Alcohol and unnatural deaths in Sweden: a medico-legal autopsy study

OBJECTIVE

To investigate alcohol involvement in all types of unnatural deaths in Sweden.

METHOD

All cases of unnatural death that underwent medico-legal autopsies (1992-1996) in Sweden were analyzed (N = 15,630; i.e., 68% of all unnatural deaths). Alcohol was regarded as contributing to the death if: (1) there was any indication that the deceased was a "known alcoholic"; (2) the underlying or contributing causes of death were alcohol-related; (3) the deceased had alcohol-related inpatient diagnosis during a period of 3 years prior to death; or (4) the case tested positive for blood alcohol.

RESULTS

Thirty-nine percent of the blood-tested cases (n = 13,099) were positive for alcohol. Almost 40% of the unnatural deaths were associated with alcohol. Alcohol involvement was most common in the intoxication group (84%), followed by the "undetermined" (65%), homicide (55%), fall (48%), fire (44%), asphyxia (41%), suicide (35%) and traffic (22%) groups. More than half (52%) of the deaths in the age group 30-60 years, 35% of those aged 0-29 years and 25% of those aged 60 and over were associated with alcohol.

CONCLUSIONS

In Sweden, two of five unnatural deaths are associated with alcohol; this is a conservative estimate. Alcohol-associated mortality varies considerably between different groups of external causes of death, between men and women, and with age.

Acoustic effects of variation in vocal effort by men, women, and children

The acoustic effects of the adjustment in vocal effort that is required when the distance between speaker and addressee is varied over a large range (0.3-187.5 m) were investigated in phonated and, at shorter distances, also in whispered speech. Several characteristics were studied in the same sentence produced by men, women, and 7-year-old boys and girls: duration of vowels and consonants, pausing and occurrence of creaky voice, mean and range of F0, certain formant frequencies (F1 in [a] and F3), sound-pressure level (SPL) of voiced segments and [s], and spectral emphasis. In addition to levels and emphasis, vowel duration, F0, and F1 were substantially affected. "Vocal effort" was defined as the communication distance estimated by a group of listeners for each utterance. Most of the observed effects correlated better with this measure than with the actual distance, since some additional factors affected the speakers' choice. Differences between speaker groups emerged in segment durations, pausing behavior, and in the extent to which the SPL of [s] was affected. The whispered versions are compared with the phonated versions produced by the same speakers at the same distance. Several effects of whispering are found to be similar to those of increasing vocal effort.

An ultrasonic method for noninvasive estimation of vascular impedance to an absolute level: in vitro validation of the relationship between impedance and phase velocity

Vascular impedance is a quantity that characterizes the properties of the vascular bed. Assuming Newtonian fluid, laminar flow and linear system, impedance is related to phase velocity. The agreement between theoretical relationship and measured data is evaluated in an in vitro study. The setup consist of a computer-controlled flow generator, a variable fluid impedance and a measuring section. Phase velocity is calculated from multiple recorded vessel pulsations detected by ultrasonic pulse-echo technique. The reference impedance is calculated from simultaneously measured high-fidelity pressure and flow data. The impedance is analyzed in the range of 1-40 Hz with 1-Hz resolution. The evaluation of the noninvasive ultrasonic technique is focused on the resonance frequencies and the characteristic impedance. No significant difference (p > 0.05) is found in the resonance frequencies nor in the characteristic impedance. However, the impedance below 5 Hz is underestimated and the extension of the measuring section causes spatial averaging effects with reduced frequency resolution.

Materials for interocclusal records and their ability to reproduce a 3-dimensional jaw relationship

PURPOSE

The purpose of this study was to determine if accuracy and dimensional stability of vinyl polysiloxanes and irreversible hydrocolloids stabilized by a tray used for fixed prosthodontics, removable partial, and complete denture cases are comparable to those of waxes and record rims and if storage time (24 hours or 6 days) affects dimensional stability of the tested materials.

MATERIALS AND METHODS

Two waxes, two record rims, three vinyl polysiloxanes, and one irreversible hydrocolloid (alginate) were examined. Three pairs of master casts with measuring steel rods were mounted on an articulator (initial position). Five records were made of each material, and the upper cast was remounted after 24 hours or 6 days so that deviations from the initial position could be measured.

RESULTS

Vinyl polysiloxanes reinforced by a stabilization tray were the most accurate materials able to reproduce a settled interocclusal position. Mounting casts (fixed prosthodontics cases) without records gave accuracy similar to wax records. Record rims used for removable partial and complete denture cases produced lesser accuracy than vinyl polysiloxanes and irreversible hydrocolloid stabilized by a tray. Accuracy was not significantly affected by storage time.

CONCLUSION

The results show that accuracy of vinyl polysiloxanes and irreversible hydrocolloids reinforced by a tray is superior to that of record rims with regard to the complete denture case and is among the most accurate with regard to the removable partial denture case. For fixed prosthodontics, however, reinforcement is unnecessary.

The expression of androgen receptors in human neck and limb muscles: effects of training and self-administration of androgenic-anabolic steroids

The purpose of this study was to investigate the immunohistochemical expression of androgen receptors (AR) in human vastus lateralis and trapezius muscles and to determine whether long-term strength training and self-administration of androgenic-anabolic steroids are accompanied by changes in AR content. Biopsy samples were taken from eight high-level power-lifters (P), nine high-level power-lifters who used anabolic steroids (PAS) and six untrained subjects (U). Myonuclei and AR were visualised in cross-sections stained with the monoclonal antibody against AR and 4',6-diamidino-2-phenylindole. The proportion of AR-containing myonuclei per fibre cross-section was higher in the trapezius than in the vastus lateralis (P<0.05). In the trapezius, the proportion of AR-containing myonuclei was higher in P compared to U and in PAS compared to both P and U (P<0. 05). On the contrary, in the vastus lateralis, there were no differences in AR content between the three groups. Myonuclear number in both muscles was higher in P compared to U and in PAS compared to both P and U (P<0.05). In conclusion, AR content differs greatly between human neck and limb muscles. Moreover, the regulation of AR-containing myonuclei following training and self-administration of androgenic-anabolic steroids is muscle dependent.

Isolation of sex-specific cDNAs from fetal mouse brain using mRNA differential display and representational difference analysis

Comparing female and male brain structures reveals a variety of sex differences in many vertebrates. These differences are manifested throughout the brain, in regions such as the hypothalamus, the preoptic area and the amygdala. Some are thought to be induced during the fetal period by the effect of steroid hormones produced in the gonads. It is well-established that fetal androgens, probably through the conversion to estrogen by the enzyme aromatase, masculinize the nervous system and set adult mounting behavior in rodents. However, less is known about molecular mechanisms involved in gender-specific development of the brain. We have taken a broad approach to isolate sex-specific genes from fetal brain. mRNAs from 18.5 days post-coitum (dpc) female and male mouse brain were screened with the classical and the recently developed signal peptide differential display (SPDD) and with representational difference analysis of cDNA (cDNA-RDA). Two sex-specific cDNAs were isolated, F29 and M17, corresponding to the female-specific Xist gene and the male-specific Smcy gene, respectively.

Smoothelin and intermediate filament proteins in human aortocoronary saphenous vein by-pass grafts

The aim of this immunohistochemical investigation was to study the distribution of the novel cytoskeletal protein smoothelin and the intermediate filament proteins vimentin and desmin in normal human great saphenous vein and in human aortocoronary by-pass vein grafts. Smoothelin was present in most smooth muscle cells in the media of the native vein. In the neointima of the vein grafts that had been in situ for three months or more, smoothelin was, in general, present only in few smooth muscle cells. Desmin was distributed in the same pattern as smoothelin in the native great saphenous vein. When desmin and smoothelin were present in the neointima, smoothelin was detected in more cells than desmin. Vimentin was present in most cells in all wall layers of both the native saphenous vein and the vein grafts. Vascular smooth muscle cells containing vimentin but not desmin or smoothelin are the principal cells in the neointima of human aortocoronary vein grafts. In some grafts, however, all three cytoskeletal proteins were detected in the neointima. The distribution of smoothelin and desmin in aortocoronary vein grafts support the postulate that these proteins are expressed mainly in the contractile smooth muscle cell phenotype.

Effects of anabolic steroids on the muscle cells of strength-trained athletes

PURPOSE

Athletes who use anabolic steroids get larger and stronger muscles. How this is reflected at the level of the muscle fibers has not yet been established and was the topic of this investigation.

METHODS

Muscle biopsies were obtained from the trapezius muscles of high-level power lifters who have reported the use of anabolic steroids in high doses for several years and from high-level power lifters who have never used these drugs. Enzyme-immunohistochemical investigation was performed to assess muscle fiber types, fiber area, myonuclear number, frequency of satellite cells, and fibers expressing developmental protein isoforms.

RESULTS

The overall muscle fiber composition was the same in both groups. The mean area for each fiber type in the reported steroid users was larger than that in the nonsteroid users (P < 0.05). The number of myonuclei and the proportion of central nuclei were also significantly higher in the reported steroid users (P < 0.05). Likewise, the frequency of fibers expressing developmental protein isoforms was significantly higher in the reported steroid users group (P < 0.05).

CONCLUSION

Intake of anabolic steroids and strength-training induce an increase in muscle size by both hypertrophy and the formation of new muscle fibers. We propose that activation of satellite cells is a key process and is enhanced by the steroid use. The incorporation of the satellite cells into preexisting fibers to maintain a constant nuclear to cytoplasmic ratio seems to be a fundamental mechanism for muscle fiber growth. Although all the subjects in this study have the same level of performance, the possibility of genetic differences between the two groups cannot be completely excluded.

Skewed secondary sex ratio in the offspring of carriers of the 214G > A mutation of the RS1 gene

Carriers of X-linked juvenile retinoschisis (RS) were previously suggested to give birth to an excess of boys. We determined the carrier status for the 214G > A mutation of the RS1 gene in 202 females belonging to a large RS founder pedigree. The secondary sex ratio (SSR) in the offspring of 149 carriers was 129.8 (z = 2.25), which differed significantly from that of the Finnish population (SSR 106) but not from that of 53 non-carrier females belonging to the same pedigree (SSR 116.7; z = 0.51). Since possible causes for the skewed SSR include factors affecting fertilisation, implantation and embryonic death, we searched for expression of RS1 in various placental and uterine cells and found that, in addition to the retina, RS1 is expressed in the uterus. We hypothesize that the RS1 protein has a role in implantation or embryonic survival.

Smoothelin in adult and developing human arteries and myocardium

The aim of this investigation was to study, with immunohistochemical methods, the distribution of the novel cytoskeletal protein smoothelin in human cardiovascular tissues, the possible changes during the development of the cardiovascular system and its correlation to the intermediate filament proteins desmin and vimentin. Smoothelin was detected in smooth muscle cells of the fetal coronary arteries. In very young subjects (up to 3 months of age), only a few cells in the media of the elastic arteries contained smoothelin, whereas it was present in most smooth muscle cells in the muscular arteries. In individuals older than 1 year, most smooth muscle cells in the media of all blood vessels contained smoothelin. In vessels with a developed intima, smoothelin was present in a variable proportion of the smooth muscle cells. With few exceptions, smoothelin was more frequently detected than desmin in medial smooth muscle cells. Smoothelin and vimentin were codistributed in the smooth muscle cells of the media in most vessels. In the cardiomyocytes (fetal to adult age), the smoothelin antibody detected epitopes located at the Z-disc level but not in the intercalated discs. In conclusion, smoothelin is more widely distributed in the muscular arteries than in the elastic arteries early in life, and thus exhibits a variable distribution during postnatal development of vascular tissues. In the adult, smoothelin is detected in the media of most vascular smooth muscle cells, both in muscular and elastic arteries, and is not necessarily codistributed with either desmin or vimentin. Evidence that smoothelin is present in human striated cardiomyocytes is also presented.

The superantigenic activity of streptococcal pyrogenic exotoxin B is independent of the protease activity

The nature of the mitogenic activity of pyrogenic streptococcal exotoxin B, also known as streptococcal cysteine protease, has been debated in the literature. Streptococcal exotoxin B has been shown to cleave interleukin-1beta precursor and create biologically active interleukin-1beta, a major cytokine mediating inflammation and shock. This activity could mimic the mitogenicity and cytokine release induced by superantigens in lymphocyte stimulating experiments. In this study, the protease activity of streptococcal exotoxin B was irreversibly inhibited by covalent binding of a tripeptide and the superantigenic properties of streptococcal exotoxin B were found not to be influenced by this inactivation. Native as well as protease-inactivated streptococcal exotoxin B was shown to stimulate T-cell proliferation without a need of metabolically active antigen presenting cells. Furthermore, streptococcal exotoxin B-induced T-cell proliferation was shown to require HLA-DQ since addition of HLA-DQ monoclonal antibodies totally inhibited the mitogenic activity of streptococcal exotoxin B, indicating that streptococcal exotoxin B, as other superantigens, makes direct contact with the T-cell receptor via HLA class II. The aim of this study was to characterize the relationship between the proteolytic and superantigenic properties of streptococcal exotoxin B.

"Avoidable" deaths in two areas of Sweden - analysis of deaths in hospital after injury

OBJECTIVE

To describe causes of death and other characteristics of "avoidable" deaths in patients admitted to hospital after trauma, and estimate and analyse changes in the avoidable death rate during the years studied.

DESIGN

Retrospective analysis of medico legal autopsy material.

SETTING

One northern and one western area in Sweden 1988-1996.

SUBJECTS

335 cases who died in hospital after trauma.

MAIN OUTCOME MEASURES

Avoidable death, defined as an Injury Severity Score (ISS) of 35 or less and Abbreviated Injury Scale (AIS) head of 4 or less and cause of death.

RESULTS

We found 70 avoidable deaths (21%). Among these, 15 (21%) died of head injuries, 17 (24%) of thoracic, abdominal, or pelvic injuries, and 38 (54%) of medical complications. The number of deaths after trauma decreased considerably from 1988-90 to 1994-96, but the proportion who died in hospital remained almost constant. The proportion of avoidable deaths decreased from 22% to 17%, mainly because the proportion of deaths from medical complications was halved.

CONCLUSION

The standard of Swedish in-hospital trauma care has improved, particularly with a reduction in post-traumatic complications. However, there is still room for improvement in the treatment of complications among elderly people.

Human papillomavirus type 16 variant lineages characterized by nucleotide sequence analysis of the E5 coding segment and the E2 hinge region

We have previously examined 29 cervical cell isolates for human papillomavirus type 16 (HPV-16) sequence variations in the E6, L2 and L1 coding regions, and the long control region (LCR). Twenty-five of these isolates as well as 23 additional isolates are characterized here as we present the complete E5 coding segment and the E2 hinge region. Eight amino acid variations were observed in the E5 coding segment, 13 were identified in the E2 hinge region and 5 were observed in the overlapping E4 coding segment. These amino acid variations may be relevant to differences in biological functions and may result in altered humoral or cell-mediated immune responses to HPV-16 variants. The characterization of sequence variation within high-risk HPV types might be important in the search for epidemiological correlates of cervical cancer risk. This work complements and extends HPV-16 genome sequence information from specific isolates previously reported by our group.

Cellular adaptation of the trapezius muscle in strength-trained athletes

The aim of this study was to elucidate the cellular events that occur in the trapezius muscle following several years of strength training. In muscle biopsies from ten elite power lifters (PL) and six control subjects (C), several parameters were studied: cross-sectional area of muscle fibres, myosin heavy chain composition (MHC) and capillary supply [capillaries around fibres (CAF) and CAF/fibre area]. A method was also developed for counting the number of myonuclei and satellite cell nuclei. The proportion of fibres expressing MHC IIA, the cross-sectional area of each fibre type and the number of myonuclei, satellite cells and fibres expressing markers for early myogenesis were significantly higher in PL than in C (P<0.05). A significant correlation between the myonuclear number and the cross-sectional area was observed. Since myonuclei in mature muscle fibres are not able to divide, we suggest that the incorporation of satellite cell nuclei into muscle fibres resulted in the maintenance of a constant nuclear to cytoplasmic ratio. The presence of small diameter fibres expressing markers for early myogenesis indicates the formation of new muscle fibres.

Intermediate filament proteins in developing human arteries

The distribution of intermediate filament proteins in adult human blood vessels and in human fetal elastic arteries is relatively well-known. However, the distribution of these proteins in the course from neonate to adult has not been established. In this investigation, human postnatal arteries were studied with immunohistochemistry, using antibodies targeted on the intermediate filament proteins desmin, vimentin and cytokeratins 8, 18 and 19. Vimentin was present in most smooth muscle cells in all vessels and at all ages. The proportions of desmin-expressing cells increased in the elastic arteries during the first year of life and was higher in the pulmonary trunk than in the aorta. In the muscular arteries, the proportion of desmin-labelled cells increased in the coronary and the deep femoral arteries, but remained constant in the renal and the cerebral arteries. Cytokeratins were detected in the pulmonary trunk earlier than in the aorta. Cytokeratins were present throughout the wall of the ductus arteriosus, but desmin was present only in some cells. Thus, there are postnatal changes in the distribution of intermediate filament proteins in the elastic arteries and in some muscular arteries, whereas the intermediate filament pattern remains unchanged in other muscular arteries.

Renoprotective effects of captopril in hypertension induced by nitric oxide synthase inhibition in experimental nephritis

OBJECTIVE

To investigate effects of angiotensin I converting enzyme (ACE) inhibition in experimental nephritis during chronic inhibition of nitric oxide (NO) synthase.

METHODS

Rats with and without autoimmune Heymann nephritis were treated with a NO synthase inhibitor L-NAME (50 mg/100 ml) and/or an ACE inhibitor captopril (20 mg/100 ml) in drinking water for 12 weeks. Urinary cGMP excretion was used as an indirect measure of NO activity. Blood pressure, urinary albumin, nitrite and nitrate levels, plasma ANP, and plasma renin activity were measured. Kidneys were examined with light microscopy and immunohistochemical methods.

RESULTS

Captopril treatment protected rats receiving L-NAME and none of the captopril-treated rats died. Mortality was greatest in the nephritis-L-NAME (57%) and L-NAME (43%) groups. Captopril normalized cGMP excretion, blood pressure, and prevented partly the appearance of albuminuria. Peritubular infiltration of mononuclear cells was clearly enhanced in the nephritis-L-NAME group (found in 80% of the rats) as compared with the nephritis (20%), L-NAME (40%), and control (0%) groups. The peritubular cell infiltration caused by L-NAME was prevented by captopril treatment. L-NAME-induced hypertension was associated with cardiac hypertrophy and this was prevented by captopril.

CONCLUSIONS

NO may play an important renoprotective role in disease progression of chronic membranous glomerulonephritis. Captopril prevents L-NAME-induced hypertension, improves survival, and ameliorates renal damage in this type of nephritis. Dysfunction of renal NO pathways may be an important factor causing progressive renal damage in chronic nephritis. Our results suggest that the dysfunctional renal NO system may be beneficially activated by ACE inhibitors.

Streptococcal DNase B is immunologically identical to superantigen SpeF but involves separate domains

The previous suggestion that streptococcal superantigen SpeF might be identical to DNase B was confirmed in this study. Polyclonal SpeF-specific antisera were able to inhibit depolymerization of methyl-green DNA by DNase B. However, T-cell mitogenicity and nuclease activity appear to involve separate immune epitopes on SpeF, since sera with the capacity to neutralize the mitogenic activity of SpeF did not always inhibit the DNase activity.

Vascular endothelial growth factor C induces angiogenesis in vivo

Vascular endothelial growth factor C (VEGF-C) recently has been described to be a relatively specific growth factor for the lymphatic vascular system. Here we report that ectopic application of recombinant VEGF-C also has potent angiogenic effects in vivo. VEGF-C is sufficiently potent to stimulate neovascularization from limbal vessels in the mouse cornea. Similar to VEGF, the angiogenic response of corneas induced by VEGF-C is intensive, with a high density of new capillaries. However, the outgrowth of microvessels stimulated by VEGF-C was significantly longer than that induced by VEGF. In the developing embryo, VEGF-C was able to induce branch sprouts from the established blood vessels. VEGF-C also induced an elongated, spindle-like cell shape change and actin reorganization in both VEGF receptor (VEGFR)-2 and VEGFR-3-overexpressing endothelial cells, but not in VEGFR-1-expressing cells. Further, both VEGFR-2 and VEGFR-3 could mediate proliferative and chemotactic responses in endothelial cells on VEGF-C stimulation. Thus, VEGF-C may regulate physiological angiogenesis and participate in the development and progression of angiogenic diseases in addition to lymphangiogenesis.

Identification of domains involved in superantigenicity of streptococcal pyrogenic exotoxin F (SpeF)

A series of 11 synthetic peptides of 30 amino acids, each with 10 amino acids overlap which spanned the entire sequence of streptococcal pyrogenic exotoxin F (SpeF), were employed in proliferation studies on human peripheral blood mononuclear cells (PBMCs). Regions 41-70, 141-170 and 181-210 were identified as important for SpeF-induced lymphocyte activation. Secondary structure predictions of these peptides showed similarities to regions in other superantigens known to be important for T cell mitogenicity. Furthermore, antisera specific to peptides covering amino acids 1-70 and 181-228 were able to inhibit SpeF-induced mitogenicity by 25% when pre-incubated with SpeF prior to PBMC activation.

Crash responsibility versus drug and alcohol use among fatally injured and hospitalized motor vehicle drivers in Sweden

The present study was aimed at determining whether drivers testing positive for drugs and/or alcohol were more often responsible for the crash than the test-negative ones. Data on 241 fatally injured and 102 hospitalized motor-vehicle drivers was collected in Northern and Western Sweden. Blood samples were taken from these drivers and screened for the presence of alcohol, licit drugs, and illicit drugs. A judgment of responsibility, and assessment of the traffic situation and crash characteristics were based on police reports. Alcohol-positive drivers (n = 49) were more often (96% vs. 70%, p < 0.0001) judged to be responsible for the crash than test-negative drivers. Ninety-three percent of the drug-positive drivers were judged to be responsible, but they were not significantly more often responsible than the test-negative drivers. Drug-positive drivers differed from the alcohol-positive drivers in that they more often crossed over to the wrong side of the road and crashed into an oncoming vehicle. The findings support previous studies that reducing the number of drug-positive drivers in traffic is bound to lead to a reduction in crashes resulting in injury. Further analysis with a larger sample is needed to elucidate the association between crash responsibility and drugs other than alcohol.

Alzheimer changes are common in aged drivers killed in single car crashes and at intersections

With increasing age, diseases affecting the cognitive functions are more frequent. These diseases may increase the risk for fatal car crashes. We analyzed the frequency of neuropathological alterations characteristic of Alzheimer's disease (i.e. neuritic and diffuse plaques, and neurofibrillary tangles) in two association areas of the brain, parietal and frontal cerebral cortex, from 98 fatally injured aged drivers. In the age groups of 65-75 and over 75 years of age, 50% and 72% of the drivers, respectively, had neuritic plaques in either parietal and/or frontal cortex. In 14% of all killed drivers the number of neuritic plaques reached the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) age-related histologic score C, which indicates the diagnosis of Alzheimer's disease (AD), and an additional 33% had score B, which suggests the diagnosis of AD. Neuropathological AD changes were most common in the brains of drivers killed in single vehicle crashes, followed by multivehicle crashes at intersections and least common in multivehicle crashes elsewhere, but the differences did not reach statistical significance. In a great majority (80-85%) of cases the killed aged driver was the guilty party of the crash. The results imply, that incipient AD may contribute to fatal crashes of aged drivers, and therefore the forensic autopsy of these victims should include neuropathological examination.

Reproducibility of ultrasonic fetal volume blood flow measurements

The intraobserver reproducibility of ultrasonic volume blood flow measurements in the human fetus was evaluated in this study. A new approach, simultaneous measurement of the vessel diameter and the flow velocity with a pulsed-wave Doppler ultrasound synchronized with a real-time ultrasound phase-locked echo-tracking system, was used to estimate volume blood flow (VBF) in the fetal descending aorta. Measurements were performed in a longitudinal study on 20 normally grown fetuses. Intraobserver reproducibility of repeated estimations of mean blood flow velocities throughout gestation was very good, with high values of intraclass correlation coefficient (IntraCC 0.80-0.91) and low values of coefficient of variation (CV 4-11%). The IntraCC of repeated vessel diameter measurements throughout gestation was low (0.30-0.68), whereas the values of CV were acceptable (< 12%), with the exception of the period between 140 and 167 gestational days (CV > 12%). The lower reproducibility of vessel diameter measurement contributed directly to the relatively low reproducibility of VBF estimations overall (IntraCC 0.25-0.70; CV 17-28%), as these are calculated from a formula using both flow velocity and vessel diameter. Nevertheless, the synchronized approach gives absolute values of vessel diameter, flow velocity and VBF comparable with values reported in the human fetus previously. The new method provides, by taking the vessel wall pulsations into consideration and by measuring diameter and velocity simultaneously, a more complete information on fetal haemodynamics and fetal physiology.

Risk of acute suprachoroidal hemorrhage with phacoemulsification

PURPOSE

To establish whether small incision cataract surgery with phacoemulsification decreases the risk of acute suprachoroidal hemorrhage (ASCH) compared with traditional nucleus expression by extracapsular cataract extraction (ECCE).

SETTING

St. Erik Eye Hospital, Stockholm, Sweden.

METHODS

A retrospective study was done on the incidence of ASCH in cataract surgery between July 1990 and July 1996. During this period, 37,565 cataract extractions (phacoemulsification and ECCE) were performed at St. Erik Eye Hospital, combined procedures excluded. The criteria for diagnosis were the suspicion of ASCH during surgery and a verified diagnosis via an expulsive hemorrhage into the wound (4 cases), postoperative ultrasonic examination (20 cases), or a choroidal mass on performing ophthalmoscopy together with a postoperative history alluding to the diagnosis (2 cases).

RESULTS

Twenty-six eyes were identified with ASCH, including 7 during phacoemulsification and 19 during ECCE. The incidence of ASCH was 0.03% in the 23,213 phacoemulsification cases and 0.13% in the 14,352 ECCE cases. The difference was statistically significant (P = .0003; chi-square test).

CONCLUSION

Small incision surgery with phacoemulsification decreased the risk of ASCH in cataract surgery compared with the traditional nucleus expression technique.

Accuracy of irreversible hydrocolloids (alginates) for fixed prosthodontics. A comparison between irreversible hydrocolloid, reversible hydrocolloid, and addition silicone for use in the syringe-tray technique

One reversible, seven irreversible hydrocolloids and two addition silicones were examined. The aim was to study their ability to reproduce six differently shaped abutments of a full arch stainless steel master model correctly, by measuring: 1) the accuracy of irreversible hydrocolloid impressions with different storage periods of 15 min, 2 h, 24 h and 95 h, reversible hydrocolloid stored 15 min and 2 h, and Type III addition silicones stored 24 h when the syringe-tray technique was used; and 2) whether mixing technique or tray design had any influence of the accuracy of irreversible hydrocolloid impressions. All the tested impression materials had difficulties in producing full arch casts, where the six abutments were correctly reproduced, because 58% of the heights and 45% of the diameters of the occlusal surfaces were shorter than the corresponding distances of the master model. Storage time, mixing technique and tray design were of significant importance for the irreversible hydrocolloids. Concerning the accuracy at the gingival margin, a shorter storage time resulted in improved accuracy, and mechanical mixing without a vacuum and a tray designed similar to a perforated stock tray gave most accurate impressions.

Chlamydia pneumoniae in human abdominal aortic aneurysms

OBJECTIVES

To investigate the presence of Chlamydia pneumoniae DNA in the wall of infrarenal abdominal aortic aneurysms, and in the wall of non-aneurysmal infrarenal abdominal aortas.

DESIGN

Case-control study.

MATERIALS AND METHODS

The study group consisted of 40 patients operated transperitoneally for an infrarenal abdominal aortic aneurysm (IAAA) (eight females, 32 males; mean age 69 years, median age 68 years). Specimens from the aneurysm wall were taken peroperatively under sterile conditions. The control group consisted of 40 deceased persons without aortic aneurysms (14 females, 26 males; mean age 71 years, median age 70 years). Specimens from the non-aneurysmal infrarenal aortas (NIAA) were collected within 48 h after death. The specimens from both groups were frozen at -70 degrees C immediately after collection. A nested polymerase chain reaction (PCR) method, using two sets of primers designed to detect a fragment of the major outer membrane protein gene of C. pneumoniae, was used.

RESULTS

The detection of C. pneumoniae-specific DNA was significantly higher in the study group (14/40 = 35%) than in the control group (2/40 = 5%); (p = 0.001). No clinical factor predicting the presence of C. pneumoniae in the aneurysm wall, could be found.

CONCLUSION

Chlamydia pneumoniae was detected at a significantly higher frequency in the wall of IAAAs than in the wall of NIAAs. Although this finding does not prove that C. pneumoniae causes IAAAs, further studies on the possible role of C. pneumoniae in the pathogenesis of aneurysms should be performed.

Adverse changes in fibre type composition of the human masseter versus biceps brachii muscle during aging

The fibre composition of functionally different regions, the superficial and the deep portions, of the human masseter and the biceps brachii muscles of six elderly subjects (mean age 74 years) was studied by morphological and enzyme-histochemical methods. When compared to previous data for young adults, the masseter muscle from elderly subjects showed a significant decrease in the proportion of type I fibres and an increase of type IM and II fibre types, concomitant with muscle fibre atrophy. In the old biceps, there were no changes in the type I fibre proportion and fibre diameter, but a significant decrease in the type IIB fibre content. The present results of changes in fibre composition, in addition to previous findings of functional deterioration of the old masseter, probably reflect a combination of age related degenerative and adaptive processes within the trigeminal neuromuscular system. When compared with previous findings in young adult masseter, it can be concluded that the human masseter muscle differs from limb muscles both in fibre composition and in structural response of the muscle during aging. These differences between the masseter and the biceps brachii muscle suggest muscle specific alterations during aging probably due to differences in genetical control, functional performance and nerve and hormonal influences.

Transfer of radiocaesium in sensitive agricultural environments after the Chernobyl fallout in Sweden: III. County of Västernorrland

In 1986 a large number of farms in the Chernobyl-affected area in the county of Västernorrland in northern Sweden were investigated for radiocaesium transfer to grass and cereal grain. The soil surface layer (0-5 cm) in 1986 and the crop products in 1986-1996 were analysed. The aim was to study the impact of soil and crop rotation on sensitivity of 137Cs transfer in a short and long term perspective. In the fallout year 1986 the transfer to grass was usually much higher than to cereal grain. In this year the transfer to grass was usually much higher in the first cut rather than the second cut. The reduction in transfer with year was large but variable with site and with crop sequence. Ploughing was effective in decreasing the transfer of 137Cs to crops. On arable sites in 1986 the transfer to cereal straw was larger at late stem elongation (LSE) than at the maturing stage. Unexpectedly, there was no clear relationship between transfer of 137Cs to the crops and any of the soil characteristics. In 1986 the transfer of 131I to grass and cereals was also investigated on some of the farms. The results are compared with the transfer of 137Cs, 2 months after the Chernobyl fallout.

[Shortcomings in the coverage of death occurring outside hospitals]

The article consists in a report of physicians' observance of legislative requirements concerning the documentation and investigation of deaths outside hospital, as studied in a series of 973 cases of death occurring in four medium-sized Swedish communities during 1993. The results showed manifest shortcomings in the performance of post-mortem investigations: long delays in submitting the death certificate, negligence in reporting unnatural and unexpected deaths to the police, and inadequate notes in the patients' journals concerning death certification, which relatives had been informed, the circumstances of death, and whether post-mortem examination had been performed. A special checklist would be of value in the documentation adn investigation of deaths occurring outside hospital.

Refined genetic localization of the Best disease gene in 11q13 and physical mapping of linked markers on radiation hybrids

Best's macular dystrophy, also known as vitelliform macular degeneration type 2 (VMD-2), is an autosomal dominant eye disorder that causes reduced visual acuity. It generally manifests itself in the teenage years. The gene mutated in VMD-2 patients may provide valuable insight into the biological mechanisms of the far more common disorder age-related macular degeneration. The VMD-2 gene has been localized to 11q13 between UGB and Fc epsilon RI. In order to clone the gene positionally, a large Swedish VMD-2 family dating back to the 17th century was studied for recombinations. Since the last study, another 40 microsatellite markers have been analyzed in the family; the closest centromeric flanking marker, D11S4076, revealed two recombinations and the closest telomeric flanking marker, UGB, revealed one recombination. The recombinations have occurred in affected individuals, which eliminates the potential problem of reduced penetrance. The order and physical distance between 22 markers located at proximal 11q13 were analyzed on the G3 Stanford radiation-reduced cell hybrids. The data suggest that the VMD-2 region flanked by the microsatellite markers D11S4076 and UGB is approximately 980 kb.

Comparison between blood analysis and police assessment of drug and alcohol use by injured drivers

Official statistics for alcohol/drug use by drivers can influence the introduction of intervention measures against impaired driving. Thus, the validity of official statistics is important. Since official statistics are based on police assessment of inebriation, the present study was aimed at investigating this issue by comparing blood analysis with the rate of police detection of alcohol/drug use by injured drivers. All injured motor vehicle drivers who were hospitalized (HD) (Umeå: n = 104) and all fatally-injured drivers (FD) who were autopsied (Umeå, Northern Sweden: n = 110; Gothenburg, Western Sweden: n = 133) from May 1991 through Dec 1993 were tested for alcohol and both licit and illicit drugs. The findings of the blood analyses were compared with police assessment of inebriation. In the HD, the police suspected inebriation in 13% (n = 13) whilst blood analyses showed drug and or alcohol in 18% (n = 19) of the drivers (sensitivity 69%; specificity 97%). In the FD, the police suspected inebriation in 7% (n = 16) of the drivers whilst blood analyses showed drug and/or alcohol in 23% (n = 57) of the drivers (sensitivity 53%; specificity 100%). The blood alcohol-positive HD who the police suspected to be inebriated had significantly higher mean blood alcohol concentrations than those not suspected. To avoid biased statistics, official statistics on inebriation of injured drivers should be based on blood analysis of drug/alcohol and not on police assessment.

Drug and alcohol use among injured motor vehicle drivers in Sweden: prevalence, driver, crash, and injury characteristics

Injured motor vehicle drivers who were hospitalized (Umeå: n = 130) and fatally injured drivers who were autopsied (Umeå, Northern Sweden: n = 111; Gothenburg, Western Sweden: n = 136) from May 1991 through December 1993 were tested for alcohol and for both licit and illicit drugs. Nineteen percent of the Umeå-hospitalized drivers (UHDs), 26% of the Umeå fatally injured drivers (UFDs), and 21% of the Gothenburg fatally injured drivers (GFDs) tested positive for drugs and/or alcohol. Ten percent of the UHDs, 8% of the UFDs, and 6% of the GFDs tested positive for drugs. Almost 5% of the UHDs, had illicit drugs, and 6% had licit drugs. Only 3% of the GFDs and none of the UFDs had illicit drugs. Benzodiazepines, followed by opiates, tetrahydrocannabinol, and amphetamine were the most common drugs detected. Twelve percent of the UHDs, 24% of the UFDs, and 17% of the GFDs tested positive for alcohol. Two percent of the UHDs, 6% of the UFDs, and 2% of the GFDs had a combination of drugs and alcohol.

Intermediate filament proteins in adult human arteries

BACKGROUND

The cytoskeleton of cells in blood vessel walls contains desmin, vimentin, and cytokeratins. The distribution of these proteins in human vessels is not fully known. We have mapped the distribution of intermediate filament proteins in human arterial walls.

METHODS

Monoclonal antibodies targeted at the intermediate filament proteins desmin, vimentin, and cytokeratins were used, and the distribution of these proteins was studied by immunohistochemistry.

RESULTS

In the muscular arteries, most smooth muscle cells in the media expressed both desmin and vimentin; in the elastic arteries, the proportion of desmin-labelled cells was lower and preferentially located to the periphery of the media. In general, the desmin immunoreactivity within the intima was weak, but some smooth muscle cells and smooth muscle cells in the musculoelastic layer showed strong immunoreactivity. The vasa vasorum exhibited a heterogeneous desmin-labelling pattern. The vimentin antibodies labelled the endothelium and showed a heterogeneous staining pattern in the other layers of the arterial wall. Cytokeratin was detected in occasional cells in the media of muscular arteries, in many adluminal cells and cell clusters in the coronary intima, and in smooth muscle cells in the media of the elastic arteries.

CONCLUSIONS

Vimentin is widely distributed in vascular smooth muscle cells, whereas the distribution of desmin and cytokeratin varies. Each artery studied had an intermediate filament pattern typical for the anatomical location. There were no interindividual variations in the distribution of intermediate filament proteins.

Vehicle-related fatalities among Swedish conscripts

All traffic fatalities among conscripts in Sweden from 1979 through 1988 (N = 106) were studied. More than half (58%) of the victims were on leave, nearly one-third (30%) were traveling to or from the regiment, and 13 (12%) were on duty. Forty-one percent of the drivers on leave who were involved in crashes were inebriated; the mean blood alcohol concentration was 1.6 g/kg. Fifty-two percent of the conscripts on leave were injured in single-vehicle crashes. Fatalities occurring during travel to or from the regiment most often occurred in crashes with another vehicle (69%), and all the drivers were sober. At least one of the fatally injured drivers on duty was inebriated, and in another two crashes, safety belts were not used although this was compulsory for both passengers and drivers. We conclude that collective travel could reduce the danger in traveling to and from the regiment. In addition, identifying alcohol abusers and preventing them from driving is of prime importance. Increased use of safety belts and installation of airbags should also be beneficial as well.

Serotonergic, noradrenergic, and dopaminergic measures in suicide brains

Concentrations of the three main monoamines (5-HT, NA, and DA), their metabolites (5-HIAA, DOPAC, and HVA), and the serotonin precursor 5-hydroxy-L-tryptophan were simultaneously measured in frontal cortex, gyrus cinguli, and hypothalamus from 23 controls and 18 suicide victims. Overall suicides did not show significant differences with respect to the control group in any of the measured compounds. Significant increases in noradrenaline and dopamine concentrations were noted in the carbon monoxide poisoning suicides, together with a significant increased hypothalamic dopamine in the drug overdose suicides. It is suggested that the suicidal behavior is not related to substantial changes in cortical and hypothalamic monoaminergic function; however, the reported results could be secondary to the rapid effect of hypoxia and of the acute self-administration of certain drugs in specific metabolic pathways.

Development of tympanosclerosis: can predicting factors be identified?

HYPOTHESIS

The etiological hypothesis is that there might be factors triggering an immunological chain reaction that eventually leads to tympanosclerosis formation.

BACKGROUND

Tympanosclerosis is a condition leading to a calcification process in the middle ear and, occasionally, also to the lining of the inner ear. This sometimes leads to hearing loss due to fixation of the middle ear ossicles. In severe cases. deafness may occur as a result of the inner ear impairment. Surgery is the treatment offered, often with poor long-term results, and, alternatively, prescription of hearing aids. Some patients develop tympanosclerosis after mild inflammatory otitis media processes whereas some heal without tympanosclerosis after more aggressive infections. This difference may be due to individual variations in the inflammatory response. The biological mechanism of calcification in tympanosclerosis is probably similar to that occurring in other calcifying tissues due to diseases.

METHODS

The present investigation was performed to develop methods for immunohistochemical analyses of this delicate tissue consisting of both hard bone and the very thin tympanic membrane. Sprague-Dawley rats were inoculated with a suspension of Streptococcus pneumoniae, type 3, into the middle ear and sacrificed after 1 week up to 6 months. A new technique was elaborated where the whole specimen was prefixed briefly and then en bloc incubated with the primary antibodies and after that decalcified in edetic acid (EDTA). Primary antibodies against macrophages were used for the immunohistochemical staining.

RESULTS

Acute otitis media was successfully induced in the rats and myringosclerosis was seen in 30% of the animals, often localized close to the bony frame where macrophages could also be detected.

CONCLUSIONS

Acute otitis media and myringosclerosis were introduced in the animals. Conventional immunological techniques were tested on this delicate tissue. A new method for immunohistochemical staining was elaborated in which specimens were stained en bloc before decalcification and sectioning were performed. Expression of macrophages was demonstrated in the tympanic membrane.

Intermediate filament proteins in adult human arteries

BACKGROUND

The cytoskeleton of cells in blood vessel walls contains desmin, vimentin, and cytokeratins. The distribution of these proteins in human vessels is not fully known. We have mapped the distribution of intermediate filament proteins in human arterial walls.

METHODS

Monoclonal antibodies targeted at the intermediate filament proteins desmin, vimentin, and cytokeratins were used, and the distribution of these proteins was studied by immunohistochemistry.

RESULTS

In the muscular arteries, most smooth muscle cells in the media expressed both desmin and vimentin; in the elastic arteries, the proportion of desmin-labelled cells was lower and preferentially located to the periphery of the media. In general, the desmin immunoreactivity within the intima was weak, but some smooth muscle cells and smooth muscle cells in the musculoelastic layer showed strong immunoreactivity. The vasa vasorum exhibited a heterogeneous desmin-labelling pattern. The vimentin antibodies labelled the endothelium and showed a heterogeneous staining pattern in the other layers of the arterial wall. Cytokeratin was detected in occasional cells in the media of muscular arteries, in many adluminal cells and cell clusters in the coronary intima, and in smooth muscle cells in the media of the elastic arteries.

CONCLUSIONS

Vimentin is widely distributed in vascular smooth muscle cells, whereas the distribution of desmin and cytokeratin varies. Each artery studied had an intermediate filament pattern typical for the anatomical location. There were no interindividual variations in the distribution of intermediate filament proteins.

Natriuretic peptide immunoreactivity in nerve structures and Purkinje fibres of human, pig and sheep hearts

Atrial natriuretic peptide is a well-described peptide in cardiac Purkinje fibres and has been shown to interfere with the autonomic regulation in the heart of various species, including man. Recently, we detected immunoreactivity for the peptide in intracardial ganglionic cells and nerve fibre varicosities of bovine hearts, by the use of a modified immunostaining technique that induced an improved detection of natriuretic peptides. These findings raised the question as to whether natriuretic peptides are detectable in these tissues in man and other species. The conduction system from human, pig and sheep hearts was dissected processed with antisera against atrial natriuretic peptide and the closely related brain natriuretic peptide. Immunostaining for the brain natriuretic peptide was detected in some Purkinje fibres in all of these species. Interestingly, in pig, sheep and human hearts, some ganglionic cells and nerve fibres showed atrial natriuretic peptide immunoreactivity, particularly in the soma of human ganglionic cells. This is the first study showing immunoreactivity for the atrial natriuretic peptide in nerve structures and for the brain natriuretic peptide in Purkinje fibres of the human heart. The results give a morphological correlate for the documented effects of atrial natriuretic peptide on the heart autonomic nervous system and for the presumable effects of brain natriuretic peptide in the conduction system of man.

Prostaglandin synthesis is suppressed by progesterone in rat preovulatory follicles in vitro

The inducible form of prostaglandin endoperoxide-2 (PGS-2) is transiently induced by activators of the protein kinase A and protein kinase C systems in rat preovulatory (PO) granulosa cells. This induction is suggested to play an important role in the ovulatory process, which shares many of the characteristics of an inflammatory reaction. The purpose of the present study was to explore the role of progesterone (P4) as an "anti-inflammatory" steroid for the regulation of PGS-2 and the synthesis of prostaglandins in the PO follicle. Isolated rat PO follicles were preincubated with different amounts of exogenous P4 before the addition of luteinizing hormone (LH) and 3-isobutyl-1-methylxanthine (IBMX) (LH + 1). Medium levels of prostaglandin E2 (PGE2) were measured by RIA and the protein contents of PGS-1 and PGS-2 were determined by immunoblotting. LH + I. Both the content of PGS-2 and the synthesis of PGE2 were decreased. The content of PGS-1 demonstrated only minor changes in response to P4. These results showed a dual regulation of PGS-2 in the rat PO follicle with both stimulatory and inhibitory pathways. One of the "anti-inflammatory" actions exerted by P4 in the present study was to reduce the expression of PGS-2 and the follicular production of prostaglandins. This action might be of importance for restriction and control of the inflammatory response in the ovulatory process in vivo.

GABA uptake sites in frontal cortex from suicide victims and in aging

The binding of [3H]nipecotic acid to GABA uptake sites was studied in post mortem human frontal cortex from 17 suicide victims and 21 controls without known neurological or psychiatric disorder. The suicide victims were subclassified according to the use of violent or non-violent methods and to the presence or absence of a known history of a depressive disorder. No difference was found between the suicide victims and the controls with regard to [3H]nipecotic acid binding to GABA uptake sites (Bmax) and apparent affinity (Kd). No differences were found either with regard to method of suicide or whether a depressive symptom existed or not. The binding of [3H]nipecotic acid to GABA uptake sites was also studied in post mortem human frontal cortex with regard to aging. The age of the subjects ranged from 16 to 84 years. No significant difference in either Bmax or Kd was found. The present findings suggest that the GABA uptake sites in the human frontal cortex are not subjected to regulation or degenerative changes in conditions investigated.

Similar distribution of mast cells and substance P- and calcitonin gene-related peptide-immunoreactive nerve fibers in the adult human larynx

The mechanisms causing supraglottic and subglottic edema in the human larynx are not fully understood. Substance P (SP)- and calcitonin gene-related peptide (CGRP)-containing nerve fibers and mast cells have been suggested to induce inflammation and edema in other parts of the body. In this study of the adult human larynx the distribution of mast cells was studied in relation to SP- and CGRP-containing nerve fibers. Substance P- and CGRP-immunoreactive nerve fibers and numerous mast cells were found in the epiglottis and in the subglottic region of the larynx. Only occasional mast cells and no nerve fibers showing SP- or CGRP-like immunoreactivity were found in the vocal cords. In conclusion, the present study has shown that the distribution of nerve fibers showing SP- and CGRP-like immunoreactivity and mast cells has a similar regional variability. As the highest density of SP- and CGRP-containing nerve fibers and mast cells was present in the regions of the larynx where edema occurs, SP, CGRP, and/or mast cells might be involved in the pathogenesis of edema.

Keratouveitis--two families with a dominantly inherited disorder

Herein we describe a relapsing acute keratouveitis without known aetiology. The disorder has been found in two families and shows an autosomal dominant inheritance. Acute anterior uveitis can be traced for five generations in one of these families. In the same family there is also an association to an autosomal dominantly inherited vascular disorder (Osler-Rendu-Weber disease). The anterior uveitis has an acute onset, a recurrent pattern and a mild activity. The associated keratitis is seen as a midstromal thin flat disc in the central cornea, sometimes with folds in Descemet's membrane as a sign of oedema. This causes a change in refraction and a mild reduction of the corrected visual acuity. There is a prompt response to topical steroid treatment, but the corneal changes have in one case become permanent. Clinical documentation and the mode of inheritance is presented.