Cardiac death 25 years after successful treatment for Hodgkin's disease—Case report

In the following case, the authors are discussing a connection between treating Hodgkin's disease in childhood and later sudden cardiac death of the patient at the age of 37. Examined expert literature describes injuries of the myocardium because of therapeutic irradiation in the childhood.     

Expert examination and assessment of state under the influence of psychoactive substances

An expert examination is a medical examination performed by a doctor on the order of a police officer or investigating judge. It includes a clinical examination of the subject, collection of samples for toxicological analysis, and the doctor's assessment of whether the subject is under the influence of psychoactive substances. The doctor requires expert knowledge, skill, experience and sufficient time to successfully perform the examination. Since the accurate assessment of the effects of psychoactive substances present depends on a comprehensive evaluation of toxicological test results, the calculation of results at the time of the event and the results of the medical examination, an unprofessionally performed examination can have far-reaching consequences, primarily legal in nature.     

The Communist Ideological Legacy and Serb–Albanian Relations in Kosovo∗

This article uses Central Asian examples to challenge theories of ethnic nationalism that locate its origins in intellectual activism (Hroch), state modernization processes (Gellner), or the rise of mass media (Anderson). Modern Uyghur cultural politics and traditional Central Asian dynastic genealogies reveal related processes used in constructing modern nationalist symbols and pre-modern ideologies of descent. Modern territorial states with ideals of social unification and bureaucratic organization rely upon nationalist discourses to elaborate and rework cultural forms into evidence for the ethnic nation. The state links citizens to institutions through nationalist content used in political discourse, schooling, and public performances. Because such content is presented as authentic but used instrumentally, its contingency and fabrication have to be concealed from view: the culturally intimate spaces of bureaucratic production of culture and narratives are separated from public performances. The creation of genealogies used to legitimate pre-modern states are similar: compositional processes and goals are kept offstage, and little is disclosed in the public historical narratives and performances.     

Post-mortem blood alcohol concentration of the traffic accident victims and changes in DUI legislation in Slovenia 1980–2006

This study aims to contribute to the analysis of the impact of alcohol consumption on road traffic safety in Slovenia and to evaluate the effectiveness of the changes in road traffic safety legislation concerning this issue within the period 1980–2006. For this purpose we have performed a retrospective analysis of 1913 autopsy reports on traffic casualties, with an emphasis on their blood alcohol concentration (BAC), mode of participation in traffic (drivers, pedestrians, etc.) and the impact of legislation changes. In addition, we have analysed the relations between BAC, the time and day of death and the gender of victims. Changes in the legislation were made in 1981, 1985, 1988, 1989, 1990, 1998 and 2005, yet only those made in 1981, 1990 and 1998 resulted in the increase of the actual fines. Within the observed period there was a substantial reduction in the average BAC in almost all of the categories of traffic participants (pedestrians: from 1.20 to 0.73; passengers: from 1.08 to 0.56; cyclists: from 1.11 to 0.56; motorcyclists: from 0.68 to 0.33) except in the category of drivers (negligible reduction from 0.81 to 0.76). Insufficient improvement in the latter category is extremely important, because many sober vulnerable traffic participants become victims of drunk drivers. Further concern arises from the finding that heavily drinking drivers are not responsive to penalty increases. We came to the conclusion that, in addition to raising fines and expanding penalty points, the introduction and effective enforcement of complex legislative measures together with wide community action are necessary to resolve DUI problems in Slovenia.     

Diagnostic value of post-mortem examination of the cardiac conduction system

Introduction (Aim)

Sudden unexplained death (SUD) is a common problem in forensic pathology. In many of these cases, the autopsy findings, toxicological examinations and patient history are inconclusive. Many studies suggest that in such cases, the cardiac conduction system (CCS) should be histologically examined. We decided to determine the diagnostic value of histological examination of the CCS.

Methods

We reviewed autopsy files from the period 2005–2007 and selected those cases in which the CCS had been sampled. These were divided into two groups, the first comprising cases with an obvious cardiac pathology (e.g. severe coronary disease, myocardial infarction, significant myocardial hypertrophy/dilatation, valvular disease, etc.) and the second comprising cases without obvious cardiac pathology (i.e. fatal injuries, intoxications and deaths unexplainable by routine procedures). The CCS was sampled according to a detailed protocol and examined under a light microscope. On the basis of the findings of histological examination of CCS, we formed subgroups of the aforementioned main groups.

Results

We analyzed 118 cases, of which 83 were males and 35 females. In 57% of cases, autopsy revealed gross pathological abnormalities of the heart. In 10 (15%) of them, examination of the CCS showed significant pathological changes (narrowing of the nodal artery and its branches, moderate to severe interstitial fibrosis, calcifications in the central fibrous body impinging upon CCS). In some, especially those with no acute findings, CCS disease can be considered to have been the cause of fatal arrhythmias. In 43% of cases, autopsy revealed no gross abnormalities of the heart, while histological examination of the CCS disclosed significant pathological changes in 4 (8%). Among them, CCS disease was regarded as the cause of death in one case and as a possible cause in another case.

Conclusion

As with other similar studies, our study showed that examination of the CCS can provide valuable information on the cause of death. We therefore consider that examination of the CCS should be performed in all SUD cases, especially those in which the cause of death cannot be established by routine procedures. Although we had only 1 confirmed cause of death linked to CCS disease and one possible, we had 14 cases with significant pathological CCS changes. This leads us to the conclusion that post-mortem examination of the CCS is of diagnostic value.     

Viability of Human Articular Chondrocytes Harvested Postmortem: Changes with Time and Temperature of In Vitro Culture Conditions

Different studies of long‐term chondrocytes viability have shown a gradual reduction as a function of time and ambient temperature. The aim of our in vitro study was to establish chondrocyte postmortem viability curves for 4°C, 11°C, 23°C, 35°C during 63 days after the donors' death. Osteochondral cylinders were procured from the knees of 16 male donors (20–47 years), stored in preservation media that was not changed, and analyzed in 3‐day intervals using a confocal laser scanning microscope. A significant influence of time on viability was found from Day 9 (p = 0.0029) and onwards (p < 0.0001). The lowest overall chondrocyte viability was at 35°C, followed by 4°C (p < 0.0001). The conditions used in this in vitro analysis suggest that similar viabilities may occur while in situ in the decedent. Further studies of chondrocyte viability from individuals with known postmortem intervals may show premise to help evaluate time since death in the late postmortem interval.     

Maternal mortality in Slovenia: Case report and the method of identifying pregnancy-associated deaths

We report on the case of fatal intracerebral haemorrhage that followed the development of severe preeclampsia/eclampsia with haemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome in a 22-year-old primipara. Peculiarities of the reported case are abrupt onset of preeclampsia/eclampsia during the delivery, fulminant course of the disease, minimal changes in kidneys and signs of pre-existing accelerated arteriosclerosis. Since very few forensic pathologists have sufficient experience with such cases and the differential diagnosis may be difficult, we consider it necessary that in all maternal deaths the post-mortem examination is performed by a team of two forensic pathologists and the case further analysed in collaboration with expert obstetrician.Maternal deaths are rare in developed countries but extremely important, because they represent the “tip of the iceberg” of severe maternal and neonatal morbidity and because they reflect accessibility and quality of prenatal and obstetric care as well as the health status of reproductive-aged women. Unfortunately, they are often misclassified in death certificates which may lead to insufficient engagement in solving underlying problems. In Slovenia, the method of active search for pregnancy-associated deaths is used in order to enable accurate monitoring of maternal mortality and minimise underreporting. The method is based on the manual revision of death certificates and the computer-based linkage of Mortality Database with birth register and foetal deaths register and has proved to be highly efficient.     

The Optimal Combination of Cartilage Source and Apparatus for Long‐Term In Vitro Chondrocyte Viability Analysis

Abstract: Most studies of long‐term chondrocytes survival were for tissue banks. They showed a gradual reduction in the viable chondrocytes percentage as a function of time and ambient temperature, but the samples were harvested under optimal conditions. The aim of our study was to determine the most reliable combination of cartilage source and assay for the in vitro postmortem chondrocyte viability analysis in the conditions that imitate a dead body. Osteochondral cylinders were procured from femoral condyles and talar trochleas of three male donors and stored in the cell culture media at 4 ± 2°C and 23 ± 2°C. The samples were analyzed by a cell viability analyzer and a confocal laser scanning microscope (CLSM) initially 24–36 h after death and then in 4‐week intervals. The results reconfirmed the significant influence of time (p = 0.0002), but not of the temperature (p = 0.237). The largest reproducibility was presented for the knee joint and the CLSM.