The suprascapular notch: its morphology and distance from the glenoid cavity in a Kenyan population.

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.

Spinal cord termination in adult Africans: relationship with intercristal line and the transumbilical plane.

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.

Locating the arcuate line of Douglas: is it of surgical relevance?

Ventral hernia formation is a common complication of rectus abdominis musculocutaneous flap harvest. The site and extent of harvest of the flap are known contributing factors. Therefore, an accurate location of the arcuate line of Douglas, which marks the lower extent of the posterior wall of the rectus sheath, may be relevant before harvesting the flap. This study is aimed at determining the position of the arcuate line in relation to anatomical landmarks of the anterior abdominal wall. Arcuate lines were examined in 80 (44 male, 36 female) subjects, aged between 18 and 70 years, during autopsies and dissection. The position of the arcuate line was determined in relation to the umbilicus, pubic symphysis, and intersections of rectus abdominis muscle. Sixty four (80.4%) cases had the arcuate line. In most cases (52), this line was located in the upper half of a line between the umbilicus and the pubic symphysis. Most males (93%) had the arcuate line, while more than a third of females did not have it. In all these cases, the line occurred bilaterally as a single arcade, constantly at the most distal intersection of the rectus abdominis muscle. Consequently, the arcuate line is most reliably marked superficially by the distal tendinous intersection of the rectus abdominis muscle. Harvesting of the muscle cranial to this point will minimize defects in the anterior abdominal wall that may lead to hernia formation.

Anatomical variations of the carotid arteries in adult Kenyans.

OBJECTIVE: To describe the topography and anatomical variations of the carotid arteries among Kenyans. DESIGN: A descriptive cross-sectional study. SETTING: Department of Human Anatomy, University of Nairobi. SUBJECTS: Eighty carotid arteries of forty cadavers were dissected. RESULTS: The bifurcation of the commonest carotid artery was high (above the reference points) in 63.8% of vessels and the external carotid was antero-lateral to the internal carotid artery in 30% of the vessels. A linguo-facial trunk was the most common variation of the external carotid artery. The origin of the right common carotid artery was high and low in 10% and 2.6% of vessels respectively. CONCLUSION: The carotid arteries show important variability and thus emphasise caution for clinicians during surgical procedures in the neck.

Gender-associated violence at a women's hospital in Nairobi, Kenya.

OBJECTIVE: To describe the pattern of gender-associated violence amongst adult survivors. DESIGN: Descriptive case analysis of prospectively collected data. SETTING: The gender violence and recovery centre (GVRC), a shelter and violence treatment facility for the gender-associated violence at the Nairobi Women's hospital (NWH). SUBJECTS: Data on 663 consecutive adult patients who presented to GVRC between February 2003 and April 2004 were evaluated. RESULTS: The patients age ranged from 18 to 74 years (mean 27.7 years). Four hundred and eight patients (61.5%) presented following sexual assault. Most of assaults were perpetrated at night. A stranger was the assault perpetrator in 75.1% and 2% of sexual and non-sexual assault respectively. An intimate partner was the perpetrator in majority (86.5%) of nonsexual violence. Most physical injuries were minor bruises and swellings. The rate of positive spermatozoa from high vaginal swabs was only 15.9% in cases of sexual assault. Sexual assault was significantly associated with single status of the victim and assault by more than one assailant. CONCLUSIONS: Violence against women is a common public health problem in the city of Nairobi. Women are vulnerable both in and out of the home. More efforts, including massive public education, are needed to protect this vulnerable population.

Lower limb amputations at the Kenyatta National Hospital, Nairobi.

OBJECTIVE: To determine the causes and pattern of lower limb amputations at the Kenyatta National Hospital. DESIGN: Descriptive prospective study. SETTING: The Kenyatta National Hospital between July 2003 and June 2004. RESULTS: A total of 77 lower limb amputations (LLA) were performed on 74 patients. The age ranged from seven months to 96 years (mean 44.8 +/- 22.5). Forty six patients (62.1%) were male. Majority of the patients (89.1%) had primary or no formal education, forty one (55.4%) were unemployed, with 39% self employed in the informal sector. Peripheral vascular diseases were the main indication for LLA (55.3%), 13 patients (17.5%) due to diabetes-related gangrene. Eighteen patients (24.3%) had tumours, mainly osteogenic sarcoma (16.2%), while trauma accounted for 18.9%. Forty two (55%) of the amputations were above-the-knee, 24 (31%) below-the-knee, four (5%) hip disarticulations and seven (9%) were foot amputations. CONCLUSION: This study found peripheral vascular diseases unrelated to diabetes to be the main indication for lower limb amputations at Kenyatta National Hospital contrary to previous institutional and loco-regional studies which report trauma as the leading cause. Further investigation into vascular causes is therefore recommended.