A case of Ludwig angina: a case report and review of the literature

Ludwig angina is a rapidly progressing submaxillary, submandibular, and sublingual necrotizing cellulitis of the floor of the mouth that can have lethal consequences due to airway obstruction. Various aerobic and anaerobic microorganisms, and less often fungi, have been implicated to cause Ludwig angina, including oral flora such as streptococci and staphylococci. Early recognition and the use of parenteral antibiotics can prevent mortality and morbidity. We report a case of a 25-year-old white man who was admitted to the hospital by his dentist after being diagnosed with Ludwig angina secondary to periodontal abscesses involving teeth #17 and #32. Although antibiotics were administered, while in the hospital, the decedent had difficulty swallowing and was drooling. He suddenly began to have seizure-like activity thought to be anoxic myoclonus. The decedent was aggressively resuscitated and taken to the operating room for neck exploration and a tracheostomy. Neck exploration revealed severe necrotizing acute inflammation of the deep soft tissues and musculature of the neck. He remained on life support for 7 days until he was declared brain dead. Ludwig angina is a progressive cellulitis that often results in death by asphyxia. Ludwig angina can be complicated by subsequent deep neck infection. The underlying etiologies and common scenarios are examined, and significant autopsy findings and dissecting procedures are discussed. The pathophysiology of Ludwig angina is studied with a review of the current literature.     

Sino–Vatican Negotiations: problems in sovereign right and national security

This article, in the context of sovereignty, discusses problems put to China and the Vatican in their long course of negotiations (1987–) which aim at a reconciliation. China’s past experience in negotiating with major powers (US and Great Britain) are reviewed while the Vatican’s aim of negotiating a concordat is also explained. The societal factors from the current Chinese political landscape, including social unrest as well as the Taiwan factor, are reviewed to identify problems in the ‘Sino–Vatican negotiations’.     

The contingent morality of war: establishing a diachronic model of jus ad bellum

According to most accounts of just war theory, jus ad bellum is concerned with the morality of initiating war. This gives jus ad bellum a temporal dimension, making it a set of principles that are applied to judge belligerents’ actions at the outset of a war, but that cannot be revisited after a war begins. I challenge this synchronic conception of jus ad bellum by arguing that the considerations the principles of jus ad bellum are meant to judge can, and often do, change substantially over the course of wars. It is inappropriate to determine the ad bellum justice of a war solely based on how the principles of jus ad bellum are satisfied at a war’s outset. Because of the mercurial nature of war, jus ad bellum principles should be applied diachronically, as moral norms that can be used to guide or to judge belligerents even after a war has been initiated.     

Social Movements and Social-Change Litigation: Synergy in the Montgomery Bus Protest

Two competing schools of thought have emerged to explain how the Montgomery bus protest of 1955–56 brought about changes on the city's Jim Crow buses. The dominant explanation attributes the changes to the bus boycott led by Martin Luther King, Jr., and the Montgomery Improvement Association. A second interpretation emphasizes the critical role of the Supreme Court's decision striking down the state and local bus segregation laws. This essay prooides a third explanation: that these two strategies–the boycott and the litigation–interacted, each shaping and reinforcing the other. Each strategy war a critical part of the struggle, but neither brought change by itself. This essay argues that the two strategies of the Montgomery protest created a synergy that was the key to bringing about changes on the buses.