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Biomedical subjects

W M O'Fallon

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

At least 145 records · Page 8Linked to original sources

Trends in colorectal cancer over a half century in Rochester, Minnesota, 1940 to 1989.

Recent reports of increasing incidence, especially in men, led us to update through 1989 an earlier study of colorectal cancer incidence in Rochester that covered the period 1940 through 1979. The combined data reflected cancer trends in the community over half a century. Data resources of the Rochester Epidemiology Project were used to identify new cases of colon and rectal cancer among Rochester residents. Incidence rates were estimated using decennial census data, and 95% confidence intervals were based on the Poisson distribution. The GLIM statistical package was used to evaluate trends over time. Age-adjusted (US white 1970) incidence rates of colorectal cancer for men were 53.7, 61.3, 53.7, 54.2, and 52.5 per 100,000 person-years, respectively, for the decades 1940 to 1949, 1950 to 1959, 1960 to 1969, 1970 to 1979, and 1980 to 1989. Comparable rates for women were 42.7, 49.3, 42.9, 40.7, and 40.9 per 100,000 person-years. No statistically significant changes were seen in the incidence of colon and rectum cancer for men or women. There was no consistent trend in tumor stage at diagnosis and the mean size of the initial lesion did not change with time. The incidence of colorectal cancer has not changed over the past 50 years in this community where case ascertainment has been consistent and complete.

Adult↗

Mechanisms underlying the formation of the T cell receptor repertoire in rheumatoid arthritis.

The contributions of germline-encoded T cell receptor segments and of HLA-DR polymorphisms in shaping the repertoire of human CD4+ CD45RO- T cells were investigated in healthy unrelated individuals and in patients with rheumatoid arthritis, an HLA-DRB1 04-associated disease. By comparing frequencies of V beta-J beta combinations, healthy individuals segregated into independent clusters, which strongly correlated with the HLA-DRB1 allele expression. The repertoire fingerprint imposed by the HLA-DRB1 alleles involved only a selected group of J beta elements, whereas the distribution of the other J beta segments was HLA independent. The HLA-restricted J beta elements are characterized by a Gly-Pro-Gly sequence within the conserved Phe-Gly-X-Gly motif, which induces rigidity in an otherwise more flexible protein backbone. The T cell receptor repertoire distinguished patients with RA from healthy HLA-DR-matched individuals, suggesting that patients share a selection mechanism that significantly distorts the composition of the T cell receptor repertoire.

Amino Acid Sequence↗

Stroke epidemiology in Novosibirsk, Russia: a population-based study.

OBJECTIVE: To determine first-ever stroke incidence, 30-day case-fatality rates, and frequency of various risk factors among patients with stroke in Novosibirsk, Russia, during 1992. DESIGN: A population-based study of an administratively defined district of Novosibirsk was conducted to identify residents with a first-ever stroke that occurred between Jan. 1, 1992, and Dec. 31, 1992. MATERIAL AND METHODS: For case ascertainment, mortality statistics, death certificates, hospital registrations, outpatient clinical data, and all ambulance calls for the study area were reviewed. Patients with stroke or suspected stroke were examined and interviewed by a cerebrovascular neurologist, and the type of stroke was determined. RESULTS: During the 12-month study period, 366 patients with first-ever stroke were registered. A diagnosis of cerebral infarction or intracerebral hemorrhage was confirmed by computed tomography or autopsy in 42% of cases. The diagnosis of subarachnoid hemorrhage was established by cerebrospinal fluid examination in all 14 cases. The age- and sex-adjusted annual incidence rate for stroke was 232 per 100,000. The distribution of incidence cases by diagnostic category was as follows: cerebral infarction, 87.7%; intracerebral hemorrhage, 8.5%; and subarachnoid hemorrhage, 3.8%. The overall 30-day case-fatality rate for stroke was 22.4%. Hypertension, angina pectoris, and cigarette smoking were the most frequent risk factors in patients with stroke in Novosibirsk. CONCLUSION: The incidence rate of first-ever stroke in Novosibirsk, Russia, is one of the highest in the world, but the 30-day case-fatality rates are similar to those in other populations.

Adult↗

Nifedipine, but not verapamil, acutely elevates parathyroid hormone levels in premenopausal women.

BACKGROUND: Calcium channel antagonist therapy in humans has been associated with changes in anterior pituitary, thyroid and adrenal hormone secretion. Human studies assessing effects of calcium channel antagonists on calciotropic hormones have been few and typically involved small numbers of subjects studied for short periods of time. Few of these previously published studies have included women. The endocrine effects of calcium channel antagonists in women have become increasingly important as more women are taking these agents for diseases such as hypertension, angina, Raynaud's phenomenon and migraine. OBJECTIVE: To assess both acute and chronic effects of calcium channel antagonists on calciotropic hormones in women. DESIGN: A four-week prospective, randomized trial. SUBJECTS: Twenty-nine premenopausal women, randomly assigned to receive either 240 mg of sustained release verapamil or 30 mg of sustained release nifedipine daily. LABORATORY END-POINTS: Total and ionized serum calcium, phosphate, creatinine, parathyroid hormone (PTH), parathyroid hormone-related protein (PTHrP) and calcitonin, measured at baseline, after 24 hours, and 28 days of treatment. RESULTS: Total and ionized calcium, phosphate, creatinine, PTHrP and calcitonin levels were not altered significantly after 24 hours or 28 days in any of the subjects, when compared to baseline. There were no significant differences in PTH levels after 24 hours or 28 days of verapamil treatment. There was a significant increase in serum PTH levels after 24 hours of nifedipine therapy; however, these differences were not evident after 28 days of therapy. CONCLUSIONS: The short-term administration of nifedipine results in increased release of parathyroid hormone; however, long-term administration has no significant effect on the concentrations of calciotropic hormones.

Adult↗

Timing of completed suicides among residents of Olmsted County, Minnesota, 1951-1985.

Previous studies of suicide timing may have been biased by incomplete ascertainment of suicides and by delays between the suicidal act and subsequent death. Those potential biases were assessed and minimized in this population-based study by using the unique resources of the Rochester Epidemiology Project in Olmsted County, Minnesota. Using these more accurate data, we confirmed previous reports of no excess suicides on birthdays (+/- 3 days), or during 3 United States national holidays. While most prior reports found excess post-holiday suicides and suicide peaks on Mondays, those findings were not observed in Olmsted County. Because 93% of deaths occurred on the date of the suicidal act, using date of death instead of the actual date of suicide is sufficient for most research purposes.

Adult↗

Risk of stroke with mitral valve prolapse in population-based cohort study.

BACKGROUND AND PURPOSE: The purpose of this study was to clarify whether mitral valve prolapse increases the subsequent risk of stroke. METHODS: A historical cohort study was conducted on 1079 residents of Olmsted County, Minnesota, who had an initial echocardiographic diagnosis of mitral valve prolapse between 1975 and 1989 without prior stroke or transient ischemic attack and who were followed up for first stroke occurrence. RESULTS: There was an overall twofold increase in the incidence of stroke among individuals with mitral valve prolapse relative to the reference population (standardized morbidity ratio, 2.1; 95% confidence interval, 1.3 to 3.2). Sex, duration of follow-up from the diagnosis of mitral valve prolapse, or calendar year of initial diagnosis did not modify the association. Within the cohort of patients who were at least 35 years old at diagnosis of mitral valve prolapse, a time-dependent proportional-hazards multivariate model and a person-years analysis revealed that age, ischemic heart disease, congestive heart failure, and diabetes mellitus were important determinants for stroke when person-years of observation after mitral valve replacement were excluded. Among seven persons with mitral valve replacement, three strokes occurred in 24 person-years of follow-up. For those with an auscultatory diagnosis of mitral valve prolapse only as the indication for echocardiography (44%), the risk of stroke relative to the population was 1.0 (95% confidence interval, 0.2 to 2.9); for those with another cardiac diagnosis, the standardized morbidity ratio was 2.5 (95% confidence interval, 1.5 to 4.0). CONCLUSIONS: Individuals with uncomplicated mitral valve prolapse did not have an increased risk of stroke, although a small increase in the risk may not have been detected.

Adult↗

Stroke incidence and 30-day case-fatality rates in Novosibirsk, Russia, 1982 through 1992.

BACKGROUND AND PURPOSE: The present study was conducted to investigate the incidence of stroke and 30-day case-fatality rates for stroke in a defined Russian population. METHODS: This is a population-based study that was established in 1982. All residents of an administratively defined and typical district of Novosibirsk (approximately 150,000 subjects) who had an incident (first-ever) stroke from January 1, 1982, through December 31, 1992, were registered. RESULTS: During an 11-year study period, 3406 incident stroke patients were registered, for an overall crude average annual incidence rate of 202/100,000 population. The rates were higher with increasing age and were significantly higher for men than for women. The age- and sex-adjusted annual incidence rate of stroke declined from 271/100,000 in 1982 to 232/100,000 in 1992. Slowing of the decline in stroke incidence was observed after 1988, and stroke incidence increased slightly in 1992. No significant differences in 30-day stroke case-fatality rates were noted from 1982 through 1992, but a slight trend toward decreasing rates was observed after 1988. There was no major change in patient age at stroke onset. CONCLUSIONS: Stroke incidence rates in Novosibirsk are among the highest in the world. We observed a decline in stroke incidence but little change in 30-day case-fatality rates in Novosibirsk from 1982 through 1992.

Adult↗

Role of parathyroid hormone in mediating nocturnal and age-related increases in bone resorption.

PTH has been postulated to play a role in both nocturnal and age-related increases in bone resorption. We tested this hypothesis directly in 10 young (ages 24-35 yr) and 10 elderly (ages 71-78 yr) normal women by measuring the cross-linked N-telopeptide of type I collagen (NTx), a marker for bone collagen breakdown, in 4-h urine collections before and during suppression of PTH secretion by a 24-h iv infusion of calcium. Serum ionized calcium and PTH levels were also measured every 2 h before and during the infusion. In both groups of women, serum PTH levels and urinary NTx excretion followed a circadian pattern before calcium infusion (analysis of variance, P = 0.0001) with peaks in the afternoon and at night for PTH and at night for urinary NTx. During the calcium infusion, the nocturnal urinary NTx excretion peak persisted (P = 0.0001), despite elimination of both PTH peaks. Urinary 24-h NTx excretion (nanomoles per millimoles of creatinine) at baseline was higher in the elderly women (mean +/- SEM, 25.7 +/- 2.1) than in the young women (19.3 +/- 1.7) (P < 0.01), and the decrease during calcium infusion was greater (7.5 +/- 1.9 vs. 4.1 +/- 1.5, P < 0.05). Therefore, the increase in serum PTH levels with age is one of the major factors responsible for the age-related increase in bone resorption. PTH does not mediate the circadian pattern of bone resorption but does play a role in setting the absolute level of bone resorption at which this pattern occurs.

Adult↗

Mitral valve prolapse and the risk of stroke after initial cerebral ischemia.

Referral-based studies suggest that patients with cerebral ischemia and mitral valve prolapse are prone to recurrent cerebral ischemic events. Our purpose was to determine the risk of subsequent stroke in a population-based group of patients with ischemic stroke or TIA and mitral valve prolapse. From 1975 through 1990, 49 residents of Olmsted County, MN, had an initial ischemic stroke or TIA and echocardiographically diagnosed mitral valve prolapse. Risk of subsequent stroke in this cohort was compared with the age- and sex-adjusted rates of recurrent stroke after initial cerebral ischemia in the Rochester, MN, population. Mean age of the patients was 72 years. Thirty-one (63%) were women. Nine had subsequent stroke (5.5 per 100 person-years). For Rochester patients who had initial ischemic stroke in the period 1975 through 1984, 10.72 recurrent strokes were expected (relative risk, 0.84; 95% confidence limits, 0.38 to 1.59). For Rochester patients with initial ischemic stroke or TIA in the period 1975 through 1979, 12.31 recurrent strokes were expected (relative risk, 0.73; 95% confidence limits, 0.33 to 1.39). There is no evidence of increased subsequent stroke risk among patients with initial episodes of cerebral ischemia and mitral valve prolapse relative to the age- and sex-adjusted recurrent stroke rates in the community.

Aged↗

The poor prognosis of ruptured intracranial aneurysms of the posterior circulation.

The first 48 hours after aneurysmal subarachnoid hemorrhage are critical in determining final outcome. However, most patients who die during this initial period are not included in hospital-based studies. We investigated the occurrence of subarachnoid hemorrhage in a population-based study to evaluate possible predictors of poor outcome. All patients diagnosed with aneurysmal subarachnoid hemorrhage between 1955 and 1984 were selected for analysis of mortality in the first 30 days using the medical record-linkage system employed for epidemiological studies in Rochester, Minnesota. One hundred and thirty-six patients were identified. The mean age of these 99 women and 37 men was 55 years. Rates for survival to 48 hours were 32% for the 19 patients with posterior circulation aneurysms, 77% for the 87 patients with anterior circulation aneurysms, and 70% for the 30 patients with a presumed aneurysm (p < 0.0001). Rates for survival to 30 days were 11%, 57%, and 53%, respectively, in these three patient groups (p < 0.0001). Clinical grade on admission to the hospital, the main variable predictive of death within 48 hours, was significantly worse in patients with posterior circulation aneurysms than in others (p < 0.0001). The prognosis of ruptured posterior circulation aneurysms is poor. The high early mortality explains why posterior circulation aneurysms are uncommon in most clinical series of patients with subarachnoid hemorrhage. The management of incidentally discovered intact posterior circulation aneurysms may be influenced by these findings.

Adolescent↗

Nimodipine as an add-on therapy for intractable epilepsy.

OBJECTIVE: To analyze the effect of nimodipine in patients with intractable epilepsy. DESIGN: We conducted a double-blind placebo-controlled crossover study in 95 patients. MATERIAL AND METHODS: The dihydropyridine calcium antagonist nimodipine was used as add-on therapy (60 mg four times a day) in a 1-year placebo-controlled crossover study in 71 patients with localization-related epilepsy and 24 with generalized seizure disorders. Of the 95 patients, 81 were receiving two or more antiepileptic drugs. Patients diaries were used to record the number of seizures and any side effects. RESULTS: Nimodipine seemed to be well tolerated during the study; only two patients were unable to complete the study because of probable adverse effects. The trial demonstrated no significant crossover effect and no significant effect of nimodipine on either the mean or the median number of seizures or seizure days. The peak median serum nimodipine level was less than 5 ng/mL in the 78 patients who completed the study. CONCLUSION: This clinical trial found no beneficial effect with use of nimodipine as add-on therapy for intractable epilepsy. Potential reasons for the absence of efficacy of nimodipine may be the inclusion of patients with very refractory seizure disorders or the relatively low serum nimodipine concentrations related to the pharmacokinetic effect of concurrent antiepileptic medication.

Adult↗

Trends in hospitalizations for gastrointestinal bleeding among patients with rheumatoid arthritis in Rochester, Minnesota, 1950-1991.

OBJECTIVE: Estimates of the incidence of significant gastrointestinal (GI) bleeding among patients with rheumatoid arthritis (RA) vary and population based estimates of this event have been unavailable. We examine the incidence of this event in a well defined cohort of patients with RA. METHODS: The study cohort consisted of patients with RA incident in Rochester, MN, between 1950 and 1974 and reported by Linos, et al (Am J Epidemiol 1980;111:87-98). These patients were followed for up to 40.5 yrs, and retrospective analysis of hospitalization for GI bleeding was performed. RESULTS: A total of 58 patients with RA were hospitalized for GI bleeding, including 46 patients who had a first episode of bleeding after the diagnosis of RA was made, for a first episode incidence rate of 0.52% per person-year of followup. These 46 patients experienced 72 hospitalizations for GI bleeding. Patients diagnosed with RA after 1963 and patients older than 53 yrs of age at the time of diagnosis of RA had a higher incidence of hospitalization for GI bleeding. Overall survival among all patients with RA was slightly less than expected in the general population, while survival in patients hospitalized for GI bleeding was significantly lower than that of nonhospitalized patients. In a nested case-control study, nonsteroidal antiinflammatory drug use was found to be a significant risk factor for hospitalization for GI bleeding (odds ratio 3.25:1 compared with nonusers). CONCLUSION: Estimates of the overall incidence of hospitalization for GI bleeding in this population based cohort of patients with RA may be somewhat lower than some reported for referral populations, but an upward trend in recent years is noted.

Anti-Inflammatory Agents, Non-Steroidal↗

Determinants of reduced survival following hip fractures in men.

To assess determinants of poor survival after hip fractures in men, a population-based cohort study was conducted among 131 men in Rochester, MN, who had their first hip fracture during the period from 1978 to 1989, and an equal number of age-matched control men from the community. One hundred nine patients with fractures died during 373 person-years of followup, but only 75 control men died during 742 person-years of observation. The risk of dying increased with the level of comorbidity among hip fracture cases (hazard ratio 3.2; 95% confidence interval, 1.2-8.2), as well as with age (hazard ratio, 1.4 per 10-year increase; 95% confidence ratio, 1.1-1.8) and mental confusion during hospitalization (hazard ratio, 4.2; 95% confidence interval, 2.5-6.9). Discharge to a nursing home and low activity status also were predictors of death in the univariate analysis. Excess mortality among men with hip fractures can be explained best by interaction of the fracture with serious underlying medical conditions.

Activities of Daily Living↗

The use of clinical characteristics to predict the results of temporal artery biopsy among patients with suspected giant cell arteritis.

OBJECTIVE: To develop a mathematical model which predicts temporal artery biopsy results. METHODS: We collected clinical and laboratory data as well as biopsy results among a consecutive cohort of all individuals who underwent temporal artery biopsy at Mayo Medical Center between January 1, 1988 and December 31, 1991. All biopsies were independently reviewed by one pathologist. Logistic regression was used to identify a set of variables which best predicted the biopsy results. This model was then used to identify patients who were highly likely (> or = 95% predictive value) to have either a negative or a positive biopsy. A receiver operating characteristic (ROC) curve was generated using the best fit model. RESULTS: Of the 525 people in the study, there were 187 men and 338 women. The logistic regression model and the ROC curve generated from this model were of modest value in predicting biopsy results from prebiopsy clinical characteristics. However, this model identified 60 (11%) individuals who had a > or = 95% probability of having a negative biopsy. None of these individuals had any symptoms of claudication, only 5 of 60 (8%) had temporal artery abnormalities on examination, 45 (75%) had synovitis (suggesting an alternate diagnosis), and their median erythrocyte sedimentation rate was only 31 mm/h (Westergren). CONCLUSIONS: In individuals with these findings, we recommend a careful search for other diagnoses before temporal artery biopsy.

Aged↗

Costs of osteoarthritis: estimates from a geographically defined population.

Using the population based data resources of the Rochester Epidemiology Project and a postal survey, we estimated all costs (direct medical, indirect medical, and nonmedical) incurred among a population based prevalence cohort of individuals with osteoarthritis (OA) and a nonarthritic comparison cohort. Cost estimates were compared between the 2 groups adjusting for age and sex differences. Our results demonstrated that people with OA incur substantial incremental medical costs, not only for arthritis care, but also for the care of neurological, gastrointestinal, cardiac, and respiratory conditions compared to nonarthritics. These data also demonstrated important and statistically significantly higher levels of work disability among people with OA compared to their age and sex adjusted peers without arthritis from the same community.

Adult↗

Long-term survival of a cohort of community residents with asthma.

BACKGROUND: Reports of an increase in asthma-related mortality have been based on studies of death certificates from the general U.S. population on which asthma was listed as an underlying cause of death. We addressed the issue in a different way by analyzing long-term survival in a defined, population-based cohort of patients with asthma. METHODS: We identified all residents of Rochester, Minnesota, in whom asthma was diagnosed from January 1, 1964, through December 31, 1983, by reviewing the medical records of all patients with asthma and associated diagnoses, using explicit predefined criteria. The patients' vital status at last follow-up was ascertained. Medical records, death certificates, and autopsy reports were reviewed to classify deaths as due either to asthma or to other conditions. RESULTS: We identified 2499 patients with definite or probable asthma. The mean duration of follow-up was 14 years (range, 0 to 29). There were 140 deaths during 32,605 person-years of follow-up. Overall survival was not significantly different from the survival that was expected for residents of Rochester. Survival was less than expected in patients who were 35 years of age or older when their asthma was diagnosed and who also had another lung disease (predominantly chronic obstructive pulmonary disease). Four percent of all deaths in the study cohort were due to asthma, and all were among adults. Survival was not related to the year of onset of asthma. CONCLUSIONS: Survival among patients with asthma but no other lung disease was not significantly different from expected survival. However, patients 35 or older who had asthma associated with chronic obstructive pulmonary disease did have worse than expected survival. Asthma was classified as the cause of death in only 4 percent of the patients, and there was no evidence of an increased risk of death among patients with a more recent diagnosis of asthma. These results provide assurance that community-based patients with asthma usually have a good prognosis.

Adolescent↗

Influence of coronary heart disease on morbidity and mortality after lower extremity revascularization surgery: a population-based study in Olmsted County, Minnesota (1970-1987).

OBJECTIVES: The aim of this study was to evaluate the short- and long-term postoperative cardiac outcome of patients undergoing lower extremity revascularization surgery in a geographically defined patient group. BACKGROUND: Among patients with peripheral vascular disease, cardiac events have an important effect on long-term outcome after peripheral vascular surgery. However, long-term outcome is poorly documented. METHODS: We examined the entire community medical records of 173 residents of Olmsted County, Minnesota, who underwent peripheral artery bypass surgery between 1970 and 1987 and were followed up to January 1, 1991. Patients were allocated to subgroups of 60 patients with and 106 patients without overt coronary artery disease. RESULTS: There were no significant differences in perioperative death, myocardial infarction or stroke between subgroups at 30 days after operation. The 5- and 10-year Kaplan-Meier survival rate after operation was 77% and 51% in those without and 54% and 24% in those with overt coronary artery disease (p < 0.001), respectively. For both groups, survival was significantly poorer than that expected for an age- and gender-matched group. Patients undergoing aortoiliac surgery were more likely to be alive at 10 years than those undergoing femoropopliteal surgery (47% vs. 28%, p = 0.001). The 5-year cumulative incidence of cardiac events was greater in those with overt coronary artery disease (50% vs. 28%, p = 0.003). In multivariable analysis, age, coronary artery disease and diabetes were independent predictors of death. CONCLUSIONS: Coronary events are the most important cause of long-term morbidity and mortality after peripheral vascular surgery. Patients without overt coronary artery disease are at significant risk for long-term cardiac events.

Arteriosclerosis↗

Risk of connective-tissue diseases and other disorders after breast implantation.

BACKGROUND: We conducted a population-based, retrospective study to examine the risk of a variety of connective-tissue diseases and other disorders after breast implantation. METHODS: All women in Olmsted County, Minnesota, who received a breast implant between January 1, 1964, and December 31, 1991 (the case subjects), were studied. For each case subject, two women of the same age (within three years) from the same population who had not received a breast implant and who underwent a medical evaluation within two years of the date of the implantation in the case subject were selected as control subjects. Each woman's inpatient and outpatient medical record was reviewed for the occurrence of various connective-tissue diseases, certain other disorders thought to have an autoimmune pathogenesis (e.g., Hashimoto's thyroiditis), and cancer other than breast cancer, as well as related symptoms and abnormal results of laboratory tests. The case subjects were categorized according to whether they received implants for cosmetic reasons, for reconstruction after mastectomy for breast cancer, or for reconstruction after subcutaneous mastectomy for cancer prophylaxis. Additional control subjects (women treated for breast cancer who did not have breast reconstruction) were studied for comparison with the case subjects. RESULTS: A total of 749 women who had received a breast implant were followed for a mean of 7.8 years, and 1498 community controls were followed for a mean of 8.3 years. In 5 case subjects, as compared with 10 subjects in the control group, one of the specified connective-tissue diseases was diagnosed (relative risk, 1.06; 95 percent confidence interval, 0.34 to 2.97). Twenty-five case subjects had signs or symptoms of arthritis, as compared with 39 control subjects (relative risk, 1.35; 95 percent confidence interval, 0.81 to 2.23). Among the various signs or symptoms examined, only morning stiffness was significantly increased among the women who had received a breast implant (relative risk, 1.81; 95 percent confidence interval, 1.11 to 2.95). CONCLUSIONS: We found no association between breast implants and the connective-tissue diseases and other disorders that were studied.

Adolescent↗