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Biomedical subjects

W M O'Fallon

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

At least 289 records · Page 16Linked to original sources
PubMed1986

The natural history of drop attacks.

We grouped 108 patients with drop attacks, according to potential mechanisms based on predominant associated medical conditions, as follows: unknown, 69 (64%); cardiac, 13 (12%); cerebrovascular insufficiency, 9 (8%); combined cardiac and cerebrovascular disease, 8 (7%); seizures, 5 (5%); vestibular, 3 (3%); and psychogenic, 1 (1%). Fifty-four percent of the patients received no treatment, but similar percentages of treated (82%) and untreated (84%) patients were symptom-free at follow-up. The stroke rate in the overall group, approximately 0.5% per year, was not significantly different from that in a normal age- and sex-matched population. The favorable long-term outcome in drop attack patients with unrevealing medical and neurologic workups suggests that treatment is unwarranted for an isolated drop attack.

Adult↗
PubMed1986

Relapsing polychondritis. Survival and predictive role of early disease manifestations.

To define the natural history of relapsing polychondritis, the probability of survival and causes of death were determined in 112 patients seen at one institution. By using covariate analysis, early clinical manifestations were identified that predicted mortality. The 5- and 10-year probabilities of survival after diagnosis were 74% and 55%, respectively. The most frequent causes of death were infection, systemic vasculitis, and malignancy. Only 10% of the deaths could be attributed to airway involvement by chondritis. Anemia at diagnosis was a marker for decreased survival in the entire group. There was an interaction between other disease variables and age in determining their impact on outcome. For patients less than 51 years old, saddle-nose deformity and systemic vasculitis were the worst prognostic signs. For older patients, only anemia predicted outcome. The need for corticosteroid therapy did not influence survival.

Adolescent↗
PubMed1986

Primary systemic amyloidosis: multivariate analysis for prognostic factors in 168 cases.

One hundred sixty-eight patients with primary systemic amyloidosis (AL) were identified. Median survival after diagnosis was 12 months and ranged from 4 months for patients presenting with congestive heart failure to 50 months for those presenting with peripheral neuropathy only. Utilizing the proportional-hazards model in a stepwise multivariate fashion to evaluate the simultaneous influence of putative risk factors as of diagnosis revealed that congestive heart failure, urine light chain, hepatomegaly, and multiple myeloma were the major factors adversely affecting survival during the first year after diagnosis. Serum creatinine, multiple myeloma, orthostatic hypotension, and monoclonal serum protein were the most important variables adversely affecting survival for patients surviving 1 year. These models were used to categorize patients according to the variables in the models into low-, moderate-, and high-risk groups for the first year after diagnosis and separately for subsequent years. The influence of these variables on survival is important in stratification of patients randomized to prospective clinical trials.

Adult↗
PubMed1986

The effect of tonsillectomy and appendectomy on the development of rheumatoid arthritis.

The possibility of an association between rheumatoid arthritis (RA) and prior tonsillectomy and appendectomy was investigated in a community based case-control study of 229 female cases of probable and definite RA and 458 appropriately matched controls. No association was found with logistic analysis even when controlling for a variety of factors such as socio-economic status, oral contraceptive use, and their interactions.

Appendectomy↗
PubMed1985

Infective endocarditis. Olmsted County, Minnesota, 1950 through 1981.

Strict criteria were used to identify all definite, probable, and possible cases of endocarditis in residents of Olmsted County, Minnesota, from 1950 through 1981. The mean annual age- and sex-adjusted incidence rates per 100,000 person-years were 3.8 for total cases and 3.2 for definite and probable cases only. Total rates were 4.3 for 1950 through 1959, 3.3 for 1960 through 1969, and 3.9 for 1970 through 1981. Rheumatic heart disease was the underlying disorder in 26% of cases, with a shift noted during 1970 through 1981 to involvement of prosthetic rather than natural valves in these patients. Mitral valve prolapse was identified in 17% of cases. No source of infection could be identified in 41% of cases, including half of those cases with rheumatic or congenital heart disease. In cases diagnosed prior to autopsy, the 60-day fatality fell from 46% during 1950 through 1959 to 22% and 26% during 1960 through 1969 and 1970 through 1981, respectively.

Adolescent↗
PubMed1985

Impact of referral bias on evaluation of cataract surgery.

Patients from a defined population (Olmsted County, Minnesota) who underwent cataract extraction during 1980 were compared with referral patients operated on at the Mayo Clinic to determine whether selective referral of patients introduces bias into studies conducted at academic centers. Rates of cataract extraction in Olmsted County increased continuously with increasing age and, in the older groups, were greater among females than males. The overall age- and sex-adjusted annual rate, 120 per 100,000 population, was considerably lower than that for 1980 in the United States, 209 per 100,000 population. A significantly greater proportion of referral patients had coexistent diabetes mellitus (P less than .05) and underwent other ophthalmic surgical procedures in combination with cataract extraction (P less than .001). Previous ophthalmic disorders were also more frequent among referral patients. Because selection for referral can distort data, this possible source of bias must be considered when interpreting data.

Adolescent↗
PubMed1985

Neck dissection and combined therapy. Study of effectiveness.

Data on 1,385 neck dissections in 1,192 patients were studied to evaluate the effectiveness of treatment with operation alone and with various forms of combined therapy in controlling cervical metastasis. Of the 1,192 patients, 837 were treated by operation (neck dissection) alone, and the remainder had preoperative or postoperative radiation to the primary site and to the entire side of the neck that was dissected. In no stage of neck disease was either form of combined therapy superior to operation alone in decreasing the rates of recurrence. In an attempt to simulate a randomized, prospective study in a clinical situation for which the end results were already known, we used a separate statistical analysis--a case-control technique to specifically address the issue of the effectiveness of postoperative radiation in decreasing the frequency of recurrences after dissection in the various stages of disease. No evidence of a relationship between recurrence and the administration of planned postoperative radiation was found.

Carcinoma, Squamous Cell↗
PubMed1985

Mortality, survival and prevalence: traumatic spinal cord injury in Olmsted County, Minnesota, 1935-1981.

Mortality, prevalence, and survival from traumatic spinal cord injury were examined in Olmsted County, Minnesota, from 1935 through 1981. One hundred and fifty-four incident cases and 30 additional cases who were Olmsted County residents on at least one of four prevalence dates were identified. The average annual age-adjusted mortality for spinal cord injury, including deaths attributable to spinal cord injury occurring at any time after injury was 28.5 per million population. The rates in males were consistently greater than females, peaking to 61.0 in the period 1965-74. Thirty-eight percent of cases did not survive long enough to be hospitalized. Survival was 58% in the first week post-injury. However, for those who survived the first day and the first year, the 10-year survival was 77 and 87%, respectively. Early fatality in males was associated with single marital status (p = 0.0033) and concomitant head trauma (p = 0.0122), and in females with pedestrian or bicyclist status at injury (p less than 0.0001). Long-term survival was dependent on age (p less than 0.0001) and functional disability (p = 0.04). Point prevalence of spinal cord injured patients increased from 197 per million population in 1950 to 473 in 1980. This increase in prevalence was due at least in part to increasing incidence over time. An improvement in survival over the time period of the study could not be detected.

Accidents, Traffic↗
PubMed1985

Congenital malformations among offspring exposed in utero to progestins, Olmsted County, Minnesota, 1936-1974.

Comparison of a cohort of 988 offspring exposed in utero to exogenous progestins with a matched cohort of unexposed offspring did not result in detection of an association of congenital anomalies with exposure. The conclusions are based primarily on outcomes of pregnancy with exposure to progesterone and 17 alpha-hydroxyprogesterone caproate, and may not apply to androgenic progestins. Offspring exposed to combinations of progestins and estrogens were excluded from this study and may have a different distribution of anomalies.

17 alpha-Hydroxyprogesterone Caproate↗
PubMed1985

Reproducibility of noninvasive tests of peripheral occlusive arterial disease.

We studied the reproducibility of four tests of peripheral occlusive arterial disease in 54 subjects, 32 of whom had this disease. We found that the reproducibility of systolic blood pressures obtained at rest from the thighs, calves, and ankles approximated that of arm systolic and diastolic blood pressures, as did the ankle-to-arm systolic blood pressure ratios. The average of the tenth and ninetieth percentile ranges of the resting systolic blood pressure ankle-to-arm ratios was +/- 0.10. Systolic blood pressures from the fingers were somewhat less reproducible, and those from the toes were even more variable. Systolic blood pressure ankle-to-arm ratios measured after the patient had exercised were less reproducible than resting ratios. The average of the tenth and ninetieth percentile ranges of the 1-, 3-, 5-, and 10-minute ratios after exercise was -0.13 to +0.16. Skin temperatures from the fingers and toes were approximately as reproducible as systolic blood pressures from the arms and legs and as the resting ankle-to-arm blood pressure ratios. Pulse-volume recordings from the thighs, calves, ankles, feet, toes, and fingers were very poorly reproducible. We conclude that information on the reproducibility of these measurements is essential in the evaluation of noninvasive arterial tests that are used to determine the course of peripheral occlusive arterial disease.

Arm↗
PubMed1985

Traumatic spinal cord injury in Olmsted County, Minnesota, 1935-1981.

The incidence rate for acute traumatic spinal cord injury in Olmsted County, Minnesota, for 1935-1981, standardizing for age, sex, and calendar year, was 54.8 per million person-years--83.4 for males and 27.7 for females. Thirty-eight per cent of cases died prior to hospitalization. The annual incidence rate for those reaching hospital alive was 34.2 per million person-years. The proportion of cases dying during initial hospitalization was 11.5%. Considering all deaths within the first year after injury, the standardized mortality rate from spinal cord trauma was 25.5 per million person-years. Automobile-related injuries constituted half of all causes of spinal cord injury and death. An increase in both incidence and hospitalization rates of traumatic spinal cord injuries in the past 17 years was observed in young men, attributable to recreational and motorcycle-related events.

Accidents, Traffic↗
PubMed1985

Multiple myeloma: significance of plasmablastic subtype in morphological classification.

We classified 100 cases of myeloma before chemotherapy as mature (28), intermediate (38), immature (19), or plasmablastic (15). The plasmablastic group had an estimated median survival (Kaplan-Meier method) of ten months, compared to 35 months for the other types (P less than .05). Decreased survival in the plasmablastic group was due to more frequent deaths in the first six months. There were no significant differences in survival among the mature, intermediate, and immature groups or among patients with different morphological grade or asynchrony scores. The plasmablastic myeloma group had more frequent renal insufficiency and higher plasma cell labeling indices, which may have contributed to the shorter survival.

Actuarial Analysis↗
PubMed1984

Long-term follow-up after palliative operation for univentricular heart.

Data are presented from 84 patients (45 males, 39 females), aged 6 days to 25 years (mean 10 years), with univentricular heart who underwent a palliative surgical procedure. The mean follow-up period was 5 years (range 1 month to 25 years). Of the 84 patients, 33 died and 51 are alive. The survivors were 1.5 to 41 years (mean 15). Systemic pulmonary artery shunts alone were performed in 43 patients, pulmonary artery banding in 15, and a combination of procedures in 26. Five years after diagnosis, 70% of patients with type A and 54% with type C univentricular heart were alive, with no statistical difference in survival between the patient groups. Because of the high attrition rate in these patients despite palliation, further attempts to perfect corrective surgery appear justified.

Adolescent↗
PubMed1984

Long-term follow-up in the unoperated univentricular heart.

Type A univentricular heart is a severe congenital cardiac defect; 50% of patients are dead 14 years after diagnosis, a death rate of 4.8% per year. Type C univentricular heart is even more lethal; 50% of patients are dead 4 years after diagnosis. Pulmonary stenosis did not protect either group of patients in terms of overall survival. Of the patients in class I or II at initial diagnosis, 34% of patients with type A and 12% of those with type C were in class III or IV or had died at follow-up. The most common causes of death were dysrhythmia, congestive heart failure and sudden and unexplained death.

Aged↗
PubMed1984

Controlled trial of hydroxychloroquine and D-penicillamine singly and in combination in the treatment of rheumatoid arthritis.

A 2-year, controlled, double-blind trial of D-penicillamine and hydroxychloroquine either alone or in combination was conducted on patients with progressive rheumatoid arthritis. The group given D-penicillamine alone improved most, but a linear fall-off in efficacy occurred. Surprisingly, the group receiving combination drug therapy did not fare as well as the group receiving D-penicillamine therapy. A subset of patients receiving hydroxychloroquine therapy had prolonged benefit. Toxicity, though not uncommon, was generally not severe.

Adult↗
PubMed1984

Trial of platelet-inhibiting drug in scleroderma. Double-blind study with dipyridamole and aspirin.

In a randomized, double-blind, controlled study, 28 patients with early scleroderma received dipyridamole (225 mg/day) and aspirin (975 mg/day) or placebo for 1-2 years. No significant clinical or objective laboratory improvement was noted in either group. Platelet survival time, plasma renin activity, and coagulation tests were not predictive of disease course. Biomechanical and vascular tests of the hands correlated with clinical extent of skin induration and presence of finger ulcers, respectively.

Aspirin↗
PubMed1984

An attempt to predict the response to gold therapy in rheumatoid arthritis.

In 54 rheumatoid arthritis patients undergoing conventional chrysotherapy, we prospectively sought predictors of response, using strict clinical and laboratory criteria of improvement. Forty-five patients who completed 6-12 months of therapy were classified into 3 outcome categories: group 0, not significantly improved (18 patients); group 1, improved (18 patients); and group 2, markedly improved (9 patients). Sixty-two entry variables were tested in univariate and multivariate analysis for predictor function. No continuous variable was predictive. The discrete variables HLA-A3 positivity and HLA-DR4 negativity were the best predictors of response to gold. In a multivariate analysis using these 2 univariates (A3 and DR4) plus hemoglobin, we developed a discriminant function that correctly predicted outcome in 21 of 23 patients in groups 0 and 2. We also observed that of 15 DR blank patients (10 of whom were DR4 blank), none entered remission.

Arthritis, Rheumatoid↗