Cancer incidence in a cohort of patients with seizure disorders.

The incidence of cancer was evaluated in a population-based cohort of 959 patients diagnosed with seizure disorders while residents of Rochester, MN, between 1935 and 1979. For all cancer sites combined, there were 65 incidence cases for a standard morbidity ratio of 1.4. Most of the excess was attributable to a 22-fold increase in the incidence of primary brain tumors among these patients. Most of the brain tumors occurred within 5 years of the seizure disorder diagnosis, suggesting that the seizure disorder was due to the brain tumor. The incidence of cancer of other sites, exclusive of brain, was not elevated. There was no evidence of an association of cancer incidence with duration of seizures or with the use of anticonvulsant drugs.

Incidence and secular trend of multiple myeloma in Olmsted County, Minnesota: 1965-77.

The average annual age-adjusted incidence rate of multiple myeloma for Olmsted County, Minnesota, for 1965-77 was 2.7/10(5) person-years. The sex-specific rates for males and females were 3.5 and 2.2/10(5) person-years, respectively; the male-to-female incidence ratio was 1.6:1.0. These rates were similar to rates reported for white people from the Third National Cancer Survey and the New York and Connecticut tumor registries. This average incidence rate did not appear different from the rate for the 20-year period 1945-64 in Olmsted County. The incidence of multiple myeloma was not shown to have increased in the past 33 years, and the observed increase in mortality from this disease reported in other parts of the country indicated improved case ascertainment during recent years, a factor not likely to be important in Olmsted County.

Incidence of multiple myeloma in Olmsted County, Minnesota: 1978 through 1990, with a review of the trend since 1945.

PURPOSE: Incidence rates of multiple myeloma appear to have increased in recent decades, but it is difficult to compare the incidence rates over time because of changes in laboratory procedures, differences in diagnostic criteria, and variations in indexing of medical records. However, Olmsted County, Minnesota, provides a rare opportunity to minimize these limitations, because the medical care has been provided mainly by the Mayo Clinic. PATIENTS AND METHODS: Records of Olmsted County residents with a diagnosis of multiple myeloma from January 1, 1978 through December 31, 1990 were reviewed. Criteria for diagnosis and residency were the same as in previous Olmsted County studies. RESULTS: The incidence rate per 100,000 age-adjusted to the 1950 United States white population was 5.4 for males and 2.8 for females; the overall rate was 4.1. The rates were age-adjusted to the 1950 United States population for comparison with earlier data from this population. The rates increased with age for both sexes. There was no significant change in incidence rates from 1945 through 1990. A comparison of the median age for Olmsted County patients with the age of those referred to the Mayo Clinic from elsewhere indicated that the local patients were appreciably older (74 v. 62 years, respectively). Thirty-two of 55 patients (58%) with multiple myeloma from 1978 through 1990 had a monoclonal plasma-cell proliferative process before the diagnosis of multiple myeloma. CONCLUSION: The incidence rate of multiple myeloma in Olmsted County, Minnesota, has not changed significantly during the past 46 years. We believe that reports of increasing rates over time are mainly due to improved case ascertainment.

Diabetes mellitus: incidence, prevalence, survivorship, and causes of death in Rochester, Minnesota, 1945-1970.

The incidence and prevalence of diabetes mellitus in residents of Rochester, Minnesota, for 25 years (1945 to 1970) were determined from available medical records. The over-all incidence rate for diabetes is 133 new cases per 100,000 population per year (age-adjusted to 1970 U.S. white population). The rate increased with age for both men and women and was higher among men over 30 years of age. The average annual incidence rates per five-year period for juvenile-onset diabetes mellitus were low and variable and showed little change. Polyuria, polydipsia, glycosuria, lean habitus, loss of weight, and high levels of fasting hyperglycemia at initial diagnosis occurred more frequently in younger than in older patients. The peak incidence in 1960 through 1964 and the decrease in the following five years may be a reflection of the introduction of the AutoAnalyzer method for blood glucose in 1958. The average annual incidence rates for 1955 through 1959 and 1965 through 1969 were essentially the same. The over-all prevalence for diabetes mellitus is 1.6 per cent, with a higher rate among men than among women over 40 years of age; among school children the rate is 0.1 per cent. Survivorship in the diabetic population is lower than that in the general population. The leading cause of death was coronary heart disease, the death rate from it being higher than for the general population.

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.

Fine structural study of neurofibrillary changes in a family with amyotrophic lateral sclerosis.

Lewy body-like hyaline inclusions in the soma and swollen, cord-like cell processes are characteristic alterations of the anterior horn cells in familial amyotrophic lateral sclerosis (ALS) with posterior column and spinocerebellar tract involvement. A fine structural analysis of these two structures has been performed in two brothers from a family ("C" family) previously described by Kurland and Mulder in 1955. The perikaryal hyaline inclusions consisted of accumulations of randomly oriented neurofilaments interspersed with thick linear densities associated with granular material. Some of the accumulations showed a central condensation. Cord-like, swollen neuronal processes were composed, for the most part, of numerous neurofilaments arranged parallel to the long axes. Dense structures were sometimes observed within the large bundles of filaments. They were composed of ill-defined dense, granular and fibrillar material associated with scattered vesicles and mitochondria. These dense areas were sometimes surrounded by various amounts of fine filaments, approximately 5 nm in diameter.

50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study.

OBJECTIVE: The aim of the study was to determine incidence and prevalence rates and long-term trends in incidence of anorexia nervosa by identifying all persons residing in the community of Rochester, Minn., during the 50-year period 1935 through 1984 who had the disorder. METHOD: From a community-based epidemiologic resource, 13,559 medical records with diagnoses of amenorrhea, starvation, weight loss, anorexia nervosa, or other conditions were screened to identify true cases of anorexia nervosa determined by using standard diagnostic criteria. RESULTS: One hundred eighty-one residents (166 female and 15 male) fulfilled the diagnostic criteria for anorexia nervosa; these were the incidence cases. Due to a quadratic trend in the rates for girls 10-19 years old, the incidence rate among female residents fell from 16.6 per 100,000 person-years in the 1935-1939 period to a low of 7.0 in 1950-1954 and increased to 26.3 in 1980-1984. The incidence rates for women 20 years old and older and for males remained constant. For females 15-24 years old, there was a linear increase. The overall age-adjusted incidence rate per 100,000 person-years was 14.6 for females and 1.8 for males. The prevalence rate per 100,000 population was 269.9 for females and 22.5 for males. CONCLUSIONS: Anorexia nervosa is more common than previously recognized. Among girls 15-19 years old it is a very common chronic illness. Its incidence has increased among females 15-24 years old but not among older women or among males.

Population-based study of herpes zoster and its sequelae.

The epidemiology of herpes zoster and its sequelae have been investigated in a community-based study. The incidence rates observed in Rochester, Minnesota, are lower than those determined in practice-based series; and this may reflect some selectivity in practice-based series compared to population-based studies. No significant sex difference or seasonal variation was observed but the incidence did increase markedly with age. An increase in incidence was also observed over the 15-year period studied. The dermatomal distribution of herpes zoster observed in Rochester was quite similar to previous studies, despite their inherent biases in case ascertainment, except for a lower proportion with cranial nerve zoster. Herpes ophthalmicus (V1) appears to affect a slightly different population than zoster of the other dermatomes, with elderly males being more at risk. Also, herpes ophthalmicus is associated with a higher complication rate compared to the other dermatomes primarily due to the fragility of the involved organ. The elderly are also at greatest risk for the most common complication, post-herpetic neuralgia. The rate of PHN is not significantly increased in any particular dermatome but is significantly decreased in lumbar herpes zoster.

Epidemiologic study of primary intracranial neoplasms.

The incidence of primary intracranial neoplasms in Rochester, Minn, from 1935 through 1977 is reviewed with regard to whether the tumor was diagnosed because of symptoms arising before death or was found incidentally at autopsy. Among males, the overall age-adjusted incidence rate of cases diagnosed before death was 8.3 per 100,000 population per year, which included a rate of 4.0 for gliomas, 1.2 for meningiomas, and 1.5 for pituitary tumors. Among females, the comparable overall rate was 10.1; that included a rate of 4.1 for gliomas, 2.6 for meningiomas, and 1.7 for pituitary tumors. Of all autopsies on subjects aged 55 years and over, about 1% confirmed or discovered gliomas and slightly more than 1% confirmed or discovered meningiomas.

Guillain-Barré syndrome. Clinicoepidemiologic features and effect of influenza vaccine.

A study of the epidemiologic and clinical features of Guillain-Barré syndrome in the population of Olmsted County, Minnesota, over the 46-year period 1935 through 1980 was conducted through the centralized diagnostic index maintained at Mayo Clinic, Rochester, Minn. A total of 48 cases were identified, giving an age- and sex-adjusted incidence of 1.8 per 100,000 person-years. The rate increased over time from 1.2 in the interval 1935 through 1956 to 2.4 in the interval 1970 through 1980. Males were affected more than females (age-adjusted rates of 2.3 and 1.2, respectively). The rate increased with age from 0.8 in those under 18 years old to 3.2 for those 60 years and older. Antecedent infectious diseases were reported in 65% of the cases. Implications with regard to the incidence of Guillain-Barré syndrome associated with the A/New Jersey/76 (swine flu) vaccine are discussed.

Incidence and prevalence of Huntington's disease in Olmsted County, Minnesota (1950 through 1989).

OBJECTIVE: To calculate average annual incidence rates for Huntington's disease (HD) from 1950 through 1989 and to estimate prevalence rates of the disease for January 1, 1960, and January 1, 1990. DESIGN: Health care records from all sources, including hospitals, outpatient clinics, and long-term care institutions, are readily available for all inhabitants of Olmsted County, Minnesota. The diagnoses entered in these records have been coded and indexed. All health care records containing a diagnosis that might suggest HD were reviewed, and those patients for whom the symptoms of HD began between January 1, 1950, and December 31, 1989, were identified. We used specific criteria for diagnosing HD. PARTICIPANTS: Health care records were reviewed; residence in Olmsted County during the year of symptom onset was required. MAIN OUTCOME MEASURES: Average annual incidence rates and prevalence rates for January 1, 1960, and January 1, 1990. RESULTS: Overall incidence rates were 0.4 (95% confidence interval [CI], 0.1 to 0.8) for women and 0.2 (95% CI, 0.04 to 0.6) for men per 100,000 person-years. Estimated prevalence rates for January 1, 1960, per 100,000 person-years were 6 (95% CI, 0.7 to 21.5) for women and 6.6 (95% CI, 0.8 to 23.8) for men. For January 1, 1990, the prevalence rates were 1.8 (95% CI, 0.04 to 10.2) for women and 2 (95% CI, 0.05 to 10.9) for men. CONCLUSIONS: Incidence and prevalence rates of HD in this community are similar to those reported in other communities. The small numbers of affected persons do not allow an estimate of variation over time.

Tuberous sclerosis complex in Olmsted County, Minnesota, 1950-1989.

The incidence of tuberous sclerosis complex in Olmsted County, Minnesota, was 0.28 per 100,000 person-years from 1950 through 1989, the point prevalence on December 31, 1989, was 6.9 per 100,000 persons, and the incidence at birth was 6.0 per 100,000 live births. The incidence was 0.13 per 100,000 person-years from 1950 through 1974 and 0.46 per 100,000 person-years from 1975 through 1989. The higher rate of diagnosis during the later period is believed to be due to the use of computed tomography. Of the 12 patients considered in this study, one patient presented with seizures and severe intellectual disability, six patients presented with seizures, three patients presented with multiple facial angiofibroma, and two patients were asymptomatic.

Antecedent medical diseases in patients with amyotrophic lateral sclerosis. A population-based case-controlled study in Rochester, Minn, 1925 through 1987.

Odds ratios (ORs) were estimated for the prevalence of antecedent endocrine, metabolic, or vascular diseases among 45 patients with amyotrophic lateral sclerosis from the Rochester, Minn, population compared with 90 control subjects matched for sex, year of birth, period of observation, and residence. Hypertension occurred less frequently in male patients with amyotrophic lateral sclerosis (4%) than in control subjects (30%; OR = .10). Because of small population size, no conclusions can be drawn with respect to the following antecedent conditions: thyroid disease (OR = 1.61), coronary artery disease (OR = .58), obesity (OR = .52), diabetes (OR = 1.00), cerebrovascular disease (OR = .21), and peripheral vascular disease (OR = 1.23). The heterogeneity of antecedent thyroid disease makes it highly unlikely that any specific thyroid lesion is causally associated with most cases of amyotrophic lateral sclerosis. Hypertension may be a marker for protective factors against the development of amyotrophic lateral sclerosis in men.

Idiopathic intracranial hypertension (pseudotumor cerebri). Descriptive epidemiology in Rochester, Minn, 1976 to 1990.

The medical records-linkage system of the Mayo Clinic was used to identify cases of idiopathic intracranial hypertension in the 15-year period, 1976 through 1990, among the population of Rochester, Minn. Nine patients (eight women and one man) were identified, corresponding to an average annual age-adjusted incidence rate per 100,000 of 0.9 for the total and 1.6 for the female population. In females aged 15 to 44 years, idiopathic intracranial hypertension occurred at a rate of 3.3 per 100,000 per year; for those defined as obese (body mass index > 26), the rate rose to 7.9. Median follow-up was 2.7 years (range, 5 months to 15 years). Three of 18 eyes developed visual impairment; this was mild in all cases.

Epidemiologic investigation of the association between herpes zoster and multiple sclerosis.

The apparent association between MS and herpes zoster reported in the literature was investigated in a community-based epidemiologic study. Five hundred ninety residents of Rochester, Minnesota, diagnosed with herpes zoster from 1945 through 1959 were followed 9,389 person-years for onset of MS. No cases were observed, whereas 0.2 case was expected, using Rochester incidence rates for MS. Calculation of the power of this study indicated that approximately 200,000 person-years of follow-up of herpes zoster patients is necessary in order to detect a threefold increase in incidence of MS with 85% probability. Conversely, 48 Rochester residents diagnosed with MS were followed for 860 person-years for subsequent onset of herpes zoster. Three cases were observed, whereas 1.8 cases were expected for a relative risk of 1.7, which is not significantly different from unity.

Lack of association between Alzheimer's disease and education, occupation, marital status, or living arrangement.

Using the resources of the Rochester Epidemiology Project, we conducted a case-control study of sociodemographic characteristics using the incidence cohort of patients with Alzheimer's disease (AD). During the conduct of ongoing studies of AD in Rochester, we identified new cases of AD as they occurred during 1975-1979 (N = 241). We selected one age- and sex-matched control from among all registrations for care in this community during the year of onset for each case. There was little difference between cases and controls for educational attainment, marital status, type of dwelling, living arrangement, or occupation. We were unable to confirm low educational level as a risk factor for AD in this population. Future attempts to identify etiologic risk factors for dementing illness should probably move toward other areas of research.

Cerebral palsy--trends in incidence and changes in concurrent neonatal mortality: Rochester, MN, 1950-1976.

We studied all identified cases of cerebral palsy (CP) born to residents of Rochester, MN, during a 27-year period. Incidence rates per 1,000 neonatal survivors were computed for three 9-year intervals. For children with persisting findings, the incidence rate of all syndromes declined from 2.3 to 1.6. For spastic syndromes, this trend was more marked (2.1 to 0.9). For newborns with birthweight over 2,500 g, both CP incidence and neonatal mortality rates (NMR) declined in parallel. For the low birthweight neonate, coincident with a precipitous drop in NMR, the CP incidence rate remained essentially unchanged. In the face of increasing neonatal survival, the overall incidence rate of CP declined. The decrease in the absolute risk of CP was limited to the greater than 2,500-g neonatal survivor.

ALS in Rochester, Minnesota, 1925-1977.

The incidence, trend, and survivorship of ALS in the population of Rochester, Minnesota, was determined for the years 1925 through 1977. The average annual incidence was 1.76 per 100,000 population. There was a small but nonsignificant increase in the rate during the 53-year period. The male:female ratio was 1.1, and the male:female ratio of incidence rates was 1.6. The median age at onset was 66 years; the incidence rates increased with increasing age. Median survivorship was 22.5 months, and was longer for younger patients than for patients with an advanced age at onset. The demographic characteristics in this total community experience are believed to reflect the pattern of ALS more accurately than previously reported clinical series.

Is the prevalence of dementia changing?

We compared the point prevalence rates of dementing illnesses in the population of Rochester, Minnesota, on January 1, 1980, with the previously published rates of January 1, 1975, by using extensive health care records available from all sources of care in the community, in order to identify and classify cases with standard diagnostic criteria derived from DSM-III. The overall age- and sex-adjusted prevalence rate per 100,000 population for dementia on January 1, 1980, was 402.5 compared with 388.4 on January 1, 1975; for Alzheimer's disease it was 259.8 in 1980 and 259.5 in 1975. The stability of the rates suggests no change in the incidence and mortality associated with these conditions. The prevalence rates for Rochester, Minnesota, are similar to many other rates estimated in other North American communities, but they differ from two other population-based estimates from East Boston and California. Case definitions and methods of assessment probably account for the differences in estimated prevalence.

How frequently does classic amyotrophic lateral sclerosis develop in survivors of poliomyelitis?

There is a paucity of reports of classic amyotrophic lateral sclerosis (ALS) developing in survivors of paralytic poliomyelitis. We describe a patient with classic ALS and an antecedent paralytic disease thought to have been poliomyelitis from which she recovered completely. If the paucity of ALS preceded by true poliomyelitis is not merely a matter of underreporting, antecedent paralytic poliomyelitis may have a protective role against the development of ALS. This has implications relevant to pathogenesis and to projected secular trends of ALS incidence since the introduction of poliomyelitis vaccines. There is a need to establish the incidence of cases of classic ALS in patients with antecedent poliomyelitis.