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PURPOSE: To investigate the pathologic substrates of sudden death in young competitive athletes. PATIENTS AND METHODS: Twenty-two cases of sudden death in young competitive athletes occurring in the Veneto region (northern Italy) in the period January 1979 to December 1989 were studied by postmortem examination. The athletes included 19 males and three females, ranging in age from 11 to 35 years (mean, 23 years). RESULTS: In 18 cases, sudden death occurred during (16 cases) or immediately after (two cases) a competitive sport activity. In 10 subjects, sudden death was apparently the first sign of disease. Postmortem examination disclosed that this fatality was due to arrhythmic cardiac arrest in 17 cases; among these, right ventricular cardiomyopathy, also known as 'right ventricular dysplasia,' was the most frequently encountered cardiovascular disease (six cases), followed by atherosclerotic coronary artery disease (four cases), conduction system pathology (three cases), anomalous origin of right coronary artery from the wrong aortic sinus (two cases), and mitral valve prolapse (two cases). In two athletes, the abrupt lethal complication was 'mechanical' and consisted of pulmonary embolism and rupture of the aorta; in three athletes, death was due to a cerebral cause. All athletes with right ventricular cardiomyopathy died during effort, and most had a history of palpitations and/or syncope. Whenever available, electrocardiographic (ECG) tracings showed inverted T waves in precordial leads and/or left bundle branch block ventricular arrhythmias. CONCLUSIONS: Clinicopathologic correlations indicate that in the Veneto region of Italy, right ventricular cardiomyopathy is not so rare among the cardiovascular diseases associated with the risk of arrhythmic cardiac arrest, and seems to account for the majority of cases of sudden death in young athletes; this disorder can be suspected during life on the basis of prodromal symptoms and ECG signs., The pathologic conditions leading to sudden death in young athletes were assessed by reviewing 22 cases. The deaths in occurred in 19 males and 3 females between January 1979 and December 1989. The ages of the athletes ranged from 11 to 35 years old. Sudden death occurred during an athletic activity in 16 cases, after the sports activity in two cases, and was the first sign of disease in 10 cases. Death resulted from cardiac arrest due to arrhythmia in 17 cases. These included six cases of right ventricular dysplasia, a heart condition characterized by abnormalities of the right heart ventricle; four cases of atherosclerotic coronary artery disease, characterized by fatty degeneration and thickening of the walls of the coronary arteries; three cases of abnormal conduction in the heart; two cases of defects in the physical structure of the right coronary artery; and two cases of mitral valve prolapse. The development of a blood clot in the lungs and rupture of the aorta occurred in two cases. Death was due to disorders affecting the brain in three athletes. All athletes with heart disease involving the right ventricle died during physical exertion and had a history of palpitations and/or fainting. These findings show that disease of the right ventricle is a common cause of sudden death among young athletes. This heart disorder is characterized by abnormalities in heart electrical activity and early symptoms, such as palpitations and fainting. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ultrastructural findings in an unusual case of chondromyxoid fibroma are reported. The tumor was located in the iliac bone of a 42-year-old woman with left hip pain of 5 years duration.

Various growth phases of Moloney murine sarcoma virus (M-MSV) induced tumors in suckling and young adult BALB/c mice have been studied by light and electron microscopy. In the early phase (3-6 days following M-MSV), observations at the injection site of the thigh muscles consisted of endo- and perimysial edema, «activated» muscle satellite cells, endothelial cells and fibroblasts, scattered type C virus particles within the muscle fibers, muscle fibers and endomysial cells undergoing necrosis and macrophage and granulocyte infiltration. During the overt tumor phase (6-12 days following M-MSV), observation of neoplastic tissue disclosed proliferation of several cell types (endothelial, periosteal, fibroblasts, etc.), poorly differentiated myoblasts along with atypical rhabdo-myoblast-like cells and sarcolytes, type C virus budding from muscle fiber and myoblast plasma membrane, and intense degenerative and regenerative changes in the muscle fibers together with more profuse granulocyte infiltration. The regressive phase (13-21 days following M-MSV) presented reduced cellularity of the neoplastic tissue, a decrease in blast cells, diminishing granulocyte infiltration with contemporaneous appearance of prominent lymphocyte foci and gradual disappearance of virus particles. Although many cell types of mesenchymal origin proliferate following M-MSV infection, the above morphological findings indicate that striated muscle is a preferential site for virus replication and transformation. Furthermore, the peculiar virus cell relationships leading to cell lysis and continuous recruitment of newly infected cells have been widely documented. In the light of these findings it is suggested that, besides the host immune control of virus spread and tumor cell multiplication, the non clonal growth pattern of M-MSV induced tumors is a crucial factor in determining the spontaneous regression which occurs with high frequency in this experimental system.

A 68-year-old man underwent reoperation because of severe incompetence of a mitral valve xenograft, 96 months following implantation. Gross examination of the device showed yellow spots on the cusps, suggesting lipid infiltration, and a torn commissure. Plasmatic cholesterol and lipiprotein levels were normal. X-ray examination of the explants showed no calcific deposits. Histologic and electron microscopic studies disclosed massive accumulation of lipid clefts and droplets, predominantly at the level of the tear; focal loss and detachment of the endothelial lining and scanty porcine fibroblasts and collagen bundles with preserved periodicity were also noted. Primary disruption of porcine valvular bioprostheses without significant calcifications or collagen breakdown is uncommon. In the present case, lipid accumulation was the main determinant of tissue failure.

The age-standardized incidence rates of non-Hodgkin's lymphoma in the province of Padova during the period 1970-1974 were 3.19/105/year for males and 1.60/105/year for females. These rates are similar to those found in other industrialized countries and slightly higher than in the province of Torino. An increasing trend with age is described, beginning in the age group 35-44, while low rates were found in younger ages in both sexes. No relevant' pattern was shown in the geographical distribution of cases, and no observed/expected ratio was significant in any of the administrative districts considered. The influence of environmental factors and the limitations due to uncertain diagnostic criteria and the small size of the population considered are discussed.