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BMJ No 7119 Volume 315 This week in brief Saturday 22 November 1997 Patients do not become tolerant to adverse effects of NSAIDs Octreotide improves survival in cirrhotic portal hypertension Malnutrition in utero in Leningrad siege did not predict adult diabetes or heart disease Regional trauma care system does not improve patients' chances of surviving major trauma Close HLA matching might lead to unequal access to kidney transplantion Reception staff can improve uptake of breast screening Patients do not become tolerant to adverse effects of NSAIDs Non-steroidal anti-inflammatory drugs are associated with serious upper gastrointestinal complications, but few data are available on the risk with continuous treatment. In their record linkage cohort study MacDonald et al found that the risk of upper gastrointestinal events was constant with continuous exposure and that the risk carried over for some time after the end of treatment (p 1333). These data provide strong evidence against the notion that patients become tolerant to these drugs. The authors suggest that patients at high risk should ideally avoid them altogether. Those who are treated should receive the lowest effective dose of the least toxic non-steroidal anti-inflammatory for the shortest possible time. Octreotide improves survival in cirrhotic portal hypertension The long term use of vasoactive drugs as adjuvant treatment to endoscopic sclerotherapy or ligation to reduce the risk of variceal rebleeding and death after the early control of acute variceal haemorrhage has been mooted. In a randomised controlled trial Jenkins et al compared long term octreotide combined with injection sclerotherapy with injection sclerotherapy alone in patients with cirrhotic portal hypertension. It was associated with a significant reduction in variceal rebleeding and an improvement in survival. Malnutrition in utero in Leningrad siege did not predict adult diabetes or heart disease Many studies have shown relations between measures of intrauterine growth and adult disease such as hypertension, diabetes, and cardiovascular disease and suggested that this could result from inadequate food intake during pregnancy. On p 1342 Stanner et al report their findings from a study of subjects exposed to malnutrition in utero during the siege of Leningrad, comparing them with subjects born before the siege began and subjects born concurrently outside the area of the siege. Intrauterine malnutrition was not associated with adult diabetes, dyslipidaemia, hypertension, or cardiovascular disease. Regional trauma care system does not improve patients' chances of surviving major trauma The Royal College of Surgeons recommended the development of regional trauma centres in an attempt to reduce avoidable trauma deaths. Over four years, Nicholl and Turner (p 1349) evaluated the effect of a regional trauma system in the north west Midlands on the survival of patients with major trauma. They found little evidence of the development of an integrated trauma system, and the proportion of patients taken directly to the trauma centre increased only for those with multiple injuries. Compared with two control regions, there was no consistent evidence that the regional trauma system improved patients' chance of survival from major trauma. Close HLA matching might lead to unequal access to kidney transplantion To see whether their unit's policy of close HLA matching of donors and recipients was reducing the chances of ethnic minority patients getting a kidney transplant Higgins et al measured the rates of renal failure, kidney donation, and transplantation among white and Indo-Asian populations of Coventry and Warwickshire (p 1354). Similar proportions of both groups were placed on waiting lists for transplants, but 33% of Indo-Asians and 19% of Europeans remained on the list for over two years. The Indo-Asians had a lower rate of organ donation, a different distribution of blood groups, and a lower proportion in each blood group who received transplants. Since 1996 the unit has loosened its HLA matching policy slightly to try to ensure that all patients waiting more than two years are offered a kidney. Reception staff can improve uptake of breast screening In another study looking at equity of access to services Atri et al performed a randomised controlled trial to improve the uptake of breast screening in a multicultural locality by training receptionists to contact non-respondents (p 1356). In the intervention group 9% of non-responders attended compared with 4% in the control group: the rates were 19% v 5% among Indian women, who formed the largest minority group and accounted for many reception staff. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline