Severe and diffuse left ventricular dysfunction may be observed after large venlafaxine overdoses and this is not always associated with severe cardiac conduction function abnormalities. The mechanisms underlying venlafaxine-related cardiac failure with preserved normal cardiac conduction are discussed. A possible explanation may be a catecholamine-induced myocardial damage in relationship with the inhibition of norepinephrine (and dopamine) reuptake.

(bte 31, 1 150 Brussels, BelgiumThe relationship between vinylchloride exposure and human angiosarcoma of the liver (ASL) received attention in 1973 when a case of this rare tumour was diagnosed at autopsy'. Case reportA 39-year old man was first seen in July 1979 with pain in the right upper quadrant. The liver was palpated at the right costal margin. Oral cholecystography and barium swallow were normal and liver function tests were in normal limits. From 1965 to 1970 he had cleaned reactors used for the polymerization of the vinylchloride monomer in PVC and was thus exposed to high amounts.He was admitted 3 months later with persisting right upper quadrant pain, loss of appetite and fatigue. The liver edge was by then hard and 4 cm below the costal margin. The ESR was accelerated (80 mm/h) and alkaline phosphatases and GGTP were elevated. Carcino-embryonic antigen (CEA) and a fetoglobulin were normal. Ultrasound showed a large dense tumour of the right hepatic lobe with areas of necrosis. The 99Tc hepatic scan confirmed the presence of an ill-defined filling defect in the inferior part of the right lobe with two small defects at the level ofthe hilum.The liver computerized tomography confirmed the integrity of the left lobe.A selective angiography of the celiac artery revealed a hypervascularized tumour of the right hepatic lobe (Figire I ) .At a right thoracophrenolaparotomy the tumour was found to be confined to the right lobe. An extended right lobectomy was then performed. The postoperative recovery was uneventful and the patient was sent home with a monthly administration of Vincristine ( I mg JV) and Adriamycin ( 1 50 mg/mz IV) which was discontinued in June 1981.Repeated controls up to September 1981 by liver scan and computerized tomography remained normal. The patient is still in good health 38 months after the resection. PathologyThe resected specimen was 2050 g. On macroscopical examination. the main tumour (13.5 x 8 cm) was yellowish and spongy and contained cystic and haemorrhagic zones. A second smaller haemorrhagic mass was found at the inferibr aspect of the right lobe surrounded by numerous purple masses.Macroscopically, the main tumour showed large areas of necrosis and haemorrhagic pseudocystic spaces (Figure 2). These spaces were surrounded by areas of dense vascular proliferation. The sinusoids were lined with variably sized irregular sarcomatous cells with hyperchromatic nuclei. Elsewhere, blood-filled spaces were surrounded by sarcomatous cells. The sarcoma cells encompassed adjacent liver cells and bile ductules and infiltrated the parenchyma. The pathological diagnosis of multicentric angiosarcoma was made. The rest of the liver was normal except for some moderately enlarged portal tracts. Progressive fibrosis separated hepatocytes at the margins ofthe portal tracts from adjacent hepatic 322

Serious drug-drug interactions may have complicated colchicine poisoning. In particular, atorvastatin, an inhibitor of P-glycoprotein and cytochrome P450 3A4, was likely responsible for an increased severity of rhabdomyolysis. In addition, propofol used for sedation during mechanical ventilation may have induced symptoms consistent with "propofol infusion syndrome," with further muscular injury and hypertriglyceridemia. The mechanism of death was unusual and similar to Reye's syndrome.

No abstract

Forensic experts play a major role in the legal process as they offer professional expert opinion and evidence within the criminal justice system adjudicating on the innocence or alleged guilt of an accused person. In this respect, medico-legal examination is an essential part of the investigation process, determining in a scientific way the cause(s) and manner of unexpected and/or unnatural death or bringing clinical evidence in case of physical, psychological, or sexual abuse in living people. From a legal perspective, these types of investigation must meet international standards, i.e., it should be independent, effective, and prompt. Ideally, the investigations should be conducted by board-certified experts in forensic medicine, endowed with a solid experience in this field, without any hierarchical relationship with the prosecuting authorities and having access to appropriate facilities in order to provide forensic reports of high quality. In this respect, there is a need for any private or public national or international authority including non-governmental organizations seeking experts qualified in forensic medicine to have at disposal a list of specialists working in accordance with high standards of professional performance within forensic pathology services that have been successfully submitted to an official accreditation/certification process using valid and acceptable criteria. To reach this goal, the National Association of Medical Examiners (NAME) has elaborated an accreditation/certification checklist which should be served as decision-making support to assist inspectors appointed to evaluate applicants. In the same spirit than NAME Accreditation Standards, European Council of Legal Medicine (ECLM) board decided to set up an ad hoc working group with the mission to elaborate an accreditation/certification procedure similar to the NAME's one but taking into account the realities of forensic medicine practices in Europe and restricted to post-mortem investigations. This accreditation process applies to services and not to individual practitioners by emphasizing policies and procedures rather than professional performance. In addition, the standards to be complied with should be considered as the minimum standards needed to get the recognition of performing and reliable forensic pathology service.