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.

Corticosteroids provoke acute endothelial injury -- an ideal ground for thrombosis in multiple sclerosis.

Despite the effect corticosteroids exert on blood clotting and the irrefutable impact of intracranial sure decreasing shortly after lumbar puncture, a certain number of intracranial thromboses remain unexplained. Corticosteroids are useful in reducing the severity and duration of relapses of multiple sclerosis. Several questions emerge concerning the reasons behind thrombosis occurring so sporadically, not pertaining to any rule, the most important of which regard the location and timing. We developed this hypothesis as an obverse to chronic endothelial injury theory which, only partially explains atherosclerosis development. We followed Virchows classical triad of conditions which are believed to be connected to the development of thrombosis. Although corticosteroids affect more than vessel wall injury, component of Virchows triad that has been our narrowest interest is exactly vessel wall injury.

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.

Accidental plant poisoning with Colchicum autumnale: report of two cases.

Colchicine poisoning is a rare but serious and potentially fatal event, which results from food poisoning or overdose with drugs containing colchicine, with no currently available antidote. We report two cases of plant poisoning with Colchicum autumnale, in which the patients had identical initial symptoms but developed extremely different clinical courses. One patient recovered after only moderate gastroenteritis and liver injury, whereas the other died of rapid progressive multiple organ failure 52 h after the plant ingestion. We recommend that all patients suspected of colchicine intoxication due to its unpredictable outcome should be managed according to the principles of intensive care, irrespective of the actual degree of poisoning.

Diving-related fatalities caused by underwater explosions: a report of two cases.

The authors report two cases of diving-related water blast with fatal outcome resulting from nearby underwater explosions. Water blast with fatal outcome almost exclusively occurs in wars at sea. Underwater explosions are extremely rare in diving because of the limited exposure. Forensic findings in both cases reported included expected injuries to gas-filled organs such as the middle ear, lungs, and intestine; some rarely described injuries such as rupture of the liver, spleen, and kidneys; and also some lesions that were not found in a search of the literature: rupture of the heart and contusion of the hypophysis. Injuries caused by fatal underwater explosions should be carefully evaluated in forensic medicine to provide data that may support a criminal investigation.

Treatment of supracondylar humerus fractures in children: minimal possible duration of immobilization.

In the period from January 1980 until December 1990 we treated 147 children and adolescents with supracondylar humerus fracture, and followed the outcome in 127 of them. Three (2.4%) patients had no displacement of fractured bones and were treated only with plaster cast immobilization. Twenty three (18.1%) underwent closed reduction of fragments and application of a plaster cast. The majority (97; 76.4%) required manual reduction and the fixation of segments with Kirschner's wires laterally and medially. Four (3.1%) patients were treated with open reduction and fixation with Kirschner's wires. Both plaster cast immobilization and fragment fixation with Kirschner's wires lasted only 14 days and were immediately followed by rehabilitation. Such a short immobilization of extremities or fixation offragments did not result in any complication. Of 56 children available for long-term follow-up, we achieved excellent treatment results in 43 (76.6%) of the patients, good and fair in 12 (21.5%), and a poor result in only 1 patient (1.8%). There were no permanent vascular or neurological complications apart from slight weakness of the ulnar nerve in 3 patients. In conclusion 14 days seemed to be the biological minimum of time needed for this type offracture to heal in children and adolescents. Fixation of the fragments with Kirschner's wires and immobilization of the extremity for only 14 days brings a significant reduction of total treatment expenses, avoids repeated x-ray examination, facilitates early physical therapy and returns the child to its family.