Ultraviolet light may have caused increased incidence of non-Hodgkin's lymphomas
The universality of the increase in the incidence of non-Hodgkin's Iymphoma over the past few decades suggests that exposure to underlying causal factors must be generally increasing. Conditions affecting immune function are documented as risk factors for non-Hodgkin's Iymphoma. To test the hypothesis that ultraviolet light, which is known to affect the immune system, could be linked to non-Hodgkin's Iymphoma, Adami et al (p 1491) used squamous cell skin cancer and malignant melanoma as surrogate markers for exposure to ultraviolet light. In 560000 person years accumulated in cancer patients diagnosed in Denmark and Sweden 1943-89, patients with non-Hodgkin's Iymphoma or chronic Iymphocytic leukaemia had up to nine times the risk of developing a skin cancer than did the general population. After a diagnosis of squamous cell skin cancer, there was a twofold risk of developing systemic malignancies. This is strong evidence that increased exposure to ultraviolet light has contributed to the increased incidence of non Hodgkin's Iymphoma in recent decades.
Somatostatin does not stop bleeding oesophageal varices
Bleeding oesophageal varices are life threatening, with high mortality. Various treatments are recommended despite lack of data from randomised trials. As bleeding often stops spontaneously, the clinician may easily be misled to believe that his or her preferred treatment is effective. Somatostatin and its derivative, octreotide, are no exceptions. A placebo controlled trial reported by G¿tzsche et al (p 1495) failed to show a benefit of somatostatin. Increasing the power by meta-analysis of the three trials performed so far did not change this conclusion. No placebo controlled trials have been reported with octreotide. Thus, there is no convincing evidence to support the widespread use of these drugs, although more studies are needed.
Family carers of demented elderly people need more help
Considerable efforts have been made to describe the circumstances of family care for demented elderly people. But the additional consequences of caring for someone with dementia over and above those of caring for an older relative without dementia have been little studied. On p 1503 Philp et al compare community based care in two matched groups of elderly people with and without dementia in a Scottish city. Contrary to expectation, the perceived financial impact on family supporters was not particularly high. On the other hand, demented elderly people and their carers made significantly greater use of mainstream domiciliary and day care services, and the carers of demented people had unmet needs for support in occupying and supervising them. Philp et al conclude that supervisory care for demented elderly people should be expanded to meet family carers' needs.
Sucrose on the tongue may be an effective analgesic in neonates
Every baby born in Britain is subjected to several painful procedures during the first few months, yet little is done to reduce the distress of these procedures. On p 1498 Haouari et al report a double blind randomised controlled trial of pretreatment with a sucrose solution to reduce pain, measured as the crying time after blood sampling. They applied one of four solutions (2 ml sterile water (control) or 12 5%, 25%, or 50% sucrose solution) to the tongues of 60 healthy neonates two minutes before blood sampling by heel prick. Both 25% and 50% sucrose solutions were associated with a significant reduction in crying time. There was a significant trend for a reduction in crying time with increasing concentrations of sucrose.