Objective. The present study was carried out with an aim to study the nutritional status of patients undergoing emergency ileostomy using simple bedside tools in a developing country. Methods. Nutritional assessment (anthropometry, biochemical, immunological, and dietary) was done within 24-36 hours of admission and 6 weeks postoperatively. Primary endpoint was the study of the nutritional status of the patients with ileostomy. Results. N = 58, 47 males with mean age 32 years. Postoperatively 50 (86.2%) patients experienced some complications including those related to ileostomy. Malnutrition varied from 7 (12.1%) using BMI to 54 (93.1%) by triceps skinfold thickness. At 6 weeks, despite adequate nutritional intake, there was a significant decrease in almost all nutritional parameters except serum albumin which was normal in most patients. Factors contributing to weight loss in 41 (70.7%) patients were decreased length of proximal bowel left (P = 0.001), increased ileostomy output (P = 0.001), delayed surgery (P = 0.004), and increased disease severity score (P = 0.005). Conclusion. Majority of patients undergoing emergency ileostomy were malnourished and had significant nutritional depletion despite adequate nutritional support. Serial assessment helps to assess nutritional recovery in these patients.

Despite identification and preservation of RLN, patients can develop postoperative voice change and RLNP although all voice change cannot be attributed to damaged RLN. Proper assessment of vocal cord functions by I/L and D/L laryngoscopy is required to rule out injuries to these nerves. Risk of damage is higher in patients undergoing more difficult surgery.

Cauterisation with silver nitrate is commonly used to treat overgranulation. Silver nitrate has a high density and a high mass attenuation coefficient, and it is therefore highly radio-opaque. We present a case in which its topical application to an area of overgranulation was interpreted as a bony fragment by the reporting radiologist in a patient with a supracondylar humeral fracture whose radiograph after removal of K-wires showed a large radio-opaque lesion. Although not a new phenomenon, it is one not widely known, and it can lead to confusion and unnecessary further imaging. KEYWORDSSilver nitrate -Radio-opacity -Overgranulation Case HistoryWe report the case of a three-year-old girl who sustained a supracondylar humeral fracture. This was treated with closed reduction and K-wire fixation. The fracture healed well and the K-wires were removed under nitrous oxide and oxygen three weeks following the injury. On removal of the wires, considerable overgranulation tissue was noted on the medial side of the elbow, which was treated with silver nitrate.Plain radiograph of the elbow following the procedure demonstrated a 15mm  10mm radio-opaque lesion on the medial side of the elbow (Fig 1), which was interpreted by the reporting radiologists to be 'a large detached bony fragment lying in the cubital fossa'. This diagnostic misinterpretation was noticed in clinic at a follow-up visit by the treating orthopaedic surgeon and reported back to the radiology department. The history of silver nitrate application had not been documented on the radiograph request form. However, previous films were available for comparison. DiscussionThe formation of granulation tissue is a necessary part of the proliferative phase of wound healing. Dermal fibroblasts increase in number and synthesise a network of protein fibrils. Local tissue hypoxia promotes angiogenesis and this protein framework is infiltrated by capillary buds. In normal wound healing, epidermal keratinocytes proliferate at the margins of the wound before migrating across the newly formed granulation tissue. These keratinocytes form an epithelial membrane and the wound is sealed. Occasionally, the proliferative phase is excessive and granulation tissue is formed well above the height of surrounding healthy tissue. This is described as 'overgranulation'. The cause of this exuberance is not well understood but it may represent an aberrant response to a persistent inflammatory stimulus.When overgranulation occurs it impedes epithelialisation and delays wound healing. Various methods have been described to treat overgranulation including topical steroids, steroid impregnated tape and cauterisation with silver nitrate. Silver nitrate inhibits fibroblast proliferation and usually leads to a rapid resolution of the overgranulation.The mass attenuation coefficient is a standardised measure of attenuation of materials independent of their physical state. This coefficient, however, is dependent on the energy of incident radiation due to K shell effects (assumed to be ...

SUMMARYOsgood-Schlatter disease is a common cause of anterior knee pain in adolescents. In a good proportion of cases the pain is relieved through stopping sport alone, or by doing so in conjunction with undertaking physiotherapy. However, resolution of symptoms may take several years. A proportion of teenagers are prevented from participating in sport for a prolonged period as a result of the condition, and some have persisting knee pain into adulthood. We report the use of a new surgical treatment for this disease. We describe the case of a 12-year-old boy who was unable to play rugby for a year due to this pain. Following percutaneous fixation of the tibial tuberosity his symptoms entirely resolved and he returned to competitive sport 6 weeks after surgery. A year later the screw was removed. As soon as he resumed sport his symptoms immediately returned and he requested that the screw be replaced. Following replacement his symptoms once more resolved. BACKGROUND

SUMMARYGluteal compartment syndrome is a rare entity but a recognised complication of prolonged immobilisation. It can present as renal failure as a result of severe rhabdomyolysis and can lead to sepsis and death. We report a case of gluteal compartment syndrome in a 25-year-old man who was found unconscious following intoxication with alcohol and cocaine of an unknown duration. He presented with tense tight left buttock swelling, right thigh swelling, cold immobile extremeties and acute renal failure. Immediate left gluteal, thigh and calf fasciotomy resulting in an improvement of lower limb and renal function. BACKGROUND