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Biomedical subjects

H Laaksonen

Publications and source records attributed to H Laaksonen.

At least 19 recordsLinked to original sources

Surveillance of human immunodeficiency virus (HIV) antibodies in medicolegal autopsies in Finland--monitoring early changes in HIV-seropositivity among risk groups and average population.

In order to cooperate with voluntary screening programs aimed at the surveillance of the HIV epidemic in Finland, we have studied medicolegal autopsies for HIV antibodies since 1986 using an enzyme immunoassay on postmortem sera. The investigation covered 47.4% and 39.2%, respectively, of all deaths under the age of 65 years in the metropolitan areas of Helsinki and Turku--two cities on the densely populated southern coast of Finland from which most HIV infections have thus far been detected. Nine HIV-positive cases (0.12%) were detected among the 7305 medicolegal autopsies tested in 1986 to 1990. This figure is higher than the prevalence of 0.01 to 0.03% in voluntary screening programs for the general population would suggest. Seven of our cases had previously tested positive, and two were previously unknown cases, indicating that people at high risk are clustered in the medicolegal autopsy series. Of the six cases in an early stage of infection, three committed suicide suggesting the importance of HIV-screening in suicide cases in tracing symptomless HIV carriers. Five of the cases were detected in 1990, a year when the number of new HIV infections had more than doubled compared to the previous two years. This suggests that testing of medicolegal autopsies as surrogate tests for the population gives useful information even in low-prevalence areas like Finland. Such testing has none of the ethical problems of many other back-up surveys, and may be particularly sensitive to early changes in epidemiology.

Adult

Relationships between myocardial macrominerals and trace elements and luminal narrowing of coronary arteries in Finnish children.

In addition to the traditional risk factors for cardiovascular diseases it has been hypothesized that a suboptimal intake of macrominerals and trace elements plays a role in the etiology of such diseases. We studied the possible correlation between preatherosclerotic changes in the coronary arteries and the myocardial concentration of K, Ca, Mg, Fe, Zn, Cu and Se in an autopsy series of children who had died mainly from accidental causes (n = 58). The concentrations of myocardial elements were comparable to values published elsewhere except for a slightly higher Cu concentration. The myocardial Se concentration indicated an adequate Se status. Narrowing of the coronary artery lumen was not correlated with myocardial element concentration except in the case of Se, for which a positive correlation was found (r = 0.23, p less than 0.04). Myocardial K was positively correlated with myocardial Mg (r = 0.65, p less than 0.001) and inversely correlated with Ca (r = -0.50, p less than 0.001). The intake of saturated vs. unsaturated fats was associated with myocardial Cu and Ca concentrations. Our results suggest that myocardial macrominerals and trace elements do not play a role in juvenile preatherosclerotic changes of the arteries.

Adolescent

Use of orthopantomographs in forensic identification.

Radiographs of the head region were used for identification of 17 victims during an 11-year period in the Department of Forensic Medicine, University of Turku, Finland. Examinations resulted in positive identification of 10 victims. Proof of identity of four people was based on exclusion identifications. In one case, comparable information supporting the identity was achieved. Due to insufficient ante- and postmortem material, two individuals remained unidentified by radiological methods. The use of orthopantomography in identification is recommended because it enables visualization of the structures of the jaws and related areas on a single radiograph.

Accidents

Dimensions of the coronary arteries in children.

The extent of narrowing of the coronary arteries was measured in a series of 106 children who died accidentally. The outer radius of left main stem coronary artery increases from 1.06 mm at the age of 1 to 1.67 mm at 15. The left anterior descending branch increased with age from 0.70 to 1.35 mm and the inner radius from 0.55 to 1.10 mm. The mean thickness of the media and intima also increased with age; the correlation between thickness and weight was less pronounced. The coronary arteries thickened concomitantly with the size of the artery but that was due mainly to thickening of the intima. Substantial narrowing was found in the youngest age groups and the extent did not correlate with age but with the size of the vessel. The greatest narrowing was 57% of the arterial lumen. The measured dimensions will serve as normal values for the coronary arteries in Finnish children at autopsy.

Adolescent

Intimal thickening in the coronary arteries of infants and children as an indicator of risk factors for coronary heart disease.

Narrowings of the coronary arteries were measured in 94 infants aged less than 1 year who died in hospital and 102 1- to 16-year-old children who died accidentally. The arteries were transformed mathematically to circles. The degree of narrowing caused by intimal thickening was determined as the ratio of intimal area to the original luminal area. This ratio was further transformed to percentage. The degree of narrowing varied between 0 and 58% (mean 20%). The mean degree of narrowing in the left coronary artery during the first year of life was 17% and, between 12 and 15 years, 34%. Narrowing was greater in males (P = 0.02), when all the 333 coronary samples were included in the analysis. The birthplaces of the subjects' grandparents were traced from population registers and it was found that narrowing in the left coronary artery of infants was greater in those descended from grandparents from eastern Finland, an area of high mortality from coronary heart disease (CHD). Intimal thickening in infants and children seems to be a morphological manifestation of hereditary predisposition to CHD.

Adolescent

Histological and histochemical studies on local coronary wall thickenings (cushions) in Finnish children who died violently. Cardiovascular risk in young Finns?

Coronary arteries of 93 clinically healthy Finnish children of both sexes were collected from successive, medicolegal autopsies of victims of violent death. In the histological and histochemical study, local, cushion-type thickenings of the coronary walls were demonstrable in 47, i.e. 50 per cent, of the children, the occurrence increasing with age. The most prominent change was the splitting of the internal elastic membrane and the accumulation of smooth muscle cells, forming a new, musculo-elastic layer. Glycosaminoglycans appeared in the luminal parts of the thickenings. There was an average decrease in the succinate dehydrogenase reaction in the cushion area, implying a degenerative process. The increase in the reaction of "injury markers", acid phosphatase and esterase based on the increase of cells rich in these enzymes, indicated pathologic process. It was concluded that change of this kind, demonstrable early in childhood, may dispose coronary arteries to atherosclerosis.

Acid Phosphatase

Coronary intimal thickenings and lipids in Finnish children who died violently.

Intimal thickenings of the coronary arteries were found in healthy children who died violently, of both sexes even in children under 5 years of age. The average incidence was 53 % of the 75 cases. Splitting of the internal elastic lamina was the primary finding, followed by local increase in smooth muscle cells. The thickening could occupy 50 % of the coronary lumen. The accumulation of esterified cholesterol in the coronary arteries began before the age of 10 years. The fatty acid composition of the cholesterol esters suggests that they are derived from the blood. The question whether the thickenings are precursors of forthcoming coronary atheromas needs further detailed studies, especially in young adults.

Adolescent

Morphometry of coronary arteries: its use in children 1 year of age or older.

Coronary arteries from 52 children were cross-sectioned semiserially at 0.2-mm intervals. The sections that showed the greatest intimal thickening were chosen for morphometric analysis, which was performed with the aid of a coordinate digitizer. The size of the arteries, the thickness of the arterial media and intima, and the cross-sectional areas of the arterial layers correlated closely with the patient's age with various body measurements, and with the anatomic dimensions of the arteries. The variation in the cross-sectional area of the media in the left anterior descending branch was almost completely explained by a stepwise regression model; the fraction explained by the model (ie, multiple correlations squared) was 0.96, which means that very little variability was due to other factors, eg, methodologic errors. This suggests that the method is reliable. With an exact method, a smaller sample is adequate, which will ease obtaining normal growth curves for coronary arteries.

Adolescent