Johanna Adami, Morten Frisch, Jonathan Yuen, Bengt Glimelius, Mads Melbye
Abstract
Objective - To investigate a possible link between exposure to ultraviolet light and the almost epidemic increase in non - Hodgkin's Iymphoma worldwide. Because ultraviolet light is known to cause skin cancers, the association between non-Hodgkin's Iymphoma and skin cancer was studied.
Design - Secondary occurrence of either malignant melanoma or squamous cell skin cancer in cohorts of patients with a first diagnosis of either non-Hodgkin's Iymphoma or chronic Iymphocytic leukaemia, and vice versa, were studied. Expected numbers of subsequent cancers were calculated by sex, age, and period specific national incidence rates multiplied by the person years under observation in the cohorts.
Setting - Denmark (1943-89) and Sweden (1958 - 89).
Subjects - Four population based cohorts identified in the nationwide cancer registries (34 641 people with non-Hodgkin's Iymphoma, 17400 with chronic Iymphocytic leukaemia, 34989 with malignant melanoma, 25 980 with squamous cell skin cancer). A total of 562 085 person years were accrued for the analysis.
Main outcome measures - The ratios of observed to expected cancers (the standardised incidence ratio) served as a measure of the relative risk.
Results - The relative risk for developing squamous cell skin cancer was 5.5 (95% confidence interval 4.6 to 6.6) among patients with non-Hodgkin's Iymphoma and 8.6 (7.2 to 10.3) among patients with chronic Iymphocytic leukaemia. The relative risk remained high over more than 15 years of follow up. Relative risks for malignant melanoma were 2.4 (1.8 to 3.2) for patients with non-Hodgkin's Iymphoma and 3.1 (2.1 to 4.4) for patients with chronic Iymphocytic leukaemia. After squamous cell skin cancer had been diagnosed there was a twofold excess risk for non-Hodgkin's Iymphoma and chronic Iymphocytic leukaemia. By contrast, in each of the cohorts the general cancer risks excluding skin and Iymphoproliferative malignancies were close to the expected.
Conclusions - The occurrence of non-Hodgkin's Iymphoma and skin cancer are strongly associated; this supports the hypothesis that the secular increase in exposure to ultraviolet light may have contributed to the increasing incidence of non-Hodgkin's Iymphoma in recent decades
Department of Cancer Epidemiology University Hospital S-751 85 Uppsala Sweden Johanna Adami doctoral student Jonathan Yuen senior researcher
Danish Epidemiology Science Centre Statens Seruminstitut DK-2300 Copenhagen S Denmark Morten Frisch doctoral student Mads Melbye professor
Department of Oncology University Hospital Uppsala Sweden Bengt Glimelius associate professor
Correspondence to: Ms Adami.
Somatostatin v placebo in bleeding oesophageal varices: randomised trial and meta-analysis
Peter C Gøtsche, Ida Gjørup, Helen Bonnén, Niels Erik Bille Brahe, Ulrik Becker, Flemming Burcharth
Abstract
Objective - To study whether somatostatin or its derivative octreotide is more effective than placebo for treating bleeding oesophageal varices.
Methods - Randomised, double blind trial and meta-analysis with blinded analysis of data and writing of manuscripts.
Setting - Departments of medical and surgical gastroenterology in Copenhagen.
Subjects - Patients suspected of bleeding from oesophageal varices and of having cirrhosis of the liver.
Main outcome measures - Survival, number of blood transfusions, and use of Sengstaken-Blakemore tube.
Results - 86 patients were randomised; in each group 16 died within six weeks (95% confidence interval for difference in mortality - 19% to 22%). There were no differences between those treated with somatostatin or placebo in median number of blood transfusions (8 v 5, P= 0.07, 0 to 4 transfusions) or in numbers of patients who needed balloon tamponade (16 v 13, P=0.54, -11% to 28%). In a meta-analysis of three trials involving 290 patients somatostatin had no effect on survival compared with placebo (P=0.59, odds ratio 1.16; 0.67 to 2.01). For blood transfusions and use of balloon tamponade there was heterogeneity between the trials with no convincing evidence in favour of somatostatin. No placebo controlled trials have been performed with octreotide.
Conclusion - Within the limited power of this study and meta-analysis we were unable to show a clinical benefit of somatostatin in the emergency treatment of bleeding oesophageal varices.
Department of Medical Gastroenterology Hvidovre Hospital Denmark
Peter C Gøtzsche registrar Helen Bonnén registrar Ulrik Becker senior registrar
Department of Surgical Gastroenterology Herlev Hospital Denmark
Ida Gjørup registrar Niels Erik Bille Brahe senior registrar Flemming Burcharth chief physician
Correspondence to: Dr Gøtzsche, Director of Nordic Cochrane Centre, Research and Development Secretariat, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen 0, Denmark.
The analgesic effect of sucrose in full term infants: a randomised controlled trial
Nora Haouari, Christopher Wood, Gillian Griffiths, Malcolm Levene
Abstract
Objective - To evaluate the effects of different sucrose concentrations on measures of neonatal pain.
Design - Randomised, double blind, placebo controlled trial of sterile water (control) or one of three solutions of sucrose - namely, 12.5%, 25%, and 50% wt/vol.
Setting - Postnatal ward.
Patients - 60 healthy infants of gestational age 37 42 weeks and postnatal age 1-6 days randomised to receive 2 ml of one of the four solutions on to the tongue two minutes before heel prick sampling for serum bilirubin concentrations.
Main outcome measure - Duration of crying over the first three minutes after heel prick.
Results - There was a significant reduction in overall crying time and heart rate after three minutes in the babies given 50% sucrose as compared with controls. This was maximal one minute after heel prick in the 50% sucrose group and became statistically significant in the 25% sucrose group at two minutes. There was a significant trend for a reduction in crying time with increasing concentrations of sucrose over the first three minutes.
Conclusion - Concentrated sucrose solution seems to reduce crying and the autonomic effects of a painful procedure in healthy normal babies. Sucrose may be a useful and safe analgesic for minor procedures in neonates.
University Division of Paediatrics and Child Health D Floor Clarendon Wing Leeds General Infirmary Leeds LS2 9NS
Nora Haouari visiting clinical fellow Christopher Wood lecturer Gillian Griffiths research nurse Malcolm Levene professor of paediatrics
Correspondence to: Professor Levene.
I Philp, K J McKee, P Meldrum, B R Ballinger, M L M Gilhooly, D S Gordon, W J Mutch, J E Whittick
Abstract
Objective - To measure and compare perceived financial burden, use of services, and perceived unmet service needs of supporters of demented and non-demented elderly people.
Design - Comparison study of age and sex matched demented and non-demented elderly people and their supporters.
Setting - 25 primary health care teams in Dundee.
Subjects - 114 community resident elderly (age over 65) people with dementia, 114 age and sex matched comparators, and the main informal supporter of each elderly person.
Main outcome measures - Carers' perceptions of financial impact of looking after an old person, service use (from a list of locally available services), unmet service needs, and needs for three types of generic service (help with supervision, housework, or personal care).
Results - Financial impact was low, except for extra household expense in the dementia group. There was significantly greater use of mainstream domiciliary and day care services in the dementia group. Dementia was nevertheless associated with a high level of unmet need, mainly for more mainstream support and help with supervision of the elderly person.
Conclusion - Supervisory care for demented elderly people should be further developed within an expanded domiciliary service to meet supporters needs.
Department of Geriatric Medicine Royal Victoria Hospital Dundee I Philp senior registrar W J Mutch consultant geriatrician
University Department of Medicine Section of Aging and Health Ninewells Hospital and Medical School Dundee K J McKee research fellow D S Gordon research fellow
University Department of Public Health Health Economics Research Unit Aberdeen P Meldrum research assistant
Royal Dundee Liff Hospital Dundee B R Ballinger consultant psychiatrist
University Behavioural Sciences Group Glasgow M L M Gilhooly lecturer
Bangor District General Hospital Lothian J E Whittick consultant psychologist
Correspondence to: Professor Ian Philp University Department of Health Care for Elderly People, Brearly Wing, Northern General Hospital, Sheffield S5 7AU.