Male suicide mortality in eastern Finland--urban-rural changes during a 10-year period between 1988 and 1997.

AIMS: To investigate urban-rural differences in male suicide mortality between 1988 and 1997 in the province of Kuopio in eastern Finland. METHODS: Male suicide mortality between 1988 and 1997 was studied in eastern Finland. The data were collected from official autopsy reports. Age, marital status, household type, place of death, method of suicide and the region within the county were analysed. RESULTS: The age-adjusted male suicide mortality remained quite constant at 67 and 65/100,000 (> 15 years of age) in 1988 and 1997, respectively. In urban areas, a decline in suicide rates was noted in all age groups of men, whereas in rural areas, after an initial decline, a marked increase took place during the last years of the study period, especially among middle-aged and elderly men. This coincided with the time of recovery from an economic recession in Finland that particularly affected rural areas. CONCLUSION: Male suicide mortality may be regionally diverging in Finland.

Forensic osteological investigations in Kosovo.

A team of Finnish forensic experts performed investigations of alleged mass graves in Kosovo under the mandate of the European Union (EU). Human skeletal remains from two locations were examined. The remains contained three almost complete skeletons, and individual bones and bone fragments, part of which were burned. Injuries, pathological changes, and findings for identification purposes were examined and documented using standard methods of forensic pathology and osteology. Gunshot injuries were found in some cases, but reliable determination of the cause and manner of death was not possible. A discrepancy arose between the number of victims reported in information received from the presiding district court, and results of the investigations. The estimation of the minimum number of victims was mostly acquired by DNA analysis.

Intra-familial child homicide in Finland 1970-1994: incidence, causes of death and demographic characteristics.

The purpose of this study was to investigate all child homicides for the 25-year period, 1970-1994 in Finland and to analyse the specific characteristics of the filicide cases. A total of 292 child homicides occurred during this period. In 201 (69%) cases the offender was a parent or a stepparent of the child. Altogether, 173 (59%) of the victims were boys and 119 (41%) were girls. For the closer examination of the filicide cases we excluded the neonaticide and homicide-suicide cases. Consequently, we report on 70 filicide victims. Of these victims, 42 (60%) were boys and 28 (40%) were girls. Twenty six (37%) of the children were killed before the age of 1 year and 53 (79%) before the age of 5 years. The offender was the mother in 43 (61%) cases and the father or the stepfather in 26 (37%) cases. The victims of the mothers were younger than those of the fathers. The most frequent causes of death were head injuries, drowning and suffocation. The most common means of assault were battering, drowning and strangulation. One in two of the fatally battered children had a documented history of previous abuse.

Imaging of experimental end-to-side anastomoses in a cast model.

OBJECTIVE: To evaluate cast models in the imaging of experimental end-to-side anastomoses. DESIGN: Experimental study. SETTING: Teaching hospital, Finland. INTERVENTIONS: 20 non-stenosed and 10 stenosed end-to-side anastomoses were constructed using a Dacron prosthesis 8 mm in diameter. Cast models were made of all anastomoses, and anteroposterior and oblique projection radiographs were taken of them. Cross-sectional radiographs were also taken of the stenosed anastomoses. MAIN OUTCOME MEASUREMENTS: The diameters and areas of anastomoses were measured on the radiographs and compared with the corresponding measurements of the casts. RESULTS: No filling defects were observed in any of the cast models and only minor differences were found between the corresponding measurements of the anteroposterior and oblique projection radiographs and casts. The lower density of the contrast medium in the stenotic anastomoses indicated a stenosis. In the cross-sectional radiographs of the stenotic anastomoses there was a significant reduction (p < 0.001) both in the diameter and the area, the mean of which was 63% and the median 61%. CONCLUSIONS: Radiographs of cast models look promising in imaging of experimental end-to-side anastomoses when cross-sectional projections are also used.

Forensic investigations in Kosovo: experiences of the European Union Forensic Expert Team.

The international community has intervened ethnic hostilities in Kosovo, the Federal Republic of Yugoslavia. A team of Finnish forensic experts worked in December 1998 and January 1999 in Kosovo under the mandate of the European Union. The team investigated human remains from three locations of alleged ethnic violence. Concerning the events in Klecka, Volujak and Racak, the International Criminal Tribunal for the former Yugoslavia received documents of great gravity. The standard methods of forensic pathology were complemented with radiological, forensic odontological, physical anthropological and molecular genetic investigations.

Macrophages, smooth muscle cells, endothelial cells, and T-cells express CD40 and CD40L in fatty streaks and more advanced human atherosclerotic lesions. Colocalization with epitopes of oxidized low-density lipoprotein, scavenger receptor, and CD16 (Fc gammaRIII).

CD40-CD40L receptor-ligand interaction plays a central role in antigen presentation, immunological reactions, and in T-cell and macrophage activation. Since all these mechanisms are important for the pathogenesis of atherosclerosis, we studied the expression profile of CD40-CD40L in different types of human atherosclerotic lesions using double immunostaining techniques with cell type-specific antibodies. Normal human intima did not contain CD40 or CD40L immunoreactivity. From type-II lesions (fatty streaks) to advanced type-VI lesions (complicated plaques), colocalization of CD40 and CD40L was observed in T cells (CD3+ cells), macrophages (CD68+ cells), and smooth muscle cells (HHF35+ cells). No correlation was found between the lesion type and CD40-CD40L expression. Positive lesions had dense infiltrations of macrophages and macrophage-derived foam cells together with T cells. The most intensive immunoreactivity for the CD40 receptor and its ligand CD40L was found in macrophage- and T-cell-rich pockets, where both cell types were in close contact with each other. The majority of macrophages, and especially those of macrophage-derived foam cells, were positive for both CD40 and CD40L. A small subset of the lesion macrophage population (10-20%) consisted of cells positive only for either CD40 or CD40L, suggesting the presence of a subpopulation of macrophages more active in inflammatory processes than in lipid uptake. Intimal smooth muscle cells in and around the macrophage-rich areas as well as some of the medial smooth muscle cells near the lesions stained positive for CD40 and CD40L. Moderate to faint expression of these proteins was also found in endothelium. In addition, CD40-CD40L immunoreactivity colocalized with epitopes characteristic of oxidized low-density lipoprotein, scavenger receptor class A, and CD16 (Fc gammaRIII), thus suggesting the involvement of CD40-CD40L and these pathogenetic mediators in foam cell formation, progression of atherosclerotic lesions, and differentiation of immunologically active subsets of macrophages. These results support the hypothesis that CD40-CD40L interaction is involved in atherogenesis and that it might provide a target for future therapeutic interventions.

Association between the density of mossy fiber sprouting and seizure frequency in experimental and human temporal lobe epilepsy.

PURPOSE: If the sprouting of granule cell axons or mossy fibers in the dentate gyrus is critical for the generation of spontaneous seizures in temporal lobe epilepsy (TLE), one could hypothesize that epileptic animals or humans with increased sprouting would have more frequent seizures. This hypothesis was tested by analyzing the data gathered from experimental and human epilepsy. METHODS: In experiment I (rats with "newly diagnosed" TLE), self-sustained status epilepticus was induced in rats by electrically stimulating the amygdala. Thereafter, the appearance of spontaneous seizures was monitored by continuous video-electroencephalography (EEG) until the animal developed two spontaneous seizures and for 11 d thereafter. Rats were perfused for histology, and mossy fibers were stained using the Timm method. In experiment II (rats with "recently diagnosed" TLE), status epilepticus was induced in rats and the development of seizures was monitored by video-EEG for 24 h/d every other day for 60 days. All animals were then perfused for histology. In experiment III (rats with "chronic" TLE), animals were monitored by video-EEG for 24 h/d every other day for 6 months before histologic analysis. To assess mossy fiber sprouting in human TLE, hippocampal sections from 31 patients who had undergone surgery for drug-refractory TLE were stained with an antibody raised against dynorphin. RESULTS AND CONCLUSIONS: Our data indicate that the density of mossy fiber sprouting is not associated with the total number of lifetime seizures or the seizure frequency in experimental or human TLE.

Lipoprotein-associated phospholipase A(2), platelet-activating factor acetylhydrolase, is expressed by macrophages in human and rabbit atherosclerotic lesions.

We studied the expression of lipoprotein-associated phospholipase A(2) (Lp-PLA(2)), an enzyme capable of hydrolyzing platelet-activating factor (PAF), PAF-like phospholipids, and polar-modified phosphatidylcholines, in human and rabbit atherosclerotic lesions. Oxidative modification of low-density lipoprotein, which plays an important role in atherogenesis, generates biologically active PAF-like modified phospholipid derivatives with polar fatty acid chains. PAF is known to have a potent proinflammatory activity and is inactivated by its hydrolysis. On the other hand, lysophosphatidylcholine and oxidized fatty acids released from oxidized low-density lipoprotein as a result of Lp-PLA(2) activity are thought to be involved in the progression of atherosclerosis. Using combined in situ hybridization and immunocytochemistry, we detected Lp-PLA(2) mRNA and protein in macrophages in both human and rabbit atherosclerotic lesions. Reverse transcriptase-polymerase chain reaction analysis indicated an increased expression of Lp-PLA(2) mRNA in human atherosclerotic lesions. In addition, approximately 6-fold higher Lp-PLA(2) activity was detected in atherosclerotic aortas of Watanabe heritable hyperlipidemic rabbits compared with normal aortas from control rabbits. It is concluded that (1) macrophages in both human and rabbit atherosclerotic lesions express Lp-PLA(2), which could cleave any oxidatively modified phosphatidylcholine present in the lesion area, and (2) modulation of Lp-PLA(2) activity could lead to antiatherogenic effects in the vessel wall.

Calretinin-immunoreactive terminals make synapses on calbindin D28k-immunoreactive neurons in the lateral nucleus of the human amygdala.

A double-labeling immunohistochemical procedure and correlated light and electron microscopy were used to examine if calretinin-immunoreactive terminals make synapses on calbindin D28k-positive cells. In the lateral nucleus of the human amygdala, calretinin terminals make symmetric-like synapses on the somata and proximal dendrites of calbindin D28k-labeled cells. Our data provide the first evidence that neurons which contain two different calcium-binding proteins form synaptic contacts with each other in the human amygdala.

Risk of harboring an unruptured intracranial aneurysm.

BACKGROUND AND PURPOSE: The purpose of the present study was to calculate the prevalence and relative risk of unruptured incidental intracranial aneurysms (IAs) among families with IA case(s) compared with the general population in one geographically defined area in East Finland and to identify the risk group that could benefit most from screening for IAs. We compared these results with our earlier study results of familial IA (FIA) cases, with two or more known IA cases in the same family. METHODS: The study groups were collected from the catchment area of the University Hospital of Kuopio in East Finland. The inclusion criteria were age 30 to 70 years and unruptured incidental IAs > or =3 mm. Patients with previous subarachnoid hemorrhage or in whom a ruptured IA was found to be the cause of death were excluded from all study groups. During routine forensic autopsies the circle of Willis was studied for IAs to estimate the number of IAs in the general population. In the families with one known IA case and in FIA families, MR angiography was used as a preliminary screening method for IAs, followed by intra-arterial angiography to verify suspected IAs. Study populations were age and sex adjusted for the statistical calculations. RESULTS: The relative risk for IAs among first-degree relatives in FIA families was 4.2 (95% confidence interval, 2.2 to 8.0) and among first-degree relatives in families with only one affected family member was 1.8 (95% confidence interval, 0.7 to 4.8) compared with the general population in East Finland. CONCLUSIONS: First-degree relatives in FIA families constitute a high-risk group for incidental IAs, and this group would benefit from screening studies for IAs. Screening for IAs in families with only one affected member or in the general population is not recommended.

Human carotid arteries: correlation of intravascular US with angiographic and histopathologic findings.

PURPOSE: To establish the intravascular ultrasound (US) morphology of the arterial wall in various segments of the carotid artery and to evaluate atherosclerotic changes correlated with angiographic and in vitro histopathologic findings. MATERIALS AND METHODS: A total of 67 carotid arteries were imaged with a 3.5-F, 30-MHz intravascular US catheter: Twenty-four arteries were studied in vivo in 22 patients during neuroendovascular interventional procedures, in situ in 10 cadaveric arteries, and in vitro in 33 fresh excised arteries. RESULTS: In vivo, none of 10 calcifications and five (29%) of 17 intimal thickenings detected at intravascular US were seen at contrast material-enhanced angiography. At intravascular US, the arterial wall morphology was consistently three layered in the internal carotid artery above the bulb, either vaguely three layered or homogeneous in the bulb and in the carotid bifurcation, and homogeneous in the majority of common carotid arteries. The medial-adventitial interface was distinct in 21 (88%) of 24 arteries in vivo. Histopathologic and intravascular US classifications of the plaque agreed for 31 (82%) of the 38 arterial specimens in vitro. CONCLUSION: In vivo intravascular US was feasible in carotid arteries with mild atherosclerosis and often revealed intimal thickenings and concentric plaques in angiographically normal segments.

Distribution of parvalbumin-immunoreactive cells and fibers in the human amygdaloid complex.

The calcium-binding protein, parvalbumin, was localized immunohistochemically in the human amygdaloid complex. Neuronal cell bodies and fibers that are immunoreactive to parvalbumin were observed in most of the amygdaloid nuclei and cortical areas. Three types of immunoreactive aspiny neurons, ranging from small spherical cells (type 1) to large multipolar cells (type 2) and fusiform cells (type 3), were observed. The densities of the types of neurons that were parvalbumin-immunoreactive varied in the different regions of the amygdala. The highest densities of parvalbumin-immunoreactive neurons were observed in the lateral nucleus, in the magnocellular and intermediate divisions of the basal nucleus, in the magnocellular division of the accessory basal nucleus and in the amygdalohippocampal area. The regions containing the lowest density of parvalbumin-immunoreactive cells were the paralaminar nucleus, the parvicellular division of the basal nucleus, the central nucleus, the medial nucleus and the anterior cortical nucleus. In general, the distribution of immunoreactive fibers and terminals paralleled that of immunoreactive cells. Parvalbumin-immunoreactive varicose fibers formed basket-like plexi and cartridges around the unstained neurons, which suggests that parvalbumin is located in GABAergic basket cells and chandelier cells, respectively. The distribution of parvalbumin-immunoreactive profiles in the human amygdaloid complex was similar to, rather than different from that previously reported in the monkey amygdala (Pitkänen and Amaral [1993] J. Comp. Neurol. 331:14-36). This study provides baseline information about the organization of GABAergic inhibitory circuitries in the human amygdaloid complex.

Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland.

Between September 1, 1981, and August 31, 1982, all patients with suspected or confirmed pneumonia among the 46,979 inhabitants of four municipalities in the province of Kuopio, Finland, were reported to a pneumonia register by their attending physicians. In addition, two study pathologists reported all cases of pneumonia found at autopsy, and two permanent registers were checked for retrospective identification of patients. Chest radiographs were obtained from 97% of all patients. The final diagnosis was based on radiologic or autopsy criteria. A total 546 patients (323 males and 223 females) had community-acquired pneumonia; of these, 37% were less than 15 years of age, and 31% were 60 years of age or older. Nineteen percent of the patients had defined chronic conditions, and 42% were admitted to hospital. The case fatality rate was 4%. The overall incidence of community-acquired pneumonia per 1,000 inhabitants per year was 11.6 (13.9 in males, 9.4 in females). The age-specific incidence per 1,000 inhabitants per year was as follows: age < 5 years, 36.0; age 5-14 years, 16.2; age 15-59 years, 6.0; age 60-74 years, 15.4; and age > or = 75 years, 34.2.

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.

Methionine adenosyltransferase activity in cultured cells and in human tissues.

We have investigated methionine adenosyltransferase activity (MAT) in extracts of a variety of normal and malignant human tissues and cultured cell lines. MAT activity assayed from 17 different cultured cell lines varied to a great extent. Ramos (human, Burkitt's lymphoma) and EL4 (mouse, T cell lymphoma) cells showed MAT activity near 300 pmol/mg per min. Daudi (human, Burkitt's lymphoma) and almost all monolayer cells had MAT activity below 100 pmol/mg per min. Human peripheral blood lymphocytes had MAT activity of 36 pmol/mg per min. The MAT activity of the cell lines can be related to doubling time: cell lines with short doubling times have much higher MAT activity than other cell lines. A large variation in MAT activity in different human tissues was observed. In autopsy samples MAT activity was highest in the brain and in the colon. Malignant tissue samples gave much higher MAT activity than normal tissues. Lung cancer (carcinoma squamocellulare pulmonis) had MAT activity of 30.7 pmol/mg per min, while in normal lung it was 2.4 pmol/mg per min.

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.