Biomedical subjects

W M O'Fallon

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

At least 235 records · Page 13Linked to original sources

PubMed1990

Relationship between serum intact parathyroid hormone concentrations and bone remodeling in type I osteoporosis: evidence that skeletal sensitivity is increased.

To define the role of parathyroid gland function in the pathophysiology of bone loss in type I (postmenopausal) osteoporosis, we measured serum intact parathyroid hormone (PTH) concentration by immunoradiometric assay (IRMA) and by multisite immunochemiluminometric assay (ICMA) in 63 postmenopausal osteoporotic women (PMOp) with vertebral compression fractures and in 75 age-comparable postmenopausal normal women (PMNl). Also, tetracycline-based histomorphometric indices in cancellous bone were assessed in iliac biopsy samples from 61 PMOp and 28 PMNl women. Serum PTH concentrations by IRMA were similar in PMOp and PMNl (medians, 3.92 and 3.77 pmol/l; NS) but were significantly lower in PMOp by the more sensitive ICMA (medians, 2.82 and 3.14 pmol/l; P less than 0.01). By multiple linear regression analysis, serum PTH was directly related (P less than 0.001) to activation frequency, bone resorption rate, bone formation rate, and the calculated rate of bone loss. For each unit (pmol/l) increase in serum PTH by ICMA, activation frequency increased by 1.3%/year more (P = 0.01), bone resorption rate increased by 3.9%/year more (P = 0.003), and the rate of cancellous bone loss was 2.8% greater (P = 0.0003) in the PMOp women compared with the PMNl women. Concentrations of serum estradiol, but not serum estrone, had a weak opposing effect to PTH, especially for bone formation rate. These data suggest that in PMOp the bone has increased sensitivity to the biologic effects of PTH. This may represent one of the fundamental pathophysiologic defects in PMOp and, in the setting of estrogen deficiency, may explain, in part, their greater rate of bone loss.

Aged↗

PubMed1990

Beta 2-microglobulin predicts survival in primary systemic amyloidosis.

PURPOSE: The study assessed whether beta 2-microglobulin levels predict survival or response in patients with primary systemic amyloidosis without associated multiple myeloma. PATIENTS AND METHODS: The study group consisted of 131 untreated patients with biopsy-proven primary systemic amyloidosis diagnosed and evaluated at the Mayo Clinic. No patient had multiple myeloma. The minimum follow-up of surviving patients is 8 years. No patient was lost to follow-up. RESULTS: The median survival of patients with an increased beta 2-microglobulin level was 10.8 months, compared with patients with a normal beta 2-microglobulin level (less than or equal to 2.7 micrograms/mL, 0.23 mumol/L) of 32.9 months (p less than 0.001). In a multivariate proportional-hazards model, the best model included congestive heart failure (p less than 0.0001) and increased beta 2-microglobulin levels (p less than 0.05). After adjustment for the presence of congestive heart failure, beta 2-microglobulin level remained significant. When the analysis was restricted to those patients with normal renal function, the median survival of those with an elevated beta 2-microglobulin level was 9.1 months versus 39.4 months for those with a normal level (p less than 0.001). The serum level of beta 2-microglobulin was increased in patients with nephrotic-range proteinuria with or without renal insufficiency (p = 0.05). CONCLUSION: The serum beta 2-microglobulin level should be measured routinely in all patients with primary systemic amyloidosis because it provides a useful objective factor to identify subsets of patients with this disease who have unfavorable outcomes.

Adult↗

PubMed1990

Comparison of case ascertainment by medical record linkage and cohort follow-up to determine incidence rates for transient ischemic attacks and stroke.

During the period 1960-1972, the medical record linkage index method provided an estimated average annual age- and sex-adjusted rate for first transient ischemic attack (TIA) of 134 per 100,000 population for those age 50 years and older. The cohort method estimate was 237 per 100,000 population (95% confidence limits (CL), 165-310). The discrepancy was due to 18 cases of TIA noted at the time of patient visits in the cohort analysis that were not identified from the medical record analysis. The cohort analysis for all strokes at age 50 years and older was not significantly different from the medical record linkage analysis. Although the cohort follow-up method provided better case ascertainment in this study, current indexing procedures provide case ascertainment equal to that of the cohort method and at less cost. No trend was found to suggest that incidence rates for TIA were decreasing in the period 1955-1979, in contrast to stroke in Rochester, Minn.

Age Factors↗

PubMed1990

Suicide in Olmsted County, Minnesota, 1951 through 1985.

During the 35-year period 1951 through 1985, 274 completed suicides occurred among residents of Olmsted County, Minnesota. The overall age- and sex-adjusted incidence was 12.5 per 100,000 person-years (95% confidence interval, 11.0 to 14.0), similar to the national averages, and rates were comparable for urban and rural portions of the county. Men outnumbered women 3.6 to 1, and the sex ratio of age-adjusted incidence rates was 4.5:1. The incidence rates increased after middle age for men but not for women. The most common suicide methods were gunshot wounds for men and poisoning for women. Two-thirds of the suicides occurred at home and were usually discovered by family members or friends. Almost half of all suicide victims were unmarried. This figure seems high, as does the greater proportion of unemployed persons than employed persons among those who committed suicide, but denominator data are unavailable.

Adolescent↗

PubMed1990

Emotional responses of athletes to injury.

Increased participation in sports is associated with increased related injuries. This study was conducted to identify the emotional responses of athletes to injury and to determine which responses might interfere with rehabilitation and necessitate psychologic or psychiatric intervention. In 72 patients, follow-up surveillance was continued from the time of injury until resumption of sports activity. Patients completed the Emotional Responses of Athletes to Injury Questionnaire and the Profile of Mood States (POMS) test, and significant differences were found when the POMS scales of depression and anger were compared with college norms. Mean POMS scores were compared (by multivariate analysis of variance) by sex, age, and severity of injury. No gender differences were found, and only for anger were age groups significantly different (younger athletes were most angered). Three severity-of-injury groups (based on the duration of time the athlete was unable to participate in sports) were also compared. The most seriously injured group experienced significantly more tension, depression, and anger and less vigor than college norms, a mood disturbance that lasted 1 month. Emotional disturbance can occur after a sports-related injury, and its prompt recognition may facilitate the athlete's optimal rehabilitation and a safe return to participation in sports.

Adolescent↗

PubMed1990

Prevalence of cardiovascular disease and diabetes mellitus in residents of Rochester, Minnesota.

To determine the prevalence of cardiac disorders as risk factors for stroke, we conducted a survey in 1986 in a stratified random sample of the population of Rochester, Minnesota, 35 years of age or older. The medical records of the 2,122 subjects in the sample were retrieved with use of the Rochester Epidemiology Project medical records linkage system. The data were used to estimate (1) the reliability of self-reported information about cardiac and cerebrovascular disorders and (2) the age- and sex-specific prevalence of diabetes mellitus and various cardiac and cerebrovascular conditions. The estimated prevalence for selected risk factors in the population 35 years of age or older was 5.8% for diabetes mellitus, 3.3% for myocardial infarction, 1.2% for mitral valve disease, 4.2% for left ventricular hypertrophy, and 2.8% for atrial fibrillation or flutter. These data can be used to estimate resources required for evaluation and management of the disorders. When the prevalence and the relative risk for stroke are known for a particular cardiac disorder, the proportion of stroke attributable to that disorder can be estimated.

Adult↗

PubMed1990

Case-control study of neuroepithelial tumors in Rochester, Minnesota, 1950-1977.

Rochester, Minnesota, has over many decades the highest reported incidence rates of primary intracranial neoplasms. This occurs in the absence of any readily identifiable risk factors. A case-control study of neuroepithelial tumors has been undertaken utilizing the records-linkage system at the Mayo Clinic. This study failed to yield any significant findings for the factors examined.

Adenoma↗

PubMed1990

Duration of cigarette smoking is the strongest predictor of severe extracranial carotid artery atherosclerosis.

The effect of cigarette smoking on extracranial carotid atherosclerosis was studies by obtaining cigarette smoking histories and information on other potential risk factors from consecutive patients undergoing carotid arteriography. At least on extracranial carotid artery was visualized in 752 patients in whom the extent of carotid atherosclerosis was assessed. The total years of cigarette smoking was the most significant independent predictor of the presence of severe carotid atherosclerosis. Other independent predictors, in order of significance, were age, hypertension, diabetes mellitus, male sex, and current systolic blood pressure. By age 60 years, the risk of having severe carotid atherosclerosis for a person who had smoked for 40 years was approximately 3.5 times that for a never smoker. The major benefit of smoking cessation is in limiting the accumulation of smoking years.

Age Factors↗

PubMed1990

Prospective comparison of a cohort with asymptomatic carotid bruit and a population-based cohort without carotid bruit.

This study is a prospective analysis of the predictive value of diffuse and localized carotid bruit. Patients with asymptomatic carotid bruits are compared with a population-based age- and sex-matched control group known not to have carotid bruit, in regard to subsequent transient ischemic attack, stroke, and death. Each person was followed until death or for 5 years. Among the 566 patients with asymptomatic carotid bruit, the annual stroke rate given survival was 1.5%/yr or 7.5% at 5 years by actuarial analysis. The annual stroke rate given survival for the 428 patients in the population-based cohort was 0.5%/yr or 2.4% at 5 years. Patients with localized carotid bruit were not significantly different from those with diffuse carotid bruits in regard to subsequent cerebral ischemic events (p = 0.11). These data indicate that patients with asymptomatic diffuse or localized carotid bruit are approximately three times more likely to have ischemic stroke than an age- and sex-matched population sample known not to have carotid bruit.

Age Factors↗

PubMed1990

The "second" side of the neck in supraglottic cancer.

The purpose of this study was to assess the impact of decisions made at operation for primary neck tumor on survival and cause of death-specifically, whether bilateral dissection, unilateral dissection, or delayed dissection influences eventual outcome. Of 244 patients with primary cancer of the supraglottis who were treated surgically, 22 (9%) had no neck treatment, 188 (77%) had unilateral neck dissection, and 34 (14%) had bilateral simultaneous neck dissection. Dissection on one or both sides of the neck was required later in 6 (27%) of the 22 patients with no neck treatment and in 32 (17%) of the 188 patients who had unilateral dissection. There were no differences among the treatment groups in the incidence of death from any cause or in the incidence of death from cancer, although neck stage did differ from group to group. The influence of delayed metastasis on survival was analyzed to explain these findings. Multivariate analysis demonstrated that death occurred at a rate 1.81 times higher in a person with a positive neck stage than in a person of the same age who had a negative stage. Also, death occurred at a rate 1.5 times higher for a person 10 years older than for a person with the same stage of disease. The influence of stage on the probability of need for a second dissection indicated that a patient with a positive neck stage had a 6.3 times greater likelihood of requiring a subsequent neck dissection than a person with a negative neck stage.

Adult↗

PubMed1990

A reappraisal of the epidemiology of multiple sclerosis in Olmsted County, Minnesota.

A review of multiple sclerosis (MS) case reports, using the unified record system at the Mayo Clinic for the Olmsted County population, revealed age- and sex-adjusted prevalence rates per 100,000 persons of 160 for Olmsted County and 173 for Rochester, Minnesota, on January 1, 1985. The annual age- and sex-adjusted incidence rate per 100,000 person-years from 1975 to 1984 for Olmsted County was 6.2 and for Rochester, 6.3. This incidence rate is significantly higher than what had been reported previously in Rochester (3.6/100,000) or in other communities. The estimated 25-year survival of the MS population was 76.2% +/- 4.5% compared with 87.7% for the general US white population of a similar age and sex. Survival for men was less than for women. There was no increase in survival for patients diagnosed with MS in more recent decades. No significant increase was found in cancer or autoimmune disease rates in the MS patients.

Adolescent↗

PubMed1990

Course of peripheral occlusive arterial disease in diabetes. Vascular laboratory assessment.

To determine comparative rates of development and progression of peripheral occlusive arterial disease, 110 healthy nondiabetic control subjects, 112 patients with peripheral occlusive arterial disease (POAD), 240 patients with diabetes mellitus (DM), and 100 patients with diabetes mellitus and peripheral occlusive arterial disease (DM + POAD) were studied over 4 yr with noninvasive techniques. The presence of peripheral occlusive arterial disease was determined by postexercise ankle-brachial index (ABI) values; progression of peripheral occlusive arterial disease was determined by the rate of change in postexercise ABI. Patients who underwent peripheral arterial reconstructive surgery or amputation were also classified as having progression of their peripheral occlusive arterial disease. On this basis, follow-up revealed that peripheral occlusive arterial disease developed and therefore progressed in 1 (1%) of the control group and 22 (9%) of the DM. Peripheral occlusive arterial disease progressed in 31 (28%) of the POAD and 26 (26%) of the DM + POAD. The presence of peripheral occlusive arterial disease predisposes to progression of disease, and peripheral occlusive arterial disease is more likely to develop in diabetic patients who do not have peripheral occlusive arterial disease than in nondiabetic control subjects. However, the presence of diabetes mellitus in patients with peripheral occlusive arterial disease does not seem to increase the risk of progression.

Amputation, Surgical↗

PubMed1990

Treatment of rheumatoid arthritis with higher dose intravenous methotrexate.

A pilot study evaluated intravenous methotrexate (MTX) (initial dose 40 mg/m2; final dose, 26 mg/m2), weekly for 12 weeks in 10 patients with rheumatoid arthritis who failed oral MTX. Statistically significant differences were noted for all the response variables examined: joint count (p = 0.0017), morning stiffness (p = 0.014), global assessment (patient, p = 0.0032, physician, p = 0.029), Arthritis Impact Measurement Scale (p = 0.0004), erythrocyte sedimentation rate (p = 0.012), grip strength (right p = 0.044, left p = 0.011). All 7 patients who completed the 12-week treatment period fulfilled the predetermined criteria for response. Intravenous MTX at these doses has potential efficacy in this patient group.

Adult↗

PubMed1990

The incidence of cholelithiasis and cholecystitis in Rochester, Minn, 1950 through 1969.

During the period 1950 through 1969, 2344 persons (755 men and 1589 women) in Rochester, Minn, met diagnostic and residency criteria for cholelithiasis. The age-adjusted average annual incidence rates per 100,000 population were 217 for men and 370 for women (adjusted rates were 255 and 276, respectively). Incidence rates increased with age in both sexes, but more rapidly so for men, so that by 70 years of age the rate for men was higher than that for women. For the decades covered in this study, no secular trend in incidence was detected for the two sexes combined or separately.

Age Factors↗

PubMed1989

Chronic renal failure in non-insulin-dependent diabetes mellitus. A population-based study in Rochester, Minnesota.

STUDY OBJECTIVE: To identify the incidence of clinically defined chronic renal failure by clinical type of diabetes in a community diabetic incidence cohort, and to evaluate the relation between persistent proteinuria and chronic renal failure in non-insulin-dependent diabetes mellitus. DESIGN: Retrospective incidence cohort study. SETTING: Population-based in Rochester, Minnesota. PATIENTS: Residents of Rochester, Minnesota, with diabetes initially diagnosed between 1945 and 1979 who had follow-up to 1984 for clinically defined chronic renal failure. MEASUREMENTS AND MAIN RESULTS: Among 1832 persons with non-insulin-dependent diabetes who were initially free of chronic renal failure, 25 developed chronic renal failure (incidence, 133 per 100,000 person-years: CI, 86 to 196). The subsequent incidence of chronic renal failure among 136 insulin-dependent diabetic Rochester residents, three of whom developed chronic renal failure, was 170 per 100,000 person-years (CI, 35 to 497). After adjusting for potential confounding factors, we found that the risk for chronic renal failure associated with the presence of persistent proteinuria at the time of the diagnosis of non-insulin-dependent diabetes was increased 12-fold (hazard ratio, 12.1; CI, 4.3 to 34.0). When persistent proteinuria developed after the diagnosis of non-insulin-dependent diabetes mellitus, the cumulative risk for chronic renal failure 10 years after the diagnosis of persistent proteinuria was 11%. CONCLUSIONS: These population-based data suggest that most cases of chronic renal failure in diabetes occur in persons with non-insulin-dependent diabetes. These data also identify the increased risk for chronic renal failure among persons with non-insulin-dependent diabetes mellitus who have persistent proteinuria present at or developing after the diagnosis of non-insulin-dependent diabetes mellitus, such data may be useful for directing interventions to prevent or delay the development of chronic renal failure.

Cohort Studies↗

PubMed1989

Predictive value of carotid bruit for carotid atherosclerosis.

To assess the predictive value of carotid bruit for moderate-to-severe carotid atherosclerosis, the results of carotid arteriograms performed on 1004 subjects were correlated with the findings of auscultation of the carotid arteries. Predictive values of carotid bruit for ipsilateral extracranial carotid atherosclerosis were 77% for localized bruits and 74% for diffuse bruits. The predictive values of extracranial carotid bruit for ipsilateral intracranial carotid atherosclerosis were 16% for localized bruits and 18% for diffuse bruits. Assessing both carotid arteries together, the predictive value of carotid bruit for moderate-to-severe atherosclerosis at any extracranial carotid site was 85%, there being no difference whether the bruits were diffuse, localized, bilateral, or unilateral. Diffuse or localized bruits, whether unilateral or bilateral, are equally predictive of moderate-to-severe atherosclerosis in the extracranial carotid artery, but both are poor predictors of intracranial carotid artery disease.

Adult↗

PubMed1989

Colles' fracture and bone density of the ultradistal radius.

To determine whether Colles' fracture, generally considered a manifestation of postmenopausal osteoporosis, is associated with a decrease in bone density at the site of fracture, we measured bone mineral density of the ultradistal radius (UDR-BMD) by single-photon absorptiometry with computer-assisted image processing. In 119 normal women (ages 22-92 years), UDR-BMD decreased by 17% between ages 30 and 75 years. From UDR-BMD measurements in these normal women and in 40 women (ages 53-80 years) with Colles' fracture alone, a population-based analysis was made to estimate fracture risk at different values of UDR-BMD. Colles' fracture was uncommon at UDR-BMD greater than 0.40 g/cm2 (the "fracture threshold"). As bone density decreased below this level, fractures became more frequent (a "gradient of risk").

Adult↗

PubMed1989

Update on the epidemiology of multiple sclerosis.

Neuroepidemiology has been important in providing clues about the cause and pathogenesis of multiple sclerosis. In this review, we update the incidence and prevalence rates of multiple sclerosis in Olmsted County, Minnesota, and examine the potential role of viruses, exposure to animals, toxins, trauma, and diet in the development of this disease. Diseases of probable autoimmune nature have also been linked to multiple sclerosis. These descriptive data may contribute to the formulation of testable specific hypotheses about the pathogenesis and treatment of multiple sclerosis and other demyelinating diseases.

Age Factors↗