Necrotising fasciitis of the posterior neck crossing the midline: a case report

Introduction and importance: Craniofacial necrotising fasciitis is a complex condition, with high mortality given its propensity to descend via the deep neck spaces into the chest and mediastinum. Management requires optimal antimicrobial therapy with associated aggressive surgical debridement. Presentation of case: A 64-year-old man presented to ENT with a posterior neck swelling. Despite incision and drainage of the swelling following a trial of antimicrobial therapy, it increased in size, with areas of overlying necrosis demonstrated. Based on radiological and clinical findings, a diagnosis of necrotising fasciitis was made. He was taken to theatre for debridement. Intra-operatively, carotid sheath suppuration was noted, after tissue retraction resulted in copious bleeding from the anterior wound bed, requiring vigorous resuscitation and clamping of underlying structures to achieve haemostasis. Senior ENT and vascular surgery involvement was quickly sought to achieve haemostasis, however bleeding from the wound bed was difficult to control. This was due to the significant watershed area at the posterior neck which would not have been amenable to selective vessel ligation. After multiple cardiac arrests, a team decision was taken to discontinue resuscitation. Clinical discussion: Operating in this area of anatomical complexity required input from a number of different specialty teams. Although input from infectious diseases, microbiology, plastic surgery and tissue viability was commendable, there was room for optimising this further. Early patient referral to a tertiary centre where on-site input was available from maxillofacial surgery and plastic surgery would have been beneficial; a set-up commonly seen in regional trauma networks. Conclusion: This case demonstrates the intricacies surrounding a rare occurrence of necrotising fasciitis of the neck crossing the midline. Multi-disciplinary team involvement is imperative and should be encouraged at an early stage

Vicarious Group Trauma among British Jews

This is the final version of the article. It first appeared from Springer via http://dx.doi.org/10.1007/s11133-016-9337-4Given that literature on the intra- and inter-generational transmission of traumas is mainly based on secondary literature and focuses on the transmission of trauma memory in terms of the historical knowledge of group trauma, this article develops the theory of vicarious group trauma and tests this theory by exploring vicarious traumatization in the everyday lives of Jews in Britain through the methods of observation and in-depth interviewing. Vicarious group trauma is defined as a life or safety-threatening event or abuse that happened to some members of a social group but is felt by other members as their own experience because of their personal affiliation with the group. The article finds that the vicarious sensation of traumatic group experiences can create anxiety, elicit perceptions of threat and, by extension, hypervigilance among Jews. The findings demonstrate that group traumas of the past interpenetrate and interweave with members’ current lives and in this way can also become constitutive of their group identity. An institutional focus on threats to Jews can inform the construction and reinforcement of traumatization symptoms and accordingly vicarious group trauma. This article suggests an association between the level of involvement of group members in the collective’s social structure and the prominence of vicarious group trauma among them

A genetic analysis of nitric oxide-mediated signaling during chronological aging in the yeast

In mammals, NO•, a signaling molecule is implicated in the regulation of vasodilation, neurotransmission and immune response. It is believed that NO• is a signaling molecule also in unicellular organism like yeast and may be involved in the regulation of apoptosis and sporulation. It has been reported that NO• is produced during chronological aging (CA) leading to an increase of the superoxide level, which in turn mediates apoptosis. Since this conclusion was based on indirect measurements of NO• by the Griess reaction, the role of NO• signaling during CA in the yeast remains uncertain. We investigated this issue more precisely using different genetic and biochemical methodologies. We used cells lacking the factors influencing nitrosative stress response like flavohemoglobin metabolizing NO•, S-nitrosoglutathione reductase metabolizing S-nitrosoglutathione and the transcription factor Fzf1p mediating NO• response. We measured the standard parameters describing CA and found an elevation in the superoxide level, percentage of death cells, the level of TUNEL positive cells and a decrease in proliferating potential. These observations showed no significant differences between wild type cells and the disruptants except for a small elevation of the superoxide level in the Δsfa1 mutant. The intracellular NO• level and flavohemoglobin expression decreased rather than increased during CA. Products of general nitrogen metabolism and protein tyrosine nitration were slightly decreased during CA, the magnitude of changes showing no differences between the wild type and the mutant yeast. Altogether, our data indicate that apoptosis during yeast CA is mediated by superoxide signaling rather than NO• signaling

Patterns of regional head and neck lymph node metastasis in primary conjunctival malignant melanoma

OBJECTIVE: To correlate patterns of regional lymph node metastasis with the site of origin in primary conjunctival malignant melanoma. DESIGN: Retrospective analysis (1990–2003) of clinical data. SETTING: Two London tertiary referral centres. PARTICIPANTS: 12 patients presenting with regional metastases after failed local treatment for conjunctival malignant melanoma. RESULTS: 6 cases predominantly involving the temporal conjunctiva metastasised to the pre‐auricular lymph nodes. Two cases predominantly involving the nasal conjunctiva metastasised to the submandibular nodes. Of the two cases with purely multifocal disease, one metastasised to the pre‐auricular nodes and another to both submandibular and parotid nodes. One primary conjunctival malignant melanoma had its origin in temporal conjunctiva but metastasised to submandibular nodes, and another case originating from nasal conjunctiva metastasised to pre‐auricular nodes. CONCLUSIONS: Temporal conjunctival melanotic lesions tend to metastasise clinically to pre‐auricular lymph nodes and nasal conjunctival melanotic lesions metastasise to the submandibular lymph nodes. Patterns appear consistent with laboratory‐based anatomically mapped lymphatic drainage basins of the conjunctiva