Isolated left sternocleidomastoid pyomyositis: a rare presentation of cervical sepsis.

An elderly gentleman self-presented to A+E with a 7-day history of significant and progressive left-sided neck pain, swelling and fevers, despite oral antibiotics from his general practitioner. Examination revealed a large left-sided neck mass involving levels 2-5 of the neck that was firm to palpate, with erythematous overlying skin.An urgent CT scan demonstrated a large collection throughout the length of the left sternocleidomastoid muscle (SCM), measuring 13×5.5×4 cm, with extensive adjacent inflammatory change. He was subsequently taken to theatre for washout and debridement, during which the collection was found to be loculated and isolated to the SCM, with surrounding structures spared.Postoperatively, he was managed with intravenous fluids and a total of 2 weeks of intravenous antibiotics. The wound partially dehisced during healing and the cavity was packed with flaminal and regularly dressed with input from the tissue viability team. This was then left to heal by secondary intention and the patient was followed up in clinic over the following weeks to ensure resolution.

Early reduction of acute anterior shoulder dislocations in a ski field setting.

OBJECTIVE: The present study describes the management of suspected shoulder dislocations in ski field clinics. METHODS: Data were collected from two clinics in Queenstown, New Zealand. Suspected anterior shoulder dislocations, with no suspicion of significant fractures and without imaging, underwent attempted reduction. RESULTS: Ninety percent (n = 49) of dislocations were successfully relocated. No short-term complications because of this procedure were observed. CONCLUSION: This short report raises the possibility that early anterior shoulder reduction in a ski field clinic can be safe without imaging, in select cases. Prospective studies including patient centred data are recommended.

A furan Diels-Alder cycloaddition approach to scyphostatin analogues.

The synthesis of two diastereoisomers of the epoxycyclohexenone core of scyphostatin, a naturally occurring sphingomyelinase inhibitor, has been achieved via a common oxabicyclic intermediate. The diastereomeric intermediates are accessed by stereodivergent oxidative functionalisation processes, followed by a Lewis acid mediated ring opening rearrangement reaction.

Highly active iridium(I) complexes for the selective hydrogenation of carbon-carbon multiple bonds.

New iridium(I) complexes, bearing a bulky NHC/phosphine ligand combination, have been established as extremely efficient hydrogenation catalysts that can be used at low catalyst loadings, and are compatible with functional groups which are often sensitive to more routinely employed hydrogenation methods.