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Biomedical subjects

W M O'Fallon

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

At least 271 records · Page 15Linked to original sources
PubMed1987

The natural history of asymptomatic carotid artery occlusive lesions.

The purpose of this retrospective study was to determine the long-term prognosis of patients with asymptomatic pressure-significant (hemodynamically significant) internal carotid system lesions. Of 640 neurologically asymptomatic patients, 292 had pressure-significant internal carotid artery occlusive lesions as determined by ocular pneumoplethysmography, while 348 had a carotid bruit only without a pressure-significant lesion. The annual stroke rate for the first three years on a Kaplan-Meier life-table basis was 3.4% and 1.5% in the abnormal and normal ocular pneumoplethysmography groups, respectively, as compared with a rate of 0.5% in a normal age- and sex-matched population. The annual total event rate (transient ischemic attack and stroke) was 5.2% in the abnormal vs 2.3% in the normal group, with 56% of all events ipsilateral to the ocular pneumoplethysmography abnormality. These results indicate that patients with asymptomatic pressure-significant carotid system occlusive lesions are at greater risk for stroke than a normal ocular pneumoplethysmography group (twofold) and a general population (sevenfold).

Adult↗
PubMed1987

Secular trends in the incidence of hip fractures.

To explore possible changes in proximal femur (hip) fracture incidence over time, an earlier study among Rochester, Minnesota residents for 1928-1977 was updated through 1982. Reanalysis of data demonstrated rising age-adjusted rates for men over this time. Crude rates rose for women as well, but age adjusted rates leveled off in the mid-1950s, as did overall rates, since the majority of hip fractures were in women. Secular trends were primarily due to changes in the incidence of initial hip fractures associated with moderate trauma, the sort usually attributed to osteoporosis. No differences were noted in trends for cervical vs. intertrochanteric femur fractures; and, excluding the low values for 1928-1942, no significant trends were noted for women within various age groups. Our results for women conflict with estimates from a number of other studies, but these differences may provide a basis for hypothesis development.

Age Factors↗
PubMed1987

Natural History Study of Congenital Heart Defects.

A strategy designed to locate and recruit individuals who were part of a study in the 1960s of congenital aortic stenosis, pulmonary stenosis, and ventricular septal defect for purposes of a follow-up examination is presented. These individuals are now adults living throughout the United States and some foreign countries. The present study, referred to as NHS-2, is designed to bring the survivors back to one of six clinical centers for medical evaluation to study the long-term results of medical and surgical treatment of such patients.

Adult↗
PubMed1987

Breast cancer in residents of Rochester, Minnesota: incidence and survival, 1935 to 1982.

The incidence and survival rates for breast cancer among residents of Rochester, Minnesota, from 1975 to 1982 were compared with rates from 1935 to 1974. The age-adjusted incidence rates of breast cancer, after exclusion of patients with carcinoma in situ, increased 14% between the periods 1965 to 1974 and 1975 to 1982 (from 87.2 to 99.5 per 100,000 person-years). Much of this increase was due to the greater number of patients with less advanced disease: the frequency of both regional lymph node involvement and distant metastatic disease at initial diagnosis decreased. In addition, the incidence of carcinoma in situ more than doubled between the periods 1935 to 1944 and 1975 to 1982. These increased proportions of less advanced disease coincide with increased public and physician awareness of the importance of early detection. No change was demonstrated in overall survival during the study period, perhaps because the follow-up for the final study period was shorter than that for the previous periods. When divided into subsets by staging characteristics, only patients with distant metastatic disease had statistically significant improvement in survival over time (P less than or equal to 0.01)--from a median survival of 21 months in the period 1955 to 1974 to 28 months in the period 1975 to 1982. This increased survival is probably related to advances in therapy (such as combination chemotherapy). In addition, earlier detection of distant metastatic disease in the later study periods might have produced the apparent improvement in survival in this subgroup.

Adult↗
PubMed1987

The association of stroke and coronary heart disease: a population study.

In a 20-year population-based study (1960 through 1979), we estimated the cumulative probability of (1) the occurrence of stroke after a diagnosis of angina pectoris, (2) the occurrence of stroke after a diagnosis of myocardial infarction, and (3) the occurrence of myocardial infarction or sudden unexpected death after a diagnosis of cerebral infarction. In patients in whom angina had been diagnosed, no significant difference was noted between the observed and the expected probability of stroke throughout 10 years of follow-up. In patients with a diagnosis of myocardial infarction, a significant difference was noted between observed and expected probabilities of stroke at 1 month and at 2 months. This early excess in probability of stroke was especially pronounced in the subgroup of patients with transmural myocardial infarction but not evident in those with subendocardial myocardial infarction. Among patients with a diagnosis of cerebral infarction, the difference between observed and expected probabilities of myocardial infarction or sudden unexpected death was not significant until 5 years after the cerebral infarction and showed no change thereafter.

Aged↗
PubMed1987

Heparin therapy for recent transient focal cerebral ischemia.

The Mayo Clinic medical records and records linkage system were used to identify stroke-free residents of Rochester, Minnesota, who were examined within 30 days after the first transient cerebral ischemic attack (TIA) during the period 1955 through 1979. The patients were divided into two groups: those given heparin within 30 days after the first attack and those not given heparin. Death, stroke, and either stroke or TIA were separate endpoints in Kaplan-Meier analyses of data from the day of initial examination through the 30th day thereafter. The probabilities of survival, survival free from stroke, and survival free from TIA for the heparin-treated group were not significantly different from those probabilities for the comparison group. The rate of hemorrhagic complications was 3.2 per 100 person-days of heparin therapy. Retroperitoneal hemorrhage, the most serious complication, was the cause of one death and one case of femoral neuropathy.

Aged↗
PubMed1987

Tracking and prediction of blood pressure in children.

A significant but weak correlation between an initial and a subsequent blood pressure measurement in the same patient has been found in several previous longitudinal studies of blood pressure in children. In the current study, single determinations of blood pressure, weight, and height were recorded in 142 children at 5.9 to 9.5 years of age and again 9 years later. Both examinations were performed in a schoolroom. Body size at the first examination was associated with body size 9 years later. A significant correlation was noted between initial and subsequent raw systolic blood pressures (r = 0.36 in boys and in girls; P less than 0.01). Correlations of systolic blood pressure based on percentiles for age and for height and weight were smaller but also statistically significant. Correlations involving diastolic blood pressure, with use of raw blood pressure measurements, were significant only for boys (r = 0.24, P less than 0.05). Correlations were not improved when indices of body size were used. Single blood pressure measurements obtained under the usual conditions in a schoolroom had only slightly weaker correlations with subsequent blood pressure determinations than those obtained in studies in which considerable care was taken to achieve more "basal" measurements. This degree of blood pressure correlation is insufficient to allow accurate prediction of subsequent blood pressure levels on the basis of a single casual blood pressure measurement in an individual child. This result was indicated by a wide 95% confidence interval for the predicted subsequent systolic blood pressure, even when sex, initial diastolic blood pressure, weight, and change in weight were considered.

Adolescent↗
PubMed1987

Immunofluorescence labeling indices in myeloma and related monoclonal gammopathies.

We measured plasma cell labeling indices (LI) in 52 patients with monoclonal gammopathies. Cytoplasmic reactivity with polyspecific or kappa- and lambda-specific light chain anti-Ig reagents identified monoclonal plasma cells, plasmablasts, and lymphocytoid plasma cells. Among newly diagnosed untreated patients, a high immunofluorescence LI distinguished those with multiple myeloma (MM) from those with stable monoclonal gammopathies (P less than 0.002). Among treated patients with MM, those in the plateau phase of the disease had low LI, whereas patients in the relapse phase or early in treatment had high LI. The immunofluorescence LI correctly classified three more patients with newly diagnosed MM than did the tritiated thymidine LI technique. LI specific for the neoplastic plasma cells resulted in excellent discrimination of patients with active disease. Because results are easily and rapidly obtained, this technique is useful clinically.

Amyloidosis↗
PubMed1987

Association between major histocompatibility antigen and reproductive performance.

Many studies have both supported and refuted an association between HLA antigens and reproductive performance. To clarify these discrepant results, HLA antigens from 59 couples experiencing recurrent spontaneous abortions and 79 couples with unexplained infertility were compared with 51 fertile couples. Patients with recurrent spontaneous abortions were classified as either primary (no children) or secondary (abortions after having children or stillbirths) aborters, and patients with unexplained infertility were classified as primary (never pregnant) or secondary (previously pregnant) infertiles. The amount of antigenic disparity, homozygosity, and the probability of producing a heterozygotic offspring were analyzed for each group. Significantly more disparities at combined HLA loci and at DR loci were observed when childbearing controls were compared with primary aborters. Significant disparity between controls and secondary aborters was at the DQ locus. Total homozygosity as well as homozygosity at DR and DQ loci were significantly increased among primary aborters, but not secondary aborters, and at the B locus among secondary, but not primary infertile couples. Significant association in probability of heterozygote production was seen at the DQ locus in patients with primary infertility. These results indicate that controversy involving association of HLA and reproductive performance can be explained by properly classifying recurrent spontaneous aborters and unexplained infertiles.

Abortion, Habitual↗
PubMed1987

Dietary calcium intake and rates of bone loss in women.

We measured bone mineral density (BMD) at the midradius and lumbar spine in 106 normal women, ages 23-84 yr (61 were postmenopausal). Three to nine measurements (median, four) were made over 2.6 to 6.6 yr (mean, 4.1 yr). The correlation between calcium intake (range, 260-2,035 mg/d) and rate of change in BMD was not significant at the midradius (r = 0.06) or lumbar spine (r = 0.08), even after adjusting for age, menopausal status, and serum estrogen levels by multiple regression analysis. Women in the lower (mean, 501 mg/d) and in the upper (mean, 1,397 mg/d) quartiles of dietary intake had similar rates of change in BMD (%/yr [mean +/- SE], at midradius, -0.78 +/- 0.24 and -0.91 +/- 0.17 for lower and upper quartiles, respectively; at lumbar spine, -1.06 +/- 0.24 and 0.98 +/- 0.24). These data do not support the hypothesis that insufficient dietary calcium is a major cause of bone loss in women.

Adult↗
PubMed1987

The significance of unruptured intracranial saccular aneurysms.

The authors report the results of a long-term follow-up study of 130 patients with 161 unruptured intracranial saccular aneurysms. Their findings suggest that unruptured saccular aneurysms less than 10 mm in diameter have a very low probability of subsequent rupture. The mean diameter of the aneurysms that subsequently ruptured was 21.3 mm, compared with a diameter of 7.5 mm for aneurysms defined after rupture at the same institution. Part of the explanation for this discrepancy may be that the size of the filling compartment of the aneurysm decreases after rupture. There is also evidence from the present study that intracranial saccular aneurysms develop with increasing age of the patient and stabilize over a relatively short period, if they do not initially rupture, and that the likelihood of subsequent rupture decreases considerably if the initial stabilized size is less than 10 mm in diameter. Consequently, the critical size for aneurysm rupture is likely to be smaller if rupture occurs at the time of or soon after aneurysm formation. There seems to be a substantial difference in potential for growth and rupture between previously ruptured and unruptured aneurysms.

Adolescent↗
PubMed1987

Deep venous thrombosis and pulmonary embolism. Risk of subsequent malignant neoplasms.

We conducted a noncurrent prospective study of all Olmsted County, Minnesota, residents who had had a lower-extremity venogram, pulmonary angiogram, or lung scan performed because of suspicion of deep venous thrombosis or pulmonary emboli. One hundred thirteen cancer-free patients were followed for 386 person-years from the date of procedure. Nine subsequent cancers were observed compared with 4.5 expected (relative risk, 2.0; 95% confidence interval, 0.9 to 3.8), using total cancer incidence rates for the Rochester, Minn, population. Five hundred seventeen cancer-free controls were followed for 2072 person-years. Twenty subsequent cancers were observed compared with 11.6 expected, yielding a relative risk of 1.7 (95% confidence interval, 1.1 to 2.7). When cases and controls were compared directly, no statistically significant difference in cancer-free survival was found.

Follow-Up Studies↗
PubMed1986

Mechanism of acute lower extremity pain syndrome in fluoride-treated osteoporotic patients.

Acute pain in the lower extremity, which has previously been attributed to synovitis or fasciitis, develops in about 15 percent of osteoporotic patients treated with sodium fluoride. This report describes 11 osteoporotic women in whom this syndrome developed while they were being treated with sodium fluoride (mean dose 78 mg per day; range, 60 to 90). [99mTc]Hydroxymethylene diphosphonate scintiscanning showed an increased number of foci of abnormal uptake in the lower extremities (p less than 0.05), when compared with results of scintiscanning in 12 nonsymptomatic osteoporotic women treated with sodium fluoride and 12 osteoporotic women treated with oral calcium carbonate only. The increased uptake was not restricted to the areas of pain. Roentgenography revealed stress microfractures in five of the 11 symptomatic patients. It is concluded that the acute lower extremity pain syndrome during fluoride therapy usually results from intense regional bone remodeling, which may be complicated by stress microfractures.

Aged↗
PubMed1986

Estimated versus measured basal energy requirements in patients with Crohn's disease.

Increased energy expenditure associated with active inflammation has been thought to be one cause of weight loss in patients with Crohn's disease. Our aim was to test this hypothesis by determining if resting energy expenditure (REE) measured by indirect calorimetry was greater than the predicted energy expenditure (PEE) calculated from the Harris-Benedict formula (variables--sex, age, height, and weight) in each patient. Fifty-four patients with radiographic evidence of Crohn's disease were studied. There was a highly significant relationship (p less than 0.001) between REE and PEE, which can be expressed as follows: REE = 39.40 + 0.99 (PEE). The mean REE was 1427 +/- 228 kcal/day, whereas the mean PEE was 1404 +/- 197 kcal/day. Patients with the lowest weights when expressed as percentages of ideal body weights had the greatest resting energy expenditure per kilogram of body weight (r = -0.73, p less than 0.001). The mean REE per kilogram per day was 25 +/- 4 kcal, and only 4 of 54 patients (7%) had REE greater than or equal to 30 kcal/kg X day. Thus, REE measured by indirect calorimetry in Crohn's disease patients was not significantly higher than PEE that can be estimated from the Harris-Benedict equation. These findings show that most Crohn's disease patients without fever or sepsis do not have increased REE.

Adult↗
PubMed1986

Sterol excretion and cholesterol absorption in diabetics and nondiabetics with and without hyperlipidemia.

Fecal neutral and acidic sterols and cholesterol absorption were measured in 12 normal control subjects, 40 diabetic subjects with and without hyperlipidemia, and 27 subjects with hyperlipidemia but without diabetes mellitus. All subjects were on a low-cholesterol diet (less than 300 mg cholesterol/day). Fecal excretion of neutral and acidic sterols was increased in patients with hypertriglyceridemia and was more marked in diabetic patients with hypertriglyceridemia. Cholesterol absorption was decreased in diabetic patients with hypertriglyceridemia. Otherwise, there were no significant differences in sterol excretion or cholesterol absorption in diabetic and nondiabetic subjects compared with control groups with similar lipid levels. The best predictors of fecal neutral- and acidic-sterol excretion and of estimated cholesterol synthesis were very low [corrected]-density lipoprotein triglycerides and high-density lipoprotein cholesterol. Correction of hyperlipidemia may be beneficial in decreasing cholesterol synthesis and, thereby, in decreasing the risk of atherogenesis.

Adult↗
PubMed1986

Osteoporosis and the risk of hip fracture.

The incidence of cervical and intertrochanteric proximal femur fractures at various levels of cervical and intertrochanteric bone mineral density, respectively, was estimated by using population-based data from ongoing studies of osteoporosis and fractures among women residing in Rochester, Minnesota. Hip fractures were uncommon among women with femoral bone density greater than or equal to 1.0 g/cm2, but their frequency increased as bone density declined below that point at both femoral sites. The incidence of cervical femur fractures was estimated at 8.3 per 1,000 person-years among women with cervical bone density less than 0.6 g/cm2, while the estimated incidence of intertrochanteric femur fractures reached 16.6 per 1,000 person-years among those with intertrochanteric bone density less than 0.6 g/cm2. This new approach to the assessment of fracture risk from bone mineral density measurements indicates that osteoporosis is an important underlying cause of hip fractures.

Adult↗
PubMed1986

Incidence and effectiveness of cerebrospinal fluid shunts in Olmsted County, Minnesota, 1956-1981.

In the period 1956 through 1981, 129 cerebrospinal fluid (CSF) shunt operations were performed on 50 patients who were residents of Olmsted County, Minn. The overall average annual age- and sex-adjusted incidence of initial CSF shunts during this 26-year period was 2.3 per 100,000 person-years. Within 5-year calendar time intervals, the average annual incidence rates per 100,000 person-years ranged from 0.8 (1956-1960) to 4.6 (1971-1975). There were 4 shunt-related deaths, 1 due to a CSF shunt infection and 3 due to acute increases in intracranial pressure. In this analysis of shunt procedures in a defined population, the diagnostic indications and changes over time in CSF shunting devices are also described.

Adolescent↗