Clinical trials in Surgery

Editoria

Superficial temporal artery among Kenyans: pattern of branching and its relation to pericranial structures

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 ± 20.9 mm, to the lateral canthus 58.6 ± 24.3 mm, and to the tragus 44.1 ± 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. Folia Morphol 2010; 69, 1: 51-5

Age changes in the tunica intima of the aorta in goat (Capra hircus)

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.Keywords: Age, Tunica Intima, Aorta, Atherosclerosi

The Cerebro-placental Ratio as a Prognostic Factor of Foetal Outcome in Patients with Third Trimester Hypertension

Background: Hypertensive disorders of pregnancy can cause complications in both the maternal and fetal circulations resulting in poor fetal outcome. These circulations can be safely and non-invasively assessed using arterial Doppler indices of the umbilical and middle cerebral arteries to obtain the cerebro-placental ratio. The study objective was to determine the role of the cerebro-placental ratio as a prognostic factor of fetal outcome in patients with hypertensive states of pregnancy delivered at least 32 weeks of gestation by dates.Methods: This was a prospective cohort study undertaken at Kenyatta National Hospital, a tertiary referral hospital in Nairobi. A total of 160 gravid patients of median age 28 years and at least 32 weeks gestations were recruited from labor ward over a 9 month study period by consecutive sampling method. Doppler ultrasound analyses of the foetal umbilical and cerebral arteries were done and the cerebro-placental ratio calculated.Results: At sonography, the average ultrasound age was 31 weeks. The median gestation at admission was 34 weeks. Twenty nine percent had an abnormal Cerebro-placental ratio (<1.0).125/160 (78%) delivered via caesarean section and 35/160(22%) delivered vaginally.51/160(32%)  severe pre-eclamptic toxaemia out of which 39% had cerebroplacental ratio<1.0 109/160(68%) had mild pre-eclamptic toxaemia out of which 24% had cerebroplacental ratio <1.0 Still births were 12.5 times more likely in mothers with cerebroplacental ratio <1.0 than those with CPR 1.0 (p value 0.05). A foetal birth score < 7 was 66 times more often in  mothers with cerebro-placental ratio< 1.0 than mothers with CPR 1.0. (P 0.05). Low birth weight was 4.7 times more likely among mothers with cerebroplacental ratio < 1.0.as compared to those with mothers with CPR1.0 (95% CI 2, 11.1; p0.001). A foetal birth score < 7 was 66 times more likely among neonates delivered vaginally as compared to those born via caesarean section(95% CI 1.3, 23; p=0.02). Still births were 14.5 times more often than among neonates born vaginally as compared to those born via caesarean section (95% CI 3, 84; p0.001). The prognostic Odds Ratio for cerebro-placental ratio was 12.5 for live births (95% CI 2, 74; p=0.005), 66 for fetal birth score <7 (95% Confidence interval 13, 340; p< 0.001) and 4.7 for low birth weight (95% CI 2, 11.1; p< 0.001) and 1.1 (95% CI 0.9, 1.4; p=0.327).Conclusion: Cerebro-placental ratio is significantly predictive of adverse perinatal outcome when used to monitor mothers with hypertensive states of pregnancy. Cerebroplacental ratio.Key words: Cerebro-placental Ratio, Prognostic Factor, Foetal Outcome, Third Trimester, Hypertensio

Role of heterogeneous astrocyte receptor expression in determining astrocytic response to neuronal disorders

Following neuronal disorders, astrocytes carry out either neuroprotection or neurodegeneration. Previous authors suggest that favoring of neurodegeneration or neuroprotection by astrocytes can be due to many factors such as the influence of cytokines following their binding on their receptors on astrocytes. These receptors have however been shown to be region specific and heterogeneous. Further, research exploiting their role and influence in determining astrocytic response remains partly elucidated. A review of previous and ongoing research on these receptors would be helpful in the disclosure of astrocytic responses to neuronal disorders.Keywords: Astrogliosis, Heterogenous astrocyte expression, Antagonistic astrocyte reaction, Nervous injury, Astrocyte mediated neurodegeneratio

Hypophosphatemia following severe traumatic brain injury is associated with increased risk of mortality

Background: Electrolyte dysfunctions following traumatic brain injury have been associated with poor outcomes. The aim of this study was to  determine the incidence of serum phosphate ion abnormalities and their association with specific clinical, radiological and acid-based parameters.Methods: This was a prospective cross-sectional study of 95 patients with severe head injury hospital admitted between November 2019 and  February 2020. Data collected included patient demographics, injury mechanisms, pre-hospital interventions, clinical examination findings, CT Scan head findings, serum electrolyte findings (at admission and 48 hours later), arterial blood gas, and outcome (30 days). The data collected was entered in the Social Sciences Statistical Package for analysis.Results: Hypophosphatemia was reported in 40 (42.1%) and 29 (48.3%) of cases, while hyperphosphatemia was reported in 5 (5.3%) and 5 (8.3%) ofcases at admission and 48 hours post-admission. Low phosphate levels were significantly correlated with pre-hospital use of intravenous fluids(P=0.041), mannitol use (p=0.048), lower diastolic pressure (p=0.043), tachypnoea (p=0.044), hypoxemia (p=0.011) and respiratory alkalosis(p<0.001). Hypophosphatemia was associated with a high risk of death; odds ratio 4.12(P=0.031) at admission and odds ratio 7.5 (P=0.098) 48hrs postadmission.Conclusion: Hypophosphatemia is the predominant serum phosphate ion abnormality seen in severe traumatic brain injury and is associated withsignificant high risk of mortality