Spinal accessory nerve in Sudanese subjects; A gross morphological study

The aim of this article was to study the spinal accessory nerve in Sudanese subjects. dissection of formalin-fixed cadavers' necks. In Sudanese the SAN exits as one trunk from the jugular foramen anterior to IJV then crosses lateral to it. Rarely SAN exits as two branches. Usually the nerve passes beneath SCMM and supply it by direct or side branch. Muscular branches of SAN have connections from the cervical plexus mainly C2, 3. There are some differences in the course, branches and connections of the spinal accessory nerve in Sudanese from what is described in standard textbooks of anatomy.

Case report and systematic review of blunt abdominal trauma as a cause of acute appendicitis

Acute appendicitis commonly presents as an acute abdomen. Cases of acute appendicitis caused by blunt abdominal trauma are rare. The aetiology and pathphysiology of appendicitis have been well investigated. However, the occasional cases of co-existent appendicitis and blunt abdominal trauma raise questions regarding a possible cause/effect relationship. We present a case and review of appendicitis following blunt abdominal trauma. The aim of this study is to collate and report the clinical presentations and experience of such case by internet search using PubMed and the keywords 'appendicitis', 'abdominal' and 'trauma' a literature review was carried out. The initial search returned 382 papers, of which 18 articles were included. We found 29 cases of acute appendicitis secondary to blunt abdominal trauma reported in the literature between 1991 and 2010. Mechanisms of injury included road traffic accidents, falls, assaults and accidents. Presenting symptoms invariably included abdominal pain, also nausea, vomiting and anorexia. Only 13 patients had computed tomography scans and 10 patients had ultrasonography. All reported treatment was surgical and positive for appendicitis. Although rare, the diagnosis of acute appendicitis must be considered following direct abdominal trama especially if the patient complains of abdominal right lower quadrant pain, nausea and anorexia. Haemodynamically stable patients who present shortly after blunt abdominal trauma with right lower quadrant pain and tenderness should undergo urgent imaging with a plan to proceed to appendicectomy if the imaging suggested an inflammatory process within the right iliac fossa

reliability of modified Alvarado score as a tool for diagnosis of acute appendicitis in Sudanese adults

Decision making in cases of acute appendicitis may be difficult especially for junior surgeons as diagnosis of that condition is sometimes difficult. In conditions like acute appendicitis, it is not possible to have definitive diagnosis by gold standard test [histopathology] before surgery, so various diagnostic modalities are introduced to establish accurate diagnosis. Modified Alvarado score [MAS] system is one of the examples. This work was carried out to evaluate the reliability and sensitivity of modified Alvarado scoring system in Sudanese adult patients with suspected diagnosis of acute appendicitis This prospective study included 866 [452 males and 414 females] who underwent appendicectomy in different centers in Khartoum, Sudan in the period from January 2006 to August 2007. It included all adult patients above 16 years with clinical diagnosis of acute appendicitis. Modified Alvarado score system was calculated for all patients; however decision to operate was clinical.The results showed that the overall sensitivity, specificity and accuracy were 87.78%, 24.78% and 79e.56% respectively. Our data suggested that the modified Alvarado scoring system had little applicability to the local adult population. Its sensitivity was high but the specificity was too low. So, we conclude that the modified Alvarado scoring system is not accurate in the diagnosis of suspected cases of acute appendicitis in Sudanese adult patients

study of the hospital stay in laparoscopic cholecystectomy versus open cholecystectomy

Each year, large numbers of Sudanese have gallbladder surgery. Surgery options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy. While elective cholecystectomy now carries extremely low morbidity and mortality rates, the operation does incur sizable expense in terms of hospitalization and time lost from work. The advantages of hospital stay in laparoscopic cholecystectomy versus open cholecystectomy were questioned because the recovery from open cholecystectomy is brief

Segregation analysis of susceptibility/resistance to periportal fibrosis in Schistosoma mansoni infections in endemic area [Umzoukra village - Gezira State - Sudan]

We carried out segregation analysis of susceptibility to periportal fibrosis caused by Shistosoma mansoni. A regressive logistic model of the disease was applied to 42 pedigrees ascertained during screening of one the infection endemic area of Sudan. The affected status was defined as a presence of the fibrosis irrespectively to severity of injury. Transmission probability model indicated a significant contribution of a major gene in the control of the pathology. The susceptibility to periportal fibrosis could be described within the framework of a recessive major gene diallele model, assuming incomplete age and squared-age dependent penetrance of genotypes. According to this model, the disease was manifested in almost all homozygous carriers of the mutant allele, while the risk of the disease for normal homozygotes and heterozygotes did not exceed 0.31. The frequency of disease allele in the population studied was estimated as 0.59. We also found non-majorgene phenotypic correlations between parents and offspring in the incidence of periportal fibrosis caused by Schistosoma mansoni

jugular foramen: a review of old and new imaging techniques and diagnoses

The imaging anatomy of the jugular foramen [JF] has been described. This is followed by an account of the various historical techniques used for diagnostic visualization. It is obvious that imaging interest has swung almost entirely to newer modalities as a result of dissatisfaction with plain films and conventional tomograms. In many parts of the world, places where no imaging facilities are available, a base view 50-70 degrees short of full extension, and a lateral oblique view are still of value in diagnosing a large foramen or fossa. Demonstration of the exact anatomic details of the bone is not possible without high resolution computed tomography [HRCT]. Conventional pleuridirectional tomography has retreated but remained complementary to computed tomography and a valuable tool in its absence. Computed tomography [CT] and magnetic resonance [MR] provide more information on intracranial or extracranial extensions of tumours as well as on the involvement of adjacent soft tissues. Four-vessel arteriography and jugular venography add important diagnostic characterization. The diagnostic criteria for each of the pathological conditions and the size of the lesion has been described with the justification for the use of a particular techniques. In nontumoral conditions, CT demonstrates smooth intact margin of the JF, except in cerebral venous thrombosis where phase contrast MR venography is the imaging modality of choice. In most tumoral lesions CT shows areas of infiltrative bone involvement, most schwannomas and meningiomas cause smooth enlargement rather than erosion. The multiplanner nature of MR imaging gives better definition and extent of soft tissues lesions, as well as more specific diagnostic criteria. Most of the tumors show low to intermediate signal intensity on T1- weighted images, and intermediate to high intensity on T2-weighted images, and enhance strongly. Each lesion requires a combination of available modalities to reach the specific diagnosis, sometimes the use of three dimentional CT is indicated, particularly in pre- and postsurgical intervention