Medicamentous thrombolysis disguises pulmonary thromboembolism as a cause of death.

We report the case of a 31-year-old female who was admitted to the emergency department with symptoms of cardiac arrest and ultimately died in spite of enormous resuscitation efforts. During resuscitation, pulmonary embolism was considered as a possible non-cardiac cause of cardiac arrest, and following its extremely unfavorable prognosis, the fatal outcome was not so surprising. However, since acute pulmonary emboli obstructing blood flow to a lobe or multiple lung segments was suspected, alteplase was indicated and administered. At the autopsy, no venous thrombosis in the vena cava, pelvic veins, or any of the lower extremity veins was documented; conversely, nor were specific signs of pulmonary thromboembolism (PTE) found macroscopically, until this was confirmed by histopathological staining which is not used as a routine diagnostic tool in forensic medicine. In this study, we conclude that PTE is generally overlooked as the principal diagnosis and the cause of death. Rightful postmortem diagnosis could lead to increased vigilance and a change in management in many of such cases, which could result in improved survival. Motivated by providing better awareness of PTE, this study aimed to illustrate unrecognized PTE and pathological findings that were masked by thrombolytic drugs.

Suicide and the war in Croatia.

Analyzing data from the Institute of Forensic Medicine (IFM) in Rijeka, a total of 853 suicides were recorded in a 15 years period (1986-2000). Quantitative and qualitative features of suicides were analyzed in three intervals: pre-wartime, wartime and post-wartime. In the wartime period (1991-1995), the suicide rate increased by 20.9% in comparison with the pre-war period. In the post-wartime period, the suicide rate dropped by 26.2% in comparison with the war period. The results show a significant increase in suicide rates in the wartime. During the wartime period, a large number of suicide victims under the age of forty increased-45.3% in comparison with the pre-war period and 56.6% in comparison with the post-war period. The use of firearms as a means of committing suicide quadrupled during the war in comparison with the pre-war period. The level of alcohol intoxication of perpetrators at the moment of suicide significantly increased in the wartime period. War had a direct impact on quantitative and qualitative characteristics of suicides in Croatia.

Primary non-Hodgkin lymphoma of the humerus following traumatic injury: case report.

A case of primary non-Hodgkin lymphoma of the right humerus which occurred in a 21-year-old male patient after an impact to the right shoulder in a car accident in July 1983 is described. Seventeen years after the injury, due to a civil lawsuit, the biopsy material was revised. Immunohistochemical analysis showed CD20 and CD79a positivity on large pleomorphic cells, while small reactive lymphocytes were CD3, Bcl-2 and CD20 positive. Molecular analysis carried out with PCR revealed a monoclonal B-lymphocyte population. The diagnosis of diffuse large peripheral B cell lymphoma of the bone was confirmed. The present case concurs with the literature on primary bone lymphoma, in which the diagnostic problem, trauma-related presentation and an excellent prognosis of malignant tumour are emphasized.