Renovasculopathies of hypertension in Hispanic residents of Dallas, Texas

BACKGROUND

Mean blood pressure levels (MBP) appear to rise with age slowly in the population of Mexico City and more swiftly in the U.S. in the black and white population, judging from published survey data. Some evidence suggests that MBP rises at intermediate rates in Hispanics in the U.S.

METHOD

This question is explored here in two ways, by review of published survey data and by a novel approach that uses renal tissues obtained from forensic autopsies to estimate MBP. Past studies have revealed good agreement between the two methods of estimating MBP.

RESULTS

Good agreement is again observed from the results of this study. Results from both methods agree that MBP is much lower at all ages in Mexican men and women than in blacks and whites in the U.S. Both methods also agree that Hispanics in the U.S. demonstrate an intermediate rise in MBP. A speculative first look at a small sample of U.S. Hispanics suggest that MBP rates of recent immigrants tend to resemble those of Mexico, while MBP levels of migrants of long-term residence resemble the native-born U.S. populations.

CONCLUSIONS

The findings underscore the need for definitive testing to confirm if Mexicans who relocate to the U.S. may acquire an acceleration of the renovasculopathies, and of the lifelong progression toward hypertension that this implies.

Immersion technique for brain removal in perinatal autopsies

Perinatal autopsies present forensic patholgists with a variety of challenges, not the least of which involves the removal and examination of very small and sometimes fragile organs. Removal of the immature brain can be particularly troublesome. Even if great care is taken during brain removal, one is often left with no more than a semifluid amorphous mass of softened tissue by the time the brain is ready to be fixed in formalin. We describe a method of perinatal brain removal which helps to preserve brain shape and integrity. By removing the brain while the head (and body) is totally immersed in water, we find that the brain is easier to remove and less apt to destruction. Subsequent fixation in formalin results in well-preserved, intact specimens, allowing for optimal examination and sectioning.

The implantable cardioverter-defibrillator. A potential hazard for autopsy pathologists

The implantable cardioverter-defibrillator (ICD) is an implantable electronic device that has been proven to be safe and effective in treating various malignant tachyarrhythmias in susceptible individuals. As the use of ICDs becomes more widespread, more individuals with the implanted devices will be encountered at autopsy. Manipulation of an activated ICD can result in electrical shock. To avoid injury, pathologists must be properly prepared to deal with bodies containing activated ICDs. These devices can also provide valuable information that may be helpful in determining the cause and mechanism of death. Herein, we present information regarding the appropriate guidelines and safeguards for pathologists confronted with an activated ICD.

Clinical and morphologic features of lipomatous hypertrophy ("massive fatty deposits") of the interatrial septum

Lipomatous hypertrophy of the interatrial septum ("massive fatty deposits in the atrial septum") may represent an incidental autopsy finding or may be associated with atrial arrhythmias, obstructive symptoms, or sudden death. Antemortem diagnosis is becoming much more common. In a literature review and in a review of our 12 cases, this condition was found to occur more frequently in obese middle-aged or elderly subjects, who frequently demonstrated atherosclerotic coronary artery disease. The unencapsulated mass generally occurred anterior or superior to the fossa ovalis, and histologically was characterized by mature fat with varying quantities of fetal fat, inflammation and fibrosis, and entrapment of myocardial fibers with cytologic atypia. Cases were included that had a minimum atrial septal thickness of 1.0 cm. The septum ranged up to 7.0 cm in maximum thickness (2.6 cm average). In our cases, no deaths were directly attributed to this disorder. It is important that forensic pathologists become more generally aware of this condition. To further delineate the true pathological significance, the atrial septum should be routinely examined by palpation and sectioning to determine its thickness and fat content.

Increased expression of early growth response-1 messenger ribonucleic acid in prostatic adenocarcinoma

PURPOSE

We isolated genes whose expression differs between normal and malignant prostate.

MATERIALS AND METHODS

Differential display polymerase chain reactions revealed a messenger ribonucleic acid (mRNA) with higher expression in prostatic adenocarcinoma versus age matched normal tissue. Deoxyribonucleic acid sequencing identified this mRNA as the product of the early growth response-1 gene.

RESULTS

Early growth response-1 mRNA levels were elevated in 12 of 12 intraprostatic adenocarcinomas but not in breast or ovarian cancers, or in rapidly dividing rat ventral prostate cells. Early growth response-1 mRNA was detected in epithelial and stromal cells at tumor margins but not in lymph node metastases.

CONCLUSIONS

Early growth response-1, a nuclear transcription factor, is implicated in the growth and invasion of intraprostatic cancers.

Primer residues deposited by handguns

There is much anecdotal information being disseminated, even offered in expert witness testimony, concerning the deposit of primer residues on the hands of persons in front of the muzzle of handguns. We present data for 9 mm and 380 Auto pistols and for a 38 caliber revolver depicting the procedure for obtaining wipings taken from targets representing the hands of a gunshot victim. These wipings from pork tissue were then analyzed for the primer residue metals antimony, barium, and lead. The data show that the two primary metals, antimony and barium, are deposited on the targets out to 4 feet for the pistols and out to three feet for the 38-caliber revolver. Testing will continue in actual cases with the gun and ammunition involved in the shooting.

Racial and ethnic patterns in firearms deaths

In the United States, there is currently an epidemic of firearms violence. Among victims of this violence, there are striking racial and ethnic patterns in the manners and circumstances of death. This study was conducted to explore and quantitate some of these differences. Autopsy and investigation reports of 554 consecutive firearms deaths in Dallas County, Texas, from March 1992 to February 1993 were reviewed. Overall suicide rates by race for 1970 and 1990 were calculated. Suicide rates for blacks have increased while overall rates (all races) have decreased slightly. Large racial and ethnic differences in the homicide-suicide ratio (H:S) were found (0.42 in non-Hispanic whites; 7.44 in others) (p < 0.001). Non-Hispanic whites who committed suicide with a firearm were less likely than other groups to do so with another person present (12% non-Hispanic whites; 49% others) (p < 0.001). Blacks and Asians who committed suicide with a firearm killed another person in 67% of witnessed cases (those with another person present during the incident). Whites (Hispanics and non-Hispanics) killed another person in only 12% of witnessed firearm suicides. The data suggest that the subtypes, psychodynamics, and causes of suicide may currently differ among racial and ethnic groups. These differences should be considered in order to formulate adequate prevention strategies and to assess the suicide and homicide risk in depressed individuals. The difficulty of accurate death certification in some cases is also discussed.

Cell type specific expression of steroid 5 alpha-reductase 2

Isozymes of steroid 5 alpha-reductase (5 alpha-reductase) have crucial roles in androgen physiology by synthesizing the potent hormone dihydrotestosterone. The expression pattern of the 5 alpha-reductase type 2 isozyme was determined in genital and extragenital tissues by developing an immunohistochemical assay using formalin-fixed tissue and affinity purified polyclonal antibodies that specifically recognize this isozyme. Expression was detected in basal epithelial and stromal cells of the normal prostate but not in luminal epithelial cells. Stromal cells of the seminal vesicle also expressed the type 2 isozyme. In contrast, staining was detected in epithelial cells of the epididymis but not in the surrounding stroma. Myofibroblasts in foreskin samples of normal and hypospadiac individuals expressed antigen and were distributed in bands throughout the prepuce, suggesting a clonal origin. In most cells the type 2 isozyme exhibited a perinuclear subcellular distribution. However, in liver hepatocytes the protein was distributed throughout the intracellular membrane compartment.

Tissue distribution and ontogeny of steroid 5 alpha-reductase isozyme expression

The synthesis of dihydrotestosterone is catalyzed by steroid 5 alpha-reductase isozymes, designated types 1 and 2. Mutation of type 2 results in male pseudohermaphroditism, in which the external genitalia are phenotypically female at birth. Two striking and unexplained features of this disorder are that external genitalia of affected males undergo virilization during puberty and that these individuals have less temporal hair regression. The tissue-specific and developmental expression patterns of the 5 alpha-reductase isozymes were investigated by immunoblotting. The type 1 isozyme is not detectable in the fetus, is transiently expressed in newborn skin and scalp, and permanently expressed in skin from the time of puberty. There was no qualitative difference in 5 alpha-reductase type 1 expression between adult balding vs. nonbalding scalp. The type 2 isozyme is transiently expressed in skin and scalp of newborns. Type 2 is the predominant isozyme detectable in fetal genital skin, male accessory sex glands, and in the prostate, including benign prostatic hyperplasia and prostate adenocarcinoma tissues. Both isozymes are expressed in the liver, but only after birth. These results are consistent with 5 alpha-reductase type 1 being responsible for virilization in type 2-deficient subjects during puberty, and suggest that the type 2 isozyme may be an initiating factor in development of male pattern baldness.

Pressure sores in a Christian Science sanatorium

We reviewed the Dallas County Medical Examiner's Office records of all individuals who had died in a local Christian Science Sanatorium during a 5 1/2-year period. Of 116 such patients, only 13 (11%) had pressure sores (decubitus ulcers). In 10 of these patients, the sores were described as small, superficial, and/or healing, while the other three patients had more serious ulcers. In contrast, for patients dying in nursing homes or hospitals, the incidence of pressure sores may be as high as 54-57%. It is our opinion that the difference in incidence is due to the personal and conscientious nursing care provided by Christian Science institutions.

Renal artery bullet embolism

Bullet embolism is a well-recognized phenomenon. While bullet embolism is not common, renal artery bullet embolism appears to be very rare. We report three cases of bullet embolism to a renal artery. Autopsy findings and bullet types are presented. Such cases are of particular interest to both the medical examiner and the clinician. Failure to consider this phenomenon clinically could lead to infarction of a kidney. A consideration of this phenomenon at autopsy could shorten the dissection time required to retrieve the bullet.

Primary hyperparathyroidism due to an oxyphil cell adenoma

A 70-year-old black man was found to have primary hyperparathyroidism due to an oxyphil cell adenoma. Ultrastructural studies were essential in elucidating the cell type of the tumor. The morphologic findings in relation to the clinical findings and a brief review of the literature are discussed.

Incidental prostatic carcinoma: tumor extent versus histologic grade

One hundred forty-three incidental carcinomas from 500 step-sectioned prostates were classified independently by two pathologists according to the Gleason system. The area involved by each tumor was measured by photographic techniques. Observer agreement was 94 per cent when tumors were divided into groups with "pattern scores" 4 or less (less than or equal to 4) and greater than 4 (greater than 4). About 25 per cent of tumors in both races had pattern scores 4 or less (less than or equal to 4). Tumors with pattern scores greater than 4 (greater than 4) were, on the average, significantly larger than those with pattern scores 4 or less (less than or equal to 4) (p less than 0.001). We therefore believe that the Gleason histologic classification system is reproducible and that it discriminates tumors with different biological behavior.

Prevalence of latent prostate carcinoma in two U.S. populations

The prevalence of latent prostate carcinoma, the suspected precursor of invasive carcinoma, was studied in 500 autopsy specimens from New Orleans, Louisiana, and found to be similar in both whites and blacks. The tumors were subdivided into latent infiltrative type (LIT) and latent noninfiltrative type tumor was measured by photographic techniques. A good correlation between size and histology was found: The mean size of LIT tumors was significanty greater than that of LNT tumors. Age-versus-size plots revealed a subset of large LIT lesions in blacks that was not found among whites of the same ages. This subset may account for the excess of invasive carcinomas in blacks. These results suggest that many latent carcinomas lack promotional stimuli to become invasive.