Sudden cardiac death due to physical exercise in male competitive athletes. A report of six cases.

In the period of 30 years, i.e. from 1973 to 2002, we noticed in Croatia 6 sudden and unexpected cardiac deaths in male athletes during or after training. Two were soccer players, 2 athletic runners, one was a rugby player and one was a basketball player. All of them were without cardiovascular symptoms. At the forensic autopsy, the first athlete, aged 29, had chronic myocarditis and thickened left ventricular wall of 15 mm. The second, aged 21, had an acute myocardial infarction of the posterior wall with normal coronaries and thickened left ventricular wall of 15 mm. The third aged 17, had hypoplastic right coronary artery and narrowed ascending aorta, suppurant tonsillitis and subacute myocarditis. Two athletes, aged 29 and 15, had hypertrophic cardiomyopathy and normal coronaries, and one dilated aorta. The sixth, aged 24, had arrhythmogenic cardiomyopathy of the right ventricle. All the 6 athletes died suddenly, obviously because of malignant ventricular arrhythmias. In Croatia the death rate among athletes reached 0.15/100 000, in others who practice exercise reached 0.74/100,000 and the difference is highly significant (c2=14.487, Poisson rates=3.81, P=0.00014) and in physicians-specialists reached 33.6/100,000. Preventive medical examinations are essential, especially in athletes before physical exercise, as are other investigations in every case suspicious of heart disease, including electrocardiogram (ECG), stress ECG, echocardiography and stress-echocardiography and other findings if indicated. Physical exercise is contraindicated in acute respiratory infection: in 2 of those cases had been a cause of death as a trigger.

Intronic polymorphism of tryptophan hydroxylase and serotonin transporter: indication for combined effect in predisposition to suicide.

Indices of disturbed serotonergic neurotransmission are the most robust biological findings in suicide. Tryptophan hydroxylase (TPH) and 5-hydroxytryptamine transporter (5HTt) are the main regulators of 5HT signaling. Owing to the assumed functionality of intronic polymorphisms of TPH (218AC) and 5HTt (VNTR-2) genes, we investigated frequencies of concurrence of the TPH and 5HTt genotypes containing "lower activity" alleles (CC and 1010, respectively), in 192 suicide victims and 377 controls. Significant differences in frequencies of 5HTt and TPH genotype combinations were found between suicide victims and control subjects (p = 0.0156), with a clear dose-effect of the suspected ("lower activity") genotypes (p = 0.0046). Concurrent presence of the two, allegedly transcriptionally less active, variants of these genes seems to be in some kind of relation to the increased susceptibility to suicide.

Allele frequencies of the 15 AmpF lSTR Identifiler loci in the population of Vojvodina Province, Serbia and Montenegro.

The 15 AmpF lSTR Identifiler loci (D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, VWA, TPOX, D18S51, D5S818 and FGA) were analyzed in the sample of 100 unrelated, autochthonous healthy adult Serbians from Novi Sad (Vojvodina Province, Serbia and Montenegro). The agreement with HWE was confirmed for all loci with the exception of D7S820 (based on the chi2-test only). The combined power of discrimination (PD) and the combined power of exclusion (PE) for the 15 tested STR loci were 0.99999999999999995 and 0.9999990, respectively. According to the presented data, D2S1338 and D18S51 are the most informative markers. Based on allelic frequencies and statistical parameters for forensic testing, it may be suggested that the AmpF lSTR Identifiler detection system represents a powerful strategy for individual identification and parentage analysis in the Serbian population.

Bosnian population data for the 15 STR loci in the Power Plex 16 kit.

The PowerPlex 16 amplification kit was used for the analysis of allele frequencies for the 15 STR loci (D3S1358, TH01, D21S11, D18S51, Penta E, D5S818, D13S317, D7S820, D16S539, CSF1PO, Penta D, VWA, D8S1179, TPOX and FGA) in unrelated, autochthonous healthy adults from Bosnia ( n=123 for TH01, Penta E, D16S539, CSF1PO, Penta D and TPOX, n=210 for D3S1358, D21S11, D18S51, D5S818, D13S317, D7S820, VWA, D8S1179 and FGA). The agreement with HWE was confirmed for all loci with the exception of Penta D (based on the chi(2)-test only). The combined power of discrimination (PD) and the combined power of exclusion (PE) for the 15 studied loci were 0.999999999999999997 and 0.999999, respectively.

Population genetics of the 15 AmpF lSTR Identifiler loci in Kosovo Albanians.

The 15 AmpF lSTR Identifiler loci (D8S1179, D21S11, D7S820, CSF1PO, D3S1358, THO1, D13S317, D16S539, D2S1338, D19S433, VWA, TPOX, D18S51, D5S818 and FGA) were analyzed in a sample of 136 unrelated Albanian adults from Kosovo. The agreement with HWE was confirmed for all loci with the exception of TPOX (based on the exact test only). The combined power of discrimination (PD) and the combined power of exclusion (PE) for the 15 studied loci were 0.99999999999999997 and 0.9999995, respectively. According to the presented data, FGA proved to be the most informative marker. An interpopulation comparison between Kosovo Albanians and Croatians (as an example of a population from the Balkans) revealed significant differences in four out of nine loci.

Sudden death due to physical exercise in the elderly.

Physical exercise has a beneficial effect to the humans. Sudden death in healthy persons engaged in physical exercise is extremely rare since healthy heart is protected from complications. The records of five elderly men who died during or immediately after exercise in the period between 1988-2001 in our region have been given, out of 23 men (and no one woman) aged 14-68 who died due to physical exercise in that time. They have been engaged in tennis, jogging and swimming recreatively. In all of them coronary heart disease has been found by the forensic autopsy. Only one has had arterial hypertension, symptoms of chest pain few years before accident and acute myocardial infarction has been found. The other four have been without symptoms. In three of them myocardial scars have been found of past myocardial infarctions. In all of them the thickness of the left ventricle wall was 15 mm or more (from 15 to 25 mm). It seems that the thickness of the wall of the left ventricle increases cardiovascular risk in persons without symptoms. In Croatia about 7% of the whole population are engaged in recreation. In this population 13% are elderly: 40,950. The reported five deaths due to recreational physical exercise in the elderly reached 1/114,660 persons every three years, or 1/573,300 persons during fourteen years.

Sudden death due to recreational exercise in physicians.

In a period from 1982-2002 we noticed five dead among Croatian male physicians aged 34 to 67, during or after recreational physical exercise: swimming, soccer, tennis and jogging. Three of them who were autopsied, have been non-smokers and without previous symptoms. In all coronary heart disease was found. The left descending anterior artery was stenotic in one and occluded in two, with myocardial scars in one. An acute myocardial infarction was found in none of them, and in two-left ventricular hypertrophy 15 and 18 mm. We could not find a recent medical record in those physicians including a clinical finding and other findings. Two physicians who were not been autopsied, had possible an alcohol cardiomyopathy. Both of them were smokers. In Croatia about 7% of the whole population are engaged in recreational physical exercise. In a period of twenty years (1982-2002) we noticed 43 sudden and unexpected deaths during or immediately after physical exercise: it reached 43/6,300,000 sudden death in Croatia in twenty years or 2.15/315,000 yearly among persons engaged in physical exercise. In Croatia there are 4,957 male physicians-specialists, and a rate of sudden cardiac death during or immediately after physical exercise in this group reached 5/99,140 in 20 years or 1/19,828 every four years. A medical check up before recreational physical exercise is essential including a clinical examination, a serum concentration of risk factors and other risk factors, an electrocardiogram at rest, a stress test and echocardiography in clinical indication, as are medical controls over persons taking exercise. This study shows that medical evaluation is important because of the underlying problems such as sudden death during exercise. In non-trained persons and in the elderly a physical exercise should be recommended of a gradually intensity, which could not exceed 6 METs.

Dental identification of war victims from Petrinja in Croatia.

In this paper the authors report their experiences and problems encountered in the identification of war victims from Petrinja in Croatia. Soon after Croatian forces regained Petrinja in 1995, four mass graves were discovered from which the bodies of 46 civilians, 38 males and 8 females, were recovered. Identification of the victims was performed at the Department of Forensic Medicine and Criminology at the School of Medicine in Zagreb. A forensic odonto-stomatologist from the Department of Dental Anthropology of the School of Dental Medicine at the University of Zagreb participated in the identification process by carrying out dental identifications. A total of 27 victims (59%) were identified, while 19 (41%) are at present still unidentified. Identification by supportive and anthropological evidence (e.g. sex, age, height, personal documents, dress, jewellery) was achieved in 43% of cases, while identification based only on dental records was achieved in 16%. The most useful dental characteristics for the purpose of identification were fixed and removable prosthetic appliances for oral rehabilitation. The reason for the low number of dental identifications was the lack of antemortem dental data which could be compared with postmortem dental records.

Identification of war victims in Croatia.

The intention of this paper is to describe the organizational principles and indicate the results already achieved in the identification of war victims in Croatia. By 25 February 1993, 6,493 victims had been identified. A model is proposed that could be used in the course of identification processes, examining the methods and principles of identification which have been complicated by the time interval of more than a year from the time of death, for a presumed number of several thousand (up to 14,000) unidentified victims, possibly in mass graves. Identification is further complicated by the lack of ante-mortem medical and dental records and the incapacity to utilize more expensive methods of identification. Attention is drawn to a group of more complex cases examined at the Institute of Forensic Medicine and Criminology.

Fatal poisonings in the city of Zagreb.

The paper deals with the results of analysis of fatal poisonings in the city of Zagreb from 1981 to 1990. The work is an extension of earlier analyses for the same area that were carried out from the foundation of the Department for Forensic Medicine and Criminology, School of Medicine, University of Zagreb in 1934 to 1967, and from 1968 to 1980. Comparative analysis of all data shows that despite the increasing rate of poisoning the number of cases of fatal poisoning has been steadily diminishing--from 11 cases per 100,000 population in the 1934-1967 period and eight cases between 1968 and 1980 to five cases in the latest period 1981-1990.

Analysis of projectile destructive effect in missile injury to the brain.

During the war in Croatia so far, more than 250 casualties having missile wounds of the brain, spinal chord and peripheral nervous system were admitted to the Neurosurgical Clinic, University Hospital-Rebro. These injuries were mainly caused by low-velocity missiles. However, the high-velocity ones, used nowadays, in direct injury to the head, cause destruction of the brain that is incompatible with survival in most of the cases. This paper deals with a patient injured by a 7.62 mm projectile. The mechanism of the brain destruction is not completely clear since the missile was found at the very entrance of the missile wound, while the brain was destroyed up to the opposite side of the endocranium. Four mechanisms of the missile's effect aimed at explaining the cause of death of the patient, as well as the bizarre position of the missile, were taken into consideration. The review shows how perilous a wound from a direct missile injury to the head could be, regardless of its speed.

Holographic analysis of the human pelvis.

Twelve fresh human pelves with preserved lumbar spines, hip joints, and ligaments, were tested by double-exposure and sandwich-hologram interferometry. During physiologic loadings (50-300 N), the pelvis moved as a whole downward and backward. Iliac wings exhibited marked undulation, except for the central part, which showed minor deformations. The sacrum moved downward and rotated forward over an axis 5-9 cm below the promontorium. Removal of the sacroiliac interosseous ligaments eliminated all joint movements and caused a tighter contact between articular surfaces. Removal of the sacrotuberous and sacrospinous ligaments had no influence on the pelvic behavior. The magnitudes of deformations as well as their underlying mineral contents were unequally distributed between the two pelvic sides. These results indicate that the sacroiliac interosseous ligaments are the main determinant of sacral movement. Asymmetric load transmittance to the hip joints might be responsible for the mineral content differences between the pelvic sides.

Acetylcholinesterase in the human frontal associative cortex during the period of cognitive development: early laminar shifts and late innervation of pyramidal neurons.

Laminar preferences in fibrillar acetylcholinesterase (AChE) staining change dramatically in the human frontal cortex during the first postnatal year and perikaryal reactivity is found only in non-pyramidal neurons. The AChE reactivity of layer III pyramidal cell bodies and surrounding fibrillar network begins to develop after the first postnatal year, increases gradually and reaches its peak intensity in young adults, displaying a cluster-like arrangement. These data suggest that AChE-rich elements participate in the innervation of cortical associative neurons and layers during the cognitive development in man.