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Gross Anatomical Variations and Congenital Anomalies of Surgical Importance in Hepatobiliary Surgery in Uganda.
No full textBackground: It is important for surgeons to appreciate the possible
anatomical variations that can be encountered during surgery. This
study was aimed at determining the gross anatomical variations and
congenital anomalies of the external hepatobilliary system in Ugandan
cadavers and to describe the nature and contents of the gallbladder
among cadavers of Ugandans. Methods: This was a cross-sectional study
done at the Department of Anatomy Dissection Laboratory at Makerere
University Medical School in Kampala, Uganda. The study involved all
cadavers dissected in a period of 8 years, from October, 1997 to June
2005, 21 each year, totaling 168 cadavers. Results: A wide range of
Anatomical variations of surgical importance were noted among the
Ugandan cadavers. In 5% of the cases, the common hepatic artery
originated from the superior Mesenteric artery. The course of the
cystic artery in 61.9% of the cases was anterior to the right hepatic
duct, in 31% it passed anterior to the right hepatic duct, in 8% it
lied posterior to the common bile duct, and in 25% of cases, there were
more than 2 cystic arteries. In 56% the common hepatic artery branched
some 2 - 4cm away from the porta hepatis, 4% branched within the
substance of the liver, 19% at the level of porta hepatis while in 5%
it branched at the level of right gastric artery. The cystic duct
branched off from the common Hepatic duct in 95% of specimens while in
5% originated from the right hepatic duct. Joining of the common
hepatic duct contributed to low branching accounting for 67% while 19%
had high branching level from the duodenum. The length of the common
bile duct ranged from 2.5cm to 12cm, the mode being 4cm and the average
5.1cm. In 4% of the cadavers there were multiple stones with the
gallbladder being adherent to neighbouring viscera. Conclusion: The
results show that within the Ugandan population, there are marked
variations of surgical importance in the gross anatomic features of the
hepatobiliary system, which need to be considered to in order to avoid
errors during gallbladder or extra hepatic biliary surgery
MANAGEMENT OF CANCER OF THE STOMACH IN MULAGO HOSPITAL KAMPALA, UGANDA
No full textObjective: To determine the cIinical presentation, mode of investigation and management ofgastric cancer at New Mulago Hospital.Design: Prospective descriptive study.Settings: Three general surgical wards, Department of Surgery, New Mdago Hospital.Subjects: Thirty five patients were studied within 12 months.Result: Gastric cancer was found to be prevalent in tribe inhabiting volcanic areas of southwestern Uganda especially the Banyankole (25% 'c) The commonest mode of clinicalpresentation was epigastric pain, weight loss, constipation, epigastric tenderness, palpable+gastric mass and anaemia. The most accurate mode of investigation was by endoscopyfollowed by barium meal. The cun~nbonest Imality was thepyloricatrium (40%) histologicallyadenocarcinun~a (95.5 Tc) predominated. Gastric cancer was found to be more common inpatients with blood group O+ve. All patient* had been subjected to some kind of medicaltreatment especially with at~tiacids, Hz receptor antagonists which contributed to the deIayin presentation. The majority of patients (94.5%) presented with advanced disease and nocurative surgery was possible.Conclusions: These results show that early diagnosis of gastric cancer is still a dream atMulago hospital since most patients present with advanced disease. To address this problem,all health workersshauld besensitisedonsympbrnsrndsignsfor early aggressiveinvestigationor an early referral tn cnable early diagnosis of gastric cancer. The investigatory capacity ofrural hospitals shouid be boosted to enable early detection of gastric cancer
Gross Anatomical Variations and Congenital Anomalies of Surgical Importance in Hepatobiliary Surgery in Uganda.
Get PDFBackground: It is important for surgeons to appreciate the possible
anatomical variations that can be encountered during surgery. This
study was aimed at determining the gross anatomical variations and
congenital anomalies of the external hepatobilliary system in Ugandan
cadavers and to describe the nature and contents of the gallbladder
among cadavers of Ugandans. Methods: This was a cross-sectional study
done at the Department of Anatomy Dissection Laboratory at Makerere
University Medical School in Kampala, Uganda. The study involved all
cadavers dissected in a period of 8 years, from October, 1997 to June
2005, 21 each year, totaling 168 cadavers. Results: A wide range of
Anatomical variations of surgical importance were noted among the
Ugandan cadavers. In 5% of the cases, the common hepatic artery
originated from the superior Mesenteric artery. The course of the
cystic artery in 61.9% of the cases was anterior to the right hepatic
duct, in 31% it passed anterior to the right hepatic duct, in 8% it
lied posterior to the common bile duct, and in 25% of cases, there were
more than 2 cystic arteries. In 56% the common hepatic artery branched
some 2 - 4cm away from the porta hepatis, 4% branched within the
substance of the liver, 19% at the level of porta hepatis while in 5%
it branched at the level of right gastric artery. The cystic duct
branched off from the common Hepatic duct in 95% of specimens while in
5% originated from the right hepatic duct. Joining of the common
hepatic duct contributed to low branching accounting for 67% while 19%
had high branching level from the duodenum. The length of the common
bile duct ranged from 2.5cm to 12cm, the mode being 4cm and the average
5.1cm. In 4% of the cadavers there were multiple stones with the
gallbladder being adherent to neighbouring viscera. Conclusion: The
results show that within the Ugandan population, there are marked
variations of surgical importance in the gross anatomic features of the
hepatobiliary system, which need to be considered to in order to avoid
errors during gallbladder or extra hepatic biliary surgery
Sternal Anomalies with Supernumerary and Subnumerary Vertebrae and Ribs Case Reports
Get PDFBackground: Variations in the number of ribs and vertebrae have been
noted in other wise normal looking people with some having
supernumerary while others subnumerary. Sternal variations and
anomalies though have not been as widely documented. These are two
cases with one having a combination of sternal anomalies, supernumerary
thoracic vertebrae and ribs and subnumerary lumbar vertebrae while the
other had subnumerary thoracic vertebrae and ribs. Findings: Case 1: A
38year old female who had eleven thoracic vertebrae and corresponding
pairs of ribs, nine pairs attached and two floating. The other skeletal
components were normal. Case 2: Adult male had 13 thoracic vertebrae
and thirteen corresponding pairs of ribs. Ten pairs of ribs attached to
the cage and three floating. There were four lumber vertebrae. The
manubrium of the sternum was much longer, ended at the third coastal
cartilage attachment and there was an oval defect in the body of the
sternum at the level of 5th costal cartilage. The rest of the skeleton
was normal. Conclusions: Osteological variations in the rib cage and
vertebrae are clinically important because they can mislead an
unsuspecting clinician during diagnostic and therapeutic lumbar
punctures, counting of ribs during heart examinations, drainage of the
thorax and the 12th rib is important in citing of the incision for
nephrectomy and other medical procedures. Radiological diagnosis,
Forensic and medical legal pathological identifications need to put
into consideration such variations
Sternal Anomalies with Supernumerary and Subnumerary Vertebrae and Ribs Case Reports
No full textBackground: Variations in the number of ribs and vertebrae have been
noted in other wise normal looking people with some having
supernumerary while others subnumerary. Sternal variations and
anomalies though have not been as widely documented. These are two
cases with one having a combination of sternal anomalies, supernumerary
thoracic vertebrae and ribs and subnumerary lumbar vertebrae while the
other had subnumerary thoracic vertebrae and ribs. Findings: Case 1: A
38year old female who had eleven thoracic vertebrae and corresponding
pairs of ribs, nine pairs attached and two floating. The other skeletal
components were normal. Case 2: Adult male had 13 thoracic vertebrae
and thirteen corresponding pairs of ribs. Ten pairs of ribs attached to
the cage and three floating. There were four lumber vertebrae. The
manubrium of the sternum was much longer, ended at the third coastal
cartilage attachment and there was an oval defect in the body of the
sternum at the level of 5th costal cartilage. The rest of the skeleton
was normal. Conclusions: Osteological variations in the rib cage and
vertebrae are clinically important because they can mislead an
unsuspecting clinician during diagnostic and therapeutic lumbar
punctures, counting of ribs during heart examinations, drainage of the
thorax and the 12th rib is important in citing of the incision for
nephrectomy and other medical procedures. Radiological diagnosis,
Forensic and medical legal pathological identifications need to put
into consideration such variations
Sternal anomalies with supernumerary and subnumerary vertebrae and ribs – case reports
No full textCase ReportBackground: Variations in the number of ribs and vertebrae have been noted in other wise normal looking people with some having supernumerary while others subnumerary. Sternal variations and anomalies though have not been as widely documented. These are two cases with one having a combination of sternal anomalies, supernumerary thoracic vertebrae and ribs and subnumerary lumbar vertebrae while the other had subnumerary thoracic vertebrae and ribs. Findings: Case 1: A 38year old female who had eleven thoracic vertebrae and corresponding pairs of ribs, nine pairs attached and two floating. The other skeletal components were normal. Case 2: Adult male had 13 thoracic vertebrae and thirteen corresponding pairs of ribs. Ten pairs of ribs attached to the cage and three floating. There were four lumber vertebrae. The manubrium of the sternum was much longer, ended at the third coastal cartilage attachment and there was an oval defect in the body of the sternum at the level of 5th costal cartilage. The rest of the skeleton was normal. Conclusions: Osteological variations in the rib cage and vertebrae are clinically important because they can mislead an unsuspecting clinician during diagnostic and therapeutic lumbar punctures, counting of ribs during heart examinations, drainage of the thorax and the 12th rib is important in citing of the incision for nephrectomy and other medical procedures. Radiological diagnosis, Forensic and medical legal pathological identifications need to put into consideration such variations
Practices of Makerere University Students during Anatomy Dissection.
No full textBackground: The knowledge, skills and practices medical students
acquire during gross anatomy dissection are fundamental to the learning
of human anatomy and eventual practice of medicine. The changes in the
curriculum and the global concerns about how students acquire their
anatomical skills and knowledge, made it important to find out what
students in our low resource settings do in the anatomy dissection
room. Methods : This was a cross-sectional descriptive survey with a
qualitative component on two cohorts of 305-second year health
professional students on what they do during anatomy dissection
practical. Results:The overall response rate was 26.9%. Of the 82
respondents, 35 (42.7%) reported that they only observed the
dissection, 25 (31.7%) read the manuals, 20 (24.4%) had actual hands on
dissection and one (1.2%) had never dissected. Significantly less male
students read the manuals as opposed to doing the hands on dissection
(0.18, P=0.0007). The interviews highlighted some of the reasons behind
the students preferred roles. Conclusion: The students’ responses
highlight differences between institutional expectations of dissection
and the actual student practices. Specific roles like reading the
manual and dissecting show significant sexual bias. There is a need to
examine of the institutional definition of dissection in relation to
its low resource settings
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Practices of Makerere University students during anatomy dissection
Get PDFBackground: The knowledge, skills and practices medical students acquire during grossanatomy dissection are fundamental to the learning of human anatomy and eventual practice of medicine. The changes in the curriculum and the global concerns about how students acquire their anatomical skills and knowledge, made it important to find out what students in our low resource settings do in the anatomy dissection room.Methods : This was a cross-sectional descriptive survey with a qualitative component on two cohorts of 305-second year health professional students on what they do during anatomy dissection practical.Results:The overall response rate was 26.9%. Of the 82 respondents, 35 (42.7%) reported that they only observed the dissection, 25 (31.7%) read the manuals, 20 (24.4%) had actual hands on dissection and one (1.2%) had never dissected. Significantly less male students read the manuals as opposed to doing the hands on dissection (0.18, P=0.0007). The interviews highlighted some of the reasons behind the students preferred roles.Conclusion: The students’ responses highlight differences between institutional expectations of dissection and the actual student practices. Specific roles like reading the manual and dissecting show significant sexual bias. There is a need to examine of the institutional definition of dissection in relation to its low resource settings
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