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Objectives: Cardiac death in a patient with symptoms and electrocardiographic changes indicative of myocardial ischemia but without available measurements of cardiac biomarkers is designated a type 3 myocardial infarction. We wanted to investigate the incidence, the frequency, and the characteristics of patients diagnosed as type 3 myocardial infarction., Methods: The occurrence of deaths in a well-defined geographic region was retrieved from the Danish Civil Registration System during a 1-year period from 2010 to 2011. Complementary data concerning causes of deaths were obtained from the Danish Register of Causes of Death, and ambulance and hospital patient files. Adjudication of the diagnosis was done by 2 local experts and one external senior cardiologist., Results: A total of 2766 of the 246,723 adult residents in the region had died. A type 3 myocardial infarction was diagnosed in 18 individuals, corresponding to an annual incidence of 7.3/100,000 person-years. During the same 1-year period, 488 patients had other types of myocardial infarction implying a 3.6% frequency of type 3 myocardial infarction (18 of 506) among all myocardial infarctions., Conclusion: Type 3 myocardial infarction is a rare observation in clinical practice with an annual incidence below 10/100,000 person-years and a frequency of 3%-4% among all types of myocardial infarction. If autopsy data are included, the number of type 3 myocardial infarctions will increase., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Intravascular optical coherence tomography (IVOCT) is an imaging technique that is used to analyze the underlying cause of cardiovascular disease. Because a catheter is used during imaging, the intensities can be affected by the catheter position. This work aims to analyze the effect of the catheter position on IVOCT image intensities and to propose a compensation method to minimize this effect in order to improve the visualization and the automatic analysis of IVOCT images. The effect of catheter position is modeled with respect to the distance between the catheter and the arterial wall (distance-dependent factor) and the incident angle onto the arterial wall (angle-dependent factor). A light transmission model incorporating both factors is introduced. On the basis of this model, the interaction effect of both factors is estimated with a hierarchical multivariant linear regression model. Statistical analysis shows that IVOCT intensities are significantly affected by both factors with p<0.001, as either aspect increases the intensity decreases. This effect differs for different pullbacks. The regression results were used to compensate for this effect. Experiments show that the proposed compensation method can improve the performance of the automatic bioresorbable vascular scaffold strut detection.

Sudden death is the most common manifestation of myocardial sarcoidosis, which is often clinically silent. The disease is rarely encountered in forensic medicine, but the diagnosis is important because it may change the interpretation of the manner of death and thus have insurance implications. Six cases of myocardial sarcoidosis diagnosed at autopsy are reported, and the significance of the findings is discussed.

The retrieval of bacteria from the lungs postmortem was examined in a population of alcoholics who had a medico-legal autopsy performed. The results were compared with non-alcoholic controls. Pneumococci were found more frequently in alcoholics, but in general there were no major differences. Proteus mirabilis was detected in three out of five alcoholics with unascertainable cause of death. It is speculated whether this species may cause septicaemia in some alcoholics due to abnormal splanchnicus circulation.

We examined the value of post-mortem radiological examination of infants who were brought in for medico-legal autopsy. Twenty children between the age of 1 month and 15 months died under the picture of SIDS. No radiological or other signs of previous child abuse were seen in our autopsy material. A fatal case of child abuse with several metaphyseal fractures is reported. Some fractures were not visible on gross examination, but could be demonstrated by radiography and histology. In our material no association between SIDS and child abuse was found. In suspected cases of child abuse, particularly rib fractures and metaphyseal fractures should be sought. We recommend that post-mortem radiography is performed in such cases. If fractures are demonstrated, they should be verified by histologic examination.

The diagnosis of electrical lesions may be difficult. Forensic material consisting of 24 post-mortem skin samples from 11 fatalities due to electricity was examined with regard to the deposition of iron or copper on the skin. Metal deposition was demonstrated on the epidermis in eight cases. It is concluded that staining for iron and copper may improve the diagnostic sensitivity of electrical lesions.

A prospective and comprehensive investigation was done on 73 medico-legal autopsies in alcoholics. The results of the toxicology analyses are described. Alcohol intoxication was the cause of death in 8%, combined alcohol/drug intoxication in 15% and drugs alone in 19%. Alcoholic ketoacidosis was found to be the cause of death in 7%. Altogether toxicology analyses were necessary for determining the cause of death in 51% of the cases. In four cases the cause of death would not have been found, had this investigation not been made. It is concluded that toxicology analyses should be the rule rather than the exception in deaths in alcoholics.

Reye's syndrome is a rare disorder appearing almost always in childhood. It is characterized by acute encephalopathy and fatty degeneration of the viscera. The mortality is high and many survivors have neurologic sequelae. A viral illness, particularly varicella or influenza B, usually precedes the syndrome. It has been associated with the use of aspirin during such infections. The number of cases has declined in countries where there has been a public education campaign and aspirin products have been withdrawn from sale. It is suggested that the same campaign is initiated in Denmark.

The weights of brain, heart, liver, kidneys, spleen, lungs, and thymus were registered in 222 forensic autopsies of Danish infants aged 1 week to 0.99 year (137 males, 85 females), who prior to death were healthy or apparently healthy based on clinical evidence. Variability of organ weights was estimated, and the relationship between individual organ weights and age, body weight, and body length, and the sum of organ weights was evaluated in relation to age, body weight, and body length. No significant differences were found between males and females, and between the healthy and apparently healthy infants. There was a positive, significant correlation of the individual organ weights with age, body weight, and body length. It was most pronounced for the weight of the brain and least pronounced for the thymus. Am. J. Hum. Biol. 9:35-38 © 1997 Wiley-Liss, Inc., (Copyright © 1997 Wiley-Liss, Inc.)

The frequency of diseases of the airways and lungs was examined in a forensic autopsy material of 441 alcoholics, who were compared with 255 controls. Lobar pneumonia was seen only in alcoholics, emphasizing alcohol abuse as a predisposing factor for this infection. Tuberculosis was more frequent in alcoholics, while there were no major differences in the occurrence of chronic lung diseases.

The causes and manners of death in medico-legal cases from a five-year period were examined. Alcoholics died more often of combined alcohol/drug intoxication and of carbon monoxide poisoning. They had a lower frequency of heart diseases, and there was no support for the existence of an alcoholic heart muscle disease. Lobar pneumonia was only found in alcoholics. There were, as expected, higher frequencies of the known alcohol-related diseases such as hepatic coma, bleeding oesophageal varices and alcohol intoxication. An observed higher frequency of death before the age of 35 could be attributed to alcohol-related diseases. The manners of death showed surprisingly small differences, as the main finding was a higher frequency of alcoholics with undeterminable manner of death.

An investigation was performed on material from deceased from the Copenhagen County, examined at the Institute of Forensic Medicine during the period 1985-1989. The basis and the reliability of the diagnosis of chronic alcoholism in a forensic post-mortem material is discussed. The frequency of alcoholics in the autopsy material varied between 25 per cent and 30 per cent annually. The frequency of women was significantly lower than that of men. The alcoholics were generally younger than controls, they were more often divorced, but cohabited with the same frequency as controls. Both the alcoholics and the controls belonged mainly to the lowest social classes. Alcoholics lived in flats and died in the living room more often than controls. Special attention is given to persons dying in bathtubs and on staircases. The interval between 'last seen alive' and 'found dead' was significantly longer in alcoholics, signifying loss of social network. Both alcoholics and controls generally lived under poor social conditions, more pronounced in the former.

Alcoholics who died because they were run over by trains, by precipitation, or were smoking in bed, were compared with a group of controls. A higher number of alcoholics were run over by trains, the manner of death most often being suicide. There was a significantly higher number of controls who fell from a height. The manner of death in the group "smoking in bed' was more often accidental and occurred more frequently in alcoholics. Preventive measures are suggested.

A cohort of alcoholics who underwent a medico-legal autopsy during a 5-year period was compared with non-alcoholic controls who did not differ from the alcoholics in selection criteria. The degree of atherosclerosis in the coronary arteries and the aorta was examined. Alcoholic men and old women had a significantly lower degree of atherosclerosis in the coronary arteries, while the opposite was found in young women. In the aorta there was no significant difference in the degree of atherosclerosis between alcoholics and controls in men. Alcoholic women generally had a lower degree of atherosclerosis in the aorta. The so-called U-shaped curve for the relationship between the daily alcohol intake and atherosclerosis is described together with some of the investigations on which it is based. There is much positive evidence for the U-shaped curve, although a causal association has not been proven as yet. The present results indicate a complex relationship, in which different confounding factors are likely to play a role.

Forensic pathologists are familiar with alcohol abusers, who are found dead and in whom the cause of death cannot be ascertained. In order to examine the possible role of ketoacidosis for the cause of death in this group of alcohol abusers, the concentrations of ketone bodies (acetone, acetoacetate, D-beta-hydroxybutyrate) were determined in post mortem blood specimens. Determination of the ketone body concentrations were made by a coupled enzymatic head-space gas chromatographic method. The material consisted of blood specimens from 131 deceased persons and was divided into three groups: Group 1: controls, 79 cases of non alcohol abusers; group 2: 35 cases of alcohol abusers with known causes of death and group 3: 17 cases of alcohol abusers without ascertainable cause of death. The geometric means for the sum of the ketone body concentrations in blood were: controls, 109 mumol/l; alcohol abusers with known causes of death, 152 mumol/l; and alcohol abusers without known cause of death, 590 mumol/l. The limit value between the controls and the group of alcoholics with unascertainable cause of death was by logistic regression found to be 531 mumol/l (343-1224 mumol/l). The term 'ketoalcoholic death' is, therefore, suggested, when the measured post mortem blood ketone body concentration in an alcoholic with otherwise unknown cause of death exceeds 531 mumol/l.

An epidural lipoma in the spinal canal in a case of Sudden Infant Death Syndrome (SIDS) is described. Histologic sections from ten SIDS cases were compared with five controls. It is concluded that there are no indications that an increased amount of fat in the spinal canal plays a role in the pathogenesis of SIDS.

The frequency of drug, alcohol and combined alcohol/drug intoxication in forensic autopsy material is described. Alcoholics had frequently abused drugs; the cause of death was drug intoxication in 12%, combined alcohol/drug intoxication in 13%, and alcohol intoxication only in 4%. The manner of death was different in the various groups as it was almost equally stated as accident, suicide and unascertainable, respectively, with only drugs involved, whereas accidents were the predominant features in the combined alcohol/drug intoxication among alcoholics. In controls, accidents predominated on both types of intoxication. The alcoholics seemed to be more 'deliberately' choosing suicide with drugs, while both alcoholics and controls need more information with regard to the dangers of mixing alcohol and drugs. The frequency of combined alcohol and drug intoxication was much higher in alcoholics.

The endothelium is intact but activated and dysfunctioning during the early phase of atherogenesis. Owing to increased endothelial permeability, many blood-derived components, including hemostatic factors, are present in early as well as advanced atherosclerotic lesions. Insudated fibrin(ogen) and related degradation products and thrombin could contribute to atherogenesis by their chemotactic (attracting monocytes/macrophages) and mitogenic (stimulating cell proliferation) properties. All key cells in plaque may express thrombin receptors, indicating that thrombin may play a role in the genesis of uncomplicated atherosclerosis by mediating inflammatory and proliferative processes. Later, endothelial denudation with platelet adherence occurs over mature plaques. Then, incorporation of microthrombi and probably platelet/thrombus-derived growth factors are critical for the progressive growth of the smooth muscle cell-related plaque component. Besides transendothelial influx and incorporation of mural thrombi, blood products in atherosclerotic plaques may originate from hemorrhage through a ruptured plaque surface or from fragile newly formed vessels (neovascularization) frequently found at the base of advanced plaques. Rupture-related plaque progression due to luminal thrombosis and/or plaque hemorrhage is the most important mechanism underlying the unpredictable rapid progression of coronary lesions responsible for acute coronary syndromes. Both platelets and fibrin play a role in the dynamic thrombotic response to plaque rupture.(ABSTRACT TRUNCATED AT 250 WORDS)

Forensic material of alcoholics was compared with controls with regard to the height, weight, state of nutrition, stature, the ageing process and the presence of traumatic lesions. Surprisingly, it was found that alcoholic women were taller than controls. Alcoholics were significantly more often slightly undernourished, while the extremes, severe obesity or severe undernourishment, did not show any differences. Alcoholics looked older than their age more often than controls. Not unexpectedly, traumatic lesions were more frequent in alcoholics. The lesions were, however, only rarely the result of deliberate violence, but were usually suffered when the alcoholic fell whilst under the influence of alcohol.

In the period from January 1986 through April 1993, 47 cases with diabetes mellitus were autopsied at the Institute of Forensic Medicine, Odense University. In 26 cases, the diabetes had been treated with insulin, in 21 cases with oral medication or diet only. In eight insulin-dependent cases, tubular vacuolation was found in the kidneys, the so-called Armanni-Ebstein lesions. The circumstances of death and postmortem analyses of blood, urine and/or vitreous humor supported a presumed diabetic coma as the cause of death in these eight cases. Of the remaining 39 cases, six were too putrefied for histologic examination. In the remaining 33 cases and in a series of 20 non-diabetics, the cause of death was ascertained as illness (other than diabetes), traffic accidents, drowning or intoxication. In none of these cases was a diabetic coma suspected, and none of these cases showed tubular vacuolation in the kidneys. The authors conclude that tubular vacuolation of the kidneys strongly indicates death in diabetic coma.

In a 3-year period (1989-1991) a non-selected, consecutive series of 62 deaths in drug addicts was autopsied at the Forensic Institute in Odense. The kidney sections from these addicts were examined for the presence of renal myoglobin using immunohistochemical methods. A reference group consisting of a non-selected, non-consecutive series of 58 autopsied non-addicts was likewise investigated for the presence of renal myoglobin. No major differences were demonstrated between the two groups. The presence of renal myoglobin probably indicates a prolonged course of events prior to death (unconsciousness, immobilization, hypovolemia). In sufficient amounts, renal myoglobin may be of importance as a cause of death or a contributing factor to death in both drug addicts and non-addicts.

Rupture of the plaque surface, often with thrombosis superimposed, occurs frequently during the evolution of coronary atherosclerotic lesions. It is probably the most important mechanism underlying the sudden, rapid plaque progression responsible for acute coronary syndromes. The risk of plaque rupture depends on plaque type (composition) rather than plaque size (volume), because only plaques rich in soft extracellular lipids are vulnerable (rupture-prone). Most ruptures are tiny, occurring at the periphery of the fibrous cap that covers the lipid-rich core--points where the cap is usually thinnest and most heavily infiltrated by macrophage foam cells. Compared with intact caps, ruptured ones usually have less tensile strength and are more extensible, containing less collagen and glycosaminoglycans, more extracellular lipid, fewer smooth muscle cells, and more macrophages. Progressive extracellular lipid accumulation (lipid core formation) and cap weakening (macrophage related?) predispose the plaque to rupture and determine the actual vulnerability, which may change with time. Luckily, the plaque components responsible for vulnerability (soft lipid and probably macrophages) are apparently most likely to regress with treatment. The dynamic interplay between the actual plaque vulnerability and external stresses ("triggers") probably determines the particular moment and point of rupture, if this occurs. Vulnerability probably plays a more important role in rupture than triggers, because exercise stress testing of patients with advanced coronary artery disease rarely triggers a rupture/thrombus-related acute heart attack. A prerequisite is the presence of a vulnerable plaque.

The majority (greater than 75%) of major coronary thrombi are precipitated by a sudden rupture of the surface of an atherosclerotic plaque (plaque fissuring) causing platelet aggregation where thrombogenic subendothelial tissue has been exposed. Whether the thrombus remains mural and limited, just sealing the rupture, or evolves into an occlusive thrombus seems to depend on: (1) the amount and character of exposed thrombogenic material; (2) the actual thrombotic-thrombolytic equilibrium; and (3) local flow disturbances due to preexisting atherosclerotic stenosis. Thrombus formation may take place within the stenosis, where blood velocity and shear forces are highest, or it may take place or extend poststenotically, where flow separation, recirculation, and turbulence prevail. Platelet aggregation within the stenosis is responsible for the primary flow obstruction, but fibrin subsequently enmeshes the platelets and thus stabilizes the thrombus. Most thrombi have a layered structure, indicating an episodic growth that may alternate with thrombus fragmentation and peripheral embolization: thrombosis and thrombolysis are dynamic processes occurring simultaneously. If the platelet-rich thrombus at the rupture site evolves into an occlusive thrombus, the blood proximal and distal to the occlusion may stagnate and coagulate, giving rise to a secondarily formed red stagnation thrombosis consisting predominantly of erythrocytes held together by fibrin membranes. A ruptured plaque with a dynamic thrombosis superimposed (with or without spasm) seems to underlie the great majority of acute ischemic syndromes: unstable angina, acute infarction, and sudden death. The clinical presentation and the outcome depend on the severity and duration of ischemia: whether the obstruction is occlusive or nonocclusive, transient or persistent--modified by the magnitude of collateral flow.

Chronic alcoholics account for an increasing number of the cases which are examined in forensic pathology. The manner and cause of death in 122 chronic alcoholics is described and compared with a previous investigation and to a group of non-alcoholics. The percentage of cases in which the manner of death is undetermined is twice as high as in the control group, whilst the percentage of suicide, surprisingly enough is only half that of the control group. The patho-anatomic findings in the liver and the causes of death are discussed in detail.

A case is reported where a 20-year-old alcohol-intoxicated man was admitted to the hospital after a minor head injury. Initially there was no neurologic disturbances or complaints but after a few hours he became comatose, and he died 4 days later without regaining consciousness. The autopsy revealed no lesions of the upper cervical spine or the vertebral arteries, but the basilar artery was occluded in its entire length. No traumatic lesions could be seen by naked eye examination of the artery, and there was no accompanying subarachnoid haemorrhage. A thorough microscopic examination, however, using step-sectioning technique revealed a significant incomplete arterial rupture with an occluding luminal thrombosis superimposed, consisting predominantly of aggregated platelets. Only the very thin adventitia separated the vascular lumen from the subarachnoid space preventing the more well known fatal complication to a minor head injury: A subarachnoid haemorrhage. To the best of our knowledge, fatal thrombosis of the basilar artery due to a minor head injury has not previously been reported. The pathogenetic mechanism seems to be identical to that underlying fatal subarachnoid haemorrhage following a similar trauma apart from the resulting arterial rupture being incomplete instead of complete.

A case of sudden death of a 35-year-old woman due to spontaneous bilateral pneumothorax from rupture of congenital lung cysts is reported. The woman had been attended by two doctors before the lethal outcome. The medicolegal aspects pertaining to medical negligence, the diagnostic difficulties and the rare occurrence of the condition are discussed, as is the autopsy procedure.

By examining 80 consecutive cases of death due to hanging, fractures of the thyroid cartilage or the hyoid bone or both, were noted in 45%. Fracture of the cricoid cartilage did not occur. No fracture occurred below the age of 25, and the frequency was slightly increasing with increasing age. There was a preponderance of fractures in males. The highest incidence of fractures was noted in typical hangings, while incomplete hanging to a very great extent was combined with congestion to the face, especially if the location of the ligature was atypical. Typical hanging in general did not produce congestion. The lividity in the declivous areas became fixed at the earliest after 5-6 h suspension time, while after 12 h almost all the cases demonstrated fixed lividity in the distal parts, especially in the legs. There is slight indication that the frequency of fractures increases with the length of suspension time.