PULMONARY EMBOLISM AT AUTOPSY: AN EPIDEMIOLOGICAL ASSESSMENT

Silvestri F, Pavletić N, Bussani R.
Institute of Pathological Anatomy - University of Trieste (Italy)

Pulmonary embolism (PE) is still a serious clinical problem regarding both the high numbers of related deaths and the difficulty in obtaining a correct, early diagnosis. Given the difficulty diagnosing it, the real incidence with regard to the number of people dying with or from PE can be obtained only through accurate studies at necropsy.

Autopsies are carried out at our Institute on more than 90% of hospital deaths in Trieste (around 2800 autopsies per year), therefore significant epidemiological studies can be achieved.

Of 27.410 subjects autopsied in our Institute from 1979 through 19881.984 males /14.6%) and 3.428 females (24.7%) had a PE, with significant frequency increase in the elderly patients. PE was massive in 469 males (23.6%) and 942 females (27.5%). The frequency of PE and pulmonary infarction was nearly 20%a in females and 14% in rnales, with a significant increase of lung infarction in older males.

In 2.902 of the 5.412 cases it was possible to reconstruct with certainty the origin of PE. In 49% of the subjects (1.417 cases) it was in the peripheral vascular district, while in 23.8% (692 cases) there were bone marrow embolism, in 16.6% (484 cases) neoplastic embolisms and in 10.6% (309 cases) embolisms originating in the cardiac chambers.

Among 1983 and 1988, 5576 subjects out of a total of 16.508 autopsies had one or more malignant tumors and/or metastases of these. 818 patients with a malignant neoplasm had suffered PE (12% of males and 19% of females). For both sexes, tumors originating in the pancreas, stomach and ovary were associated with the highest number PE (20% of the subjects affected).

An inversely proportional relation between age of patients with PE and correct clinical diagnosis was noted.

Bussani R, Mannone T, Silvestri E
Institute of Patohological Anatomy - University of Trieste (Italy)

In the period April 1994 - June 1995 five cases of heart rupture without evidence of atheromas or thrombi in the coronary arteries nor acute myocardial infarction have been diagnosed at autopsy at the Institute of Pathological Anatomy of Trieste (four females, mean age: 76 years and one 55-year-old male).

In one case a transmural left ventricular rupture of the anterior paraseptal wall has been evidenced. In the other cases there were multiple intramyocardial and epicardial hemorrhages with focal epicardial erosions.

In all cases a myocarditis was histopathologically proven. Inflammatory infiltrates were of mixed type (T lymphocytes, macrophages, leukocytes, plasmacells, mastcells, and in one case also several eosinophils) and a perivascular and interstitial distribution were predominant.

In two cases cytofluorimetric apoptotic index was higher than 20%, in other two cases the values were higher than 11 but lower than 20, while in one case the index was lower than 10.

Extravasation of red blood cells into the interstitium with separadon of the myocytes was evident in the apical regions (anterior paraseptal) in four cases, and in the basal region of the right ventricle in one case.

Clinical cardiological characteristics were almost aspecific: sinus tachycardia in two patients, right bundle-branch block and atrioventricular block in one subject. All patients presented dyspnoea. One patient had a fatal cardiac arrest in emergency room.

Possible pathogenetic factors of hemorrhagic myocarditis may be: vasculitis of coronary arteries, autoimmune vascular damage, microvascular damage and an inereased capillary permeability with subsequent reduction of delivery of oxygen substrates to the myocardium, vascular spasm, leakage of macromolecules into the interstitium and intramyocardial hemorrhage.

Krušlin B.
"Ljudevit Jurak", department of clinical pathology, University Hospital "Sestre milosrdnice", Zagreb, Vinogradska 29

Apoptosis or programmed cell death is an important phenomenon in the developrnent of the mature vertebrate nervous system. Neurogenesis produces about twice as many neurons in a given structure as survive in the adult organism. There are two types of apoptosis in developing nervous system: morphogenetic cell death and naturally occurring cell death. Morphogenetic cell death occurs during the embryonic phases of the development and participates in the morphological shaping of the brain. The creation of region-specific densities, or distribution of cells, as well as the creations of spaces, channels and holes reflect morphological cell death. For example, morphological cell death occurs during remodeling of the neural tube. Naturally occurring cell death occurs in a relatively late developmental stages, and involves the loss of a significant number of neurons in a given population (20-80%). This type of cell death may be unique to neural tissue. For many types of neurons that exhibit naturally occurring cell death, the regulation of the timing and extent of cell loss is controlled, at least in part, by influences derived form or associated with the synaptic targets of the cells and with afferent inputs. Other factors including neurotrophic agents and hormones might also be related to neuronal death.

Molecular mechanisms of developmental neuronal death are extensively studied, particularly in invertebrates; however, they are poorly studied in the brain of the humans and monkeys.

Ožegović M¹, Talan Hranilović J^{2
1Department of pathology, University hospital "Dubrava" Zagreb and 2"Ljudevit Jurak" department of clinical pathology, University hospital "Sestre milosrdnice' Zagreb '}

Apoptosis is programmed cell death, control mechanism of cell elimination, process with genetic surveillance. It is energy dependent process that can be initiated, inhibited and modified with different exogenic and endogenic factors.

In the recent literature there is small number of information about researches on human material and very small number of information about findings of apoptosis in primary tumors of CNS.

This work is pilot study of research the apoptosis in pilocytic astrocytoma as prototype of primary benign gIioma and in metastatic brain tumors.

It is known that the pilocytic astrocytoma is slowly growing benign glioma (grade I) and we were interested if the control mechanism of the growth of the tumor is in domain of apoptosis.

Bioptic material was analyzed histologically in 30 cases and was treated stereologically in order to determine the volume density of apoptotic cells at this moment.

The results show that apoptotic cells were not found in the group of pilocytic astrocytoma and that the largest volume density of apoptotic cells was in the group of metastatic brain tumor - type adenocarcinoma and smaller one in the group of metastatic brain tumor - type solid carcinoma.

¹Mijić A, ²Ferenčić Ž, ²Belicza M, ¹Fučić-Štefulj A, ¹Radošević S, ¹Bekavac-Bešlin M, ¹Georgijević A.
¹Department of surgery and ²"Ljudevit Jurak" department of clinical pathology, University hospital "Sestre milosrdnice"

We have analysed the occurrence of apoptotic cells in formalin-fixed paraffin-embedded human healthy gastric mucosa, polyps and carcinoma specimens. Histological classifications were carricd out on hematoxylin and eosin stained slides. The materials were randomly chosen from the files of the "Ljudevit Jurak" Department of Clinical Pathology, University Hospital "Sestre milosrdnice," Zagreb. The materials werc classified into:1. healthy gastric mucosa, 2. adenomatous polyps. Gastric carcinoma specimens wcre histologically classified according to Lauren classification into 3. intestinal adenocarcinoma with mctastasis, 4. intestinal adenocarcinoma without metastasis, 5. mixed adenocarcinoma with metastasis, 6. mixed adenocarcinoma without metastasis, 7. diffuse adenocarcinoma with metastasis and 8. diffuse adenocarcinoma without metastasis.

Counts of apoptotic cells were performed using the 40X objective with a calibrated eye piece Weibels' numerous-purpose M 42 stereological test system. Each group was treated stereologically determining numeric density of apoptotic cells.

Using the SAS/STAT statistical soflware (SAS Institute, Cary, NC) analysis constitutes strong statistical evidence of difference between mean numeric densities of apoptotic cells in the healthy gastric mucosa, polyps and carcinomas.

The results show the progressive and statistically significant increase of numeric densities from normal gastric epithelium to adenomatosus polyp and finally to cancer, which contained the greatest numbers of apoptotic cells, especially intestinal Lauren type.

Duncam Multiple Range Test separated gastric cancer in three statistically different groups according to a numeric density of apoptotic cells: I. intestinal gastric cancer with metastasis (the greatest number), II. intestinal gastric cancer wiihout metastasis and diffuse gastric cancer with metastasis (medium number), III. diffuse gastric cancer without metastasis, mixed gastric cancer with and without me-tastasis (the smallest numbcr of apoptotic cells).

Comparing gastric carcinoma with and without metastasis with T test we found in intestinal and diffuse adenocarcinoma statistically significant difference, P<0.01. In these two groups, carcinomas with metastasis contained greater number of apoptotic cells than without metastasis. The greatest number of apototic cells was found in intestinal adenocarcinoma with metastasis.

In conclusion we confirm resutts that determined apoptosis by light microscopy examination of conventionally H&E stained slides.

Our data show the progressive increase of apoptotic cells in the sequence of the healthy gastric epithelial mucosa > polyp > advanced adenocarcinoma supports thc vicw that apoptotic activity is strongly associated with gastric carcinogenesis.

Apoptotic activity is specifically associated with promotion of intestinaltype gastric adenocarcinoma with metastasis.

Šarčević B, Belicza M.
Department of pathology, Oncological clinic Zagreb and "Ljudevit Jurak" cIinical department of pathology,University hospitaI "Sestre miIosrdnice", Zagreb

We have analysed stereologically a number of apoptotic bodies in two human tumor models. In the first model we have investigated we found the lowest numeric density of apoptotic bodies in the adenomatous polyps of colon, ihe greater density in adenovillous polyps, and ihe greatest density in colon adenocarcinomas, specially in the Dukes B group. These findings suggested a possible role of apoptosis in the carcinogenesis of colon carcinomas.

In the second model we investigated, the numerical and volume density of apoptotic bodies shows the difference in apoptotic celI number among the hormonal dependent and independent tumors. By comparing the cancers of the breast and basaliomas, breast cancers and melanomas, and endometrial carcinomas and melanomas, an important difference was statistically established because in every case (with probability 99%) border value t was P < 0,01. In the group of the breast cancer, the results showed an outstanding dependence of apoptosis on the trophical hormon. This dependence was noticed based on the inerease of apoptatic cell number in the second half of menstrual cycle, and tumors with negative estrogen receptors. In the group of the endometrial carcinoma that are the tumors of the older age,women in postmenopause, when the downfall of the trophical hormon is clearly present, a higher number of apoptotic cells then in the endometral hyperplasias and the skin tumors had been proved.

All these findings are suggesting that a number of tumor apoptotic cells ("apoptotic index") could be eventually a good parameter of tumor growth.

¹Heinzel R, ²Baličević D, ²Belicza M
¹Department of pathology, University hospital "Dubrava', Zagreb and ²"Ljudevit Jurak" department of clinical pathology, University hospital "Sestre milosrdnice", Zagreb

To determine the volume and numeric density of apoptotic bodies in hyperplasias and prostatic carcinomas we have examined all histological slides stereologically using Weibel's test system M 42, at PF of 400X. In our investigation of numeric density of apoptotic bodies in all types of hyperplasias as a group and in prostate carcinomas we have found statistically significant bigger number of apototic bodies in hyperplasias than in welldifferentiated prostate carcinomas G1. This finding implicated our further investigation of apoptotic bodies in different types of hyperplasias of the prostate including atypical hyperplasia and PIN.

Our finding of greater number of apoptotic bodies expressed by numeric and volume density in the postsclerotic and basal cell types of prostate hyperplasias implicates ćhe possible role of prostate stroma in carcinogenesis of prostate carcinoma. Of special interest is big number of apoptotic bodies found in basal cell hyperplasias what implicates possibility of further influence of prostate stroma in the pathogenesis of this type of hyperplasia and possible transformation in prostate carcinoma.

Many previous investigations have suggested that number of apoptotic bodies may be a good parameter of tumor growth. On this point of view our findings of great number of apoptotic bodies in the postsclerotic and the basal cell hyperplasias correlate with the opinion of other investigators who pointed out these two hyperplasias as precancerous conditions. This implicates the hypothesis that carcinogenesis in a prostate is not intraluminar and glandular process only

Veljača M, Glojnarić I, Ševeljević D, Ferenčić Ž
Pliva Research Institute, Biomedical Department, Zagreb, Croatia

The alloxan toxicity concept has been based on its rapid and selective uptake by islet B-cells and their high sensitivity to alloxan formed peroxides.

Since reactive oxygen metabolites have been demonstrated to cause apoptotic cell death,the aim of this study was to investigate weather alloxan causes morphological picture of apoptosis rather than previously described necrosis.

The forty-eight hours after single subcutaneous administration of 150 mg/kg of alloxan monohydrate, female Wistar rats developed severe hyperglycaemia as well as apoptotic B-cell loss. Histological analysis of 4m m thick HE-stained paraffin embedded sections (6 per cach animal) has demonstrated apoptosis,not necrosis of B-cells in alloxan treated animals,an average of 37 islets per animal being counted, with a mean of 0,4 apoptotic cell per islet.Contrary, no apoptotic cells were observed in controls where an average of 53 islets per animal was counted.

The period for which an apoptotic cell,once formed, remains recogniz-able has been estimated as between 4 and 9 hours.Because of relatively short a time, the small increase in the proportion of apoptotic cclls in tissue sections can conceal large rates of cell loss, meaning that 0,4 apoptosis per islet in our study equals a sustained B-cell loss even 48 hours after alloxan administration.

Krvavica A.
Department of pathology, General hospital, Zadar

The author presents a case of carcinosarcoma of the uterus with metastases in the cervix uteri, right ovary and liver in 70 years old patient who was presented with abnormal uterine bleeding. Gross examination of the excised uteri disclosed polypoid tumor measured 6.5x6x3 cm filling the endometrial cavity, involving inner third of thickened myometrium and solid intracervical tumor measured 1.5 cm in mean diameter. The right ovary was enlarged, measuring 14x10x7 cm, on cut surface was partly polycystic containing gelatinous haemorrhagic material, partly solid with areas of necrosis and haemorrhage. Polypoid tumor of the uterine corpus was composed of pleomorphic, poorly differentiated cells, often bizarre and multinuclear with high mitotic count and sarcomatous, homogenous stroma of spindleshaped cells covered with atypical squamous epithelium. Epithelial component of the ovary biphasic tumor was serous and mucinous type of carcinoma. The tumor was analyzed by immuno-histochemical methods and author presents the new views of histogenesis, different from scientific literature.

Lipej Z, Šoštarić B
Croatian Veterinary Institute, Zagreb

The gastric ulcers as pathologic entity among gastrointestinal diseases of swine is showing many epidemiological, pathogenic, morphological and other simiiarities with peptic ulcers in humans. It has to be remembered that swine is the onIy one domesticated rnonogastric omnivorous species with marked anatomical and physiological similarities with humans.

By general understanding, both, in human as welI as in veterinary pathology, the gastric ulcers develop due to unbalanced protection of gastric mucosa and some aggressive action over it. However the exact mechanisms of development and all possible edologic agents remain despite extensive research unknown. In this perspective the recent believe about Helicobacter (Campylobacter) pylori as important etiology agent in pathogenesis of gastric ulcer is triggering a number of investigations, especially in the field of human condition.

During longer period of mortality monitoring in different pig farms, special attention was paid to incidence, age distribution and pathoanatomicaI appearance of gastric ulcers. Based on autopsy findings the incidence of gastric ulcers varies from 2.4% in suckling piglets to 9.7% in fattening pigs. Pathognomonic in their location esophagogastric ulcers were found in 42.6% of alI cases in fattening, while their incidence was much higher, 75.7% in breeding animals more than one year of age. At the time of autopsies over 100 samples of gastric ulcers were collected and studied bacteriologically, with special emphasis to presence of H. pylori, but in no case the organism was isolated. However this results should not be understand as conclusive because many of animals received antibiotic therapy which could inhibit growth of bacteria.

Šoštarić B, Lipej Z
Croatian Veterinary Institute, Zagreb

During the end of June 1995 two yearling ewes delivered from flock counting over 200 animals were admitted to our Institute with diagnostic purposes. Namely, several dozens of animals died during last few months in the flock, and all of hem had a history of progressive respiratory difficulties.

Complete autopsy of both animals was performed, and pertinent samples were studied by histopathological, rnicrobiological and parasitological mean.

In both animals the lungs were markedly enlarged, heavy, and failed to collapse when removed from chest cavity. Scattered throughout the lungs were multiple, uneven sized, grayish areas protruding somewhat over the pleural surface. On the cut surface the masses were seen to be of similar gray-bluish color and were expanding into, and compressing the normal lung tissue in a form of solid circumscribed masses.

Histopathologically the masses were composed of tissue where much of alveolar lumina was obliterated by cellular infiltrates and of formation of large numbers of tubule-like structures in the lung parenchyrna, characterized by folds of multilayered round cells with abundant eosinophilic granular to foamy cytoplasm.

Microbiological and parasitological examinations failed to reveal any causative agent.

Based on presented history and patognomonic morphologic results and supported by negative microbiological and parasitological findings a pulmonary adenomatosis of the sheep was diagnosed.

¹Bratulić M, ¹Grabarević Ž, ²Marinculić A, ¹Čuljak K, ¹Artuković B.
¹Department for general pathology and pathological morphology and ²Department for parasitology, Veterinary faculty University of Zagreb

Because of the high mortality among the sheep and lambs in the Lika region, pathomorphological and histopathological examination, as well as parasitological and biochemical analyses and hematology were performed. Affected animals showed general weakness, specially on the hind legs, anemia and anorexia. Gross examination revealed in most animals' vax dystrophy of heart and skeletal musculature, enlarged subcutaneous lymph nodes, atrophic spleen and general anemia and cachexia. Histopathologically the most prominent findings were wax dystrophy of heart and skeletal muscles and tubulonephrosis. Biochemical analysis of blood samples showed significant inerease of creatin phosphokinase and hematology revealed normo- and macrocytic hypochrome anemia. Parasitological analysis of fecal samples shoved mild to medium invasion with Trichostrongilydae, Trichuridae and Fasciola hepatica and Paraphistomum, and in most animals' skin was invaded with Psoroptes ovis.

Results from pathological examination indicate specific illness caused by absolute or relative deficiency of vitamin E and/or selenium, which is, because of pale brownish discoloration of skeletal musculature, known as "White Muscle Disease'. Extensive damage of musculature caused elevation of kreatin phosphokinaze while anemia was due to decreased erythropoesis and chronic blood loss. As for parasitological data fasciolosis and paramphystomosis probably had some influence on the pathology, but other parasitic invasions were mild and of no significance.

Strahinić T, Jurić-Lekić G, Bulić-Jakuš F
Department of histology and embryology and Department of biology, Medical faculty, University of Zagreb.

9-days old Fischer rat embryos consisting of three germ-layers were cultivated using a modified organ culture method in a chemically defined serum-free medium and grafted under the kidney capsule of isogeneic animals for 14 days to obtain well developed experimental teratomas. The purpose of this experiment was to discover the influence of apotransferrin (human transferrin substantially iron-free) upon differentiation of a wider variety of tissues than those that usually develop in teratoma-like explants after in vitro culture only. Embryos were cultivated in a simple serum and protein-free medium (Eagle's MEM) with transferrin and controls in a serum-supplemented MEM and in pure MEM. In teratomas obtained from embryos previously cultivated with transferrin neural tissue, cartilage, muscles, fat tissue and glands appeared with the similar incidence as in those previously cultivated in pure MEM. On the other hand thyroid glandlike structures differentiated only in grafts previously cultivated in serumsupplemented medium.

It seems that apotransferrin alone enhances overall differentiation process in experimental teratomas obtained from cultivated embryos.

¹Herak-Perković V, ²Grabarević Ž
¹Pliva Investigation Institute and ²Department for general pathology and pathological morphology Veterinary Faculty, University of Zagreb

The aim of this study was to demonstrate the effects of dopaminergic drugs on 2,4-dinitrofluorbenzene (DNFB) 'induced inflammatory bowel disease (BD) in previously sensitized BALB/c mice. The number and extent of ulcerations and erosions, the intensity of hemorrhages, edema, presence of neutrophils and eosinophils, intensity of dynamics of mononuclear cell accumulation within colonic lamina propria and submucosa and giant cells' granulomas were assessed. The 180 BALB/c mice were divided info three groups of 60 animals each. The mice of the first experimental group were treated with domperidone, a peripherial dopamine antagonist. The mice from the second experimental group were treated with bromocriptine, dopamine agonist. The mice from the control group were treated with an equivolume of normal saline in the same manner. Ten animals from each group were sacrificed on days 1,2,3,5,10,20 subsequent to the challenge enema of DNFB solution. Gross and microscopic examinations of the colon were performed. Histopathological scores were statistically evaluated. Application of IBD bromocriptine was observed to induce clinical improvement and a decreased mortality rate 2,/60 (3%), while domperidon application inereased mortality rate to 12/60 (20%). The analysis of the total score of colonic lesions in animals from the experimental and the control groups showed protective effects of bromocriptine on gut mucosa, while domperidone aggravated colonic lesions.

¹Lambaša S, ²Nanković V, ¹Belicza M.
^1"Ljudevit Jurak" department of clinical pathology, University hospital "Sestre milosrdnice" Zagreb and ²Clinic of Traumathology, Zagreb.

During the period from 1993. to 1996. there were 205 biopsy specimens delivered from Clinic of traumathology in Zagreb. Fifteen of them were biopsies from joints and synovia. Among these we have found in 11 cases synovitis, in two cases ganglion, in one case cystis Bakeri and in one case fingeroma. The differential diagnosis of synovitis is discussed.

Ćupić H, Belicza M
"Ljudevit Jurak" department of clinical pathology, University hospital "Sestre milosrdnice", Zagreb

We analysed samples of synovial tissue obtained from joints of lower extremities after amputation because of gangrene secondary to vascular disease. We tried to assess the degree of pathomorphological changes. The samples consisted of synovial tissue from 40 patients after amputation of lower extremities. The rnaterial was fixed in 40% formaline, embedded in paraffin blocks and sections were stained with HE and Mallory trichrome methods and examined by light microscope. These samples were divided in five groups according to the degree of proliferation of lining cells, reactive formation of synovial villi, increased vascularisation, and presence of inflammatory cells. We have observed the significant pathomorphological changes of synovial tissues in 20 patients. In our material there were no direct correlation between observed degree of synovial pathomorphological changes and the degree of vascular diseases and gangrene in the patients we analyzed.

Belicza M
"Ljudevit Jurak" clinical department of pathology, Universitiy hospital "Sestre milosrdnice" Zagreb, Croatia

During the period from 1991 to 1996, almost all of Croatian pathologist was involved in some way in the forensic elaboration of war victims caused by Yugoserbian aggression on Croatia and Bosnia and Herzegovina. Especially those departments of pathology located close to the war operation have examined a great number of war victims in the routine activities and they made many of professional papers in the literature presenting their experience in this very difficult work. So, the departments of pathology in Osijek, Vinkovci, Slavonski Brod, Sisak, Karlovac, Zadar, Split and Dubrovnik and in some proportion others, have collected professionally very impressive documentation about each case of war victim examined. Of course, the departments of forensic medicine in Zagreb, Rijeka, Split and Osijek have collected an impressive documentation by themselves and in the close collaboration with pathologists. These facts could be a good basis for professional, scientific and ethical investigation of war victims in Croatia and Bosnia and Herzegovina.

Mracikić, M
Department for pathological anatomy and forensic medicine, Clinical hospital Osijek

Examination and identification of postmortem remains of 23 killed members of Croatian Army was performed in the Department for pathological anatomy and forensic medicine of Clinical hospital in Osijek. Identification was performed in March and September, 1994, and in April, 1996. 'The bodies were delivered from occupied territories of Eastern Slavonia and Baranja, after the negotiation between the Government Commission for missing persons of Republic of Croatia and Serbian Committee for exchange of captured and killed.

It is our intention to discuss our findings and to share our experience from those identifications that can be of value for this complicated procedure in future.

Oraić D, Zrnčić S, Šoštarić B
Croatian Veterinary Institute, Zagreb

Mariculture on the Croatian side of Adriatic sea is among earliest established of that kind of production in the Mediterranean. The species of high market value (sea bream and sea bass) are regularly produced on few dozens fish farms throughout our coast. Probably more than in another man bred species of animals, different pathological conditions are limidng factors in economic production of fish. Certainly vibriosis caused by V anguillarum in its different forms, ranging from peracute septicemic attacks, until chronic granulomatous infection is one of the most important and devastating diseases in this type of production in Croatia as well as all over the world.

In this work clinical behaviour, pathological changes and bacteriological findings in one specific but characteristic outbreak of vibriosis cage cultured sea bass (D. labrax) is presented. At the fish farm where investigations were carried on increased and permanent mortality of the market sized fish (250-350 grams) at the age of two years was observed.

The affected fish swam slowly at the water surface, were separated from the lot and were reluctant to eat.

On ihe paihoanatomical examination fish had skin discoloration, presence of the erythema on fin base and the mouth, multiple, circumscribed hemorrhages of the skin on the vent, while in more advanced cases ulcerations varying somewhat in size and depth, surrounded by a rim of fresh hemorrhage were noted as well.

At histopathological examination of those later lesions, the interruption of normal skin continuity, characterized by loss of scales and the presence of large masses of necrotic tissue debris admixed with inflammatory cell component and occasionally with varying degree of granulation tissue was seen.

Bacteriological examinations of liver, kidney and spleen, yielded repeatedly Vibrio anguillarum biovar I.

At the facility in question treatment with antibiogram indicated antimicrobial agent was undertaken with favorable outcome.

¹Božić Z, ¹Kraus O, ¹Baličević D, ²Belicza M, ³Duančić V
¹Department of Urology and ²Department of Pathology, University Hospital "Sestre milosrdnice" , Zagreb, Department of Epidemiology, ³Medical Centre for Prevention and Rehabilitation of Heart Diseases,Zagreb, Croatia

The 11-year prospective epidemiological study has encompassed 58 cases of upper urinary tract urothelioma, including 21 solitary tumors of renal pelvis, 9 solitary ureteral tumors and 28 multifocal tumors. An analysis of sex, age and residential distribution of patients was carried out as well as their occupation, frequency and distribution of symptoms, test results, tumor locality, "staging", histopathological characteristics and tumor relapses, frequency of simultaneous primary cancer, surgical approach and techniques, intraoperative and postoperative complications, as well as postoperative death rate. The aim of the study is to estabtish the basic clinical and epidemiological parameters important for the assessment of; the relationship between this disease and risk factors, the clinical picture of the disease, the applicability of diagnostic procedures, the pathological characteristics of the disease and surgical treatment results.

This comprehensive procedure is necessary for reassessment of this seldom and in many ways distinctive casuistry, which is particularly important for our national pathology. The participation of patients from the focuses of endemic uropathy amounting to 34.5% and of rural residents amounting to 31.0% indicates the epidemiological distinction of observed group of patients. Poor and frequently unrecognized symptomathology, high relapse rate accompanied by neglecting of recurrent hematuria as well as of constantly positive urinary citology, inadequate surgical results with the postoperative death rate of 15.5% and low 5-year survival rate, call for revision of the recent clinical approach to the upper urinary tract urothelioma.

Baličević D
"Ljudevit Jurak" Clinical Department of Pathology, University Hospital "Sestre milosrdnice' , Zagreb, Croatia

Identifikacija žrtava Domovinskog rata predstavlja za Republiku Hrvatsku prvorazredni moralni, socijalni i stručno medicinski problem, a prethodi joj proces ekshumacije, o uspješnosti kojeg u dobroj mjeri ovisi i postotak uspješnosti identifikacije. Na području Zapadne Slavonije, Banovine i Korduna, u proteklih devet mjeseci obavljena je ekshumacija u nekoliko masovnih i brojnim pojedinačnim grobnicama ljudi stradalih tijekom srbočetničke okupacije tih hrvatskih prostora.

U radu su prikazani načini neposrednog lociranja groba, sam proces ekshumacije mrtvih tijela, označavanje tijela i svega nađenog te priprema za transport, i to sa motrišta patologa koji je i u stručnom pogledu nadzirao ekshumacije.

Dosadašnja iskustva potvrdila su važnost ekshumacije za sudskomedicinsku ekspertizu jer predstavlja fazu prikupljanja posmrtnih ostataka i predmeta važnih za identifikaciju ali i okolnosti pod kojima je osoba izgubila život. Kvalitetno obavljena ekshumacija je pretpostavka svakoj uspješnoj identifikaciji ali i kriminalističkoj obradi slučajeva iz kategorije ratnog zločina, što svemu zajedno daje osobit značaj. Na temelju do sada obavljenih ekshumacija čini se da bi u metodologijskom pristupu trebalo i više pojedinačnih grobova na određenoj mikrolokaciji (dvorište, ulica, zaselak i sl.) smatrati masovnom grobnicom jer su iskustva pokazala da se radi o pobijenom lokalnom stanovništvu slične dobi, koje je izgubilo živote i pokopano je u istim okolnostima, na sličan način i u kratkom vremenskom razdoblju.