AIM:To validate the Rockall scoring system for predicting outcomes of rebleeding, and the need for a surgical procedure and death. METHODS:We used data extracted from the Registry of Upper Gastrointestinal Bleeding and Endoscopy including information of 1869 patients with non-variceal upper gastrointestinal bleeding treated in Canadian hospitals. Risk scores were calculated and used to classify patients based on outcomes. For each outcome, we used χ 2 goodness-of-fit tests to assess the degree of calibration, and built receiver operating characteristic curves and calculated the area under the curve (AUC) to evaluate the discriminative ability of the scoring system. RESULTS:

SUMMARYBackground: The administration of proton pump inhibitors intravenously after endoscopic treatment of peptic ulcers significantly reduces the recurrence of bleeding. Aim: To evaluate the incremental cost-effectiveness in Canada of intravenous proton pump inhibitor before endoscopic therapy to patients presenting with acute upper gastrointestinal bleeding, compared with endoscopic treatment alone. Methods: From a third-party payer perspective, we modelled the costs and effectiveness over 60 days of the two approaches using decision analysis. The probabilities of various outcomes, such as re-bleeding and the need for surgery, were taken from the published literature. We included the costs of intravenous proton

Of 165 ovarian metastases recorded in the files of L'Hôtel-Dieu de Québec, Canada, between 1951 and 1987, 64 (38%) were from breast adenocarcinomas. Histopathologic material was available in 59 instances, of which 22 were autopsy cases and 28 were incidental findings at therapeutic oophorectomy. The patients' ages ranged from 25 to 80 years (average, 48.6 years). Sixty-four percent of the metastases were bilateral and 36% were unilateral. An ovarian metastasis was detected before the breast cancer in only one instance. The median interval between the diagnosis of breast carcinoma and the ovarian metastasis was 11.5 months and was related to the initial stage of the breast disease. The median survival after the diagnosis of ovarian metastasis was 16 months. The ovaries were grossly normal in 27 (46%) cases and 18 (31%) metastases were less than 1 mm in diameter. The size of the metastases was not related to the interval after the diagnosis of the breast carcinoma and did not influence the outcome of the patients. Forty-four metastases (75%) showed an indian file or ductal patterns easily identifiable as metastases of breast origin. The remaining cases presented various histologic features mimicking primary ovarian tumors or tumor-like conditions such as stromal luteoma, hyperthecosis, dysgerminoma, granulosa cell tumor, and carcinoid tumor. No metastasis had features of Krukenberg tumor. The authors conclude that metastases from breast cancer are generally small and are the reflection of an advanced disease. A metastasis of breast origin can be suspected histologically in most cases.

The expression of the Rhizobium meliloti glutamyl-tRNA synthetase gene in Escherichia coli under the control of a trc promoter results in a toxic effect upon isopropyl-beta-D-thiogalactopyranoside induction, which is probably caused by a misacylation activity. To further investigate this unexpected result, we looked at the pathway of Gln-tRNAGln formation in R. meliloti. No glutaminyl-tRNA synthetase activity has been found in R. meliloti crude extract, but we detected a specific aminotransferase activity that changes Glu-tRNAGln to Gln-tRNAGln. Our results show that R. meliloti, a member of the alpha-subdivision of the purple bacteria, is the first Gram-negative bacteria reported to use a transamidation pathway for Gln-tRNAGln synthesis. A phylogenetic analysis of the contemporary glutamyl-tRNA synthetase and glutaminyl-tRNA synthetase amino acid sequences reveals that a close evolutionary relationship exists between R. meliloti and yeast mitochondrial glutamyl-tRNA synthetases, which is consistent with an origin of mitochondria in the alpha-subdivision of Gram-negative purple bacteria. A 256-amino acid open reading frame closely related to bacterial glutamyl-tRNA synthetases, which probably originates from a glutamyl-tRNA synthetase gene duplication, was found in the 4-min region of the E. coli chromosome. We suggest that this open reading frame is a relic of an ancient transamidation pathway that occurred in an E. coli ancestor before the horizontal transfer of a eukaryotic glutaminyl-tRNA synthetase (Lamour, V., Quevillon, S., Diriong, S., N'Guyen, V. C., Lipinski, M., and Mirande, M.(1994) Proc. Natl. Acad. Sci. U. S. A. 91, 8670-8674) and that it favored its stable acquisition. From these observations, a revisited model for the evolution of the contemporary glutamyl-tRNA synthetases and glutaminyl-tRNA synthetases that differs from the generally accepted model for the evolution of aminoacyl-tRNA synthetases is proposed.