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

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

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

The Handling of Credit Problems in Bank Financial Restruction

The effort to minimize potential losses from problem loans is that banks can carry out credit restructuring. Implementing credit restructuring for problem loans means that debtors can again fulfill their obligations to the bank, namely in the form of paying principal installments and/or credit interest which has been given relief tailored to the debtor's capabilities. The result of credit restructuring is that the debtor's business continuity becomes viable again so that the debtor can fulfill his obligations to the bank. The obstacles that arose in the restructuring process were able to be overcome by the bank optimally and proportionately. The solution adopted is also a method that is profitable for both parties, so that both parties (debtor and creditor) avoid the element of loss

Pengaruh Ketebalan Inner-Helical Fin Terhadap Charcteristic of Performance Pada Head Exchanger

Effect of inner-helical fin on the rate of heat transfer and flow friction factor in a double pipe heat exchanger (double tube heat exchanger) to make a split and disrupt the flow pattern of a streamlined flow of the fluid flowing in the pipe section in the (inner tube) that cause turbulence (molecule-molecule level of randomness good fluid) that can increase the heat transfer rate in the the pipe . Inner-helical fin has a varied thickness of 1 mm, 22 mm and 3 mm are mounted on the pipe where the inside diameter of the inner-helical fin attached to the wall in the inner pipe. Hot water discharge on the inner pipe ditelitil ranging from 400 to 900 liters / h with interval increase in 100 liter / hour and the volumetric flow rate of cold water on the outer tube (outertube) is kept constant 900 liters / hour. The test results of each inner-helical fin thickness compared with the test results without the inner-helical fin (plain tube) and obtained the overall heat transfer rate has increased 60 to 65% of the plain tube, heat exchanger effectiveness of58.56 to 63, 64% and friction factor of 63.13 to 63.51 of the plain tube

Capillary electrophoretic and extraction conditions for the analysis of Catha edulis FORKS active principles

A capillary electrophoretic method, which allowed the detection and separation of the active principles of Catha edulis, i.e. cathinone, cathine and phenylpropanolamine, was developed. A suitable internal standard (nicotinamide), which permitted the quantification of the analytes reducing the variability of the migration times due to EOF changes, was identified. The analytical method was validated, assessing linearity, sensitivity and repeatability, showing optimal features for the analysis of the vegetable material. Moreover extraction conditions were investigated to achieve the exhaustion of the plant material in the fastest and most efficient way to meet the requirements of the Court