameter of coronary sinus ostium and its correlation with the weight
of the heart. Seventy-four hearts of adult black Kenyans [43 male, 31 females; age range 20 – 70 years]
obtained during autopsy at the Department of Human Anatomy, University of Nairobi, Kenya were
weighed. The coronary sinus ostium was identified and its transverse and supero-inferior diameters
measured in millimeters. The measurements were analyzed using SPSS version 17. Sex comparison was
established using student’s t test. Association between diameter and heart weight was established using
Pearson’s correlation test and considered significant at a p-value of ≤0.05. Data were presented using
scatter plots. Transverse and supero-inferior diameters of the ostium were 11.04±1.88mm and
9.50±1.80mm respectively. The mean diameter was 10.27 mm. These correlated positively with weight
of the heart. When corrected for weight of the hearts, the transverse and supero-inferior diameters were
larger in females (0.042 and 0.036 respectively) than in males (0.034 and 0.03 respectively). The
diameter of coronary sinus ostium is larger in females and shows positive correlation with weight of the
heart. These data should be considered during design and use of cardiac devices introduced through
the coronary sinus.

Origin of labyrinthine artery is important because it influences the presentation of occlusion of anterior inferior
cerebellar and basilar arteries. It shows ethnic and geographical variation, but there is no data from black African
populations. This study, therefore examined the pattern of origin of labyrinthine artery in adult black Kenyans.
Three hundred and fourty six arteries from one hundred and seventy-three formalin fixed brains were examined
by dissection at the Department of Human Anatomy University of Nairobi, Kenya. Labyrinthine artery arose from
basilar artery in 260 (75.1%); as common trunk with anterior inferior cerebellar artery in 48 (13.9%) and from
the latter in 38 (11.0%) of cases. There was no side and gender difference in the pattern of origin. This implies
that majority of labyrinthine arteries arise from basilar artery, different from that in oriental, Indo-Asian and
Caucasian populations, in which it arises from the anterior inferior cerebellar artery. Preoperative evaluation of
basilar artery branching is recommended.

Abstract: Femoral artery intima - media thickness is a reliable surrogate marker of atherosclerosis and is important for prediction of coronary and peripheral vascular disease, but is seldom reported among black Sub Saharan African populations. This study, therefore, aimed at describing the intima - media thickness of the femoral artery in relation with age, gender and some of its geometric factors. Materials for this study were obtained during autopsy from 208 adult black Kenyans (154 males, 54 females, mean age 36.4 years) who had died of non cardiovascular causes. Those with history of cardiovascular risk factors were excluded. Femoral artery was exposed by dissection. Terminal branching pattern was recorded, and length and bifurcation angle measured. Materials for determination of intima - media thickness were processed routinely for paraffin embedding and sectioning. Five micron sections were stained with Mason’s trichrome, examined with light microscope and pictures taken. The images were digitized and intimal and medial thickness determined according to the protocol by Nakashima et al. [1]. The mean intima - media thickness was 0.76 ± 0.016 mm. It increased with age and was higher in males than females; for trifurcations (0.95 ± 0.032 mm) and also short arteries and those with wide bifurcation angles. Age and gender differences and those between arterial trifurcation and bifurcation attained statistical significance. In conclusion, the mean femoral intima-media thickness of the black Kenyan population studied is higher than those reported for Caucasian populations, increases with age and is higher in males and cases of trifurcation. This suggests that the study population is susceptible to atherosclerosis and that variant terminal branching pattern constitutes a geometric risk factor for atherosclerosis. We recommend ultrasound screening for those at risk.

Histological and biochemical studies reveal that Launaea taraxacifoliadisplays chemoprotective effects against druginduced oxidative stress, neuronal death and alteration of brain microanatomy (Oweoye et al., 2015). In this issue of the Anatomy Journal Africa,Oweoye and Onwuka(2016)report further structural and chemical evidencethat extracts of this plant ameliorate lead induced neurotoxicity and postulate that theseneuroprotective effectsare due to its antioxidant activity. Anti oxidants protect against oxidative stress induced tissue damage. This suggests that extracts of this plant may affectmultiple organs. Readers of Anatomy Journal of Africa arethereforeencouraged to learn more about such plants and their potential effects.Launaea taraxacifolia,known as wild lettuce, is a leafy vegetable of the family of Asteraceae found in several African countries (Adebisi, 2004). The leaves are eaten fresh as salad or cooked as sauces. They are potential sources of nutrients because they are rich in flavonoids, cardiac glycosides, tarpenoids, tannins, steroids, saponins, cardemolides, β-catotenes; valuable minerals like copper, iron, zinc, sodium, magnesium, calcium, manganese, potassium and phosphorus; essential vitamins such as ascorbic acid, riboflavin, tecopherol; proteins; essential fatty acids and fibre (Adinortey et al., 2012; Gbadamosi et al., 2012; Olugbenga et al., 2015).The antiatherogenic effects of this plant are derived from its chemical composition which confer antioxidant, anti-inflammatory, hypolipidemic, hypotensive, hypoglycemic and free radical scavenging properties (Adewale et al., 2013; Adejuwon et al., 2014;Koukoui et al., 2015; Sanoussi et al., 2015). I advocate for more research on the compositin and therapeutic effects of this plant

Knowledge of anatomical features of the renal artery is important in prediction, management and control
of atherosclerotic renal artery stenosis. These features show population variations but data from black
African populations are scarce. The aim of this study was therefore to describe the anatomical features
of the renal artery in a black Kenyan population. Six hundred and ten (610) single renal arteries from
305 adult black Kenyans [206 males, 99 females; age range 22 – 79 years] were studied by dissection
at Department of Human Anatomy, University of Nairobi, Kenya. Specimens with macroscopic features
of stenosis and dilatation were excluded. The implantation angle, length and branching pattern were
studied. These features were correlated with intima-media thickness and luminal diameter. The latter
were determined by micrometry on Eosin/hematoxylin stained 5 micron sections obtained from the
proximal segment of the renal artery. Data was analysed by SPSS version 16.0. Student’s t-test, was
used to test for statistical significance at 95% confidence interval where P value of < 0.05 was taken as
significant. The results are presented in a bar graph, tables and macrographs. The mean implantation
angle was 940±150 (range 580-1250). In 26.7% cases, the angle was more than 1000. Mean length was
34±1.4 mm with 21.6 % of arteries measuring ≤ 20 mm. Variant branching pattern was present in 40.5
% of cases. It comprised trifurcation (33 %), quadrifurcation (6.6 %) and pentafurcation (0.8 %). Higher
implantation angle, short arteries and variant branching were associated with statistically significant
higher intima - media thickness and luminal diameter. These results suggest that higher implantation
angle, shorter length and variant branching pattern constitute geometric risk factors for renal artery
atherosclerosis. Ultrasound screening for individuals with suboptimal geometric features for renal artery
atherosclerosis is recommended.

Branching pattern of the left anterior descending coronary artery is important in explaining variations in
occurrence of coronary atherosclerosis, informing management strategies for coronary heart disease and
interventional cardiology. Data on African populations are, however, scarce. Since coronary heart disease
is increasing in Africa, the aim of this study was to describe branching pattern of the left anterior
descending coronary artery in an indigenous Kenyan population. Two hundred and eight hearts obtained
during autopsy were dissected at the Department of Human Anatomy, University of Nairobi, Kenya. The
entire left anterior descending coronary artery was exposed. Number of branches, pattern of termination
and level of bifurcation were determined. Images of representative patterns were taken using a high
resolution digital camera. Data are presented in macrographs and tables. The number of septal and
diagonal branches varied between 1 and 3. Termination occurred in the posterior interventricular sulcus
in 68.8% and at the apex in 23% cases. Most common mode of terminal branching was bifurcation
(76.9%) followed by trifurcation (11.3%), quadrifurcation (3.4%) and pentafurcation (1.5%). Bifurcation
occurred in the distal segment in 48.8% and in the proximal segment in 15% of cases. The left anterior
descending coronary artery displays high variability in number of septal and diagonal branches, level of
termination, mode of terminal branching and level of terminal bifurcation. These patterns may constitute
risk factors for atherosclerosis and should also be acknowledged during cardiac procedures. Pre –
operative ultrasound evaluation is recommended to minimize inadvertent iatrogenic injury.

The Basilar Artery (BA), usually terminates by dividing into two posterior cerebral arteries [1,2]. Variant terminations described include double posterior cerebral arteries and common trunks for Posterior Cerebral Arteries (PCA) and Superior Cerebellar Arteries (SCA) trifurcation, quadrifurcation and pentafurcation [3-5]. Such variant branching patterns of arteries predisposes them to atherosclerosis and aneurysms [6,7], and may complicate surgery at basilar bifurcation angle and clivus [8]. The abnormalities may also alter the relationships with and compress occulomotor nerve [9]. There are, however, few reports on variant termination of the basilar artery. We recently reported up to 5 branches. In all cases of trifurcation, qudrifurcation and pentafurcation, the variation was due to duplication and rostral shift of superior cerebellar artery [4]. Potentially, more than five branches is possible but hitherto unreported in spite its importance. This study, therefore investigated the pattern of termination of the basilar artery in a black Kenyan population, for cases where there were more than five terminal branches.

The morphology and morphometry of the distal articular surface of the lunate exhibits inter-population variations.
They are of clinical importance to hand surgeons due to their influence on the occurrence of proximal pole arthrosis which is a cause
of ulnar-side wrist pain. The objective of the study was to determine the morphology and morphometry of the distal articular surface
of the lunate bone in an adult Kenyan population. A descriptive cross-sectional study at the Department of Human Anatomy, University
of Nairobi. Fifty-six human hands obtained for routine dissection were used. The morphology of the distal articular surface of the
lunate was classified as either Type I or Type II depending on the absence or presence of a medial facet for articulation with the hamate
respectively. The width of the wrists and of the medial facet in Type II lunates was measured with SOMETTM CN-25 1234 vernier
calipers (accurate to 1mm). Photomacrographs of representative lunate were taken. Data were analyzed using SPSS version 17.0. The
Pearson correlation test was used to check for any correlations. Type II lunate morphology was more common with a prevalence of 34
(61 %) while 19 (34 %) were Type I. The mean width of wrists with Type I lunate was 41.1±2.8 mm while those with Type II had a
mean width of 46.1±4.3 mm. The mean width of the medial facet in lunate type II was 4.4±1.4 mm. Lunotriquetral fusion was
demonstrated in 3 (5 %) wrists. Prevalence of Type II lunate was higher than Type I. Wrists with a Type II lunate were wider than those
with Type I. There was no correlation between the width of the wrist and the width of the medial facet of the lunate.

The connective tissue between the rectus capitis posterior major and the cervical dura, popularly known
as the myodural bridge has been postulated to contribute to dural tension monitoring. It prevents dural
enfolding thus preventing stimulation of dural nociceptors which would result in cervicogenic headaches.
Its length may be an indicator of its effectiveness; however, determination of its length radiographically
is difficult. The osteodural bridge, the connective tissue between the axis and dura can be measured
radiographically. The aim of the study was therefore to determine if there is a relationship between their
lengths. Thirty formalin fixed cadavers were meticulously dissected at the department of Human
Anatomy, University of Nairobi, to expose the suboccipital triangle. The lengths of the bridges were
measured using a pair of digital vernier caliper. The data was recorded, coded and analyzed using
Statistical Package for Social Sciences (SPSS) version 21.0. The means and standard deviations were
determined. Histograms and probability plots were generated to determine the normality of the data. A
Pearson’s correlation coefficient was generated to determine a correlation between the length of the
myodural bridge and osteodural bridge. Of the 30 cadavers dissected, all had the myodural bridge and
Osteodural bridge present. The mean length of the myodural bridge was 4.02+/- 0.395 mm. Mean length
of the osteodural bridge was 2.71 +/- 0.311 mm. There was a linear relationship of the equation y=1.02x
+ 1.26 (R2 =0.640). The length of the osteodural bridge may be used as a predictor of the myodural
bridge’s length.

Introduction: Kangaroo Mother Care (KMC) is a useful and cheap method of caring for low birth weight and premature newborn infants in economically underprivileged countries where access to incubators is limited. Data on knowledge of and barriers to this method amongst health care professionals are important in informing planning for newborn care health services but are largely lacking for African population.
Objective: This study aimed at assessing the knowledge of and barriers to Kangaroo Mother Care amongst health care providers in Kenya.
Method: A structured pretested questionnaire was administered to 155 health workers in Kenya to test the knowledge and barriers to KMC. Data were analyzed using SPSS version 15.0 for windows and results presented using tables, bar and pie charts.
Results: All the 155 health care professionals had heard of Kangaroo Mother Care. Almost half did not have sufficient information on benefits and requirements for KMC. Most respondents (91.2%) thought that personnel with special skills on the practice were needed to oversee it. The most common barriers to practice of Kangaroo Mother Care were inadequate skills (59%), uncooperative mothers (22%), reluctant health care provider (11%) and fear for the safety of the baby (8%).
Conclusion: Most of health professionals in Kenya are aware of Kangaroo Mother Care. Its practice is, however, hampered by their lack of know-how of its benefits, requirements and inadequate skills. Training programs to enlighten health care professionals are recommended

Background: Trauma remains a significant cause of morbidity and mortality globally. Trauma registries are a key component of trauma systems in developed countries which have promoted improvement of patient care and outcomes. The experience with trauma registries in low income countries is limited. The current study shares preliminary data from the Kenyatta National Hospital Trauma Registry whilst documenting the process of design to implementation. Methods: A de novo registry dataset was designed based on previous studies and programmed as a custom application for deployment to the site. Scope of data collected was demographic, details of injury, pre-hospital events, hospital care and outcomes. Data were summarized as percentages and means for analysis. Results: The development of the registry from concept to operational software took 12 months. Preliminary data revealed an average completion rate of 88.6%. Majority of patients were young males who were referred to the hospital. Accidental injury at home or on the roads was the most common cause of admission with majority of patients not receiving any pre-hospital care. Sixteen percent of patients died while admitted. Conclusion: The data obtained from this de novo registry largely aligns to previous institutional reports while revealing data points for increased focus during training for registry abstraction. This experience may form the platform for trauma quality improvement initiatives at the institution as well as scaling to other institutions to allow for collation of regional trauma data.

physico-mechanical properties and the basis for extent of atrial fibrillation and ablation. These features
are only scarcely reported. This study therefore aimed at describing regional differences in the mural
structure of coronary sinus among black Kenyans. This was a descriptive cross-sectional study on
coronary sinuses from fifteen hearts obtained during autopsy on adult black Kenyans at the Department
of Human Anatomy, University of Nairobi. Five-millimeter-long specimens were taken from the proximal,
middle and terminal segments of the coronary sinus and processed routinely for paraffin embedding and
sectioning. Seven-micron thick sections were stained with Masson’s Trichrome to demonstrate connective
tissue and smooth muscle while Weigert’s Resorcin Fuschin stain was used to demonstrate elastic fibres.
The slides were examined with a light microscope and photomicrographs taken with a high resolution
digital camera. The results are presented in micrographs. The wall comprised three layers namely
internal, middle and external. Regional differences were observed in the middle layer. In the proximal
segment, there were concentrically oriented smooth muscles scattered within connective tissue. The
middle and terminal segments on the other hand comprised cardiac muscle oriented both concentrically
and longitudinally. The muscle was separated by connective tissue rich in elastic fibres and abundant
vasa vasora. The external layer comprised connective tissue.
In conclusion the middle layer of the wall of the coronary sinus displays regional differences. The smooth
muscle at the proximal segment may confer contractility to enhance blood flow while the cardiac muscle
in the other segments enables it to function in synchrony with the right atrium during atrial systole. The
complex arrangement of circular and longitudinal muscle facilitates blood flow and may also constitute a
sphincter mechanism.

The sheep is a valuable model for cardiovascular studies and its aorta is frequently afflicted by
atherosclerosis and aneurysms. The structure of sheep aorta is, however, only seldom reported. This
study, therefore, aimed at describing the microscopic organization of the tunica media of the aorta in
sheep. Specimens obtained from the aortae of six healthy young adult sheep were fixed in 10%
formaldehyde solution and routinely processed for paraffin embedding and sectioning. Five micron
sections were stained with Weigert’s Resorcin Fuchsin/Van Gieson and examined with a light microscope.
Micrographs were taken with a high resolution digital camera. The tunica media in the ascending, arch
and thoracic regions comprised two zones namely a luminal elastic zone with continuous uniform elastic
lamellae and adventitial musculo-elastic one where there were muscle islands frequently interrupting the
elastic lamellae. The proportion of musculo-elastic zone with the muscle islands declined caudally. In the
abdominal region, however, the tunica media comprised regular continuous concentric elastic lamellae.
These results show that the aorta in sheep displays regional variations characterized by transmedial
zonation of the thoracic segments into an elastic luminal and musculo-elastic adventitial zones. These
differences may underpin the regional differences in physicomechanical properties and vulnerability of
the aorta to diseases such as atherosclerosis and aneurysm.

Background:
Jugular foramen lesions are among the major complications
of skull base surgery. Morphological variations in the structure are pertinent
during interpretation of skull base radiographs and in surgical procedures
within the foramen. This study therefore aimed at describing the
morphology of the jugular foramen in a Kenyan population.
Methods:
One
hundred and five adult skulls from the Nairobi National Museums were
used. Jugular foramen septation, dome and dimen sions were studie d
extracranially. Statisti cal analysis was performed using SPSS (Version
21.1 IBM).
Results:
Septation was present in 202 (96.2%) jugular
foramina, type I partial septation being the most common (78.7%). A
dome was observed in 81 (38.6%) jugular foramina. Respectively, the
mean right and left anteroposterior dimensions were 11.17
±
2.05mm
vs.8.88
±
2.30mm (p <0.001), mediolateral dimensions 17.47
±
2.18mm vs.
15.30
±
2.53mm (p <0.001), jugular dome depth 12.38
±
2.64 mm vs.
11.25
±
2.15 mm (p=0.054), posterior wall thickness7.95
±
2.20mm vs.
9.68
±
1.98mm (p <0.001) and medial wall thickness 3.73
±
1.10 mm vs.
3.73
±
0.98mm (p = 0.992).
Conclusion:
Partial septation, asymmetry in
dimensions and a wide range in the dome depth of the jugular foramen
were frequent. Preoperative imaging of jugular foramen morphology is
therefore recommended to avoid inadvertent injury to its contents and
surrounding structures owing to variability.

Variations of pulmonary veins (PV) were previously considered rare, only documented as isolated case reports.
Recent cadaveric, autopsy, CT, MDCT and MRI studies have revealed substantial variations with respect to their
number and drainage pattern into the left atrium (Marom et al., 2004; Calkins et al., 2007; Wannasopha et al.,
2012; Harbi et al., 2014; Rajguru and Fulzele, 2016). The most commonly described variations include
supernumerary or less pulmonary veins and the corresponding arterial ostia. The article in this issue
(Kinfemichael and Dawit, 2016) presents a case of 5th pulmonary vein originating from the middle lobe of the
right lung. This is consistent with previous reports of supernumerary pulmonary veins and ostia (Marom et al.,
2004; Calkins et al., 2007; Prasanna et al., 2014). These vary from 2 – 7 (Wei et al., 2014; Yuan et al., 2015;
Rajguru and Fulzele, 2016; Kumzel – Piotrowska et al., 2016). The commonest cause of such variations is the
right middle pulmonary vein (Calkins et al., 2007; Klimek – Piotrowska et al., 2016). These variations have
informed various classifications based on number of pulmonary veins and ostia (Marom et al., 2004). One of the
most straight forward classifications was proposed by Shukla et al (2012). The principle of this classification in
the table below may be extended to include, say type VI or VII depending on the number of veins.

Background: Intima-Media thickness is an acknowledged surrogate marker for predicting and profiling of
atherosclerotic cardiovascular disease. It displays geographical and ethnic variation but is seldom reported among
black populations of Africa. The left anterior descending coronary artery is one of the most frequently afflicted
arteries by atherosclerosis. This study, therefore, aimed at correlating its intima – media thickness with
morphological features of left coronary artery in a black Kenyan population.
Materials and methods: Materials for this study were 126 hearts obtained during autopsy at the Department of
Human Anatomy, University of Nairobi Kenya from black adult Kenyans [72 males, 54 females] who died of noncardiovascular
causes. The left coronary artery was identified, its termination pattern recorded and its length and
bifurcation angle measured. Specimens for light microscopy were taken from the proximal segment of the left
anterior descending artery and processed for paraffin embedding and sectioning. Five micron sections were stained
with Masson’s trichrome and examined at magnification x35. The results were analyzed using SPSS version 17.0.
Student t-test was performed at 95% confidence interval where p ≤ 0.05 was taken to be statistically significant.
They are presented in micrographs and tables.
Results: The mean intima – media thickness was 0.332 mm. It was higher in males (0.357 ± 0.06 mm) than in
females (0.25 ± 0.03 mm), increased with number of branches of left coronary artery, from 0.336 ± 0.014 mm in
bifurcation to 0.506 ± 0.01 mm in pentafurcation; and was also higher in left coronary arteries that were shorter than
5 mm and those with bifurcation angles >800.
Conclusion: The intima – media thickness of left anterior descending artery is influenced by length, bifurcation
angle and terminal branching pattern of left coronary artery, and is higher in males than in females. This suggests
that these morphological features of left coronary artery constitute anatomical risk factors for atherosclerosis.
Individuals with these features should be screened for atherosclerosis, to inform early intervention.

Background: The pattern of stroke displays ethnic and geographical variations. In Sub-Saharan Africa there is
scarcity of data from Eastern and Central Africa.
Objective: To describe the characteristics of patients with ischemic cortical stroke in a Kenyan referral hospital.
Study design and set up: Retrospective study at Kenyatta National Hospital, Nairobi Kenya.
Patients and methods: Records of adult black Kenyan patients seen with ischemic cortical stroke at Kenyatta
National Hospital, Nairobi, Kenya between January 2007 and December 2011 were examined for age, sex, site,
comorbidities and outcome. Only files with complete data were included. Data were analyzed by SPSS version 17.0
for Windows and presented in tables and bar charts.
Results: Three hundred and seven cases of ischemic cortical stroke were analyzed. Mean age was 54.7 years,
with 20.6% of cases occurring below 40 years. The male: female ratio was 1:1.2 with female predominance in all
age groups. Brain regions most commonly affected were fronto-parietal (32.8%) and parietal (31.6%), while 11.6%
involved extensive regions of the cerebral cortex. Predominant single comorbidities were hypertension (64.1%),
smoking (19.2%), alcohol (13.4%), HIV infection (6.8%) and bacterial infections (6.8%). Multiple risk factors were
implicated in 42.4% cases. Two hundred (65.1%) suffered paralysis; 70 (22.8%) clinically recovered and 37 (12.1%)
died within 90 days.
Conclusion: Ischemic cortical stroke occurs in young individuals in over 20% of the study population and is
female predominant. Hypertension, cigarette smoking and infections including HIV are the leading comorbidities,
and it causes high morbidity. Control measures comprising regulation of blood pressure, reduction of smoking and
prudent management of infections should be instituted from early in life.

Knowledge of potential antiatherogenic effects of plant extracts is important to inform strategies of
improving alternative preventive and therapeutic approaches for atherosclerosis and related diseases
(Salvamani et al., 2014). As atherosclerosis emerges to be of major public health concern in Sub Saharan
Africa, there is need to mitigate the imminent epidemic of this disease through, for example, promotion
of safe use of plant products which are readily available. Ocimum gratissimum is a herbaceous plant
which belongs to the Labiatae family. It is indigeneous in tropical Africa where it is used to treat various
conditions including bacterial, fungal and parasitic infections; degenerative and cardiovascular diseases
(Mlitan et al., 2014; Yvette et al., 2014).
In the current issue of Anatomy Journal of Africa, Iyiola et al (2015) have detailed the chemical
components and uses of Ocimum gratissimum. They have demonstrated that chronic use of its extracts
causes neurodegeneration. This is consistent with toxicity associated with excessive or prolonged drug
use. These observations call for judicious use of the extracts, without negating the positive applications
of this plant, some of which manifest in morphological alterations, and hence interest among anatomists.
Indeed, antiatherogenic effects of plant products have been confirmed through histological observations
(El – Shatanovi et al., 2012).

This study aimed at describing the structure of tunica media of the uterine artery of domestic
pig, since this structure influences the pattern of blood flow and reproductive performance.
Specimens were obtained from main trunk, broad ligament segment and the terminal portion
of twelve healthy adult domestic pigs (Sus scrofa domesticus) age range 6 – 18 months. They
were fixed in 10% formaldehyde solution, and routinely processed for paraffin embedding and
sectioning. Seven micron thick sections were stained with Hematoxylin & Eosin, Mason’s
Trichrome and Weigert resorcin fuchsin counterstained with Van Gieson stains. Tunica media
comprising predominantly smooth muscle occupied approximately fifty percent (50%) of the
volume of the entire wall with vasa vasora present deep into its inner zone. It showed zonal
and regional variation in that in the main trunk and broad ligament segments was divided into
inner two thirds having predominantly circular smooth muscle orientation while outer third
was preponderantly fibroelastic with longitudinally disposed smooth muscles. The terminal
segment had only circular layer. Density of vasa vasora declined distally. The predominantly
muscular tunica media of the uterine artery in pigs shows zonal and regional suggesting
segmental differentiation of function. The main trunk of this artery, due to its additional
longitudinal layer of smooth muscle may be involved in regulation of blood flow to the uterus
depending on the functional demands of the uterus.

The tunica adventitia has previously been regarded as a passive connective tissue covering that offers
only nutritive and physical support to the arterial wall. Recently, however, emphasis has been given to
its role in atherosclerosis. Although the normal structure may bear the anatomical basis of these
functions, microscopic anatomy of the tunica adventitia in normal arteries is seldom reported. These
data are important in understanding disease process and potential areas of intervention. The goat is a
suitable model for studying cardiovascular disease and the aorta is frequently afflicted by
atherosclerosis. This study, therefore, aimed at describing the structure of tunica adventitia of normal
aorta in goat. Materials for the study were obtained from abdominal aorta of 6 healthy young adult
male goats (capra hircus) age range 12 – 24 months. Fresh specimens from euthanized animals were
fixed in 3% phosphate buffered glutaraldehyde, post fixed in 1% phosphate buffered osmium tetroxide
then embedded in durcupan. Ultrathin sections were stained with uranyl acetate counterstained with
lead citrate and examined with electron microscope. Some specimens were processed routinely for
paraffin embedding and sectioning. They were stained with Mason’s Trichrome and Weigert
elastic/Van Gieson stains. The tunica adventitia was fibroelastic with numerous capillaries, arterioles
and multiple cell types. The cells were active fibroblasts, phagocytic, perivascular and endothelial cells
embedded in the fibrous stroma. These findings suggest that the tunica adventitia of the goat aorta is
a metabolically active vascular compartment. These features namely microvasculature and multiple cell
populations probably enable it to maintain structural and functional integrity and appropriately respond
to vascular injury.

Branching pattern of common femoral artery is important during artery catheterization, orthopaedic,
plastic and general surgery in the proximal thigh. Frequency of variant branching shows ethnic
variation but there are no data for black African populations. Since atherosclerotic diseases are
increasing and femoral artery catheterization is rising, variation in branching of common femoral artery
was studied by dissection in a black Kenyan population. 208 femoral arteries in 104 limbs were studied.
Bifurcation occurred in only 72.1% of cases. Trifurcation into superficial femoral, profunda femoris and
lateral circumflex femoral arteries occurred in 27.9% of cases. Trifurcation of common femoral artery
is a common variation in the black Kenyan population. Pre – operative ultrasonic evaluation of the
femoral arterial system is recommended to minimize inadvertent arterial injury during catheterization or
surgery.

Knowledge of variant origin of the superior cerebellar
artery is important during neuroradiological
and neurosurgical procedures at the basilar termination
and clivus regions, and may influence the
occurrence of atherosclerosis and aneurysms.
These variations show ethnic differences, but there
are hardly any reports on the black African population.
This study therefore examined the various
origins of 394 superior cerebellar arteries from 173
brains of black adult Kenyans, obtained during autopsy
at the Department of Human Anatomy, University
of Nairobi, Kenya. The cranial cavity was
opened and the brain removed en bloc. Arachnoid
matter was gently removed to expose the arteries
at the base of the brain. The distal third of the basilar
artery was exposed and superior cerebellar
artery identified as that which supplied the superior
surface of the cerebellar hemispheres. It was
traced to its origin and the source recorded. Representative
patterns were photographed with a
high resolution digital camera. The data were analyzed
for frequency and are presented in macrographs
and a table. The conventional single artery
origin from the basilar artery was present in only
284 (72.1%) cases. In the remainder, it was duplicated
in 84 (21.3%), originated from posterior cerebral
artery in 16 (4.0%) and from common trunk
with posterior cerebral artery in 10 (2.5%) cases.
Variant origin of the superior cerebellar artery occurred
in nearly 28% of cases studied. This influences
the pattern of termination of the basilar artery,
may complicate posterior cranial fossa surgery
and predispose to atherosclerosis and aneurysms.
Preoperative evaluation of the superior cerebellar
artery is recommended.

Carotid intimal medial thickness, a marker for early atherosclerosis, has high clinical utility. It
shows gender, regional, age and ethnic differences but data from black African populations
are scarce. This study describes the carotid intimal medial thickness in a black Kenyan
population. One hundred and fifty histological samples from 25 males and 25 female left
common carotid arteries were routinely processed for light microscopy and stained using
Mason’s Trichrome stain. The intimal medial thickness was measured on the
photomicrographs using the Scion Multiscan software. The mean age of the cases was
28+19yrs. Mean carotid intimal medial thickness is higher in males (0.97+0.22) than
females (0.77+0.06), p=0.05 and increases distally. Carotid intimal medial thickness
increased with age being 0.5+0.16mm, 0.87+0.24mm and 1.21+0.36 mm for the age
groups 0-20yrs, 21-40yrs and 41-60yrs respectively (p=0.035). Carotid intimal medial
thickness in black Africans is similar to that reported for Caucasian populations. It is higher
in males, increases distally and with age.

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

Knowledge of the characteristics of vascular smooth muscle cells is important in understanding
physicomechanical properties, functions, mechanisms of development, remodelling,
regeneration of blood vessels, development and progression of their diseases like
atherosclerosis. As the latter diseases become more common, there is need to understand their
pathogenesis to inform mitigation strategies. Goat is a suitable model for vascular studies but
the organization of vascular smooth muscle cells in its aorta have not been elucidated. This
study therefore examined the characteristics of smooth muscle cells in the aorta of goat.
Materials were obtained from aortae of six healthy young adult male domestic goats (Capra
hircus) [age range 12 – 36 months]. Specimens from thoracic aorta were fixed in
glutaraldehyde, post fixed in osmium tetroxide and processed for ducurpan embedding.
Ultrathin sections stained with uranyl acetate, counterstained with lead citrate were examined
by transmission electron microscope. The aortic tunica media contained several phenotypic
dispositions of smooth muscle cells; spindle shaped or elongated organelle - poor cells;
irregularly shaped cells rich in rough endoplasmic reticulum, mitochondria and a prominent
nucleus. The smooth muscle cells also ran in various directions: transverse, oblique and
longitudinal. These findings reveal that the smooth muscle cells of the tunica media of goat
aorta are phenotypically heterogeneous and run in multiple directions. These characteristics
probably confer mechanical strength and functional plasticity to the aortic wall. Designers of
aortic substitutes should bear this in mind.

Knowledge of cellular composition of aortic tunica media is important to improve understanding
of aortic pathology. The aorta of 6 healthy male goats was studied by electron microscopy to
elucidate cell types within the tunica media. Glutaraldehyde fixed specimens were processed for
durcupan embedding and sectioning, stained with uranyl acetate, counterstained with lead
citrate and ultrathin sections examined at high magnification. Two non muscle cells were
observed, one resembling fibroblasts and the other with features of macrophages. It is
concluded that these cells are normal constituents of the aortic media, involved in synthesis of
extracellular matrix and immunosurveillance respectively. Their involvement in repair and
disease process needs further investigation.
Keywords: tunica media, aorta, fibroblast, macrophage.

Background: Pattern of origin of anterior inferior artery is important in interpretation of posterior circulatory stroke
and during posterior cranial fossa surgery for aneurysms, arteriovenous malformations, tumors, posterior cerebral
revascularization, and in diagnostic as well as interventional neuroradiology. The pattern displays ethnic variation
but data from African populations are scanty. This study therefore aimed to describe the pattern of origin of anterior
cerebellar artery in a black Kenyan population.
Materials and Methods: One hundred and seventy three [99 male: 74 female] basilar arteries from adult formalin
fixed brains were studied at Department of Human Anatomy, University of Nairobi, Kenya. Site and pattern of origin
of anterior inferior cerebellar arteries were recorded. Data were analyzed by SPSS version 17.0 for Windows, and
presented in a table and macrographs.
Results: Anterior inferior cerebellar artery arose directly from basilar artery in 138 (79.8%), as common trunk with
labyrinthine artery in 24 (13.9%), from verterbral and labyrinthine arteries in 3% cases each.
Conclusion: In about 14% cases, anterior inferior cerebellar and labyrinthine arteries arise as common trunks
from basilar artery. These proportions differ with those in prevailing literature from Caucasian and oriental
populations. Extra care should therefore be exercised during surgery and neuroradiology in the posterior cranial
fossa, and in interpretation of signs of posterior circulation stroke. Pre-operative ultrasound evaluation of the
vascular bed is recommended.

Topography of aortic bifurcation is important for gynaecologists, surgeons and radiologists operating in
the retroperitoneal area, in order for them to minimize vascular injury. It also influences the occurrence
of aortic-iliac atherosclerosis. It shows ethnic variations, but data from African populations are scarce.
This study therefore investigated the topography of aortic bifurcation in a black Kenyan population by
dissection of 106 cadavers. After removal of abdominal viscera, peritoneum, fibrofatty connective tissue,
inferior vena cava was removed to expose the termination of abdominal aorta. Vertebral level, angle and
asymmetry of bifurcation were recorded. Data were analysed by SPSS version 17.0 for windows and are
presented in tables and bar charts. All aortae terminated by bifurcating into 2 common iliac arteries. The
most common level of bifurcation was L4 (73.6%). It bifurcated below L4 in 22.7% of the cases. Mean
angle of bifurcation was 55.20 (range 23 – 780); 55.60 in males and 54.30 in females. Mean bifurcation
asymmetry was 4.4 (range 0 – 23). Topography of aortic bifurcation in the black Kenyan population
varies from conventional descriptions on over 20% of the individuals studied. Surgeons and radiologists
must be aware of this to avoid inadvertent vascular injury. Higher bifurcation angles and asymmetry
than those reported for Caucasian and Indo Asian populations suggest higher vulnerability to abdominal
aortic atherosclerosis. Preoperative evaluation of terminal aorta, and follow up for atherosclerosis are
recommended.

Knowledge of variant termination of common carotid artery is important to prevent inadvertent
vascular injury during surgical, interventional and diagnostic radiological neck procedures. The
variations show population differences but there are scanty data from the black African populations.
Further, though trifurcations have been reported, quadrifurcations and pentafurcations are hitherto
undocumented. This study therefore examined the pattern of termination of 208 left common carotid
arteries in the black Kenyan population by cadaveric dissection at the Department of Human Anatomy,
University of Nairobi. The conventional bifurcation into internal and external carotid arteries occurred in
only 128 (61.5%) of cases. Trifurcation occurred in 66 (31.7%), quadrifurcation in 11(5.4%) and
pentafurcation in 3 (1.4%). In all cases of trifurcation, superior thyroid artery was the third branch.
The common carotid artery quadrifurcated into external, internal carotid, superior thyroid and
ascending pharyngeal arteries. The pentafurcations comprised internal carotid, external carotid,
superior thyroid, occipital and posterior auricular arteries. These findings imply that the black Kenyan
population has over 38% frequency of variant termination of common carotid arteries comprising
trifurcation, quadrifurcation and pentafurcation which may complicate radical neck dissection, vascular
surgery, carotid catheterization and selective embolization. Surgeons and radiologists should approach
the common carotid bifurcation with extra caution.

Variant termination of the left coronary artery is
important in interpreting effects of its occlusion,
a n d in guiding cardiac surgery and intervention
procedures. It also constitutes a geometric risk
factor for atherosclerosis. These features show
ethnic variations, but data from African populations
are scarce. This study therefore aimed at
describing the variant patterns of termination of
the left coronary artery in an indigenous Kenyan
population. Left coronary arteries of 208 formalinfixed
hearts were studied by dissection at the
Department of Human Anatomy, University of
Nairobi. The number of terminal branches was
recorded. Images of representative patterns were
taken using a high resolution camera. Frequencies
were calculated. Results are presented using
tables and macrographs. Single left coronary arteries
from the left aortic sinus were present in all the
208 hearts studied. The most frequent termination
pattern was bifurcation (54.8%), followed
by trifurcation (32.2%), quadrifurcation (9.6%)
and pentafurcation (3.4%). Over 45% of left coronary
arteries have variant patterns of termination.
Pentafurcation is not uncommon. This calls
for extra caution during interventional coronary
artery angiography, instrumentation and surgery.
Preoperative angiographic evaluation is recommended.

Vertebral artery hypoplasia (VAH) refers to those arteries
with diameter of less than 2.0mm [1–3].This condition predisposes
to posterior circulation stroke [4–7] and vertebral
artery (VA) atherosclerosis [2, 8, 9] and can be confusedwith
pathological occlusion from, say, atherosclerosis or dissection
[10]. It is also associated deformities of other arterial components
of posterior circulation including basilar and posterior
communicating arteries [11, 12].Characteristics of this condition
are also important in selection andmoulding of catheters
during interventional neuroradiological procedures as well
as mitigating complications of endovascular treatment and
prognostication of cerebrovascular disease [11].
These characteristics of VAH show ethnic variation [13,
14]. As intracranial cerebral atherosclerosis becomes more
common in Sub-Saharan African countries [15], there is
need for data on African populations to informmanagement
of disorders in posterior circulation. There are, however,
currently few data from black African populations. This
study, therefore, investigated the pattern of vertebral artery
hypoplasia in an adult black population.

Carotid birfucation anatomy influences predisposistion to atherosclerosis, which is a common cause of ischaemic stroke. Due to increased prevalence of stroke in Sub-Saharan Africa, this study undertook to establish whether or not the population has geometric risk factors for atherosclerosis. Common carotid arteries were exposed by dissection in 208 cadavers and autopsy specimens of adult black Kenyans. The arteries were cleared of fibrofatty tissue and internal jugular vein and nerves retracted away. Mandible was also removed, branches exposed and followed to their destinations. Pattern of termination of common carotid artery was recorded and representative photographs taken with a high resolution digital camera. Angles of bifurcation were measured. Internal diameters of common, internal and external carotid arteries were measured and outlet: inlet area ratios calculated. Intimomedial thickness was determined and correlated with pattern of termination, bifurcation area ratio and angle. Frequencies, means and standard deviations were determined using SPPS17.0 for windows.
The commonest mode of termination was bifurcation (58.9%) followed by trifurcation (26.8%), quadrififcation (5.4%) and pentafurcation (1.7%). Mean bifurcation outlet: inlet ratio was 1.05, with 35.7% being above 12 and 30.4% being below 1.0. The mean angle of bifurcation was 24.1° (Range 9° to 39°). Most of the cases were between 20° and 30°. Among the cases studied, 30.4% were below 20° while 19.6% were above 30°. Intimomedial thickness increased with number of branches, bifurcation angle and area ratio.
Over 25% of the carotid bifurcations in the study population have anatomical risk factors for atherosclerosis, namely additional branches, wide bifurcation angle and non-optimal area ratio. Control measures against atherosclerosis should start early.

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.

Age changes in the aortic tunica intima may explain the higher prevalence of atherosclerosis among the elderly. Goat is a suitable model for the study of cardiovascular disease but the age changes in its aortic tunica intima are unreported. This study therefore examined structural changes that occur in the tunica intima of its aorta. Six healthy goats three aged over 60 months, and three aged less than 12 months, were used in this study. The animals were euthanized with sodium pentabarbitone and specimens taken from the various segment of the aorta studied by light microscopy and transmission electron microscopy. Materials for light microscopy were fixed 10% formaldehyde solution, processed for paraffin embedding and 7 micron sections stained with Mason’s Trichrome and Weigert’s Resorcin Fuchsin/Van Gieson stains. Those for transmission electron microscopy were fixed in 3% phosphate buffered glutaraldehyde solution, post fixed in osmium tetroxide and prepared for durcupan embedding. Ultrathin sections were stained with uranyl acetate, counterstained with lead citrate and examined by EM 201 phillips© electron microscope. Observations reveal that aging is characterized by endothelial discontinuities, presence of lymphocytes and dendritic cells in the tunica intima, subendothelial thickening, vacuolation and disintegration of internal elastic lamina. It is concluded that the intimal breaches observed in intimal aging may promote ingression of macromolecules into the vessel wall, and underpin the higher prevalence of atherosclerosis among the elderly. Control of serum atherogenic molecules should be enhanced in this age group.

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