- Email: [email protected]
Taste disturbance with acetazolamide
1446
RELATIVE RISK FOR LEUKAEMIA AND NON-HODGKIN LYMPHOMA AMONG DANISH PHYSICIANS HANDLING ANTINEOPLASTIC DRUGS
mucin
depletion and epithelial damage should surely be more susceptible to acid attack. We suggest that in a new histological classification of gastritis and H pylori such as the Sydney system aims for, the presence and number of H pylori, the bacterial distribution (continuous or patchy), the pattern of adhesion, and epithelial degeneration should be regarded as a major unit that can be classified in two well is closely related to the natural history of and distinguished patterns
morphological/functional peptic disease. School of Gastroenterology, University of Ferrara, 1-44100 Ferrara, Italy
MICHELE CASELLI ARRIGO ALEOTTI ALESSANDRO BARBONI VITTORIO ALVISI
1. Misiewicz JJ, Tytgat GNJ, Goodwin CS, et al. The Sydney system: a new classification of gastritis. In: Working party reports. World Congresses of Gastroenterology, 1990. Oxford: Blackwell Scientific Publications (in press). 2. Caselli M, Figura N, Trevisani L, et al. Patterns of physical modes of contact between Campylobacter pylori and gastric epithelium: implication about the bacterial pathogenidry. Am J Gastroenterol 1989; 84: 511-13.
*Adjusted for pairs.
sex
and age
by conditional logistic
regression
analysis
of matched
intervals for the risk estimates obtained in this study are broad. Longer follow-up or larger studies are needed for more exact risk estimates. Increased risks for miscarriage and congenital malformation among health personnel exposed to antineoplastic drugs have been reported4-7 and these drugs need handling with the utmost care.
Taste disturbance with acetazolamide SIR,-Dr McMurdo and colleagues (Nov 10, p 1190) report taste disturbance with acetazolamide in 3 subjects at altitude. Contrary to the perceived view this side-effect is well known to ophthalmologists who care for glaucoma patientsY This effect of the drug is not seen consistently among these patients, for unexplained reasons, but in a study from the UK,3it was noted in 3 patients who were on 500 mg of acetazolamide daily. Eye Department, Southport District General Hospital, Southport PR8 6NJ, UK 1. Lichter PR.
PATRICK W.
JOYCE
side-effects of carbonic
Reducing anhydrase inhibitors. Ophthalmology 1981; 88: 266-69. 2. Wistrand PJ. The use of carbonic anhydrase inhibitors in ophthalmology and clinical medicine. Ann NY Acad Sci 1984; 424: 609-19. 3. Joyce PW, Mills KB. Comparison of the effect of acetazolamide tablets and Sustets on diurnal intraocular pressure in patients with chronic simple glaucoma. Br J Ophthalmol 1990; 74: 413-16.
Risks for
physicians handling antineoplastic drugs
SiR,—The treatment of several diseases with alkylating antineoplastic drugs carries a substantial risk of secondary malignancies,1-3 and in the late 1970s concern arose about the potential risks to health-care personnel who handle these drugs. Some studies have focused on adverse reproductive outcomes in female nurses and physicians,’ but studies of cancer risks among health personnel have not been published. We have done a case-referent study of leukaemia and nonHodgkin lymphoma in a cohort of 21 781 physicians who had been members of the Danish Medical Association at any time during the period 1965-88. Almost all doctors in Denmark are members of this association. By linkage with the Danish cancer register in February, 1989, 20 incident cases of leukaemia and 25 incident cases of non-Hodgkin lymphoma were identified in the cohort. 4 sex and age matched referents were selected per case from the cohort at the time of diagnosis. Data about the careers of cases and controls were extracted from several sources, including the Danish Blue Book of Physicians, the Physicians’ Pension Fund, and hospital administrations. The proxy variable for exposure to antineoplastic drugs was employment for at least 6 months in a department which treated patients with these drugs at the time of the doctor’s employment. 5 cases and 16 controls had such work. The earliest exposure took place in 1950, and the latency period from the start of the exposure to the diagnosis ranged from 7 to 33 years. The relative risks for leukaemia and non-Hodgkin lymphoma following potential exposure to antineoplastic drugs are shown in the table. Relative risks were calculated by conditional logistic regression
analysis.8 Leukaemia and
producing few
non-Hodgkin lymphoma are rare diseases, in a large cohort, and the confidence
cases even
Danish Cancer Registry, Danish Cancer Society, DK-2100 Copenhagen, Denmark
TORSTEN SKOV ELSEBETH LYNGE
Department of Oncology, Københavns Amts Sygehus, Herlev
BIRGIT MAARUP
Institute of Social Medicine, University of Århus
JØRN OLSEN
Department of Oncology, Rigshospitalet, Copenhagen
MIKAEL RØRTH
Department of Haematology, Rigshospitalet, Copenhagen
HANNA WINTHEREIK
1. International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans suppl 7&mid ot; overall evaluation of carcinogenicity an
updating of IARC monographs 1 to 42 Lyon IARC, 1987. LJ. Incidence of cancer in rheumatoid arthritis and other disorders after immunosuppressive drugs. Am J Med 1985; 78 (suppl 1A): 44-49 3. Valagussa P, Santoro A, Fossati-Bellani F, Banfi A, Bonadonna G. Second acute leukemia and other malignancies following treatment for Hodgkin’s disease. J Clin Oncol 1986; 4: 830-37. 4. Hemminki K, Kyyronen P, Lindbohm M-L. Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of Commun Health 1985; 39: 141-47. outcome. Epidemiol J 5. Selevan SG, Lindbohm M-L, Homung RW, Hemminki K. A study of occupational exposure to antineoplastic drugs and fetal loss in nurses N Engl J Med 1985; 313: 2 Kinlen
1173-78 6. McDonald
AD, McDonald JC, Armstrong B, et al. Congenital defects and work m Br J Ind Med 1988; 45: 581-88. 7. Stucker I, Caillard J-F, Collin R, Gout M, Poyen D, Hemon D. Risk of spontaneous abortion among nurses handling antineoplastic drugs Scand J Work Environ Health 1990, 16: 102-07. 8. Breslow NE, Day NE. Statistical methods in cancer research, I: the analysis of pregnancy.
case-control studies.
Lyon: International Agency for Research on Cancer, 1980.
Effect of sodium monofluorophosphate and calcium on bone density and fracture rate in
osteoporosis S]R,—Dr Mamelle and colleagues (July 28, p 243) emphasise their positive results with fluoride preparations in the treatment of vertebral osteoporosis. The long European experience with fluoride is challenged by data from the US. We report preliminary results of a one-year prospective, controlled, double-blind trial with a sodium monofluorophosphate (MFP) preparation.2 20 patients with osteoporotic vertebral fractures received 100 mg MFP twice daily (equivalent to 13-2 mg fluoride) plus 1250 mg calcium carbonate as an effervescent tablet either on a continuous or on an intermittent monthly dose schedule (control, calcium only). Continuous therapy led to an increase of bone mineral density, as measured by computed tomographic densitometry, of 119 units (p < 0-05), whereas the increase with intermittent treatment was 3 units. These results are in accord with data from many research groups, and even a very cautious evaluation of fracture rates in this cohort indicates a beneficial effect, since only 3 vertebral fractures (0 188
RELATIVE RISK FOR LEUKAEMIA AND NON-HODGKIN LYMPHOMA AMONG DANISH PHYSICIANS HANDLING ANTINEOPLASTIC DRUGS
mucin
depletion and epithelial damage should surely be more susceptible to acid attack. We suggest that in a new histological classification of gastritis and H pylori such as the Sydney system aims for, the presence and number of H pylori, the bacterial distribution (continuous or patchy), the pattern of adhesion, and epithelial degeneration should be regarded as a major unit that can be classified in two well is closely related to the natural history of and distinguished patterns
morphological/functional peptic disease. School of Gastroenterology, University of Ferrara, 1-44100 Ferrara, Italy
MICHELE CASELLI ARRIGO ALEOTTI ALESSANDRO BARBONI VITTORIO ALVISI
1. Misiewicz JJ, Tytgat GNJ, Goodwin CS, et al. The Sydney system: a new classification of gastritis. In: Working party reports. World Congresses of Gastroenterology, 1990. Oxford: Blackwell Scientific Publications (in press). 2. Caselli M, Figura N, Trevisani L, et al. Patterns of physical modes of contact between Campylobacter pylori and gastric epithelium: implication about the bacterial pathogenidry. Am J Gastroenterol 1989; 84: 511-13.
*Adjusted for pairs.
sex
and age
by conditional logistic
regression
analysis
of matched
intervals for the risk estimates obtained in this study are broad. Longer follow-up or larger studies are needed for more exact risk estimates. Increased risks for miscarriage and congenital malformation among health personnel exposed to antineoplastic drugs have been reported4-7 and these drugs need handling with the utmost care.
Taste disturbance with acetazolamide SIR,-Dr McMurdo and colleagues (Nov 10, p 1190) report taste disturbance with acetazolamide in 3 subjects at altitude. Contrary to the perceived view this side-effect is well known to ophthalmologists who care for glaucoma patientsY This effect of the drug is not seen consistently among these patients, for unexplained reasons, but in a study from the UK,3it was noted in 3 patients who were on 500 mg of acetazolamide daily. Eye Department, Southport District General Hospital, Southport PR8 6NJ, UK 1. Lichter PR.
PATRICK W.
JOYCE
side-effects of carbonic
Reducing anhydrase inhibitors. Ophthalmology 1981; 88: 266-69. 2. Wistrand PJ. The use of carbonic anhydrase inhibitors in ophthalmology and clinical medicine. Ann NY Acad Sci 1984; 424: 609-19. 3. Joyce PW, Mills KB. Comparison of the effect of acetazolamide tablets and Sustets on diurnal intraocular pressure in patients with chronic simple glaucoma. Br J Ophthalmol 1990; 74: 413-16.
Risks for
physicians handling antineoplastic drugs
SiR,—The treatment of several diseases with alkylating antineoplastic drugs carries a substantial risk of secondary malignancies,1-3 and in the late 1970s concern arose about the potential risks to health-care personnel who handle these drugs. Some studies have focused on adverse reproductive outcomes in female nurses and physicians,’ but studies of cancer risks among health personnel have not been published. We have done a case-referent study of leukaemia and nonHodgkin lymphoma in a cohort of 21 781 physicians who had been members of the Danish Medical Association at any time during the period 1965-88. Almost all doctors in Denmark are members of this association. By linkage with the Danish cancer register in February, 1989, 20 incident cases of leukaemia and 25 incident cases of non-Hodgkin lymphoma were identified in the cohort. 4 sex and age matched referents were selected per case from the cohort at the time of diagnosis. Data about the careers of cases and controls were extracted from several sources, including the Danish Blue Book of Physicians, the Physicians’ Pension Fund, and hospital administrations. The proxy variable for exposure to antineoplastic drugs was employment for at least 6 months in a department which treated patients with these drugs at the time of the doctor’s employment. 5 cases and 16 controls had such work. The earliest exposure took place in 1950, and the latency period from the start of the exposure to the diagnosis ranged from 7 to 33 years. The relative risks for leukaemia and non-Hodgkin lymphoma following potential exposure to antineoplastic drugs are shown in the table. Relative risks were calculated by conditional logistic regression
analysis.8 Leukaemia and
producing few
non-Hodgkin lymphoma are rare diseases, in a large cohort, and the confidence
cases even
Danish Cancer Registry, Danish Cancer Society, DK-2100 Copenhagen, Denmark
TORSTEN SKOV ELSEBETH LYNGE
Department of Oncology, Københavns Amts Sygehus, Herlev
BIRGIT MAARUP
Institute of Social Medicine, University of Århus
JØRN OLSEN
Department of Oncology, Rigshospitalet, Copenhagen
MIKAEL RØRTH
Department of Haematology, Rigshospitalet, Copenhagen
HANNA WINTHEREIK
1. International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans suppl 7&mid ot; overall evaluation of carcinogenicity an
updating of IARC monographs 1 to 42 Lyon IARC, 1987. LJ. Incidence of cancer in rheumatoid arthritis and other disorders after immunosuppressive drugs. Am J Med 1985; 78 (suppl 1A): 44-49 3. Valagussa P, Santoro A, Fossati-Bellani F, Banfi A, Bonadonna G. Second acute leukemia and other malignancies following treatment for Hodgkin’s disease. J Clin Oncol 1986; 4: 830-37. 4. Hemminki K, Kyyronen P, Lindbohm M-L. Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of Commun Health 1985; 39: 141-47. outcome. Epidemiol J 5. Selevan SG, Lindbohm M-L, Homung RW, Hemminki K. A study of occupational exposure to antineoplastic drugs and fetal loss in nurses N Engl J Med 1985; 313: 2 Kinlen
1173-78 6. McDonald
AD, McDonald JC, Armstrong B, et al. Congenital defects and work m Br J Ind Med 1988; 45: 581-88. 7. Stucker I, Caillard J-F, Collin R, Gout M, Poyen D, Hemon D. Risk of spontaneous abortion among nurses handling antineoplastic drugs Scand J Work Environ Health 1990, 16: 102-07. 8. Breslow NE, Day NE. Statistical methods in cancer research, I: the analysis of pregnancy.
case-control studies.
Lyon: International Agency for Research on Cancer, 1980.
Effect of sodium monofluorophosphate and calcium on bone density and fracture rate in
osteoporosis S]R,—Dr Mamelle and colleagues (July 28, p 243) emphasise their positive results with fluoride preparations in the treatment of vertebral osteoporosis. The long European experience with fluoride is challenged by data from the US. We report preliminary results of a one-year prospective, controlled, double-blind trial with a sodium monofluorophosphate (MFP) preparation.2 20 patients with osteoporotic vertebral fractures received 100 mg MFP twice daily (equivalent to 13-2 mg fluoride) plus 1250 mg calcium carbonate as an effervescent tablet either on a continuous or on an intermittent monthly dose schedule (control, calcium only). Continuous therapy led to an increase of bone mineral density, as measured by computed tomographic densitometry, of 119 units (p < 0-05), whereas the increase with intermittent treatment was 3 units. These results are in accord with data from many research groups, and even a very cautious evaluation of fracture rates in this cohort indicates a beneficial effect, since only 3 vertebral fractures (0 188