Zdenek Hrubec

Acromegaly and gastrointestinal cancer

A cohort of 1041 men who were discharged from the hospital with a diagnosis of acromegaly were examined for subsequent cancer. With a mean follow‐up time of 8.3 years, an increased rate of cancers of the digestive organs was observed (27 cases; standard incidence ratio [SIR], 2.0; 95% confidence interval [CI], 1.3 to 2.9). Rates were elevated for cancers of the esophagus (7 cases; SIR, 3.1), stomach (4 cases; SIR, 2.5), and colon (13 cases; SIR, 3.1). The increased risk of colon cancer in acromegaly is consistent with previous clinical reports and suggests opportunities for etiologic research and early cancer detection. It would seem prudent to also evaluate this risk in current research on the use of growth hormone in older individuals to increase muscle mass and reduce body fat.

Residential radon exposure and lung cancer in Swedish women

A case-control study was undertaken to investigate the role of residential radon exposure for lung cancer. The study included 210 women with lung cancer diagnosed from 1983-1986 in the county of Stockholm and 191 hospital and 209 population controls. Interviews provided information on lifetime residences and smoking. Radon concentrations measured in 1,573 residences of the study subjects showed a lognormal distribution with arithmetic and geometric means of 127.7 and 96.0 Bq m-3, respectively. Lung cancer risks tended to increase with estimated radon exposure, reaching a relative risk of 1.7 (95% confidence interval: 1.0-2.9) in women having an average radon level exceeding 150 Bq m-3 (4 pCi L-1). Stronger associations were suggested in younger persons and risk estimates appeared to be within the same range as those projected for miners. However, further studies are needed to clarify the level of risk associated with exposure to residential radon.

Survival following first diagnosis of coronary heart disease

Abstract 1. 1. Survival tables over a 15 year period are presented for white males between the ages of 20 through 64 who were diagnosed to have a first clinical occurrence of coronary heart disease while in Army service. Diagnostic groupings for this analysis were separated into two categories: myocardial infarction-coronary thrombosis-coronary occlusion and angina pectoris-coronary insufficiency. 2. 2. Both the immediate prognosis for survival and the prognosis over the 15 year period were less favorable for cases initiating as myocardial infarction-coronary thrombosis-coronary occlusion, than for cases initiating as angina pectoris-coronary insufficiency. 3. 3. The first 24 hours after onset of clinical manifestations of either group of coronary disease syndromes was the period of the highest concentrated mortality rate. 4. 4. At all ages the myocardial infarction-coronary occlusion-coronary thrombosis group had a higher mortality rate (16.7 per cent) in the first year of follow-up than in any subsequent year. After the first year, the annual mortality rate in this group was about 5 per cent and did not vary much with length of follow-up. In the angina pectoris-coronary insufficiency group, the annual mortality rate was about 3 per cent throughout the follow-up period. 5. 5. Comparison of the observed mortality rate in the infarction-thrombosis-occlusion group with that expected for American males of the same age and race in the same calendar period reveals a steady decrease in the mortality ratio (observed/expected) from about 30 in the first year to approximately 2 in the interval 11–15 years after diagnosis. In both diagnostic groups, mortality ratios of older patients were lower than those of younger patients.

Familial factors in early deaths: Twins followed 30 years to ages 51–61 in 1978

SummarySubjects in the National Academy of Sciences-National Research Council Twin Registry of 31,848 male twin veterans were followed for mortality from 1 January 1946, or from the date of entry into military service if that was later, to 31 December 1978. During this time 3,573 deaths occurred among them, 837 due to trauma and 2,712 due to disease.Mortality from all causes for the entire follow-up period was 10.2% among 11,350 monozygotic (MZ) twins and 11.4% among 14,450 dizygotic (DZ) twins. Mortality of veterans is known to be favorable compared to U.S. males. Among U.S. males of the same ages as the two respective twin zygosity groups, a mortality of 13.9% would have been expected during this time period. Observed mortality from trauma was 2.3% for MZ twins and 2.5% for DZ twins, with 3.0% expected in either group. Observed mortality from all disease was 7.9% for MZ twins and 8.8% for DZ twins, with 10.9% expected in either group.For total mortality, the case twin concordance rates, based on individual deaths, were 28.2% among MZ twins and 17.7% among DZ twins. For trauma, respectively by zygosity, these concordance rates were 6.9% and 3.9%. In this sample, familial factors appear to be of little consequence in trauma deaths. For all disease the concordance rates were 30.1% and 17.4%. Estimating heritability of liability to death from disease, as proposed by Edwards (1969), provides values of h2=r=0.51 for MZ twins, h2=2r=0.48 for DZ twins, and h2=2(rMZ−rDZ=0.54 using data for the two zygosity groups combined.

TRAUMATIC LIMB AMPUTATIONS AND SUBSEQUENT MORTALITY FROM CARDIOVASCULAR DISEASE AND OTHER CAUSES

Abstract Men drafted into the Army, hospitalized during 1944–1945 for service-connected trauma to the extremities, and consequently separated for disability were followed for mortality from January 1946 to April 1977. Three groups were established consisting of those whose injury resulted in: 1. (a) limb amputation; 2. (b) disfigurement without loss of body part; 3. (c) loss of part of hand or part of foot. Group (a) had a mortality, standardized for age and calendar time, 1.4 times that of group (b), matched on age and length of service at admission, and 1.3 times that of group (c), similar in age and length of service to group (a). The excess mortality of limb amputees was statistically significant (p

Childhood cancer among Swedish twins.

The risk of childhood cancer was evaluated among 35,582 twins born in Sweden between 1952 and 1967. Cancers were identified through linkage with national cancer and mortality registries. Overall, 59 childhood cancers and 41 deaths from cancer occurred before the age of 16. For both sexes combined, the cancer incidence was similar to that in the general population of primarily single-born children (number observed/number expected [O/E]=1.0,95 percent confidence interval [CI]=0.7–1.2). For males under age five, cancer incidence was reduced significantly (O/E=0.3, CI=0.1–0.7). There was a substantial increase in all-cause mortality among twins (O/E=3.7), attributable to a high mortality during the first year of life. Excluding this first year, the O/E for death (all causes) was 1.1 (CI=1.0–1.3). For cancer mortality of both sexes, the O/E was 0.9 (CI=0.6–1.2), with no significant reduction of risk in any sex-age group. We conclude that with the possible exception of males aged 0–4 years, the childhood cancer risk of twins appears similar to that of singletons.

A prospective study of tobacco use and multiple myeloma: evidence against an association

The relationship between the use of cigarettes and other tobacco products and the risk of multiple myeloma was examined in a cohort of nearly 250,000 American veterans followed prospectively for 26 years. Compared with men who had never used tobacco, the risk of death from myeloma was not increased among current (relative risk [RR]=0.9, 95 percent confidence interval [CI]=0.8−1.2) or former (RR=1.0, CI=0.8−1.3) cigarette smokers, nor among users of chewing tobacco or snuff (RR=1.0, CI=0.4−2.3). Risk was only slightly and nonsignificantly increased among pipe or cigar smokers (RR=1.2, CI=0.9−1.5). There was no indication of increasing risk with amount of tobacco used or earlier age at first use. With over 90 percent power to detect a 30 percent increased risk of this tumor occuring among current cigarette smokers, this study provides the strongest evidence to date against an association of cigarette smoking with multiple myeloma.

Cigarette smoking and liver cancer among US veterans

The relationship of tobacco use with risk of primary liver cancer was investigated using data from a 26-year mortality follow-up of nearly 250,000 US veterans, mostly from World War I. Significantly increased risks for liver cancer (289 deaths) were associated with most forms of tobacco use, including pipe and cigar smoking. Elevated relative tisks (RRs) were seen for current cigarette smokers (RR=2.4; 95 percent confidence interval [CI] 1.6–3.5) and former cigarette smokers (RR=1.9, 1.2–2.9). A strong dose-response relationship (P<0.001) was found for cigarette smoking, with smokers of 40 or more cigarettes per day having almost a fourfold risk (RR=3.8, 1.9–8.0). Risks were also found to increase significantly with years of cigarette use and with earlier age at the start of cigarette smoking. These results are consistent with those of other cohort and case-control studies, suggesting that cigarette smoking may be related to the risk of liver cancer.

Weight changes in adult twins

Longitudinal study of 514 pairs of US white male twin veterans was made possible by compiling data from military records, mailed questionnaires, and physical examinations. Height and weight were used to calculate the Quetelet index for twins at different ages covering induction into the Armed Forces (generally 17-24 years), 25 years, 40-50 years at questionnaire response, and 42-56 at physical examination. Cross-sectional analyses of Quetelet Index at these 4 points in time showed consistent evidence of significant genetic variance. Additional twin analyses of change in Quetelet Index both from induction and from age 25 to approximately age 48 were done. Both analyses showed significant genetic variance for change in Quetelet Index during this time span of 25 or more years for most subjects. Heritability estimates were 0.6 for change in Quetelet Index from induction (mean age 20) to examination (mean age 48) and 0.7 for change in Quetelet Index from age 25 to examination. While studies of younger twins have shown significant genetic influence on growth (height and weight), this study of adults demonstrates significant genetic influence on change in weight even after maturation.

Socioeconomic differentials in prognosis following episodes of coronary heart disease

Abstract Survival of first admissions to Army hospitals for coronary heart disease occurring from June 1943 to December 1944 was evaluated in a sample of 1495 white males who were alive 6 months after the date of admission. Included in this study are only cases whose hospital diagnosis was confirmed by an independent review of the history, laboratory data, and ECG recordings in their service medical records. Physicians were found to have a better prognosis than other occupations. When physicians were excluded, professional men with college education had a somewhat better survival than other occupation or education groupings. Physicians were more likely to have the diagnosis of angina pectoris or coronary insufficiency than others; however, their favorable prognosis was also found within diagnostic groups with specified ECG findings. The much better long-term survival of physicians may give some measure of the extent to which early detection and appropriate medical regimens can improve prognosis in coronary heart disease if followed by optimally motivated patients.