Occurrence of Hashimoto's thyroiditis and diabetes mellitus in patients with rheumatoid arthritis.
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Arthritis, Rheumatoid↗
Biomedical subjects
W M O'Fallon
Publications and source records attributed to W M O'Fallon.
A case-control study of occupational exposures and leukaemia.
Between 1955 and 1974, 138 cases of leukaemia occurred in residents of Olmsted County, Minnesota. Each case was compared with 2 control subjects matched for age, sex, and residence with regard to their occupational and chemical exposures before the diagnosis of leukaemia. Farming and health-related occupations have been previosly implicated in the development of leukaemia and occurred frequently enough in our group of patients and control subjects to permit analysis. Neither of these 2 occupations occurred more frequently enough in our group of patients and control subjects to permit analysis. Neither of these 2 occupations occurred more frequently in cases than in control subjects.
Agriculture↗
The epidemiology of rheumatoid arthritis in Rochester, Minnesota: a study of incidence, prevalence, and mortality.
A study of the incidence and prevalence of rheumatoid arthritis conducted in Rochester, MN, during the period 1950 through 1974 revealed an average annual incidence rate of 28.1 per 100,000 population for males and of 65.7 per 100,000 for females. These rates include classic, definite, and probable cases. Age-specific rates generally increased with age. The secular trend of the incidence in males and females differed. Rates for males, although fluctuating, remained relatively stable throughout the entire 25-year period, whereas rates for females declined dramatically during the last 10 years of the study. The decline was present both in cases presenting as definite at the time of earliest diagnosis and in the probable cases. No explanation was found for the observed decline, but the authors believe that a factor introduced in the 1960s and acting selectively on females has affected the incidence rates. From recent evidence, it could be inferred that oral contraceptives and postmenopausal estrogens are likely causes. Prevalence rates for January 1, 1975, were 4.0 per 1000 for males and 10 per 1000 for females. Among adults, prevalence rates were 5.8 per 1000 for males and 13.4 for females. Mortality among the patients with rheumatoid arthritis was not different from that for the total Olmsted County population.
Adolescent↗
The unchanging pattern of subarachnoid hemorrhage in a community.
The average annual incidence of subarachnoid hemorrhage (SAH) from aneurysm rupture in Rochester, Minnesota, has remained remarkably constant at about 11 per 100,000 population. Age-specific incidence increased with age. Survival after SAH depended on: (1) clinical grade, (2) time after onset of SAH, and (3) presence of intracerebral hematoma. Among those who survived to receive medical attention, 48% were clinical grade 1 or 2, 20% were grade 3, and 32% were grade 4 or 5. Proved rebleeding occurred within 10 days of the first SAH in 20% of patients who survived until hospital admission.
Adolescent↗
Breast cancer in DES-exposed mothers: absence of association.
Reports in the popular press have suggested that exposure to diethylstilbestrol (DES) is followed by an abnormally high incidence of breast cancer. The reports were based on a reanalysis of data not considered ominous originally; and both data and analyses are summarized here. In addition, new data are presented on mothers of young women enrolled in the National DESAD Project at its Mayo Clinic Center. Among 408 women given DES, there were 8 confirmed instances of breast cancer, in comparison with an expected number of 8.1, based on breast cancer incidence rates among parous women in the local population. A previous case-control study of the possible association of antihypertensive therapy and breast cancer in the local population revealed DES exposure in 10% of the breast cancer group and 12% of the controls. These apparently negative results clearly indicate a need of further studies of the alleged effect of DES.
Adult↗
Breast cancer incidence, prevalence, mortality, and survivorship in Rochester, Minnesota, 1935 to 1974.
The epidemiologic features of breast cancer in Rochester, Minnesota, were studied over the 40-year period 1935 to 1974. During this time, the age-adjusted incidence rate increased 25% to 82.7 per 100,000 person-years. Most of the increase occurred among women 45 to 64 years of age. Overall, the incidence of breast cancer increased with advancing age, as did breast cancer prevalence, which was 901.4 per 100,000 women on Jan. 1, 1975. Age-adjusted mortality rates declined slightly from 24.9 to 23.3 per 100,000 person-years during the study period. Survival after the diagnosis of breast cancer seemed to improve somewhat among women who were less than 45 or more than 65 years old at the time of diagnosis. This was associated with a decline in the proportion of these women with regional lymph node involvement or distant metastases present at the time of initial diagnosis.
Adenocarcinoma↗
Lack of evidence for cancer due to use of metronidazole.
Experimental studies have shown that metronidazole is carcinogenic in rodents and mutagenic in bacteria. In 771 women given metronidazole for the treatment of vaginal trichomoniasis, more cancers developed than had been expected after exclusion of carcinoma of one uterine cervix (observed, 24 cases; expected on the basis of the Connecticut Tumor Registry, 21.7; expected on the basis of the Third National Cancer Survey, 18.4). However, the excess was not statistically significant (P greater than 0.05). The observed and expected numbers of breast-cancer cases were the same, but four lung-cancer cases were observed, whereas 0.6 would have been expected. This finding is confounded by the fact that all four lung cancers developed in women who were smokers. Overall, we observed no appreciable increase in cases of cancer.
Adolescent↗
The declining incidence of stroke.
A major decline in the incidence of stroke occurred in the population of Rochester, Minnesota, during the period 1945 to 1974. For every 100 first episodes of stroke that occurred per unit of population during the period 1945--49, only 55 occurred in the period 1970--74. Although the decline was present in both sexes and in all age groups, the reduction in rates was more pronounced in the elderly. There was no major change in age at onset. Analysis of cohorts born during successive five-year periods from 1865 to 1915 confirmed the decreasing incidence rate in all age groups.
Age Factors↗
Use of air to decrease endothelial cell loss during intraocular lens implantation.
We performed 26 consecutive intracapsular cataract extractions with lens implantation. The last 17 implantations were performed with air instilled in the anterior chamber, whereas the first nine operations were performed without air. The central corneal endothelium of each eye operated on was photographed before and within five days after lens implantation. A computer analysis of the endothelial photographs showed that, on the average, 32% of the central corneal endothelial cells were lost during lens implantation without the use of air and 15% were lost when the lens was implanted with air. Increased endothelial cell loss was significantly correlated with the failure to implant the lens with use of air, with increased operative endothelial trauma, and with higher postoperative intraocular pressures. A significantly larger increase in corneal thickness on the first postoperative day occurred in patients with larger or more varied cell sizes preoperatively.
Air↗
Squamous cell carcinoma of the tonsil and tongue-base region.
From 1969 through 1975, 145 patients were treated for squamous cell carcinoma of the tonsil and tongue-base region; 119 received initial treatment, and salvage operations were done in 26. The overall five-year survival rate was 42%. Cervical metastasis was the most important determinant of survival. Pathologic stage I or II disease was controlled by surgical treatment. In patients with stage III or IV disease, operation alone controlled the primary lesion better than radiation alone or combined preoperative radiation and surgical treatment. With operation alone, however the rate of neck recurrence was higher than with the other two methods of treatment. In advanced disease, surgical treatment combined with postoperative radiation should be considered. Mandibular osteotomy and excision of the primary lesion are as effective in local tumor control as composite resection. In patients with a tumor-free margin, osteotomy can be used to preserve the mandible.
Aged↗
Ovarian cancer: incidence and case-control study.
The incidence of ovarian cancer in Rochester, Minnesota over the 40-year period 1935 through 1974 was determined; and risk factors for epithelial ovarian cancer occurring in Rochester from 1945 to 1974 were examined in 116 patients and 464 controls. Among the characteristics studied, only nulliparity was found to be a significant risk factor--relative risk 1.8. Other suspected risk factors--including hypertension, obesity, age at menopause, prior therapeutic pelvic radiation, and prior exposure to exogenous estrogen--were found not to differ significantly between patients and controls. The ovarian cancer patients were found to have a significantly lower frequency of prior hysterectomy and of unilateral oophorectomy than the control group. Thus out data show that hysterectomy, even when one or both ovaries are preserved, is associated with a lower risk of subsequent ovarian cancer.
Adolescent↗
Statistical methods for analyzing data on daily activity cycles of primates.
Many field studies on primates have recently been carried out in which quantitative data have been collected using instantaneous scan sampling techniques. However, data collected in this manner are difficult to analyze statistically because of the problem of independence of samples, and a number of investigators have analyzed such data incorrectly. In this paper, we evaluate such analyses and suggest alternative techniques that may be more appropriate. Examples are drawn from data on daily activity cycles of Lemur catta and Lemur fulvus.
Activity Cycles↗
Use of a self-administered questionnaire for detection of transient cerebral ischemic attacks: I. Survey of elderly persons living in retirement facilities.
A self-administered questionnaire designed to identify people with transient cerebral ischemia (TIA) in large population groups was distributed to approximately 10,000 elderly persons living in public and private retirement facilities in the United States. The population resided in eight cities, and 74% completed the survey. Transient focal neurological symptoms compatible with a diagnosis of TIA within the previous year were reported by 6.4% of the respondents. Uncertain manifestations of TIA, i.e., dizziness, light-headedness, or loss of balance, were noted by an additional 15.4%; the remaining 78.2% had no manifestations of this disorder. A clinical history for TIA was taken by a neurologist in a sample of 1,712 respondents to determine the validity of the questionnaire responses. Thirty (7.1%) of 423 persons presumed by the questionnaire to have TIA met the standard clinical criteria for the diagnosis. An additional 8 cases of TIA were found by the neurologist among the 1,289 interviewed persons presumed by the questionnaire to have uncertain TIA or no evidence of the disorder. The twelve-month period prevalence of TIA was estimated to be 8.2 per 1,000 in the total respondent population and 5.8 per 1,000 among those without a history of prior completed stroke. Despite the high proportion of false-positive neurological symptoms of TIA elicited by the questionnaire, this survey instrument nevertheless screened out for further study the 6% of the population in whom 55% of the TIAs occurred.
Aged↗
Increased von Willebrand factor in diabetes mellitus.
Abnormal platelet function may play a role in the genesis of vascular complications in diabetes mellitus. We measured plasma levels of ristocetin-Willebrand factor and factor VIII antigen in 75 subjects and also measured aggregation-enhancing factor in subsets. We found increased levels of ristocetin-Willebrand factor in all groups of diabetics studied, even in mild diabetics free of vascular disease. Factor VIII antigen was increased only in diabetics with vascular disease. We could not find an aggregation-enhancing factor in any group.
Adult↗
Renal stone epidemiology: a 25-year study in Rochester, Minnesota.
There are no adequate studies of the incidence of urolithiasis in the United States, in spite of earlier claims that a "stone belt" exists in the southeastern section of the country. This report is the first description of the incidence and recurrence rates for symptomatic noninfected renal stones in a well-defined population. A total of 798 patients were enrolled in the study group, of whom 672 were incidence cases having had their first episode as documented residents of Rochester, Minnesota, between 1950 and the end of 1974. The annual age-adjusted incidence rate for females was stable over the 25-year study period at 36.0 per 100,000 population. That for males increased significantly (P less than 0.02) from 78.5 per 100,000 to 123.6 per 100,000. Recurrence calculations showed a high rate for both sexes in the first year, followed by lower but constant rates for all succeeding years.
Adult↗
Limb fractures in a defined population. I. Frequency and distribution.
This population-based study revealed that 2,519 limb fractures occurring during a 3-year period produced an age-adjusted incidence rate for all limb fractures of 1,596 per 100,000 person-years. Fractures of the upper limb had a bimodal age distribution and were commoner than those of the lower limb, which had a J-shaped age distribution. The most frequent anatomic site was the lower end of the radius and ulna. Limb fractures occurred as solitary events in 93% of cases; only 4% were classified as open and more than half of the total were closed and undisplaced. Fractures were distributed evenly throughout all time periods of the day. The commonest place of fracture occurrence was the home, and the most important direct cause was falls, particularly in females. A wide range of sports activities were a major source of fractures, particularly in younger males. Underlying bone pathology was uncommon, other contributory causes being more important, particularly in the elderly. The increased ratio of metaphyseal to diaphyseal fractures with age indicated a relative loss of cancellous bone in the elderly, but no evidence was found to suggest that elderly women had reduced resistance of bone to impact forces in comparison with elderly men.
Accidents, Home↗
Limb fractures in a defined population. II. Orthopedic treatment and utilization of health care.
This study describes the orthopedic treatment and utilization of health care obtained by 2,333 patients in the population of Rochester, Minnesota, who suffered 2,519 limb fractures during the period 1969 through 1971. Overall, 24% of fracture occurrences required patient hospitalization, the remainder involving care on an ambulatory basis only. The mean number of physician visits was 4.5 per fracture, with the visits occurring during an interval of 103 days from the time of first evaluation. Fifteen percent of limb fractures were subject to at least one surgical operative procedure as part of their orthopedic treatment. The frequency of operative treatment increased markedly with patient age. Seventeen percent of patients with limb fractures received physiotherapy or occupational therapy or both, 4% were ambulatory patients, and the remainder were hospital inpatients. Fractures of the head and neck of the femur constituted only about 7% of fractures in the series, yet utilized an inordinate proportion of health care resources. Hip fractures were responsible for 27% of the hospital admissions, 52% of all bed days utilized, and 56% of the physiotherapy sessions.
Adolescent↗
Rheumatoid arthritis and oral contraceptives.
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Arthritis, Rheumatoid↗