Kurland, Leonard T.

Among 210 deaths in infants aged 2 weeks to 2 years in Olmsted County, Minnesota, during the 20-year period 1946 through 1965, review of the clinical and pathologic reports disclosed 37 instances of sudden, unexpected, unexplained death (SUUD). The incidence rate was 1.2/1,000 live births. The death occurred between midnight and noon in 90% of cases, and all but one of the children were found dead in bed. Some seasonal variation was noted. Autopsy was done in 75% of the 210 instances, including 86% (32) of the SUUD cases. More than two thirds of the cases of SUUD coming to autopsy had some evidence of an infectious disease, but these findings were minimal and in no case sufficient in themselves to cause death. Therefore, it was concluded that a second factor is necessary to initiate the sequence of events that leads to death, although the specific trigger mechanisms are unknown and may be quite variable.

Abstract Multiple myeloma was diagnosed in six residents of Thief River Falls, Minn. in 1968 (a rate of 84/100,000). A survey of the normal population for monoclonal serum protein peaks was undertaken in 1969. Serum from 1200 residents of the city, who were 50 yr of age or older, was collected. Fifteen (1.25%) had monoclonal serum protein peaks: IgG in 11, IgA in one, and IgM in three, with kappa in 11 and lambda in four. No clinical, laboratory, or roentgenographic evidence of myeloma or macroglobulinemia was found in any of the patients. The incidence of monoclonal serum protein peaks is similar to that reported from Sweden. It was concluded that there was no significant increase in monoclonal proteins in the population of Thief River Falls. The 1968 socalled epidemic of multiple myeloma in Thief River Falls remains unexplained.

Abstract All cases of multiple myeloma diagnosed in bona fide residents of Olmsted County, Minnesota, during the years 1945 through 1964 were identified and reviewed. Pathologic material was available for reconfirmation of the diagnosis in 33 of the 35 cases reported. In the remaining two cases the diagnosis was based on roentgenologic findings and protein abnormalities as well as a typical clinical picture. The incidence rate for males was 1.9 times that for females. During the 20 year period covered in this study the average annual incidence rate in the total population has remained about 3/100,000 and when computed for persons 30 years of age and over, it is 6.3/100,000. Incidence figures by place of residence did not reveal a significant difference in the urban-rural rates. Myeloma was listed as a cause of death in 74 per cent of the death certificates. The mean survival time from onset in all cases was about 2 years, with a median survival of approximately 1 year. The age-specific rate increased with age, the highest rates being among male residents 80 years of age and older.

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.

Atrial septal defect (ASD) of the fossa ovalis type was found in 16 members of one family and confirmed in 15 members at autopsy or surgery or by cardiac catheterization. Sinus rhythm was present in 12 affected members, 11 of whom had electrocardiographic evidence of prolonged atrioventricular (A-V) conduction. Five other family members without ASD also had prolonged A-V conduction. The pedigree chart suggests that the syndrome ASD with prolonged A-V conduction is the manifestation of a single mutant autosomal gene with dominant effect, a high degree of penetrance, and some variation in expressivity. Earlier reports of familial ASD showing the autosomal-dominant pattern of inheritance reveal a similar frequency of prolonged A-V conduction among affected persons. The great majority of cases of ASD are sporadic, with little likelihood of recurrence in subsequent sibs or children. We suggest, however, that when ASD of the fossa ovalis type is accompanied by prolonged A-V conduction, the genetic prognosis may be drastically changed to a risk of almost 50% that the condition will recur in subsequent sibs or children of affected persons.