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Breast tissue from a forensic autopsy series of 486 women (15 to 98 years of age) was studied radiographically and by histologic sampling. Prevalence of Wolfe P2/Dy parenchymal patterns decreased with age. Radiographic nonvascular microcalcification and histologic presence of marked ductal epithelial hyperplasia and lobular microcalcification increased with age. Both of these histologic parameters of increased risk for breast cancer correlated with the presence of radiographic microcalcification and Wolfe P2/Dy parenchymal pattern. The predictive value of the radiographic parameters for presence of "high-risk" proliferative fibrocystic change increased with age.

Twenty-four of 87 (28%) parthenogenetic Chihuahuan spotted whiptails (Cnemidophorus exsanguis) from nine counties of New Mexico and seven counties of Texas were infected with one or more endoparasites. These included a linstowiid cestode (Oochoristica bivitellobata) in seven (8%), a larval spirurid nematode (Physaloptera sp.) in nine (10%) and an oxyurid nematode (Pharyngodon warneri) in 10 (11%). This note, the third in a series of reports on helminths of Cnemidophorus spp., documents parasites in C. exsanguis for the first time.

An epidemiological study of malignant melanoma in Puerto Rico was done by reviewing the Puerto Rico Cancer Registry for all melanoma cases reported between the years 1981 to 1987. A total of 367 new cases were documented with the annual incidence ranging from 1.20 to 2.12 per 100,000 inhabitants with a mean of 1.59. Most of the patients were between 40 and 80 years of age with a peak in the sixties. Nearly one half of the tumors were located on the extremities, most notably on the feet, sharing this predilection with Blacks and Japanese. The most frequently recognized clinico-histologic type was the superficial spreading melanoma followed by the acral lentiginous, the nodular and the lentigo maligna melanoma. Nearly one third of the total cases were not classified according to the histologic type, while Clark's levels and Breslow's thickness were not reported in 44 and 84% of the cases, respectively. When compared to a previous study during 1977 to 1980, the average annual incidence of new cases increased from 0.92 to 1.59 per 100,000 documenting an increased incidence of the condition in our population, but not as significant as that registered in the United States.

265 students attending a southwestern university were surveyed about their use of smokeless tobacco products. 27% of 84 male respondents indicated they consumed smokeless tobacco. The women did not report routine use of smokeless tobacco.

Eosinophilia-myalgia syndrome (EMS) is characterized by intense eosinophilia and, very often, debilitating generalized myalgia in the absence of infectious or neoplastic causation. The Centers for Disease Control have established that the latter two features, along with an eosinophil count greater than 1000 cells per cu mm, are criteria for the syndrome. EMS has been reported in epidemic proportions over the last several months. Early data strongly suggested that in at least a small percentage of patients the syndrome leads to death. Epidemiological work in New Mexico, Minnesota, and Oregon has linked EMS most impressively to L-tryptophan-containing products (LTCPS).

Twelve of 61 (20%) unisexual New Mexico whiptails (Cnemidophorus neomexicanus) from three counties of central New Mexico (USA) and two counties of extreme southwestern Texas (USA) were found to be infected with one or more endoparasites. These included a linstowiid cestode (Oochoristica bivitellobata) in seven (11%), a larval spirurid nematode (Physaloptera sp.) in three (5%), an oxyurid nematode (Pharyngodon warneri) in two (3%) and an unidentified acanthocephalan cystacanth in a single (2%) lizard. This report constitutes the first record of helminths from C. neomexicanus.

We compared self- and spouse reports of snoring and other symptoms of sleep apnea syndrome ascertained from married couples in a community-based survey. Agreement between the two types of report varied between 70-98%, but was modest (kappa = -0.01-0.52) when adjusted for chance. For men, spouse reports yielded higher prevalence rates for snoring and for four other symptoms. For women, estimates of symptom prevalence were consistently lower by spouse report than by self-report. In multivariate analyses, the effect on snoring of gender and obesity increased and of age decreased when spouse reports were compared to self-reports. Snoring, according to spouse reports, was a significant risk factor for ischemic heart disease, but snoring according to self-reports showed a smaller effect and was not statistically significant. Snoring was not associated with hypertension when defined by either self- or spouse report. These observations suggest that questionnaire data of snoring and other symptoms of sleep apnea syndrome may be misclassified in part, and that such misclassification can affect estimates of prevalence and effects.

The Manual of the International Classification of Diseases, Injuries, and Causes of Death includes the category, "symptoms, signs, and ill-defined conditions" for nonspecific causes of death. To determine whether this categorization of cause of death is commonly applied to New Mexico's minority populations, the authors examined state vital records data for 1958-1982. Age-specific and age-adjusted death rates were calculated by 5-year intervals for Hispanics, American Indians, and non-Hispanic whites. Death rates attributed to symptoms, signs, and ill-defined conditions in all three major ethnic groups in New Mexico far exceeded the national rate for whites. For males in the period 1978-1982, American Indians had the highest rates (115.6 per 100,000 males), followed by Hispanics (58.3 per 100,000 males), and non-Hispanic whites (49.2 per 100,000 males); the national rates were 41.3 and 13.1 per 100,000 males for blacks and whites, respectively. Comparable differences were observed among females. The authors suggest that the death rate for deaths attributed to symptoms, signs, and ill-defined conditions may be a potential indicator of access to and use of health services and that the categorization may strongly affect cause-specific death rates in minority populations.

On Oct 30, 1989, the New Mexico Health and Environment Department learned of 3 patients with eosinophilia and severe myalgia who had been taking L-tryptophan. Further review of these and similar cases led to the initial recognition of the eosinophilia-myalgia syndrome (EMS) epidemic. To elucidate the apparent association between L-tryptophan-containing products (LTCPs) and EMS a case-control study was done. The case definition was unexplained peripheral eosinophilia (2000/microliters or more) and incapacitating myalgia. Cases were found through review of white blood cell counts from May 1 to Oct 31, 1989, in nine medical laboratories in New Mexico. 11 cases and 22 matched controls were interviewed for information on symptoms and other clinical findings, on the use of LTCPs, and on potential confounding factors. All 11 cases (100%) used LTCPs compared with only 2 controls. These findings led to a ban on the sale of LTCPs in New Mexico, followed by a nationwide recall of such preparations in the United States.

To examine ethnic differences in infectious disease-related mortality in New Mexico's American Indian, Hispanic White and other White populations, we analyzed vital records data from 1958 to 1987. We found that for most infectious causes, American Indians had the highest mortality rates, followed by Hispanics. The state's minority populations remain at increased risk for infectious disease mortality.

Snoring was investigated in a survey of respiratory disease in Hispanic-Americans of a New Mexico community. A population-based sample of 1222 adults was studied with questionnaires and measurements of height, weight, and blood pressure. The age-adjusted prevalence of regular loud snoring was 27.8% in men and 15.3% in women. Snoring prevalence increased with age and obesity in both men and women. Cigarette smoking was also associated with snoring, but chronic obstructive lung disease and alcohol consumption were not. Snorers more frequently had hypertension, ischemic heart disease, and excessive daytime sleepiness. In contrast to other studies, after adjustment for confounding factors, there was no effect of snoring on hypertension (odds ratio, 1.0; 95% confidence interval, 0.7 to 1.5), but an effect on myocardial infarction was still demonstrable (odds ratio, 1.8; 95% confidence interval, 0.9 to 3.6). The association of snoring with sleepiness suggests that respiratory disturbance of sleep related to upper airway obstruction, such as sleep apnea, occurs more frequently in snorers in this population.

We describe a rare and apparently unique neuropathic syndrome among Navajo children living on the Navajo Reservation. Clinical features include sensorimotor neuropathy, corneal ulcerations, acral mutilation, poor weight gain, short stature, sexual infantilism, serious systemic infections, and liver derangement including Reye's syndrome-like episodes. Progressive CNS white matter lesions were diagnosed through magnetic resonance imaging. We identified 20 definite and 4 probable cases occurring between 1959 and 1986. Mean age at the time of 1st recognized symptom was 13 months (range, 1 month to 4 years 6 months). Ten individuals have died; 6 of the deaths occurred before 5 years of age. The incidence of this syndrome on the western Navajo reservation is 5 times higher than that on the eastern reservation (38 compared with 7 cases per 100,000 births). Although the etiology is unknown, this syndrome is consistent with an inborn error of metabolism, inherited in an autosomal recessive manner.

Hypertension is more common among persons with non-insulin-dependent diabetes mellitus than among appropriately matched nondiabetic populations. The presence of hypertension in persons with non-insulin-dependent diabetes mellitus is associated with increased rates of the microvascular and macrovascular complications of non-insulin-dependent diabetes mellitus. A cross-sectional study of a cohort of 817 diabetic Navajo Indians was performed to determine the age-, sex-, and duration-specific prevalence of diagnosed hypertension. Persons with end-stage renal disease were excluded from the population. A total of 388 of the patients (47.5%) had diagnosed hypertension. The prevalence of hypertension increased with increasing age. Contrary to findings in other populations, women did not have higher rates of hypertension than men. The duration of diabetes did not have a consistent effect on the rates of hypertension. The current prevalence of hypertension among Navajos with diabetes is higher than that reported two decades ago.

During a 5-year period (1981 through 1985), 586 of 46,512 (1.26%) deaths in New Mexico had pulmonary embolism (PE) listed on the death certificate. The frequency of death due to PE was mentioned more frequently in the autopsied than in the non-autopsied component of the study (2.4% v 1.1%). This observation, together with published data on the accuracy of clinical diagnostics among persons dying with autopsy-documented PE, suggests that the frequency of death due to this disease is considerably higher than previously thought. Among autopsied persons who died of PE, risk factors and associated diseases are not appreciably different for those who die in or out of the hospital. Important associations with respect to persons dying of PE include male gender, advanced age, serious medical or surgical disease, immobilization, and trauma.

Adult female and juvenile Mexican free-tailed bats (Tadarida brasiliensis mexicana) were collected bimonthly at Lava Cave, New Mexico from May through September. The purpose of this study was to examine the prevalence of active rabies infection as well as to determine individual immune status in these hosts. All bats were bled and examined for rabies antibody (total antibody versus IgM) utilizing a modified serum neutralization test. The brains were removed and examined by the fluorescent rabies antibody (FRA) test. No significant difference was observed in the number of adults with rabies neutralizing antibody (total) over the study period. Significant differences in rabies neutralizing antibody (total) were observed among the juveniles sampled during July and August. The number of adults with IgM specific antibody was low (15 of 750, 2%) and did not fluctuate significantly. However, the number of juveniles with IgM antibody did show increased levels in August and September. The number of adults positive by the FRA was low (4 of 750, less than 1%) and did not appear to fluctuate significantly over the study period. The number of juveniles positive by the FRA was three and one-half times higher than observed for the adults (14 of 600, 2%). These results indicate that the Mexican free-tailed bat appears to be exposed to rabies virus shortly after birth as evident by its immune status. The low prevalence (4 of 750, less than 1%) of active infection as determined by the FRA and mouse inoculation and the high prevalence (514 of 750, 69%) of IgG antibody in the adult females indicate that the Mexican free-tailed bat recovers from rabies virus infection.