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Biomedical subjects

W M O'Fallon

Publications and source records attributed to W M O'Fallon.

At least 181 records · Page 10Linked to original sources
PubMed1994

Incidence of multiple myeloma in Olmsted County, Minnesota: 1978 through 1990, with a review of the trend since 1945.

PURPOSE: Incidence rates of multiple myeloma appear to have increased in recent decades, but it is difficult to compare the incidence rates over time because of changes in laboratory procedures, differences in diagnostic criteria, and variations in indexing of medical records. However, Olmsted County, Minnesota, provides a rare opportunity to minimize these limitations, because the medical care has been provided mainly by the Mayo Clinic. PATIENTS AND METHODS: Records of Olmsted County residents with a diagnosis of multiple myeloma from January 1, 1978 through December 31, 1990 were reviewed. Criteria for diagnosis and residency were the same as in previous Olmsted County studies. RESULTS: The incidence rate per 100,000 age-adjusted to the 1950 United States white population was 5.4 for males and 2.8 for females; the overall rate was 4.1. The rates were age-adjusted to the 1950 United States population for comparison with earlier data from this population. The rates increased with age for both sexes. There was no significant change in incidence rates from 1945 through 1990. A comparison of the median age for Olmsted County patients with the age of those referred to the Mayo Clinic from elsewhere indicated that the local patients were appreciably older (74 v. 62 years, respectively). Thirty-two of 55 patients (58%) with multiple myeloma from 1978 through 1990 had a monoclonal plasma-cell proliferative process before the diagnosis of multiple myeloma. CONCLUSION: The incidence rate of multiple myeloma in Olmsted County, Minnesota, has not changed significantly during the past 46 years. We believe that reports of increasing rates over time are mainly due to improved case ascertainment.

Adolescent↗
PubMed1994

Abnormalities of parathyroid hormone secretion in elderly women that are reversible by short term therapy with 1,25-dihydroxyvitamin D3.

Serum PTH concentrations increase with aging and may play an important causal role in age-related bone loss. To better define possible PTH secretory abnormalities with aging, we studied 10 young (aged 27-34 yr) and 10 elderly (aged 71-77 yr) women using sequential infusions of calcium and EDTA. To assess possible age-related resistance of PTH secretion to modulation by 1,25-dihydroxyvitamin D [1,25-(OH)2D], the infusions were repeated after 1 week of oral 1,25-(OH)2D3 therapy (1 microgram/day). Baseline serum intact PTH concentrations were higher in the elderly compared to the young women (mean +/- SEM, 3.8 +/- 0.5 vs. 2.7 +/- 0.4 pmol/L; P = 0.03). In addition, the elderly women had a significantly higher maximal PTH response to hypocalcemia compared to the young women (16.6 +/- 1.1 vs. 12.8 +/- 1.0 pmol/L; P = 0.03). The elderly women also had a greater nonsuppressible component of PTH secretion (0.8 +/- 0.1 vs. 0.4 +/- 0.1 pmol/L; P < 0.001). The set-point for PTH secretion, however, was identical in the elderly and young women (1.18 +/- 0.01 vs. 1.19 +/- 0.01 mmol/L; P = NS). After 1,25-(OH)2D3 administration, both groups had similar reductions in baseline and maximally stimulated PTH levels, indicating that elderly women have normal responsiveness to 1,25-(OH)2D3 suppression of PTH secretion. In addition, maximally stimulated PTH levels in the 1,25-(OH)2D3-treated elderly women decreased to the pretreatment values of young women (13.3 +/- 1.1 vs. 12.8 +/- 1.0 pmol/L; P = NS). thus, elderly women have greater basal, maximal, and nonsuppressible levels of PTH secretion, without alterations in the set-point. These abnormalities are similar to those found in patients with secondary hyperparathyroidism and parathyroid hyperplasia. Further, the abnormal PTH secretory dynamics in elderly women are reversible by short term 1,25-(OH)2D3 therapy.

Adult↗
PubMed1994

Incidence of cluster headaches: a population-based study in Olmsted County, Minnesota.

The epidemiology of cluster headache is virtually unknown. Using the unique resources of the Rochester Epidemiology Project for population-based studies, we identified 26 Olmsted County, Minnesota, residents who fulfilled the International Headache Society criteria for newly diagnosed cluster headache between 1979 and 1981. As part of a large study of migraine and cluster headache, we screened more than 6,400 patient records from several diagnostic rubrics to obtain this cohort, accomplished case ascertainment exclusively through medical record review, and assigned diagnoses by the consensus of two neurologists. The age-adjusted incidence was 15.6 per 100,000 person-years (p-y) (95% CI, 8.9 to 22.3) for males and 4.0 per 100,000 p-y for females (95% CI, 0.4 to 7.6). The overall age- and sex-adjusted incidence was 9.8 per 100,000 p-y (95% CI, 6.0 to 13.6) or approximately 1/25 that of migraine. The peak incidence was among men aged 40 to 49 years and women 60 to 69 years. There was a higher than expected prevalence of history of smoking among males with cluster headaches (p < 0.05), supporting the possibility that smoking predisposes to the development of cluster headaches in men.

Adolescent↗
PubMed1994

Fracture risk in patients with ankylosing spondylitis: a population based study.

OBJECTIVE: To assess the risk of fractures among patients with ankylosing spondylitis (AS). METHODS: A population based cohort study compared fracture incidence in an inception cohort of 158 Rochester, Minnesota residents newly diagnosed with AS between 1935 and 1989 with expected rates from the same community. RESULTS: In 2,398 person-years of observation, there was no increase in the risk of limb fractures, but there was a pronounced increase in the risk of thoracolumbar compression fractures (standardized morbidity ratio = 7.6; 95% CI, 4.3-12.6) among those with AS. CONCLUSION: These data point to the importance of measures aimed at maintaining axial skeletal status in patients with AS.

Adolescent↗
PubMed1993

Esthesioneuroblastoma: the role of adjuvant radiation therapy.

PURPOSE: We describe our experience with adjuvant radiation therapy in patients who underwent operation for esthesioneuroblastoma. METHODS AND MATERIALS: Between January 1951 and December 1990, 49 patients with esthesioneuroblastoma received their initial treatment at the Mayo Clinic. There were 27 male and 22 female patients; their ages ranged from 3 to 79 years (median, 54 years). The tumors were Kadish Stage A in 4 patients, Stage B in 13, Stage C in 29, and modified Kadish Stage D in three (cervical nodal or distant metastasis). The tumors were graded according to Hyams' classification. Treatment included gross total resection alone in 22 patients and gross total resection and postoperative adjuvant radiation therapy in 16. The patients treated with adjuvant radiation had a greater proportion of advanced-stage and high-grade tumors. RESULTS: The 5-year actuarial overall survival, disease-free survival, and local control rates were 69.1% + 7.0%, 54.8% + 7.6%, and 65.3% + 7.4%, respectively. The only significant predictor for overall survival, disease-free survival, and local control was Hyams' grade. Local control was improved in patients who received postoperative adjuvant radiation even though this group of patients had more advanced and higher-grade tumors (5-year rate of local control was 85.9% + 9.3%, compared with 72.7% + 9.5% for those who had operation alone, p = 0.26). CONCLUSION: Adjuvant radiation therapy for esthesioneuroblastoma improves local tumor control, particularly for high-grade and high-stage tumors. We recommend additional treatment with radiation (55.5 Gy) after complete resection of esthesioneuroblastoma.

Adolescent↗
PubMed1993

Plasma cell labeling index and beta 2-microglobulin predict survival independent of thymidine kinase and C-reactive protein in multiple myeloma.

The plasma cell labeling index (PCLI) and serum beta 2-microglobulin (beta 2M) are independent prognostic factors in multiple myeloma (MM). Recently, levels of thymidine kinase (TK) and C-reactive protein (CRP) have been shown to have prognostic value. We studied 107 patients with newly diagnosed myeloma to determine whether TK and CRP values added prognostic information not already available using the PCLI and beta 2M. Univariate survival analysis showed prognostic significance for the PCLI, TK, beta 2M, age, serum albumin, and CRP. Multivariate analysis showed that only PCLI and beta 2M have independent prognostic significance. The survival curves were better separated using the PCLI and beta 2M than with other combinations of variables. Among nine patients under age 65 with low PCLI and low beta 2M, eight were alive almost 6 years after starting chemotherapy. These good-risk patients could not be identified by standard clinical features. Although creatinine and calcium were normal, other features such as bone lesions, osteoporosis, fracture, and anemia were present and stage distribution was similar to other patients in the study. In conclusion, PCLI and beta 2M measured at diagnosis are independent prognostic factors. They must be considered when interpreting the results of clinical trials and should be helpful in counseling patients and in designing new trials. When the PCLI and beta 2M values are known, the TK and CRP values do not add useful additional prognostic information.

Adult↗
PubMed1993

Population-based study of survival after osteoporotic fractures.

Vertebral fractures are the most frequent of the fractures associated with osteoporosis, yet little is known of their impact on health in the United States. To aid in this understanding, the authors examined the survival rate of 335 residents of Rochester, Minnesota, who had an initial radiologic diagnosis of vertebral fracture between 1985 and 1989. Seventy-six died during 809 person-years of follow-up. The overall survival rate was worse than expected, and diverged steadily from expected values throughout the course of the study. At 5 years after diagnosis, the estimated survival was 61% compared with an expected value of 76% (relative survival = 0.81, 95% confidence interval (CI) 0.70-0.92). The 5-year relative survival after a hip fracture in Rochester was a comparable 0.82 (95% CI 0.77-0.87), but there was a much greater excess of deaths within the first 6 months as compared with patients with vertebral fractures. The 5-year relative survival rate after a distal forearm fracture was 1.00 (95% CI 0.95-1.05). Clinically diagnosed vertebral fractures are rarely fatal, and the reduced survival seen subsequently could related to comorbid conditions. Nonetheless, the excess mortality should be accounted for in assessing the public health impact of osteoporosis.

Arm Injuries↗
PubMed1993

Accuracy of the death certificate in a population-based study of asthmatic patients.

OBJECTIVE: To quantify the reliability of death certificate data concerning asthma. DESIGN: The complete medical records of decedents were reviewed by a physician certified in allergy and pulmonology who determined the cause of death without having access to the original death certificate. Disagreements between the death certificate and the reviewer were adjudicated by an expert panel. SETTING: The community of Rochester, Minn. PATIENTS: The mortality cohort included 339 deaths from a larger cohort of 5241 Rochester residents who received medical treatment for asthma between 1964 and 1983. MAIN OUTCOME MEASURES: Kappa coefficients were used to measure agreement beyond that expected by chance between the reviewer and the death certificate. The sensitivity and specificity of the death certificate diagnosis of asthma were calculated against the standard of the reviewer/panel diagnosis. RESULTS: Death certificates reported asthma as an immediate or underlying cause of death in 22 instances (6%), whereas the reviewer/panel identified asthma in 53 cases (16%). In four cases, the death certificate listed asthma and the panel identified another cause of death. The death certificate had a sensitivity of 42% and a specificity of 99% compared with the reviewer/panel. Agreement between death certificates and the reviewer was not influenced by whether an autopsy was performed. CONCLUSIONS: Death certificate diagnosis of asthma as an underlying cause of death had a low sensitivity but a high specificity. Increases in mortality due to asthma are not likely caused by false-positive diagnoses of asthma as an underlying cause of death. Asthma mortality rates, determined from death certificate data, may indeed underestimate actual asthma-related mortality.

Adolescent↗
PubMed1993

Idiopathic intracranial hypertension (pseudotumor cerebri). Descriptive epidemiology in Rochester, Minn, 1976 to 1990.

The medical records-linkage system of the Mayo Clinic was used to identify cases of idiopathic intracranial hypertension in the 15-year period, 1976 through 1990, among the population of Rochester, Minn. Nine patients (eight women and one man) were identified, corresponding to an average annual age-adjusted incidence rate per 100,000 of 0.9 for the total and 1.6 for the female population. In females aged 15 to 44 years, idiopathic intracranial hypertension occurred at a rate of 3.3 per 100,000 per year; for those defined as obese (body mass index > 26), the rate rose to 7.9. Median follow-up was 2.7 years (range, 5 months to 15 years). Three of 18 eyes developed visual impairment; this was mild in all cases.

Adolescent↗
PubMed1993

Long-term fracture prediction by bone mineral assessed at different skeletal sites.

Bone mineral density (BMD) was measured at the lumbar spine and cervical and intertrochanteric regions of the proximal femur by dual-photon absorptiometry and bone mineral content was assessed at the distal and midradius by single-photon absorptiometry in an age-stratified random sample of 304 Rochester, Minnesota women aged 30-94 years. Over follow-up extending to 10 years (median 8.3 years), 93 women experienced 163 new fractures. After adjusting for age, these bone mineral measurements predicted the likelihood of any incident fracture due to moderate trauma, with relative hazards varying from 1.4 to 1.6 per SD decrease in baseline bone mineral. A 1 SD decrease in lumbar spine BMD increased the risk of a new vertebral fracture comparably to a 17 year increase in age; a 1 SD decrease in femoral BMD was comparable to a 13-14 year increase in age on the risk of a hip fracture. We conclude that bone mineral measurements made at a variety of skeletal sites can predict the occurrence for at least 8-10 years of moderate trauma fractures of the sort that might be related to osteoporosis.

Absorptiometry, Photon↗
PubMed1993

Prevalence and incidence of vertebral deformities.

There is a need to identify vertebral fractures from radiographs taken at a single point in time, but considerable controversy surrounds the methods to be used. We extended a data set to comprise baseline radiographs of the thoracic and lumbar spine on an age-stratified random sample of 762 Rochester, Minnesota, women and used revised methods to define vertebral deformities morphometrically. Changes in the method of measuring vertebral heights, changes in the source of normal values for vertebral measurements and changes in the criteria for assessing vertebral deformity had little impact on estimated prevalence and incidence in this population. The prevalence of any vertebral deformity was estimated at 25.3 per 100 Rochester women aged 50 years and over (95% CI, 22.3-28.2), while the incidence of a new deformity in this group was estimated at 17.8 per 1000 person-years (95% CI, 16.0-19.7). Projected nationally, these data suggest that over 500,000 white women in the United States develop vertebral deformities for the first time each year and that over 7 million white women aged 50 years and over might be affected at any given time. These estimates are limited by the absence of a reliable 'gold standard' with which to determine false positive and false negative rates associated with this or any other morphometric method. Information on the health consequences of vertebral deformities of various sorts would be most helpful in choosing between alternative approaches to defining them.

Aged↗
PubMed1993

Influence of breastfeeding and other reproductive factors on bone mass later in life.

The influence of reproductive factors on bone mass at six skeletal sites was assessed in an age-stratified random sample of white women residing in Rochester, Minnesota. After age-adjustment, whether or not women had ever breastfed, total duration of breastfeeding and duration of breastfeeding per child were not associated with reduced bone mineral, but breastfeeding for more than 8 months was associated with greater bone mineral at some sites. There were no consistent effects on bone mineral, after adjusting for age, of gravidity or parity, age at menarche, age at first delivery, use of oral contraceptives or estrogen replacement therapy, various sex hormones, nor any of the other reproductive factors assessed. There was a strong protective effect of obesity, which was also correlated with a number of the reproductive variables. While animal studies suggest that pregnancy and lactation may be associated with calcium loss from the skeleton, these data indicate that such factors have little long-term impact on bone mass in humans and little potential for identifying women at high risk of osteoporosis later in life.

Adult↗
PubMed1993

Stroke incidence with hypertension and ischemic heart disease in Rochester, Minnesota.

The primary contribution to increased incidence rates for ischemic stroke in Rochester, Minnesota, for the 1980 to 1984 time period in the age groups from 55 to 84 years was from those persons in the population with ischemic heart disease. The rate and pattern of the decline in incidence rates of ischemic stroke in hypertensive individuals and in nonhypertensive individuals were quite similar, showing no demonstrable population effect of antihypertensive medication. These observations emphasize that there must be some, as yet unidentified, factor that is important in the decline of stroke incidence.

Aged↗
PubMed1993

Competitive athletes: preinjury and postinjury mood state and self-esteem.

In a prospective study, we determined whether preinjury and postinjury differences existed in the mood state and self-esteem of competitive athletes. The influence of severity of injury, gender, level of participation in sports, and type of sport on these dependent variables was also measured. Among 238 male and 38 female athletes from hockey, basketball, baseball, and volleyball teams, 36 sustained 43 injuries. Significant postinjury increases were noted for depression (P < 0.0001) and anger (P = 0.0012), whereas vigor (P < 0.0001) was significantly less after injury. When the 36 injuries were classified, 27 were minor or moderate (nonparticipation in sports for only one or two weekly assessments), and 9 were severe (nonparticipation for three or more weekly assessments). When a stepwise multiple regression equation was used to predict the scores for postinjury depression, the only significant predictor was the severity of injury (F = 8.48 [1, 34]; R2 = 0.30; P = 0.0063). Of the following physical and psychosocial variables--level of participation, type of sport, age, previous injury, preinjury stress, gender, mood state scales, and self-esteem--only level of participation (P < 0.0001) and type of sport (P = 0.0004) were predictors of injury. The significant preinjury and postinjury differences in mood state suggest that postinjury mood disturbances reported in previous studies are likely attributable to the occurrence of injury, are related to the severity of injury, and do not merely reflect a disturbed preinjury mood.

Affect↗
PubMed1993

Short-term effects of recombinant human insulin-like growth factor I on bone turnover in normal women.

Because insulin-like growth factor I (IGF-I) is a potent stimulator of osteoblast proliferation, it has potential in the treatment of osteoporosis. However, IGF-I affects multiple organ systems, and it is unclear whether treatment can stimulate bone formation without producing unacceptable side effects. Therefore, we evaluated the effects of treatment with recombinant human IGF-I in 18 postmenopausal women who received various dosages (30, 60, 120, or 180 micrograms/kg.day) by sc injections for 6 days. Serum IGF-I concentrations increased by 2- to 4-fold during treatment. There were dose-dependent increases in serum type I procollagen carboxyl-terminal propeptide concentration (r = 0.85, P < 0.001), an index of collagen synthesis, and of urinary excretion of deoxypyridinoline (r = 0.75, P = 0.001), an index of bone collagen breakdown. At the two higher dosages, recombinant human IGF-I caused orthostatic hypotension, sinus tachycardia, bilateral parotid discomfort, weight gain, and edema in some women. Hypoglycemia did not occur. However, treatment at the 2 lower dosages increased serum type I procollagen carboxyl-terminal propeptide significantly and produced minimal or no side effects. Long-term studies on the effects and the safety of low dosage recombinant human IGF-I on bone mass should now be undertaken in osteoporotic women.

Aged↗
PubMed1993

Hip fracture incidence before and after the fluoridation of the public water supply, Rochester, Minnesota.

Recent ecological comparison studies have suggested a positive association between fluoridation and hip fracture. Using data from the Rochester Epidemiology Project, we found the incidence of hip fracture for the 10 years before the fluoridation of the Rochester, Minn, public water supply was 484 per 100,000, compared with 450 per 100,000 in the following 10 years. When the effects of calendar time and age were controlled for, the relative risk associated with fluoridation was 0.63. These ecologic trend data suggest that the fluoridation of public water supplies is not associated with an immediate increase in rates of hip fracture. Further studies of this association at the individual level are clearly required before public policy decisions can be made.

Aged↗
PubMed1993

Urban vs rural increase in hip fracture incidence. Age and sex of 901 cases 1980-89 in Olmsted County, U.S.A.

To determine if hip fracture incidence rates are greater in urban than in rural areas of the United States, as they appear to be in Scandinavia, we undertook a study in Olmsted County, Minnesota. During the decade 1980-89, the age- and sex-adjusted incidence of proximal femur fractures among urban residents of the central city of Rochester was 36 percent greater than among residents of the rural remainder of Olmsted County. The difference was almost entirely accounted for by an excess of fractures due to moderate trauma in elderly urban women. These first detailed results from the United States confirm earlier observations from Scandinavia that hip fracture rates are lower in rural areas.

Adolescent↗