Atherosclerosis and biochemical composition of coronary arteries in Finnish men. Comparison of two populations with different incidences of coronary heart disease.

Men in Eastern Finland show a substantially higher rate of coronary heart disease (CHD) than men in the Western part of the country. To study possible differences in the biochemical composition and atherosclerotic involvement of coronary arteries between these two populations, we analyzed major lipid and non-lipid components of coronary arteries from 15- to 60-year-old Finnish men after accidental death. The material consisted of 59 age-matched pairs from East and West Finland, respectively, collected at successive autopsies during 1979-1983. The coronary arteries from East Finland contained significantly more esterified cholesterol and a higher percentage of oleate in cholesteryl esters. The findings were most conspicuous under the age of 40 years, and imply a higher degree of atherosclerosis together with an increased rate of intracellular cholesterol esterification in coronary arteries in Eastern as compared with Western Finland. The vessels from East Finland also tended to contain more free cholesterol and raised lesions, but the differences were not statistically significant. No major regional differences were seen in total phospholipids, phospholipid subfractions, DNA, calcium, collagen, total protein, or glycosaminoglycans.

Comparison of different ways of presenting the results of biochemical analyses of human coronary arteries.

Three methods of expressing the results of biochemical analyses of normal and atherosclerotic human coronary intima-medias were compared by calculating the results per unit area of vessel surface to obtain the content, per unit weight of dry defatted tissue (d.t.) to obtain the concentration, and per unit weight of organic d.t. to obtain the inorganic salt-corrected concentration. The content reflects the amount of a substance in an anatomically defined portion of the arterial wall, whereas the concentration gives the amount of the substance relative to a defined mass of arterial tissue. Since calcium salts form a sizable portion of fibrous plaques, concentrations become overcorrected in the oldest age groups. For example, there was an unexpected age-related decrease of collagen concentration in fibrous plaques-containing coronary arteries while its content and inorganic salt-corrected concentration increased. In studies involving arterial biochemical analyses it is appropriate to calculate the results in terms of both the content and the concentration. If severely affected specimens are studied, it is recommendable also to use the inorganic salt-corrected concentration, especially when different age groups are compared with one another.

Glycosaminoglycans in normal and atherosclerotic human coronary arteries.

Glycosaminoglycans (GAGs) were studied in normal and atherosclerotic coronary arteries of 15- to 60-year-old Finnish men who had died accidentally. The GAGs were fractionated and quantified with electrophoretic techniques. The contents of sulfated GAGs (micrograms/cm2 vessel surface area) increased continuously until 20 to 30% of the vessel surface area was covered with fibrous plaques, after which they started to decrease. The largest increases were seen in chondroitin sulfates A and C and dermatan sulfate, the former of which rose earlier with lesion development. In normal coronary arteries the contents of dermatan sulfate and chondroitin sulfates A and C increased significantly with age, but the rises were much smaller than those found in affected vessels. The age-related changes in the percentage composition of GAGs in normal coronaries were qualitatively similar to those found in affected coronaries during lesion development. The alterations in arterial GAGs, therefore, seem to be related to two processes, both of which involve increased formation of connective tissue components by arterial smooth muscle cells: the normal growth and maturation of the vessels with a slow development of diffuse intimal thickening, and atherogenesis, which greatly increases the contents of sulfated GAGs in affected arteries.

Body burden of cadmium in man at low level of exposure.

Specimens of heart, kidney, liver, lung, pancreas and skeletal muscle were collected at autopsy from 86 traumatic accident victims. The concentration of cadmium in the samples was determined by atomic absorption spectrophotometry. Tissue burdens and the body burden of cadmium were calculated using individual weights of different organs as a function of age. Total body burden reached its maximum level of approximately 8 mg, in the 30-39 year age group. The highest value (8.3 mg) was measured in the 40-49 year age group. The highest average value of tissue burdens at 40-49 years of age was in kidney (4.9 mg), the amount of cadmium diminishing in different tissues in the following order: liver (1.8 mg), muscle (0.15 mg), lung (0.09 mg), pancreas (0.06 mg) and heart (less than 0.01 mg). At a low level of exposure, kidneys and liver alone contain on an average 85% of the total body burden of cadmium. This value differs greatly from earlier reported figures of 45-50%.

Clinical versus autopsy diagnosis of cranio-cerebral injury.

The accuracy of the clinical diagnoses of the victims who died at the Department of Neurosurgery, Helsinki University Central Hospital in 1975 and 1976 of a lethal injury to the head was investigated. Standard clinical and X-ray means were used without computed tomography whose value as an additional tool will be reported later. Most of the patients were traffic accident victims of which 71% died within 24 h after trauma. The rate of the correct diagnoses of fractures was 87% in the vault, 76% at the base of the skull, and 67% in the facial bones. Of all intracranial lesions, 75% were correctly and 9% partially diagnosed. The discrepancy would have been more marked if such entities as cerebral contusion and laceration and hemorrhage had been presented separately. This study indicates that many head injuries remained undiagnosed by standard clinical means. The value of X-ray examination also appeared small in the postmortem diagnostics of skull fractures and intracranial lesions.

Sphenoid sinus fluid level in skull-base fractures.

The value of a sphenoid sinus fluid level in the diagnosis of a skull-base fracture was studied in two materials: one of 41 accident victims who died from brain injury an had their skull-base fracture verified at autopsy; and another of 36 patients with a sphenoid sinus fluid level visible on their emergency skull radiographs. The inclusion of sphenoid fluid in the diagnostic criteria for skull-base fracture improved the diagnostic accuracy from about 65% to about 80%. The false positive cases were caused by facial fractures. The false negative cases mainly occurred among severely ill patients, who had a small amount of sphenoid fluid and suboptimal radiographs.

Acute lethal trauma of the trunk: clinical, radiologic, and pathologic findings.

The correctness of the clinical diagnoses of all victims who died of an acute lethal injury of the trunk at the Department of Orthopaedics and Traumatology, Helsinki University Central Hospital in 1975-1976 was investigated. A clinicopathologic comparison on the injuries as of the time of death and severity of the trauma complex resulted in the following main observations: About 80% of all lethal injuries, 70% of the associated severe lesions, and 80% of the other more minor injuries were correctly diagnosed by clinical means with an overall accuracy of 74.5%. When victims were dead on arrival, 50% of the injuries were diagnosed by plain physical examination. When the patient died within 24 hours, 80% of the injuries wre clinically diagnosed, and when the patient died between 1 and 7 days postinjury the rate was 90%. Injuries of the heart and great intrathoracic vessels, ruptures of the liver and spleen, as well as medullary contusions remained most often undiagnosed in patients who died within a few hours. Of all clinically diagnosed injuries, of which one was severe, 5.7% were nt noted at autopsy.

Gross deformity of the spine; a lumbar myelographic risk with Conray and Dimer X.

Convulsions and fracture of the neck of the femur following myelography with Conray and Dimer X are reported in two patients with a gross post-tuberculous gibbus deformity of the thoracic spine. The possible causes of the increased risk associated with myelography of the patients with gibbus are discussed.