The impact of the introduction of PECARN head CT rules on the utilisation of head CT scans in a private tertiary hospital in Sub-Saharan Africa.

BACKGROUND: The decision to order head CT scans to rule out clinically significant traumatic brain injury in mild head injury in children is made on the basis of clinical decision rules of which the Paediatric Emergency Care Applied Research Network (PECARN) CT head rules have been found to be most sensitive. PURPOSES: The purpose of this study is to determine the proportion of head CT scans done for children with mild head injury and to determine disposition of patients from casualty after the introduction of PECARN head CT rules compared to the period before. The research question is "will introduction of the PECARN CT head rules reduce the proportion of head CT scans requested for children under 18 years with mild head injury at the AKUHN?" METHODS: A before and after quasi experimental study with a study population including all children under 18 years presenting to the AKUHN with mild head injury and a Glasgow coma scale of 14 and above on presentation. Sample size was 85. RESULTS: A total of 42 patients files were analysed in the before study while 43 patients were selected for the after study. The median age was 5 years. The proportion of head CT scans reduced from 56% in the before group to 33% in the after group with no missed clinically significant traumatic brain injury. More patients were discharged home after evaluation in the after group (81%) than in the before group (58%). CONCLUSIONS: The number of head CT scans ordered reduced without missing any clinically significant traumatic brain injury.

Variations in the branching pattern of the celiac trunk in a Kenyan population / Variaciones en el patrón de ramificación del tronco celíaco en una población de Kenia

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 percent), bifurcated in 22 (17.9 percent) and gave collaterals in 25 (20.3 percent). Dorsal pancreatic artery was the most common collateral and occurred in 14.8 percent. Other branches included gastroduodenal and inferior phrenic arteries present in 3.3 percent and 4.9 percent 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.

El tronco celíaco es la principal fuente de suministro de sangre al compartimento supracólico abdominal. Por lo general, para irrigar la región, el tronco celíaco se ramifica en las arterias esplénica, hepática común y gástrica izquierda. Sin embargo, se ha demostrado que presentan variaciones étnicas en su patrón de ramificación. El conocimiento de estas variaciones pueden ser importante en los procedimientos quirúrgicos y radiológicos alrededor de la cabeza del páncreas. El objetivo de esta investigación fue ilustrar las variaciones más comunes en el patrón de ramificación del tronco celíaco en una población de Kenia. El estudio fue realizado en el Departamento de Anatomía Humana de la Universidad de Nairobi. Fueron estudiados 123 cadáveres tanto de disección como de autopsia, previa aprobación del comité de ética y el consentimiento de los familiares. Se realizó la disección macroscópica de la pared anterior del abdomen mediante una incisión mediana extendida, realizando la retracción del hígado y el estómago. El tronco celíaco se presentó trifurcado en 76 (61,7 por ciento) casos, bifurcado en 22 (17,9 por ciento), y dio colaterales en 25 (20,3 por ciento) casos. La arteria dorsal de páncreas fue la colateral más común (14,8 por ciento). Otras ramas incluidas las arterias gastroduodenal y frénica inferior se presentaron en el 3,3 por ciento y 4,9 por ciento, respectivamente. La población de Kenia tiene una mayor incidencia de bifurcación y ramificación colateral del tronco celíaco, por lo tanto, es necesario tomar precauciones durante los procedimientos quirúrgicos del compartimiento abdominal supracólico.

Appendicectomy for recurrent and chronic appendicitis.

In recent years, several reports have underlined the possible existence of chronic appendicitis. Up to 38% of spontaneously resolving acute appendicitis may recur. We studied 41 patients operated on between July 2000 and June 2001 for chronic and recurrent appendicitis at a teaching hospital in the city of Nairobi. The patients comprised 17.8% of all patients undergoing surgery for appendicitis during the study period. The majority (65.9%) were females. The faecolith rate was 51.2%. About half of appendices removed for these symptoms were normal at histology. Nearly 70% of the normal appendices contained faecoliths. Symptoms resolved in 90% of faecolith-containing appendices and 87.5% of non-faecolith-containing appendices that were normal on histology.