Injury to the recurrent laryngeal nerve (RLN) is an important but avoidable complication of thyroidectomy. This complication may be avoided by the identification of the nerve facilitated by important landmarks found along its course. The setting for this work is the Human Anatomy Laboratory of the University of Nairobi. The aim of this work is to determine the topographic relationship of the RLN with the inferior thyroid artery (ITA), the tubercle of Zuckerkandl (TZ), and the ligament of Berry (LB) in a Kenyan population. The relationship between the nerve and the above landmarks was determined during dissection of 146 right and left thyroid lobes. One right side of the neck had a nonrecurrent nerve. Of the specimens where relationship was determined, the nerve was anterior to the ITA in 37% of cases and posterior in 51.4%. In relation to the LB, 45.3% were superficial (dorsolateral). The TZ was clearly delineated in 86 of the 146 specimens. No nerve traversed the tubercle. The RLN exhibited variations similar to those in other populations. The TZ when present was a reliable landmark to the nerve.

Objective: to evaluate the colorectal cancer clinical data with respect to the anatomical location and stage of disease. Design: retrospective observational study. Setting: Kenyatta national Hospital (KnH), nairobi, Kenya. Subjects: Two hundred and fifty three tumours were categorised as right colonic (RCC), left colonic (lCC) and rectal (rC) lesions. the distribution of symptoms (rectal bleeding, tenesmus, change in bowel habits, abdominal pain, intestinal obstruction, rectal mass), anaemia, transfusion requirement, and the dukes' stages were compared for right colon, left colon and rectal tumours. Results: there were 54 rCC, 59 lCC, 140 rC lesions. Patient delay from onset of symptom(s) to presentation was a mean of 26.6 ± 43, 20 ± 25 and 33.7 ± 42 weeks for right, left and rectal lesions respectively (p = 0.092). the proportion of patients presenting with rectal bleeding was 21%, 44% and 79% for rCC, lCC and rC lesions, respectively. the prevalence of intestinal obstruction was 14.8%, 27.1% and 43.6% in right, left and rectal lesions, respectively. the haemoglobin levels were significantly lower for right sided lesions (p = 0.05 for right colon/rectum pair; p = 0.059 for right colon/ left colon pair). the sites of the lesions had no relationship to the stage of disease at presentation. Conclusion: in patients with colorectal cancer, the duration of symptoms was prolonged irrespective of the anatomical sub-sites. symptoms were evenly distributed across the anatomical regions except for bleeding and obstruction which predominated in rectal and left colon cancers respectively. this underlines the need for early investigations in patients with rectal bleeding, change of bowel habit, intestinal obstruction and anaemia.

BackgroundAfrica has 4% of the global vehicles but accounts for about one tenth of global vehicular deaths. Major trauma in Kenya is associated with excess mortality in comparison with series from trauma centers. The determinants of this mortality have not been completely explored.ObjectivesTo determine the factors affecting mortality among road users in Nairobi, Kenya.MethodsCross-sectional study of prospectively collected data of trauma admissions at the Kenyatta National Hospital over a calendar year (2009–2010). Information collected included age, gender, road user type, principal anatomical region of injury, admission status, admission blood pressure and GCS, disposition destination, Injury Severity Score (ISS), injuries sustained, treatment and mortality at two weeks. Major or severe injury was defined as injuries of ISS > 15. Groups based on in-hospital survival were compared using determinants of mortality using X2 or students t-test as appropriate. Logistic regression was used to assess the independence of predictive variables.ResultsOne thousand six hundred forty seven (1647) patients were admitted for trauma during the study period. Traffic admissions were 1013 (61.7%) and males predominated (79.8%). The average age of patients admitted was 31.7 years. Pedestrians, vehicle occupants and motorcyclists represented 43.3%, 27.2% and 15.2% of the road users injured. The proportion of patients with ISS > 15 was 10.9%.The overall mortality was 7.7%. Mortality for ISS > 15 was 27.6%. The following factors significantly predicted mortality on univariate analysis: head injury, abdominal injury, transfer in status, blood transfusion, ICU admission, age > 60 years, Glasgow coma scale (GCS) and injury severity. GCS (p = 0.001) and ISS > 15 (p < 0.05) remained significant predictors on regression analysis.ConclusionTrauma mortality rates in this study exceed those from mature trauma systems. Head injury and injury severity based on the ISS are independent predictors of mortality after traffic trauma. Improvements in neurosurgical and critical care services ingrained within wider primary and secondary prevention initiatives are logical targets.

The use of unclaimed bodies for anatomical dissection has been the main method of instruction at our institution. There is however a shortage of cadavers for dissection given the increase in the number of medical schools as well as in the number of students enrolling in these schools. This shortage could be mitigated by having voluntary human body donation programs. This study aimed at assessing the attitudes of medical students and surgical residents towards body donation for anatomy learning. We conducted an online survey involving 72 first-year medical students and 41 surgical residents at University of Nairobi who had completed one year of anatomy dissection. For the medical students, this was their first dissection experience while it was the second exposure for the surgery trainees. Most of the surgical trainees (70.7%) and medical students (68.1%) were opposed to self-body donation. This was mainly due to cultural (37%) and religious (20%) barriers. Surprisingly, of those not willing to donate themselves, 67.9% (82.8% surgical trainees, 59.2% medical students) would recommend the practice to other people. Exposure to repeated dissection does not change the perceptions towards body donation. It is noteworthy that culture and religion rank high as clear barriers amongst this “highly informed” group of potential donors.

SUMMARY:The celiac trunk is the major source of blood supply to the supracolic abdominal compartment. Usually, it branches into the splenic, common hepatic and left gastric arteries to supply this region. It has however been shown to display ethnic variations in its branching pattern. Knowledge of these variations may be important in surgical and radiological procedures around the head of the pancreas. The aim was to illustrate the commonest variations in the branching pattern of the celiac trunk in a Kenyan population. The study was conducted in the Department of Human Anatomy, University of Nairobi. Were collected one hundred twenty three (123) bodies obtained from dissection cadavers and autopsy cases following ethical approval and consent from next of kin. Gross dissection of the anterior abdominal wall using an extended midline incision and retraction of the liver and stomach was performed. The celiac trunk was trifurcated in 76 (61.7%), bifurcated in 22 (17.9%) and gave collaterals in 25 (20.3%). Dorsal pancreatic artery was the most common collateral and occurred in 14.8%. Other branches included gastroduodenal and inferior phrenic arteries present in 3.3% and 4.9% respectively. The Kenyan population has a higher incidence of bifurcation and collateral branching of the celiac trunk hence need for caution during surgical procedures of the supracolic abdominal compartment.