Jørgen Lange Thomsen

Nationwide study of sudden cardiac death in persons aged 1–35 years

AIMS The aim of this investigation was to study the incidence of sudden cardiac death (SCD) in persons aged 1-35 years in a nationwide setting (5.38 million people) by systematic evaluation of all deaths. METHODS AND RESULTS All deaths in persons aged 1-35 years in Denmark in 2000-06 were included. Death certificates were read independently by two physicians. The National Patient Registry was used to retrieve information on prior medical history. All autopsy reports were read and the cause of death was revised based on autopsy findings. We identified 625 cases of sudden unexpected death (10% of all deaths), of which 156 (25%) were not autopsied. Of the 469 autopsied cases, 314 (67%) were SCD. The most common cardiac cause of death was ischaemic heart disease (13%); 29% of autopsied sudden unexpected death cases were unexplained. In 45% of SCD cases, the death was witnessed; 34% died during sleep; 89% were out-of-hospital deaths. Highest possible incidence rate of SCD in the young was 2.8 per 100 000 person-years including non-autopsied cases of sudden unexpected death. Excluding those, the incidence rate declined to 1.9 per 100 000 person-years. CONCLUSIONS A total of 7% of all deaths in the young can be attributed to SCD, when including non-autopsied cases (autopsy ratio 75%). The incidence rate of SCD in the young of 2.8 per 100 000 person-years is higher than previously reported.

Incidence and etiology of sports-related sudden cardiac death in Denmark—Implications for preparticipation screening

BACKGROUND Studies on incidences of sports-related sudden cardiac death (SrSCD) are few and data are needed for the discussion of preparticipation screening for cardiac disease. OBJECTIVE We sought to chart the incidence and etiology of SrSCD in the young in Denmark (population 5.4 million) and to compare this to the incidence of sudden cardiac death (SCD) in the background population. METHODS All 5,662 death certificates for decedents in the period 2000 to 2006 in the age group 12 to 35 years in Denmark were read independently by 2 physicians to identify cases of SCD. Information from autopsy reports, selected hospital records, and multiple registries was used to identify cases of SCD and SrSCD. SrSCD was defined as SCD occurring during or within 1 hour after exercise in a competitive athlete. The size of the athlete population was estimated from national survey data. RESULTS Fifteen (range 0 to 5 per year) cases of SrSCD were found, 8 of which had antecedent symptoms. The incidence rate was 1.21 (95% confidence interval [CI]: 0.68 to 2.00) per 100,000 athlete person-years. The most common autopsy findings were arrhythmogenic right ventricular cardiomyopathy (n = 4), sudden unexplained death (n = 4), and coronary artery disease (n = 2). The incidence of SCD in the general population age 12 to 35 was 3.76 (95% CI: 3.42 to 4.14) per 100,000 person-years. CONCLUSION In Denmark, SrSCD is a rare occurrence and the incidence rate is lower than that of SCD in the general population. This may imply a low value of preparticipation screening of athletes in Denmark.

Histologic changes and silicone concentrations in human breast tissue surrounding silicone breast prostheses.

Using a previously developed method for quantitative measurements of silicone concentrations in breast tissue, material from 86 biopsies from 67 breasts in 55 patients who had silicone implants was examined. In the 49 breasts with unruptured prostheses, there was a positive relation between the concentrations and inflammatory reactions, the only exception being the amount of plasma cells, which showed a negative relation. It is concluded that silicone prostheses provoke an inflammatory response not only because they act as foreign bodies, but also because of silicone seepage through intact membranes.

Sports-related sudden cardiac death in a competitive and a noncompetitive athlete population aged 12 to 49 years: Data from an unselected nationwide study in Denmark

BACKGROUND Preparticipation screening programs have been suggested to reduce the numbers of sports-related sudden cardiac deaths (SrSCD). OBJECTIVE The purpose of this study was to identify and characterize all SrSCD aged 12-49 years and to address the difference in incidence rates between competitive and noncompetitive athletes. METHODS All deaths among persons aged 12-49 years from 2007-2009 were included. Death certificates were reviewed. History of previous admissions to hospital was assessed, and discharge summaries and autopsy reports were read. Sudden cardiac deaths (SCDs) and SrSCD cases were identified. RESULTS In the 3-year period, there were 881 SCDs, of which we identified 44 SrSCD. In noncompetitive athletes aged 12-35 years, the incidence rate of SrSCD was 0.43 (95% confidence interval [CI] 0.16-0.94) per 100,000 athlete person-years vs 2.95 (95% CI 1.95-4.30) in noncompetitive athletes aged 36-49 years. In competitive athletes, the incidence rate of SrSCD was 0.47 (95% CI 0.10-1.14) and 6.64 (95% CI 2.86-13.1) per 100,000 athlete person-years in those aged 12-35 years and 36-49 years, respectively. The incidence rate of SCD in the general population was 10.7 (95% CI 10.0-11.5) per 100.000 person-years. CONCLUSION The incidence rates of SrSCD in noncompetitive and competitive athletes are not different. The study showed an increase in the incidence rate of SrSCD in persons aged 36-49 years in both noncompetitive and competitive athletes compared to those aged 12-35 years. Importantly, SCD in the general population is much more prevalent than is SrSCD in all age groups.

Burden of Sudden Cardiac Death in Persons Aged 1 to 49 Years Nationwide Study in Denmark

Background—Knowledge of the burden and causes of sudden cardiac death (SCD) is sparse in persons aged <50 years; better understanding is needed to lower the risk of SCD. The aim of this study was to report SCD incidence rates and autopsy findings in persons aged 1 to 49 years. Methods and Results—All deaths in persons aged 1 to 49 years were included in 2007 to 2009. Death certificates were reviewed by 2 physicians. History of previous admissions to hospital was assessed, and discharge summaries were read. Sudden unexpected death cases were identified and autopsy reports were collected. In the 3-year study period, there were 7849 deaths of which we identified 893 (11%) SCD cases. The annual incidence rate per 100 000 persons increased from 2.3 (95% confidence interval, 2.0–2.7) to 21.7 (95% confidence interval, 20.2–23.4) in persons aged 1 to 35 and 36 to 49 years, respectively. Coronary artery disease was the most common cause of death and was found in 158 (36%) autopsied cases, followed by 135 (31%) cases of sudden unexplained death. Conclusions—In a nationwide cohort of persons aged <50 years, the annual incidence rate of SCD was ≈10× higher in persons aged 36 to 49 years than in persons aged 1 to 35 years. Notably, coronary artery disease was the most common cause of SCD, followed by unexplained deaths. These findings may help in developing strategies to prevent SCD in the future.

The postmortem distribution of ketone bodies between blood, vitreous humor, spinal fluid, and urine

The distribution of the ketone bodies: acetone, acetoacetate, and d-β-hydroxybutyrate, between blood, vitreous humor, spinal fluid, and urine was examined in 105 medico-legal autopsies. The ketone body concentration in the body fluids was determinated by head-space gas chromatography. The correlation between blood and the body fluids could be described with regression lines on the logarithmic-transformed results. The correlation is dependent on the ketone body concentration. The ketone bodies in spinal fluid show the best correlation to blood, followed by vitreous humor, and last urine. The concentration dependence in spinal fluid is mainly due to ketone bodies being metabolized in the brain. The human brain utilizes ketone bodies during normal nutritional state. In vitreous humor, the dependence is mainly due to protein bindings of acetoacetate and β-hydroxybutyrate in blood and the difference in dry matter between blood and vitreous humor.

Lipids in the proximal tubules of the kidney in diabetic coma.

Vacuolization of the renal tubular epithelial cells (the Armanni-Ebstein lesion) associated with diabetic hyperglycemia is usually regarded as an accumulation of glycogen. In a case of death of diabetic coma, the vacuoles were stained strongly for lipids. This observation may have both clinical and therapeutic consequences, and may increase our knowledge of the metabolism in diabetes.

Detection of injuries in traumatoc deaths. The significance of medico-legal autopsy

A material of 218 medico-legal autopsies on persons with traumatic injuries was analysed. All these persons had been admitted to hospital. In 75 (34%) injuries had been missed in hospital. In 11 (5%) the overlooked injuries were the sole cause of death, while in 51 (23%) they were contributory. The missed injuries were found in all regions: 27% were moderate (AIS 2), 28% serious (AIS 3), 40% severe (AIS 4), and 5% critical (AIS 5). It is concluded that medico-legal autopsies are necessary for an exhaustive evaluation of traumatic deaths. They are of significance not only to legal security, but also to the social need for analysing injury mechanisms and the consequent possibility of preventive efforts.

Nature, frequency and duration of genital lesions after consensual sexual intercourse—Implications for legal proceedings

OBJECTIVE The purpose of this study was to make a normative description of the nature and duration of genital lesions sustained during consensual sexual intercourse, using the three most commonly used techniques; visualisation using the naked eye, colposcopy and toluidine blue dye followed by colposcopy. METHODS Ninety eight women were examined within 48 h of consensual sexual intercourse. Fifty of the women were examined twice again within the following 7 days of sexual abstinence after the first examination. RESULTS The participants had a median age of 22.4 years and 88% were nulliparous. Lesions were frequent; 34% seen with the naked eye, 49% seen with colposcopy and 52% seen with toluidine blue dye and subsequent colposcopy. The lesions lasted for several days; the median survival times for lacerations were 24, 40 and 80 h, respectively. CONCLUSIONS The legal implications of these findings are that genital lesions by themselves do not corroborate a rape complaint. Genital lesions may, however, corroborate specific details of a case and should be documented as carefully as any other lesion in rape complaints.

Long-term lithium treatment: effect on simulated driving and other psychological tests

SummaryThe effect of lithium administered for six months on simulated car driving and other psychological tests was studied in patients with Menières disease. The dose of lithium was adjusted every two weeks to maintain the serum level between 0.7 and 1.0 mmol/l. The trial was double-blind and cross-over in type, the effect of lithium being compared with a placebo. The subjects were within the normal range of Becks depression scale and Marke-Nymans temperament scale. Lithium was found neither to influence the simulated driving nor to affect the scores in the two rating scales. The only specific complaints observed during lithium treatment were tremor and increased thirst.