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A medical history of abnormal blood clot formation and smoking appear to be risk factors for deep vein thrombosis and pulmonary embolism in pregnant women, according to a study of 85 pregnant women who had either condition during pregnancy and 85 pregnant women who did not. Deep vein thrombosis and pulmonary embolism are both caused by a blood clot that blocks the flow of blood.

BACKGROUND: Reports of increased mortality from cardiovascular disease and malignancy in primary hyperparathyroidism have been based primarily on patients who have undergone parathyroidectomy. In order to assess the true impact of primary hyperthyroidism on mortality in the general population, we assessed survival in a large inception cohort of Rochester, Minnesota residents with primary hyperparathyroidism. Initially diagnosed over a 28-year span, the majority of whom were followed with uncomplicated disease. METHODS: All Rochester residents with primary hyperparathyroidism first recognized in 1965 to 1992 were identified through the Rochester Epidemiology Project medical records linkage system. Included as cases were patients with pathologic confirmation of hyperthyroidism, hypercalcemia with inappropriately elevated parathyroid hormone levels, or hypercalcemia for more than a year with no other cause. Survival was estimated using the Kaplan Meier product-limit method. The Cox proportional hazards model was used to determine associations, as relative hazards (RR) with 95% confidence intervals (CI), of various risk factors with time to death. RESULTS: During the study period, 435 cases of primary hyperparathyroidism were identified. Altogether, parathyroid surgery was performed on 126 patients (29%), with a mean delay between the initial elevated serum calcium level and surgery of 3.3 years. Patients who underwent surgery had higher maximum serum calcium levels than the patients who were observed (mean [+ or -] SD, 11.3 [+ or -] 0.7 versus 10.7 [+ or -] 0.4 mg/dL, P [is less than] 0.001), but their mean ages were similar (54 [+ or -] 16 versus 56 [+ or -] 17 years). Overall survival in the patients with primary hyperthyroidism was better than expected (P = 0.02), but by age-adjusted multivariate analysis, higher maximal serum calcium level was an independent predictor of mortality (RR = 1.3 per mg/dL; 95% CI: 1.1-1.6; P [is less than] 0.02). CONCLUSION: Overall survival is not adversely affected among unselected patients with mild primary HPT in the community, although patients with more severe disease, as manifested by higher serum calcium levels, may have an increased risk of death. Am J Med. 1998;104:115-122. [C] 1998 by Excerpta Medica, Inc.

In certain geographical regions, clusters of premature thelarche (breast development) have been reported, but due to lack of information about the condition, the significance of these clusters is unclear. Medical records from the Mayo Clinic for a 45-year period were studied to determine the characteristics of premature thelarche. Of 66 cases, 48 had premature thelarche without other conditions. Development began between the age of six months and two years in 60 percent of the cases. Frequency of reported cases increased at school age and was greater for the city of Rochester, Minnesota, possibly due to preschool or other regular examinations. Half of the girls had bilateral (both sides) development, and of those with unilateral development, slightly more were on the right side. In cases of both bilateral and unilateral development, over half regressed from six months to six years after diagnosis, while in a small number (under 15 percent), the condition persisted or increased slightly before regressing. Breast development persisted in only four of the cases. Age and breast size at diagnosis was not predictive of outcome. Thirty-nine of the now teenage and adult women responded to health survey questionnaires. No cases of breast or gynecologic cancer or autoimmune disease were reported, but there were three cases of minor breast dysfunction. All achieved normal height and development, and reproduction was normal among those attempting pregnancy. The results of the study indicate that premature thelarche, a self-limiting disease of low incidence, has no apparent adverse consequences associated with it. (Consumer Summary produced by Reliance Medical Information, Inc.)

BACKGROUND: Although patients with gastroesophageal reflux are often instructed to change their lifestyle, population-based data on the risk factors for reflux in the United States are lacking. METHODS: We performed a cross-sectional study in an age-and gender-stratified random sample of the population of Olmsted County, Minnesota. Residents aged 25 to 74 years were mailed a valid self-report questionnaire that measured reflux symptoms and potential risk factors. Logistic regression was used to estimate the odds ratios (OR) with 95% confidence intervals (CI) for reflux symptoms (heartburn or acid regurgitation) associated with potential risk factors. RESULTS: Overall, 1,524 (72%) of 2,118 eligible subjects responded. A body mass index [is greater than] 30 kg/m2 (OR = 2.8; CI, 1.7 to 4.5), reporting an immediate family member with heartburn or disease of the esophagus or stomach (OR = 2.6; CI, 1.8 to 3.7), a past history of smoking (OR = 1.6; CI, 1.1 to 2.3), consuming more than seven drinks per week (OR = 1.9; CI, 1.1 to 3.3), and a higher psychosomatic symptom checklist score (OR per 5 units = 1.4; CI, 1.3 to 1.6) were independently associated with frequent (at least weekly) reflux symptoms. CONCLUSION: Obesity is a strong risk factor for gastroesophageal reflux, although the value of weight reduction remains to be proven. That family history was also a risk factor suggests that there may be a genetic component to the disorder. Am J Med. 1999;106:642-649. [C]1999 by Excerpta Medica, Inc.