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• 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.(Arch Otolaryngol 105:479-485, 1979)

In this historical cohort study we identified, located, and, if living, interviewed 10,590 vasectomized men from four cities, along with a paired neighborhood control for each. The times between procedure data and interview or death ranged from under one to 41 years, with median equal to 7.9 years and with 2,318 pairs having ten or more years of follow-up. Participant reports of diseases or conditions that might possibly be related to vasectomy through an immunopathological mechanism were validated by direct contact with physicians and review of medical records. Results of this study do not support the suggestions of immunopathological consequences of vasectomy within the period of follow-up. Except for epididymitis-orchitis, the incidence of diseases for vasectomized men was similar or lower than for their paired controls.(JAMA 1984;252:1023-1029)

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 17α-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.

Recent independent case-control studies have indicated that treatment with exogenous estrogen is associated with an increase in the risk of endometrial cancer. This question was studied in Olmsted County, Minnesota, by identifying all cases of endometrial cancer among residents over a 30 year period (1945 through 1974) and by matching four controls to each of the 145 patients. The rate of past exposure to any exogenous estrogen for any duration was about the same for patients as for controls. However, the estimated relative risk of endometrial cancer associated with conjugated estrogen treatment of 6 months or longer was 4.9 (P < 0.01), and this increased to 7.9 (P < 0.01) with exposure for 3 years or longer. The risk increased with larger dose (1.25 mg. or more) and continuous administration of conjugated estrogens. The incidence of endometrial carcinoma over the three decades of the study, corrected for an increasing rate of hysterectomy, was constant. Thus to this time, the low rate of use of conjugated estrogens in this region over the past 30 years apparently has not had an appreciable impact on the incidence of endometrial cancer.

Increased energy expenditure associated with active inflammation has been thought to be one cause of weight loss in patients with Crohn's disease. Our aim was to test this hypothesis by determining if resting energy expenditure (REE) measured by indirect calorimetry was greater than the predicted energy expenditure (PEE) calculated from the Harris-Benedict formula (variables—sex, age, height, and weight) in each patient. Fifty-four patients with radiographic evidence of Crohn's disease were studied. There was a highly significant relationship (p < 0.001) between REE and PEE, which can be expressed as follows: REE = 39.40 + 0.99 (PEE). The mean REE was 1427 ± 228 kcal/day, whereas the mean PEE was 1404 ± 197 kcal/day. Patients with the lowest weights when expressed as percentages of ideal body weights had the greatest resting energy expenditure per kilogram of body weight (r = − 0.73, p < 0.001). The mean REE per kilogram per day was 25 ± 4 kcal, and only 4 of 54 patients (7%) had REE ≥ 30 kcal/kg · day. Thus, REE measured by indirect calorimetry in Crohn's disease patients was not significantly higher than PEE that can be estimated from the Harris-Benedict equation. These findings show that most Crohn's disease patients without fever or sepsis do not have increased REE.

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.(JAMA 1985;254:1199-1202)

Bone mass and its mineral content are under genetic control. The vitamin D receptor (VDR) gene has been shown to be a major locus for genetic effects on bone mineral density (BMD), and polymorphisms in this gene accounted for a large proportion of genetic variance in BMD in an Australian population. In this study, we investigated whether similar associations are present in a North American population. We studied 139 normal healthy women (age 53.2 ± 14.5, mean ± SD) and 43 severely osteoporotic postmenopausal women (age 65.8 ± 5.9). In the 127 of them with complete genetic studies, the distribution of genotypes, determined by polymerase chain reaction on leukocyte DNA samples, agreed closely with that in the Australian population. BMD was strongly related to age and weight, and, thus was adjusted for these parameters prior to genetic analysis. We found that age modulated the effect of VDR genotypes on femoral neck BMD (FN‐BMD) (TaqI, p= 0.036;BsmI, p= 0.118; ApaI, p= 0.041) such that the effect of genotype was greatest among younger (premenopausal) women and declined with age so that there was no discernible difference by age 70. Among the younger women, a high FN‐BMD was associated with the TT (or aa or bb) genotype while low FN‐BMD was associated with the tt (or AA or BB) genotype. In osteoporotic women, although the difference in FN‐BMD between alternate TaqI homozygotes (TT vs. tt) was 0.13 g/cm2(or about 18%), the overall difference among the genotype groups was not significant (TaqI, p= 0.13; BsmI, p= 0.21; ApaI, p= 0.09), possibly due to the small sample of osteoporotic women. There was no relationship of VDR genotype to lumbar spine BMD. We conclude that the VDR gene modulates differences in BMD in premenopausal women. Subsequent interaction of the gene and environmental factors and the role of VDR genotypes in predisposing to osteoporosis needs further study.