Unexpected sudden death due to recreational swimming and diving in men in Croatia in a 14-year period.

The article deals with 17 sudden deaths which occurred during recreational swimming and diving in men in Croatia in a 14-year period: from January 1, 1998 to December 31, 2011. The sample is taken out from the total number of 61 sudden deaths in men during or immediately after sport or recreational exercise. Included are also sudden deaths of 8 foreigners spending holidays at the Croatian Adriatic Coast. In all of them forensic medicine autopsy was done. Thirteen males from Croatia died during recreational swimming. Three of them were aged 15-29 yrs: one had signs of hypertrophic cardiomyopathy, the second suffered from chronic myopericarditis with left ventricular aneurysm, and the third had cardiomegaly and blood alcohol level of 1.7 per thousand. Five were aged 30-64 yrs: four of them have suffered from coronary atherosclerosis and left ventricular hypertrophy of 15-18-18-22 mm, and one with left ventricular hypertrophy drowned suddenly, probably because of malignant ventricular arrhythmia. The fifth suffered stroke and drowned. Five elderly men, aged 65-85 yrs, have suffered from coronary atherosclerosis, myocardial fibrosis or myocardial scars, and three of them had left ventricular hypertrophy of 19 mm. Four males died during recreational diving. One aged 26yrs drowned, at autopsy he had left ventricular hypertrophy of 17 mm. Three males were middle-aged: two had coronary atherosclerosis, two of them had a severe degree of coronary atherosclerosis and one had coronary atherosclerosis of medium degree but with myocardial fibrosis and left ventricular hypertrophy of 18 mm. Seven male foreigners died, five of them during swimming: two aged 30-64 and two aged 65-85. They all have had coronary atherosclerosis: one of them had an acute myocardial infarction of the posterior wall, and one hypertrophic cardiomyopathy as well. One middle-aged and one elderly man died during diving, and both had an acute myocardial infarction of the posterior wall. One elderly foreign woman died during swimming, she had coronary atherosclerosis and a myocardial scar. In Croatia, death rate during both swimming and diving in men aged 15-29 years amounted to 0.63/1,000.000 (p=1.0000); in those aged 30-64 it reached 0.56/1,000.000 (p=0.3698), and in those aged 65-85 it was 1.41/1,000.000 (p=0.1849). The death rate during swimming in men aged 15-29 amounted to 1.47/1,000.000 (p=0.9864), in men aged 30-64 it reached 0.35/1,000.000 (p=0.2245), and in those aged 65-85 it was 1.41/1,000.000 (the difference is significant, p=0.0472). The death rate during diving in men aged 15-29 was 0.16/1,000.000, and in men aged 30-64 the observed rate was 0.21/1,000.000 (p=1.0000).

Arrhythmogenic right ventricular dysplasia and sudden cardiac death in Croatians' young athletes in 25 years.

The paper deals with the sudden cardiac death during training in male athletes in Croatia. The data are a part of a retrospective study dealing with 67 sudden death due to physical activity in men in Croatia during 25 years: from January 1, 1986 to December 31, 2010. Two of them suddenly died during training due to malignant ventricular arrhythmia because of the arrhythmogenic right ventricular dysplasia. First was a short trails runner aged 24, with no any previous physical discomforts, who suddenly collapsed and died during training. The second was a soccer player aged 13, with no any previous physical discomfort, who suddenly collapsed and died during training. A sudden cardiac death due to physical exercise in young athletes in Croatia suffered of arrhythmogenic right ventricular dysplasia reached 0.07/ 100.000 yearly (p = 0.00000), in all young athletes suffered of heart diseases reached 0.19/100 000 (p = 0.00005), and in the total male population aged 15-40 engaged in sports and recreational physical exercise: 0.71/100.0000 (p = 0.00001).

Physical activity and sudden cardiac death in elders--a Croatian study.

The paper deals with the sudden cardiac death in elders due to physical activity in Croatia and to compare it to other population groups who practice physical activity. The data are a part of a retrospective study dealing with 59 sudden death due to physical activity in men in Croatia: from January 1, 1988 to December 31, 2008. Fifteen aged 65 to 82 years were recreationally engaged in physical activity: six in swimming, four in tennis, one in driving a bicycle, one in jogging, two in bowling and one died during sexual act. Only one had symptoms of pectoral angina, two suffered from arterial hypertension, and two had congestive heart failure. Eleven were without symptoms before exercise. At forensic autopsy, fourteen had coronary heart disease, seven had critical coronary artery stenosis, three had occluded left descendens anterior coronary artery and four critical coronary stenosis, four had a recent myocardial infarctions, and eleven had myocardial scars due to previous myocardial infarctions. Twelve of them had left ventricular hypertrophy: 15-25 mm. In Croatia, about 7per cent of the entire male population undertake recreational physical activity, while 13 per cent of them are elders. A sudden cardiac death due to recreational physical activity in elders reached 1.71/100 000 yearly, in the entire male population engaged in recreational physical exercise: 0.75/100 000 (p = 0.05730), in the total male population aged 15-40 engaged in sports and recreational physical exercise: 0.57/100.0000 (p = 0.00387), in young athletes: 0.15/100 000 (p = 0.00000). Medical examination of all elderly persons has to be done before starting of recreational physical activity: by clinical examination, searching for risk factors for atherosclerosis, performing ECG at rest, stress ECG, and echocardiography and to repeat the medical examination at least once a year Physical activity should start with a warm-up period and with a gradually increasing load, and usually not to exceed 6-7 metabolic equivalents (METs).

Immunohistochemical detection of early myocardial damage in two sudden deaths due to intentional butane inhalation. Two case reports with review of literature.

The abuse of household and other commercially available products containing volatile organic solvents is underrecognized. Not infrequently intentional butane inhalation results in high morbidity and mortality. A fatal outcome of butane abuse can be caused by asphyxia, cardiac arrhythmia or trauma. The reported number of cases in which death was the consequence of pure butane inhalation is limited, and in most cases a mixture of propellants was involved. This report covers two cases of sudden death due to the sniffing of a cigarette lighter refill containing butane. Autopsy was followed by toxicological, pathohistological and immunohistochemical analysis. Butane gas was confirmed in samples of blood, urine, brain and lungs by the gas chromatography method - "headspace" technique. Histology showed almost identical changes in the lungs and heart in both cases. The morphology of heart damage on standard H/E stains was of special interest because it displayed all the characteristics of chronic and acute myocardial hypoxia found in the absence of atherosclerotic heart disease. In order to confirm early cardiac death caused by asphyxia due to butane inhalation a panel of immunohistochemical agents was used: Myoglobin, Desmin, Fibronectin, Fibrinogen and CC9.

Hypertrophic cardiomyopathy and sudden cardiac death due to physical exercise in Croatia in a 27-year period.

The paper deals with the sudden cardiac death during physical exercise in males in Croatia. The data are a part of a retrospective study dealing with 69 sudden death due to physical activity in men in Croatia during 27 years: from January 1, 1984 to December 31, 2010. Three of them suddenly died during training and two of them died during recreational physical exercise, probably because of malignant ventricular arrhythmia due to hyperthrophic cardiomyopathy. One had an obstructive form of hypertrophic cardiomyopathy with i.v. septum of 40 mm and four had a non-obstructive forms of hyperthrophic cardiomyopathy with left ventricular wall of 18-20-22-25 mm. First athlete was a short trails runner, aged 24, with no any previous physical discomforts, who suddenly collapsed and died during training. The second athlete was a soccer player aged 18, with no any previous physical discomfort, who suddenly collapsed and died during training. The third aged 15, was a school boy, basketball player, with no any previous physical discomfort, who collapsed and died during training. Two aged 25 and 34, were with no physical discomfort during exercise and died suddenly during recreational soccer games. A sudden cardiac death due to physical exercise in young athletes in Croatia suffered of hyperthropic cardiomyopathy reached 0.06/100 000 yearly (p = 0.00000) in 27 years, in teenagers 0.26/100 000 (p = 0.00226), in teenagers suffered of hypertrophic cardiomyopathy reached 0.10/100 000 (p = 0.00000), in all young athletes suffered of other heart diseases reached 0.19/100 000 (p = 0.00005), and in the total male population aged 15 or more, engaged in sports and recreational physical exercise: 0.71/100.0000 (p = 0.00001).

Physical exercise and cardiac death due to pneumonia in male teenagers.

From 1998 to 2008 we noticed 3 cardiac deaths in male teenagers aged 18-19 during or after physical exercise. The first was working at the site recreatively, the second was engaged in soccer recreatively and the third was professional soccer player. One felt general tiredness and was exhausted of a heavily physical effort, the other after physical exercise became septic and the third was without symptoms. One died suddenly during physical exercise at the field and two died in the hospital. At the forensic autopsy the first had bilateral bacterial pneumonia, possible high-altitude non-cardiogenic pulmonary edema and cerebral edema. The second had bilateral bacterial pneumonia, adult respiratory distress syndrome, disseminated intravascular coagulation, suprarenal bleeding, cerebral edema, hypoplastic right coronary artery and myocardial fibrosis. The third had bilateral bacterial pneumonia, fibrinous pericarditis, cerebral contusion with edema, thickenning of the left ventricle 20 mm and hypoplastic ascending aorta. In Croatia the death rate among athletes reached 0.15/ 100,000, in athletes suffered of acute pneumonia 0.28/ 100,000, in others who practice exercise recreatively 0.57/ 100,000 (p = 0.0068), in all males who practice exercise recreatively 0.75/ 100,000 (p = 0.0014). Physical exercise is contraindicated in acute respiratory tract infections. Every such case has to be treated by physician. When to start with physical training after bacterial pneumonia depends on disappearing of clinical and X-ray signs of pneumonia, normalization of erythrocite sedimentation rate and of white cell count.

Myopericarditis and sudden cardiac death due to physical exercise in male athletes.

In the period 1998-, we registered four sudden and unexpected cardiac deaths in male athletes due to myopericarditis during or after physical exercise. Three of them were professional soccer players and the fourth was engaged in swimming. One aged 29, had symptoms of tiredness, heart enlargement and left ventricular premature beats during training. Three of them, aged 17-18-18, were without symptoms. Three died during training and the fourth died in the hospital after head trauma at training. In the first one, aged 29, forensic autopsy showed chronic myopericarditis, thickening of the left ventricular wall of 15 mm and enlargement of the whole heart. The second one, aged 17, had subacute diffuse myopericarditis, suppurative tonsillitis and narrowed ascending aorta. The third, aged 18, had chronic myopericarditis and cardiac aneurysm of the left ventricle. The fourth, aged 18, had fibrinous pericarditis, thickening of the left ventricle 20 mm, hypoplastic ascending aorta, bilateral bronchopneumonia and cerebral contusion with edema. In Croatia, death rate among athletes, including all its causes, reached 0.15/100,000, in athletes suffering from myopericarditis it was 0.34/100,000, in others who practice exercise recreatively it amounted to 0.57/100,000 (p=0.0068), and in all males who practice exercise it measured 0.75/100,000 (p=0.0014). Physical exercise has to be contraindicated in cases of myopericarditis for at least six months from the onset of the illness.

Prediction of stature based on radiographic measurements of cadaver long bones: a study of the Croatian population.

We tested a new approach to the stature prediction that could be used in the identification process of human skeletal remains of unknown identity. The stature of 19 female and 21 male adult cadavers was measured within 24 h after death and considered to be equal to the living stature. The antero-posterior radiographs of all limbs were taken, and the maximum length of the six long bones was measured from radiographs. There was a significant difference in the stature and maximum length of long bones between female and male cadavers (p<0.001 for all). The correlation between the stature and long bone length was the best for the humerus in females (r=0.792) and the tibia in males (r=0.891). Regression equations specific to the Croatian population were computed separately for each long bone in males and females and proven to be reliable in predicting the living stature of the individual.

Variability of the tryptophan hydroxylase gene: study in victims of violent suicide.

Tryptophan hydroxylase (TPH), the enzyme controlling serotonin synthesis, is considered to be a potential contributor to the biological substrate of suicide. The association of the promoter (-7065CT) and intron 7 (218AC) polymorphisms, and the related haplotype, of the Tph1 gene with suicidal behavior was investigated in a sample of 160 victims of violent suicide and 284 healthy controls. All individuals were males of Croatian (Slavic) origin. Allele frequencies of both polymorphisms in Croatian controls were similar to control values reported for other European populations. Alleles at the two loci demonstrated highly significant linkage disequilibrium. No differences between controls and victims for the Tph1 genetic variation, either at single loci, or at a haplotypic level, were demonstrated, albeit there was a tendency, not reaching statistical significance, towards an increase of the intron 7CC genotype in the suicide group. Negative association results on the individual Tph1 loci, in accordance with the majority of previous reports, confirmed the lack of their major effect also in the Slavic ethnicity. Haplotypic results, on the other hand, opposing the previous positive finding, point to the possible influence of ethnicity (or gender) on the association between the Tph1 gene polymorphism and suicide.

Serotonin 1B (5HT-1B) receptor polymorphism (G861C) in suicide victims: association studies in German and Slavic population.

Serotonergic dysfunction is believed to be involved in the susceptibility to suicide due to functional alternations in the serotonin-related genes. Serotonin 1B (5HT-1B) receptor mediates aggressive behavior in mice models and was proposed to be involved in the control of aggression and impulsivity in humans. In this study we have investigated the association of G861C polymorphism of the 5HT-1B receptor gene with suicide commitment. Study was based on two independent samples, one of German (245 suicide victims vs. 248 controls) and the other of Slavic/Croatian (118 suicide victims vs. 192 controls) ethnicity. No significant differences in allele or genotype frequencies between victims and controls were demonstrated either in German or Croatian sample. There were no differences in allele frequencies between German and Croatian population, and the combined sample, having high statistical power, also did not demonstrate significant differences between victims and controls. Results provide evidence that the investigated 5HT-1B receptor gene variants are not implicated in the susceptibility to suicide.

Acute cardiovascular complications due to physical exercise in male teenagers.

Five sudden cardiac deaths in male adolescents (age 14-18 years) were detected in a 5-year period in Croatia. Two of them had been engaged in physical exercise at school, one as a professional soccer player, one in recreational swimming, and the fifth had just finished secondary school and was working at the site. All of them were autopsied and in three congenital cardiovascular diseases was found. Two had hypoplastic coronary arteries. The third had hypertrophic cardiomyopathy with interventricular wall of 40 mm. The fourth had normal heart findings including coronaries, but had bilateral pneumonia with a possible altitude (non-cardiogenic) pulmonary edema. The fifth had a chronic myopericarditis with an aneurysm of the left ventricle. All of them had not reported definite symptoms at exertion. According to this data, the death rate in adolescent males in Croatia during or after recreational physical exercise was 1/100,000 per year or 5/500,000 in five years. Thorough preparticipation medical examination including indicated laboratory tests and avoidance of heavy exertion at the time of respiratory infection might have helped to avoid some of the lethal events.

Discriminant function sexing of fragmentary and complete femora: standards for contemporary Croatia.

Determining sex is one of the first and most important steps in identifying decomposed corpses or skeletal remains. Previous studies have demonstrated that populations differ from each other in size and proportion and that these differences can affect metric assessment of sex. This paper establishes standards for determining sex from fragmentary and complete femurs in a modern Croatian population. The sample is composed of 195 femora (104 male and 91 female) from positively identified victims of the 1991 War in Croatia. Six discriminant functions were generated. one using seven variables, three using two variables, and two employing one variable. Results show that complete femora can be sexed with 94.4% accuracy. The same overall accuracy, with slight differences in male/female accuracy, was achieved using a combination of two variables defining the epiphyses, and with the variable maximum diameter of the femoral head.