Jonas Hallgrimsson

Chronic non-rheumatic aortic valvular disease: a population study based on autopsies.

Abstract In Iceland the autopsy rate is high and relatively unselected and therefore well suited for population studies of chronic diseases. Chronic non-rheumatic aortic valvular diseases were studied at autopsy during a period of 9 yr. The series included 29.6% of those who died in Iceland at the age of 15 yr and older. Calcific aortic stenosis was found in 130 hearts, or in 3.43% of males and in 3.82% of females, and uncalcified bicuspid aortic valves in 19 hearts, or in 0.72% of males and in 0.21% of females. Most subjects with calcific aortic stenosis also had coronary heart disease and among them myocardial infarcts were found in 44.7%, of males and in 25.9% of females. Among those with calcific aortic stenosis, the valvular disease was considered significant as contributory to the death of 40.8% of males and in 33.3% of females and its importance had been underestimated by both pathologists and clinicians. Aortic valvular disease is more frequently found at autopsy than reported in hospital and mortality statistics. The Icelandic results may apply in many other countries of the Western world, where it would be almost impossible to perform a comparable autopsy study.

16. Malignant tumours of the stomach

Iceland is one of the high‐risk countries for stomach cancer. During the period 1955‐84 the incidence declined from 76 to 28 per 105 p.a. for males and from 30 to 12 for females. Tissue material from the primary site in 978 males and 448 females was available for histological typing. By the WHO classification tubular carcinoma was most frequent in both sexes, 66% in males and 63% in females, and signet‐ring carcinoma second, 13% in males and 16% in females. By the Laurén classification in males 78.1% were intestinal and 16.5% diffuse carcinomas, and in females 73.1% were intestinal and 20.7% diffuse carcinomas. The decline in stomach cancer in Icelanders has mostly affected the intestinal type of tumour (Laurén) and the tubular type of tumour (WHO). Diffuse type tumours (Laurén) have declined slightly. This supports the theory that intestinal carcinomas are more influenced by environmental and especially dietary factors, and that diffuse carcinomas are more influenced by other as yet unknown factors. For epidemiological studies both histological classifications have their value, the WHO especially in that it is based on standard histopathological criteria and the Laurén especially in that it only includes two tumour types. The WHO classification can roughly be transcribed to the Laurén classification as tubular, mucinous and papillary carcinomas fall into the group of intestinal tumours, and signet‐ring and more than half of undifferentiated carcinomas into the group of diffuse tumours.

Tumours in Iceland 12. Malignant tumours of the corpus of the uterus

All malignant tumours of the corpus of the uterus diagnosed in Iceland during 1955–1984 and available for review were typed histologically, using both the WHO Classification and the more recent classifications proposed by the International Society of Gynecological Pathologists. Of a total of 391 tumours 53 were excluded for various reasons. Of the 338 remaining tumours 309 were carcinomas, 17 sarcomas, 10 mixed Müllerian tumours and 2 choriocarcinomas. The adenocarcinomas were by far the most common of the carcinomas, comprising 93%. The incidence of carcinomas is similar to that found in the other Nordic Countries. A considerable increase in the incidence of adenocarcinomas was observed during the survey period and this was largely due to a steady steep rise in incidence of the best differentiated or Grade I tumours. This might be looked at as supportive evidence for the etiological role of estrogen replacement therapy which has been in constantly increasing use during the latter two decades of the study period. The mean age at diagnosis increased during the survey period. Generally, survival of patients did not clearly improve during the period but, however, increased considerably for the better differentiated tumours. Finally, we give our evaluation of the two systems of classification used in the study.

Gastric carcinoma : correlation of diagnosis based on biopsies and resection specimens with reference to the Laurén classification

Gastric carcinomas in 382 patients were studied histologically and the results from the preoperative endoscopic biopsies were compared with those from the resected specimens. Using the Lauren classification an overall histological diagnostic agreement between the two specimens was reached in 317 cases, or 83%. The highest diagnostic agreement, 87%, was for intestinal carcinomas. For diffuse carcinomas the diagnostic agreement was 75%. The disagreement in intestinal carcinomas was mainly due to foci of undifferentiated cells and/or signet‐ring cells predominating in the biopsy. The disagreement in diffuse carcinomas was mainly because glandular structures were present at the surface in some of the cases and therefore led to an erroneous diagnosis of intestinal carcinoma. In conclusion, the intestinal type of gastric carcinoma can in most cases be diagnosed correctly from an endoscopic biopsy, whereas the diagnosis of a diffuse carcinoma is less accurate until the resected specimen is available for histological study.

CHRONIC RHEUMATIC VALVULAR HEART DISEASE

The frequency of chronic non-rheumatic valvular heart disease in Iceland was investigated via autopsies performed from November 1965 through December 1974. During this period, about 12.400 Icelanders died at the age of 16 years and older and 28.8 per cent of these were included in the study. At autopsy, males outnumbered females by 2:1. The frequency of calcific aortic stenosis was found to be 3.63 per cent and the prevalence was calculated to be 3.17 per cent among males and 4.50 per cent among females. Calcific aortic stenosis in tricuspid valves was more frequent in females and calcific aortic stenosis in bicuspid valves was more frequent in males. Among the hearts with calcific aortic stenosis, 70.8 per cent were found to have normally tricuspid valves, 25.4 per cent bicuspid valves and 3.8 per cent tricuspid valves with an unicommissural fusion. In 0.59 per cent of the hearts the aortic valve was either bicuspid or had an unicommisural fusion without the features of calcific stenosis. However, a functional stenosis was suggested by the increased weight of most of these hearts. The frequency of bicuspid aortic valves was 1.2 per cent with a prevalence in males of 1.54 per cent and in females 0.50 per cent. A calcified mitral annulus was found in 1.98 per cent of the hearts and in most, it was either associated with calcific aortic stenosis in a tricuspid valve, or it was a single valvular disease. Rheumatic valvular disease was found in 1.08 per cent of the hearts examined.

CHRONIC RHEUMATIC VALVULAR HEART DISEASE: An Autopsy Study

The frequency of chronic non-rheumatic valvular heart disease in Iceland was investigated via autopsies performed from November 1965 through December 1974. During this period, about 12.400 Icelanders died at the age of 16 years and older and 28.8 per cent of these were included in the study. At autopsy, males outnumbered females by 2:1. The frequency of calcific aortic stenosis was found to be 3.63 per cent and the prevalence was calculated to be 3.17 per cent among males and 4.50 per cent among females. Calcific aortic stenosis in tricuspid valves was more frequent in females and calcific aortic stenosis in bicuspid valves was more frequent in males. Among the hearts with calcific aortic stenosis, 70.8 per cent were found to have normally tricuspid valves, 25.4 per cent bicuspid valves and 3.8 per cent tricuspid valves with an unicommissural fusion. In 0.59 per cent of the hearts the aortic valve was either bicuspid or had an unicommisural fusion without the features of calcific stenosis. However, a functional stenosis was suggested by the increased weight of most of these hearts. The frequency of bicuspid aortic valves was 1.2 per cent with a prevalence in males of 1.54 per cent and in females 0.50 per cent. A calcified mitral annulus was found in 1.98 per cent of the hearts and in most, it was either associated with calcific aortic stenosis in a tricuspid valve, or it was a single valvular disease. Rheumatic valvular disease was found in 1.08 per cent of the hearts examined.

Regulating Multiple Externalities: The Case of Nordic Fisheries

ABSTRACT Open access is a well-known externality problem in fisheries causing excess capacity and overfishing. Due to global warming, externality problems from CO2 emissions have gained increased interest. With two externality problems, a first-best optimum can be achieved by using two regulatory instruments. However, solving the open-access externality problem also affects CO2 emissions. By using a bio-economic model covering Iceland, Norway, Denmark, Sweden, and the Faroe Islands, it is shown that regulations of the open-access externality problem have a large effect on both economic performance and CO2 emissions, while an additional CO2 regulation only has minor effects. The second-best solution achieved by only regulating open access reduces emissions by approximately 50% compared to current fisheries, with the exception of Iceland, which already has a well-developed fisheries management system. JEL Codes: Q22, Q54.

Myocardial Lipids in Relation to Coronary Artery Disease in Man

The purpose of this study was to examine the fatty acid composition and content of phospholipids, and free fatty acids in human heart muscle samples obtained at autopsy from people that died suddenly in accidents and from people that died suddenly from heart disease, with or without coronary artery disease.

Sucrase-Isomaltase Expression in Dysplasia Associated With Barrett's Esophagus and Chronic Gastritis

Aberrant cytoplasmic sucrase-isomaltase has been detected in colonic neoplasia, including dysplasia in ulcerative colitis. We investigated expression by immunostaining in 28 cases of Barretts esophagus and 67 cases of chronic gastritis. Staining location (membrane or cytoplasmic) and percent positivity (< 1% = 0; 1-50% = 1+; > 50% = 2+) were record ed. Fifteen cases with Barretts esophagus were negative for dysplasia, 1 was indefinite, and 12 were positive. All demonstrated surface membrane staining, while 2 of the 15 neg ative (1+) cases, 0 of the 1 indefinite case, and 11 of the 12 dysplastic (2+ in 7) cases revealed cytoplasmic positivity (P < .001). In chronic gastritis (23 were negative, 5 were indefinite, and 39 were positive) all revealed surface membrane staining, whereas cyto plasmic positivity was present in 1 of 23 negative (1+) cases, 1 of 5 indefinite cases, and 37 of 39 dysplastic (2+ in 18) cases (P < .001). In Barretts esophagus and chronic gastri tis, cytoplasmic sucrase-isomaltase expression strongly correlates with the presence of dys plasia. Int J Surg Pathol 2(4).-281-286, 1995

Reducing Climate Impact from Fisheries : A Study of Fisheries Management and Fuel Tax Concessions in the Nordic Countries

Few doubt the impact from human activities on global warming and the negative consequences of rising temperatures for both terrestrial and marine ecosystems. Efficient policy instruments are needed ...