Unsolved questions and preferred solution about living will.

Background: Ethical problems about end-of-life medicine include a variety of issues approached in different ways by physicians and, more recently, special emphasis to this kind of ethical issues and possible answers has done by Italian National Ethical Committee in the issue named “Deep and continuous palliative sedation in the imminence of Death” (January, 2016). The debate is very critical in Intensive Care Units and Cancer Wards, where health care professionals face-off with terminally-ill patients is an outright routine; the Authors investigated their medical knowledge and ethical perception about patient critical and terminal condition to discuss the most relevant conclusions. Material: In the Sicilian province of Palermo, physicians working in Intensive Care and Oncology fields were been given a questionnaire that takes inspiration from the Ethicatt Questionnaire-Doctor. The authors reported the results obtained, by selecting and analyzing the most involved questions about living wills. Results: Generally, the respondents showed a great sensibility on this topic. Overall agreement on the living will was observed, as past surveys, but also a new conception. Euthanasia remains not very popular, attitude in line with other countries. Opinions and aptitudes of relatives have minor importance towards patient’s wishes, that are in some cases in first place. Conclusion: Explicit positive answer towards dilemmas about living wills lifts the veil and reveals how these ones would represent a very useful tool for health care professionals in this study. It is also plausible that, if doctors had available an advance directive (living will) document, they would follow it, overcoming any contingent ethical objections

Perioperative and anesthetic deaths: toxicological and medico legal aspects

Background: Anesthesia has become safer during decades, though there is still a preventable mortality; the complexity of medical and surgical interventions, increasingly older and sicker patients, has created a host of new hazards in anesthesiology. In this paper, some of these perioperative (PO) fatal adverse events are investigated in terms of health responsibility. Selective literature research in several data bases, concerning perioperative and anesthetic deaths and medical responsibility, was performed. Main text: A generally accepted definition of the anesthesia and perioperatory-related death still remains one of the major concerns in forensic pathology, and the terms “operative deaths” and “anesthetic deaths” are usually applied inaccurately within the medico-legal literature. Such events involve comprehensively PO fatalities and allow for subtle separation of natural and unnatural death, at least from the prospective of forensic pathology. Iatrogenic deaths in this field can be separated into some major categories, as attributable to previous patient’s unfavorable conditions or depending from surgical procedure per se (such as PO cardiac and cerebrovascular events). In this review, the authors carried out syntheses of specific research areas regarding epidemiology, complications of general and spinal anesthetic, failure in airway management and patient’s circulatory homeostasis, and adverse drugs reactions; analysis considering the challenge of anesthetic-related mortality, epidemiology and classifications, by indicating causal chain of death, in respect of both contributing and associated anesthetic and surgery facts. Conclusions: Perioperative quality control programs and its relevance for medico-legal evaluation are emphasized as, although mortality rates have decreased worldwide over the last decades, however, preventable drug-related deaths still happen. Such fatal events have to be considered within the field of forensic pathology experts, with regard of malpractice claims, to implement a strategy for preventing potentially fatal complications

Deep MERLIN 5GHz Radio Imaging of Supernova Remnants in the M82 Starburst

The results of an extremely deep, 8-day long observation of the central kpc of the nearby starburst galaxy M82 using MERLIN (Multi-Element Radio Linked Interferometer Network) at 5 GHz are presented. The 17E-06 Jy/beam, rms noise level in the naturally weighted image make it the most sensitive high resolution radio image of M82 made to date. Over 50 discrete sources are detected, the majority of which are supernova remnants, but with 13 identified as HII regions. Sizes, flux densities and radio brightnesses are given for all of the detected sources, which are all well resolved with a majority showing shell or partial shell structures. Those sources within the sample which are supernova remnants have diameters ranging from 0.3 to 6.7 pc, with a mean size of 2.9 pc. From a comparison with previous MERLIN 5 GHz observations made in July 1992, which gives a 9.75 year timeline, it has been possible to measure the expansion velocities of ten of the more compact sources, eight of which have not been measured before. These derived expansion velocities range between 2200 and 10500 km/s.Comment: 34 pages, 10 figures. Accepted by MNRA

Monitoring of the prompt radio emission from the unusual supernova 2004dj in NGC2403

Supernova 2004dj in the nearby spiral galaxy NGC2403 was detected optically in July 2004. Peaking at a magnitude of 11.2, this is the brightest supernova detected for several years. Here we present Multi-Element Radio Linked Interferometer Network (MERLIN) observations of this source, made over a four month period, which give a position of R.A. = 07h37m17.044s, Dec =+65deg35'57.84" (J2000.0). We also present a well-sampled 5 GHz light curve covering the period from 5 August to 2 December 2004. With the exception of the unusual and very close SN 1987A, these observations represent the first detailed radio light curve for the prompt emission from a Type II-P supernova.Comment: (1) Jodrell Bank Observatory (2) University of Valencia (3) University of Sheffield 6 pages, 1 figure. To appear in ApJ letter

Determination of propofol by GC/MS and fast GC/MS-TOF in two cases of poisoning

Two cases of suspected acute and lethal intoxication caused by propofol were delivered by the judicial authority to the Department of Sciences for Health Promotion and Mother-Child Care in Palermo, Sicily. In the first case a female nurse was found in a hotel room, where she lived with her mother; four 10 mg/mL vials and two 20 mg/mL vials of propofol were found near the decedent along with syringes and needles. In the second case a male nurse was found in the operating room of a hospital, along with a used syringe. In both cases a preliminary systematic and toxicological analysis indicated the presence of propofol in the blood and urine. As a result, a method for the quantitative determination of propofol in biological fluids was optimized and validated using a liquid-liquid extraction protocol followed by GC/MS and fast GC/MS-TOF. In the first case, the concentration of propofol in blood was determined to be 8.1 \u3bcg/mL while the concentration of propofol in the second case was calculated at 1.2 \u3bcg/mL. Additionally, the tissue distribution of propofol was determined for both cases. Brain and liver concentrations of propofol were, respectively, 31.1 and 52.2 \u3bcg/g in Case 1 and 4.7 and 49.1 \u3bcg/g in Case 2. Data emerging from the autopsy findings, histopathological exams as well as the toxicological results aided in establishing that the deaths were due to poisoning, however, the manner of death in each were different: homicide in Case 1 and suicide in Case 2

15 years of VLBI observations of two compact radio sources in Messier 82

We present the results of a second epoch of 18cm global Very Long-Baseline Interferometry (VLBI) observations, taken on 23 February 2001, of the central kiloparsec of the nearby starburst galaxy Messier 82. These observations further investigate the structural and flux evolution of the most compact radio sources in the central region of M82. The two most compact radio objects in M82 have been investigated (41.95+575 and 43.31+592). Using this recent epoch of data in comparison with our previous global VLBI observations and two earlier epochs of European VLBI Network observations we measure expansion velocities in the range of 1500-2000km/s for 41.95+575, and 9000-11000km/s for 43.31+592 using various independent methods. In each case the measured remnant expansion velocities are significantly larger than the canonical expansion velocity (500km/s) of supernova remnants within M82 predicted from theoretical models. In this paper we discuss the implications of these measured expansion velocities with respect to the high density environment that the SNR are expected to reside in within the centre of the M82 starburst.Comment: Accepted for publication in MNRAS, 9 pages, 8 figure