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BMJ No 7119 Volume 315 Papers - Abstracts Saturday 22 November 1997
Association of upper gastrointestinal toxicity of non-steroidal
anti-inflammatory drugs with continued exposure: cohort study Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort studyT M MacDonald, S V Morant, G C Robinson, M J Shield, M M McGilchrist, F E Murray, D G McDevittT M MacDonald, S V Morant, G C Robinson, M J Shield, M M McGilchrist, F E Murray, D G McDevitt AbstractObjectives: To determine the profile of risk of upper gastrointestinal toxicity during continuous treatment with, and after cessation of, non-steroidal anti-inflammatory drugs.Design: Cohort study with a prospectively constructed, population based, record linkage database containing details of exposure to all community dispensed non-steroidal anti-inflammatory drugs and also all admissions to hospital for upper gastrointestinal diagnoses. Setting: The population of Tayside, Scotland. Subjects: 52,293 subjects aged 50 and over who received one or more non-steroidal anti-inflammatory between 1 January 1989 and 31 December 1991 and 73,792 subjects who did not receive one during the same period (controls). Main outcome measures: Admission to hospital for upper gastrointestinal bleeding and perforation, and admission for other upper gastrointestinal diagnoses. Results: About 2% of the non-steroidal anti-inflammatory cohort were admitted with an upper gastrointestinal event during the study period compared with 1.4% of controls. The risk of admission for upper gastrointestinal haemorrhage and perforation was constant during continuous non-steroidal anti-inflammatory exposure and carried over after the end of exposure. The results were similar for admissions for all upper gastrointestinal events. Conclusion: This study provides evidence that non-steroidal anti-inflammatory toxicity persists with continuous exposure. There seems to be carryover toxicity after the end of prescribing. These findings have implications for the management of patients requiring non-steroidal anti-inflammatory drugs.
Medicines Monitoring Unit, Searle, Correspondence to: Dr MacDonald
Randomised trial of octreotide for long term management of cirrhosis after variceal haemorrhageSpencer A Jenkins, John N Baxter, Mair Critchley, Andrew N Kingsnorth, Carol A Makin, Simon Ellenbogen, J Steven Grime, Janet G Love, Robert Sutton
AbstractObjective: To assess the efficacy of long term octreotide as adjuvant treatment to programmed endoscopic sclerotherapy after acute variceal haemorrhage in cirrhotic portal hypertension.Design: Randomised clinical trial. Setting: University hospital. Subjects: 32 patients with cirrhotic portal hypertension. Interventions: Programmed injection sclerotherapy with subcutaneous octreotide 50 µg twice daily for 6 months, or programmed injection sclerotherapy alone. Main outcome measures: Episodes of recurrent variceal bleeding and survival. Results: Significantly fewer patients receiving combined octreotide and sclerotherapy had episodes of recurrent variceal bleeding compared with patients given sclerotherapy alone (1/16 v 7/16; P=0.037, Fisher's exact test), and their survival was significantly improved (P<0.02, log rank test); this improvement was maintained for 12 months after the end of the study. Combined treatment also resulted in a sustained decrease in portal pressure (median decrease -6.0 mm Hg, interquartile range -10 to -4.75 mm Hg, P=0.0002) compared with sclerotherapy alone (median increase 1.5 mm Hg, interquartile range 0.25 to 3.25 mm Hg), as well as a significant improvement in liver function as assessed by plasma concentrations of bilirubin, albumin, and alanine aminotransferase and by hepatocyte metabolism of aminopyrine labelled with carbon-14. Conclusion: Long term octreotide may be a valuable adjuvant to endoscopic sclerotherapy for acute variceal haemorrhage in cirrhotic portal hypertension. Departments of Surgery and Nuclear
Medicine, Robertson Centre for
Biostatistics, Correspondence to: Mr R Sutton
Clinical and Cancer Trial Unit, Does malnutrition in utero determine diabetes and coronary heart disease in adulthood? Results from the Leningrad siege study, a cross sectional studyS A Stanner, K Bulmer, C Andrès, O E Lantseva, V Borodina, V V Poteen, J S YudkinAbstractObjectiveDesign: Cross sectional study. Subjects: 169 subjects exposed to malnutrition in utero (intrauterine group) during the siege of Leningrad (now St Petersburg) in 1941-4; 192 subjects born in Leningrad just before rationing began, before the siege (infant group); and 188 subjects born concurrently with the first two groups but outside the area of the siege (unexposed group). Setting: Ott Institute of Obstetrics and Gynaecology, St Petersburg. Main outcome measures: Development of risk factors for coronary heart disease and diabetes mellitus - obesity, blood pressure, glucose tolerance, insulin concentrations, lipids, albumin excretion rate, and clotting factors. Results: There was no difference between the subjects exposed to starvation in utero and those starved during infant life in: (a) glucose tolerance (mean fasting glucose: intrauterine group 5.2 (95% confidence interval 5.1 to 5.3), infant group 5.3 (5.1 to 5.5), P=0.94; mean 2 hour glucose: intrauterine group 6.1 (5.8 to 6.4), infant group 6.0 (5.7 to 6.3), P=0.99); (b) insulin concentration; (c) blood pressure; (d) lipid concentration; or (e) coagulation factors. Concentrations of von Willebrand factor were raised in the intrauterine group (156.5 (79.1 to 309.5)) compared with the infant group (127.6 (63.9 to 254.8); P<0.001), and female subjects in the intrauterine group had a stronger interaction between obesity and both systolic (P=0.01) and diastolic (P=0.04) blood pressure than in the infant group. Short adult stature was associated with raised concentrations of glucose and insulin 2 hours after a glucose load - independently of siege exposure. Subjects in the unexposed group had non-systematic differences in subscapular to triceps skinfold ratio, diastolic blood pressure, and clotting factors compared with the exposed groups. Conclusions: Intrauterine malnutrition was not associated with glucose intolerance, dyslipidaemia, hypertension, or cardiovascular disease in adulthood. Subjects exposed to malnutrition showed evidence of endothelial dysfunction and a stronger influence of obesity on blood pressure. Department of Medicine,
Correspondence to: Ms Stanner Design: Controlled trial, randomised
by general practice.
Setting: Inner London borough of
Newham.
Subjects: 2,064 women aged 50-64 years who had
failed to attend for breast screening. Women came from 26 of 37
eligible practices. 31% were white, 17% were Indian, 10% Pakistani,
14% black, 6% Bangladeshi, 1% Chinese, 4% were from other ethnic
groups, and in 16% the ethnic group was not reported.
Main outcome measures: Attendance for
breast screening in relation to ethnic group in women who had not taken
up their original invitation.
Results: Attendance in the
intervention group was significantly better than in the control group
(9% v 4%). The response was best in Indian women - it
was 19% in the intervention group and 5% in the control group.
Conclusions: This simple, low cost intervention
improved breast screening rates modestly. Improvement was greatest in
Indian women - probably because many practice staff shared their
cultural and linguistic background. This intervention could be
effective as part of a multifaceted strategy to improve uptake in areas
with low rates.
Healthy Eastenders Project, Department of Medical Statistics and Evaluation, North Thames Breast Programme Quality
Assurance,
Correspondence to: Dr Robson
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