[Forensic medicine yesterday--forensic sciences tomorrow].
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Biotechnology↗
Biomedical subjects
A Penttilä
Publications and source records attributed to A Penttilä.
[Autopsies as a guarantee of legal protection and quality of patient care].
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Autopsy↗
Exploitation of autopsy in determining natural cause of death: trends in Finland with special reference to the diagnostics of ischemic heart diseases and cerebrovascular diseases in middle-aged males, 1974-1993.
Finnish mortality statistics show a marked decrease in coronary disease mortality especially among middle-aged males during the last 20 to 25 years. At the same time, the overall autopsy rate in deaths due to natural, non-violent causes has diminished in Finland. National mortality statistics are based on medical information given in death certificates. How often are the causes of death based on autopsy and is there any definitive trend? Possible changes in cause-of-death determination practices may have contributed to the mortality changes observed. In this study, deaths due to ischemic heart diseases (IHD) and cerebrovascular diseases (CVD) from 1974 to 1993 in Finland were compared with natural deaths, i.e. all of the deaths due to natural causes, in regard to use of autopsy. It was found that IHD-diagnosis as the underlying cause-of-death was, unlike natural deaths and CVD in particular, increasingly based on autopsy. It is thus concluded that the recent decline in coronary disease mortality among middle-aged men in Finland cannot be explained by any deterioration in cause-of-death examination practices.
Adult↗
Initial stability of femoral neck osteosynthesis with absorbable self-reinforced poly-L-lactide (SR-PLLA) and metallic screws: a comparative study on 21 cadavers.
The initial stability of femoral neck osteosynthesis provided by three self-reinforced poly-L-lactide (SR-PLLA) or three metallic cannulated screws was compared. A standard transverse subcapital osteotomy was created with a hand saw in 19 pairs of human cadaver femora. Two fixation methods were randomly used in each pair. Fixations were exposed to a progressive cyclic loading test to determine the deflection curves, the ultimate load-carrying capacity, and the total amount of load absorbed. One pair served as a pilot and two nonoperated pairs served as controls. The positioning of the three fixation screws, whether one screw proximally and two screws distally or vice versa, provided equal stability. Metallic fixation proved to be more stable than SR-PLLA fixation as the average maximum load-carrying capacity was 3400N for the metallic and 2600N for the SR-PLLA fixation. However, SR-PLLA screws showed sufficient fixation properties for considering clinical trials in Garden I-II femoral neck fractures in well cooperative patients.
Absorption↗
Scanning and transmission electron microscopical evidence of the capacity of diatoms to penetrate the alveolo-capillary barrier in drowning.
The diagnostic value of diatom analysis for drowning is considered to be one of the most controversial arguments in forensic medicine. However, the theoretical assumption of the method, i.e. the capacity of diatoms to penetrate the alveolo-capillary barrier during drowning, has never been addressed. Using scanning (SEM) and transmission electron microscopy (TEM), we have investigated the interaction of a natural population of diatoms and an unialgal culture of Phaeodactylum tricornutum (PT) with the alveolo-capillary barrier in an experimental model of drowning. The SEM analysis allowed the identification of several diatom species along the whole airways and their close interaction with the alveolar wall, but was poorly informative about the effective penetration of diatoms into pulmonary vessels. The TEM analysis was more informative and allowed a precise identification of the PT cells in alveolar spaces and to detect their phagocytosis by alveolar macrophages. PT penetrated into the pulmonary vessels through the thinnest portions of the alveolo-capillary barrier and through the interstitial spaces and were identified in pulmonary capillaries and venules. The morphological demonstration of the capacity of diatoms to penetrate the alveolo-capillary barrier is a step forward in assessing the potentiality, reliability and limitations of diatom analysis on a new basis as a tool for the diagnosis of drowning.
Animals↗
Water traffic accidents, drowning and alcohol in Finland, 1969-1995.
OBJECTIVE: To examine age- and sex-specific mortality rates and trends in water traffic accidents (WTA), and their association with alcohol, in Finland. MATERIALS AND METHODS: National mortality and population data from Finland, 1969-1995, are used to analyse rates and trends. The mortality rates are calculated on the basis of population, per 100000 inhabitants in each age group (<1, 1-4, 5-14, 15-24, 25-44, 45-64, > or = 65), and analysed by sex and age. The Poisson regression model and chi2 test for trend (EGRET and StatXact softwares) are used to analyse time trends. RESULTS: From 1969 through 1995 there were 3473 (2.7/100000/year; M:F= 20.4:1) WTA-related deaths among Finns of all ages. In 94.7% of the cases the cause of death was drowning. Alcohol intoxication was a contributing cause of death in 63.0% of the fatalities. During the study period the overall WTA mortality rates declined significantly (-4% per year; P < 0.001). This decline was observed in all age groups except > or = 65 year olds. The overall mortality rates in WTA associated with alcohol intoxication (1987-1995) also declined significantly (-6%; P = 0.01). CONCLUSIONS: In Finland, mortality rates in WTA are exceptionally high. Despite a marked decline in most age groups, the high mortality in WTA nevertheless remains a preventable cause of death. Preventive countermeasures targeted specifically to adult males, to the reduction of alcohol consumption in aquatic settings and to the use of personal safety devices should receive priority.
Accident Prevention↗
Postmortem pancreatic angiography in 45 subjects with non-insulin-dependent diabetes mellitus and 51 controls.
We evaluated, from 96 postmortem angiographs, the main feeding arteries and degree of vascularity of the pancreas to discover to what extent atherosclerosis affects pancreatic blood supply in subjects with and without non-insulin-dependent diabetes mellitus (NIDDM). Patients with NIDDM more often showed intrapancreatic arteries with irregularities in the body-tail of the pancreas (p = 0.050) and more frequently demonstrated decreased vascularity in both the body-tail and the head of the pancreas (p < 0.001) than did the controls. When the arterial system from the aorta to the intrapancreatic branches was examined as a whole, 26 (58%) of the NIDDM patients and 10 (20%) of the controls (p = 0.0001) showed one or more of the following: >50% stenosis in the celiac or splenic artery, two or more irregular intrapancreatic branches, or a distinctly decreased degree of vascularity in the body-tail portion of the pancreas, the region responsible for most insulin secretion. Only 1 NIDDM patient, compared to 10 controls, showed a totally normal angiogram. In conclusion, vascular disease in the feeding arteries of the pancreas is more common in NIDDM patients than age- and gender-matched controls.
Aged↗
Arteriovenous anastomoses exist in the body and tail of the pancreas.
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Adult↗
Sudden death by arrhythmogenic right ventricular dysplasia in a South American transsexual?
Arrhythmogenic right ventricular dysplasia (ARVD) is a rare, but increasingly diagnosed, anatomoclinical entity, characterized by a regional or diffuse replacement of the myocardium of the right ventricle (RV) by adipose/fibroadipose tissue. We report a probable case of a sudden death by ARVD, initially misinterpreted by investigators as a violent death, in a 22-year-old, South American transsexual, HIV-positive, while attempting clandestine immigration from Switzerland to Italy. The demonstration of the causal connection between RVD, electrical instability of the RV and death may be puzzling, especially when circumstances of death are unclear. The still unclear nosological borders between normal adipose content, 'near physiological' lipomatosis and RVD, the uncertain topographic correlation between (fibro) adipose infiltration and electrical instability of the RV as well as the incidental finding of extensive fibrofatty infiltration of the RV also in victims of violent deaths indicate the need to consider with caution--and always after the exclusion of other causes--the causal connection between RVD and sudden death.
Adult↗
Polymorphism in the cytochrome P450 2E1 gene and the risk of alcoholic liver disease.
BACKGROUND/AIMS: To study the genetic susceptibility to alcoholic liver disease, we investigated the association between genetic polymorphism in the cytochrome P450 2E1 gene and the occurrence of alcoholic liver disease. METHODS: Four previously described restriction fragment length polymorphisms (RFLPs) in the cytochrome P 450 2E1 gene were analyzed by restriction endonuclease (Dra I, Msp I, Pst I and Rsa I) digestion of polymerase chain reaction amplified DNA segments. Polymorphisms in these loci were compared to the occurrence of fatty liver, alcoholic hepatitis and liver fibrosis in 319 males comprising total abstainers, moderate alcohol consumers and chronic alcoholics. RESULTS: The allelic frequencies for each RFLP in this series were: 0.89 and 0.11 (Dra I), 0.98 and 0.02 (Msp I) and 0.99 and 0.01 (Pst I and Rsa I). The distribution of the alleles did not vary significantly between the different consumption groups. The allelic frequencies among patients with fatty liver, alcoholic hepatitis or liver fibrosis were not significantly different from the allelic frequencies among patients with normal liver histology. Comparison of different genotypes among moderate alcohol consumers (n = 43) or chronic alcoholics (n = 243) with or without liver disease showed no statistically significant associations. However, the rare polymorphic (d2) allele in the Dra I RFLP was found slightly more often among moderate consumers as well as alcoholics with alcoholic liver disease. CONCLUSIONS: These results indicate that the Msp I, Pst I and Rsa I RFLPs were very rare in the Finnish population, suggesting at most minor contribution to the inherited susceptibility to alcoholic liver disease. Polymorphism in the Dra I locus was more common in this study population, but showed no statistically significant association with alcoholic liver disease.
Adult↗
Pulmonary platelet production: physical fragmentation and platelet territories.
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Adult↗
Mast cells in rupture-prone areas of human coronary atheromas produce and store TNF-alpha.
BACKGROUND: Mast cells, a cell type involved in inflammatory reactions, are present in coronary atheromas and localize to the erosion or rupture site of atheromas in myocardial infarction. Here we report the presence of TNF-alpha, a proinflammatory cytokine, in mast cells of human coronary atheromas. METHODS AND RESULTS: From samples of 37 coronary arteries from subjects autopsied for medicolegal reasons, sections of the bifurcation area of the left coronary artery were stained immunohistochemically for mast cells and TNF-alpha. In addition, macrophages, T lymphocytes, smooth muscle cells, and endothelial cells were investigated for their content of TNF-alpha. In normal intimas and fatty streaks, none of the cell types studied were TNF-alpha-positive. In 14 of the 24 atheromas found, TNF-alpha-positive cells were present. Of the total number of mast cells, 23% stained for TNF-alpha; of the macrophages, 1.3%; and of the smooth muscle cells, 0.4%. The majority (55%) of TNF-alpha-positive mast cells in the atheromas were located in the shoulder region and the remaining 35% in the cap and 10% in the core regions. Immunoelectron microscopy showed that the TNF-alpha in mast cells resided within their cytoplasmic secretory granules, demonstrating that these cells contain stores of TNF-alpha that will be released on degranulation. CONCLUSIONS: This study demonstrates the presence of mast cells with TNF-alpha-containing secretory granules, particularly in the shoulder region of human coronary atheromas. By releasing their TNF-alpha, mast cells may play an active role in the inflammatory reactions of these rupture-prone areas of atheromas.
Adult↗
Active oxygen intermediates and chlorophyllin bleaching.
Bleaching of chlorophyllin, a water soluble copper containing porphyrin molecule, was investigated with regard to the potential role of active oxygen intermediate involvement. It was found that the bleaching was highly aerobic and also biphasic in nature. The aerobic photobleaching and the dark bleaching were effectively prevented by the addition of reductants such as ascorbate and cysteine. In addition, the reductant and peroxyl radical scavenger, Trolox, was highly effective in preventing bleaching. Catalase was moderately effective in preventing photobleaching whereas peroxidase and superoxide dismutase hastened the photobleaching process. It is concluded that the bleaching of chlorophyllin is a peroxidative process which does not involve singlet oxygen, superoxide, nor the .OH radical.
Chlorophyllides↗
Immunohistochemical identification of syncytiotrophoblastic cells and megakaryocytes in pulmonary vessels in a fatal case of amniotic fluid embolism.
The histological diagnosis of amniotic fluid embolism (AFE) is based on finding amniotic fluid components in the pulmonary microvasculature. In addition to the distinctive constituents of AFE, placental and decidual tissue fragments as well as isolated trophoblastic cells and megakaryocytes are potentially detectable within pulmonary vessels. The identification of single syncytiotrophoblastic cells (STC), and their differentiation from circulating megakaryocytes (MK) within the lumen of small and medium-sized pulmonary vessels is difficult by classical morphological methods. In a fatal case of AFE, we have successfully detected the simultaneous presence of STC and MK in the pulmonary microvasculature by means of a panel of specific monoclonal (CD61-GpIIIa, beta-hCG) and polyclonal (FVIII-vW, hPL) antibodies. The immunohistochemical analysis for identification of STC and MK should provide more precise data on their incidence and distribution in physiological and pathological conditions as well providing new insights into their physiopathological implications and their correlation with AFE and other gynaecological complications.
Adult↗
Mast cells accompany microvessels in human coronary atheromas: implications for intimal neovascularization and hemorrhage.
Mast cells have been assigned a role in neovascularization. Therefore, we examined the deep regions of human coronary atheromas, the areas known to be prone to neovascularization, for the presence of mast cells. Specimens of atherosclerotic human coronary intima from 37 autopsy cases with ages of 24-84 years were stained with elastica-van Gieson to detect atheroma formation and with monoclonal antibody against von Willebrand factor to detect neovascularization. Mast cells were detected by staining the atheromas with monoclonal antibodies against the two major proteases of mast cells, tryptase and chymase. Of the 24 coronary atheromas found, 13 contained mast cells in the deep regions. All these 13 deep regions also displayed neovascularization, and the number of microvessels and the number of mast cells around the microvessels correlated strongly with the size of the atheroma. On the other hand, of the 11 deep regions lacking mast cells, only one displayed neovascularization. In the neovascularized areas of the coronary atheromas, the mast cells were in close proximity to the microvessels. All the mast cells contained tryptase, and some of them chymase, both known for their angiogenic and matrix-degrading potential. In light microscopic studies, degranulated mast cells were observed indicating activation of these cells, with release of tryptase and chymase. The selective localization of activated mast cells containing angiogenic factors around newly formed microvessels in human coronary atheromas suggests that mast cells play a role in the neovascularization of these lesions. Moreover, mast cells may also, by virtue of their neutral proteases, injure the microvessels, and thereby produce intraplaque hemorrhages and, ultimately, unstable lesions.
Adult↗
Glutathione S-transferase-M1 'null' genotype and alcohol-induced disorders of human spermatogenesis.
The association between alcohol-induced disorders of human spermatogenesis and glutathione S-transferase-M1 genotype was investigated in an autopsy study comprising 271 subjects, including interviews with relatives or close acquaintances on the alcohol consumption of the deceased. Of the 50 moderate drinking men (reported mean daily alcohol consumption < 40 g), 21 (42.0%) had normal spermatogenesis, whereas 24 men (48.0%) had partial, and five (10.0%) complete arrest of spermatogenesis. Of the 21 men with normal spermatogenesis, nine (42.9%) had GST M1 'null' genotype, while this genotype was found in 13 (44.8%) of the 29 men with partial or complete spermatogenic arrest. Of 212 heavy-drinking men (reported mean daily alcohol consumption > 80 g), only 45 (21.2%) had normal spermatogenesis, whereas 77 (36.3%) had partial spermatogenic arrest. Complete arrest of spermatogenesis was found in 81 men (38.2%) and nine men had Sertoli-cell-only syndrome (4.2%). Of the 45 heavy drinkers with normal spermatogenesis, 27 (60%) men had GST M1 'null' genotype (OR 2.7 with 95% confidence intervals: 1.0-4.0, when compared to those with disorders of spermatogenesis). The frequency of GST M1 'null' genotype in heavy drinkers with normal spermatogenesis also differed from that of corresponding moderate drinkers, whereas the frequency of GST M1 'null' genotype in heavy drinkers with disorders of spermatogenesis was similar to moderate drinkers with or without disorders of spermatogenesis. The finding that > 20% of men in the heavy-drinking group had normal spermatogenesis suggests individual variations in sensitivity to alcohol-induced disorders of this process. Heavy drinkers with GST M1 'null' genotype were slightly less prone to develop disorders of spermatogenesis. Thus, the GST M1 locus may be associated with susceptibility to develop alcohol-induced disorders of spermatogenesis.
Adult↗
Polymorphism in the cytochrome P450 2E1 gene and alcohol-induced disorders of human spermatogenesis.
The association between alcohol-induced disorders of human spermatogenesis and four restriction fragment polymorphisms (DraI, MspI, PstI and RsaI) of the cytochrome P450 2E1 gene was investigated in an autopsy study on 254 men. Acquaintances were interviewed and the mean daily alcohol consumption of the subjects was calculated on the basis of the interviews. Spermatogenesis score and testicular morphology were assessed by light-microscopy, and cytochrome 2E1 polymorphic genotypes were determined using the polymerase chain reaction. Of the 204 heavy-drinking men, 42 (20.6%) men had normal spermatogenesis (p < 0.001, compared to moderate drinkers). Partial spermatogenic arrest was observed in 76 (37.3%) men and complete spermatogenic arrest in 79 (38.7%) men (p < 0.001, compared to moderate drinkers), whereas seven men (3.4%) had Sertoli cell only syndrome. The overall allelic frequencies for the common and rare polymorphic alleles were 0.98 and 0.02 (MspI) and 0.99 and 0.01 (PstI and RsaI), respectively. No associations between heterozygosity in the MspI, PstI or RsaI loci, or the allelic frequencies of common and rare alleles, and disorders of spermatogenesis were observed. The allelic frequencies for the common and rare polymorphic alleles in the DraI locus were 0.90 and 0.10, respectively. No significant difference was observed, either among moderate or heavy drinkers, in the frequency of the rare allele between men with disorders of spermatogenesis and those with normal spermatogenesis in the respective group, although men with disorders of spermatogenesis in general had a slightly lower frequency of the rare allele when compared to those with normal spermatogenesis. In conclusion, we were unable to demonstrate a significant association between any polymorphisms in the CYP2E1 gene and disorders of spermatogenesis. RsaI, MspI and PstI polymorphisms were extremely rare in our population and could thus possibly be excluded as reasons for genetic susceptibility to disorders of spermatogenesis in our series.
Adult↗
Glutathione-S-transferase GST M1 "null" genotype and the risk of alcoholic liver disease.
The present study was conducted to investigate possible association between the occurrence of glutathione-S-transferase GST M1 "null" genotype and alcoholic liver disease (ALD). The"null" genotype indicating absent activity of class mu glutathione transferase was assessed in 33 abstainers, 43 moderate alcohol consumers, and 313 heavy alcohol consumers by polymerase chain reaction. The genotypes were compared with occurrence of alcoholic fatty liver, alcoholic hepatitis, and alcoholic liver fibrosis. The "null" genotype was found among 44.7% of patients in the series, with no significant differences between different consumption groups: controls, 36.4%; moderate consumers, 39.5%; and heavy consumers, 46.3%. Occurrence of GST M1 "null" genotype was not associated with occurrence ALD among moderate alcohol consumers. Frequency of the "null" genotype was, however, statistically nearly significantly [p = 0.07, odds ratio (OR) = 1.75] lower among heavy consumers with normal liver histology than in alcoholics with ALD. Furthermore, when compared with heavy consumers without ALD, the "null" genotype was nearly significantly more frequent among heavy consumers with at least slight liver fibrosis (p = 0.05, OR = 1.8) and statistically significantly more frequent among among alcoholics with advanced liver fibrosis (p < 0.025, OR = 2.3). Results of the present Finnish association study suggest that homozygous deletion of the GST M1 gene may indicate increased susceptibility to develop irreversible liver damage in response to the toxic effects of ethanol. Significant association was found between the occurrence of the "null" genotype and the occurrence of alcoholic liver cirrhosis.
Adult↗