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Objective. To determine if preendoscopy Rockall score (PERS) enables safe outpatient management of New Zealanders with upper gastrointestinal haemorrhage (UGIH). Methods. Retrospective analysis of adults with UGIH over 59 consecutive months. PERS, diagnosis, demographics, need for endoscopic therapy, transfusion or surgery and 30-day mortality and 14-day rebleeding rate, and sensitivity and specificity of PERS for enabling safe discharge preendoscopy were calculated. Results. 424 admissions with UGIH. Median age was 74.3 years (range 19–93 years), with 55.1% being males. 30-day mortality was 4.6% and 14-day rebleeding rate was 6.0%. Intervention was required in 181 (46.6%): blood transfusion (147 : 37.9%), endoscopic intervention (75 : 19.3%), and surgery (8 : 2.1%). 42 (10.8%) had PERS = 0 with intervention required in 15 (35.7%). Females more frequently required intervention, OR 1.73 (CI: 1.12–2.69). PERS did not predict intervention but did predict 30-day mortality: each point increase equated to an increase in mortality of OR 1.46 (CI: 1.11–1.92). Taking NSAIDs/aspirin reduced 30-day mortality, OR 0.22 (CI: 0.08–0.60). Conclusion. PERS identifies 10.8% of those with UGIH as low risk but 35.7% required intervention or died. It has a limited role in assessing these patients and should not be used to identify those suitable for outpatient endoscopy.

Gallium nitrate, an approved antitumor drug, has found clinical application in the treatment of cancer-related hypercalcemia and of Paget’s disease; the exact mechanism of its action, however, remains unknown. The present study utilized rats in a 7-day exposure to gallium at doses similar to those used clinically. Quantitative histomorphometry and ultrastructural examination of osteoclast fine structure were carried out on specimens from animals with documented hypocalcemia. Gallium exposure produced striking changes in the osteoclast. The number of nuclei/osteoclast increased, and the ruffled borders of the osteoclasts were markedly decreased along the length of the Howship’s lacunar cavity. The absence of a decrease in osteoclast number and the types of changes seen in ultrastructure suggest that the mechanism of action of gallium seen here may differ from that of calcitonin, a nontoxic, reversible antiresorbing agent. Results underscore the difficulty in assessing the toxicity of agents such as gallium on the osteoclast, a mature differentiated cell which does not divide and which does not produce a characteristic extracellular matrix component.

IntroductionThe aim of this retrospective study was to evaluate the patient demographics, route of admission, main diagnosis, duration of stay and quality of discharge summaries on the two 25 bedded gastroenterology wards at Leeds teaching hospitals NHS trust (LTHT) over a two month period. LTHT is a tertiary referral GI unit with 9 WTE consultants covering a population of 800,000. Leeds has one of six UK liver transplant units but non-transplant hepatology is covered by general gastroenterology. Methods Patients admitted over a 2 month period on the two designated gastroenterology wards were identified from ward registers of admission. Information regarding age, gender, route of admission, main diagnosis, duration of stay and quality of the discharge summary were recorded. Results 362 patients were identified (123 (55%) male, mean age of 54 (range of 17 to 96)). Routes of admission were 254 (70%) from the emergency department or surgical assessment unit, 43 (12%) day cases, 18 (5%) elective admissions, 18 (5%) transferred from other specialities, 15 (4%) from clinic, 7 (2%) from endoscopy and 7 (2%) unclear. The main diagnoses are listed in table 1. There were 13 deaths (4% mortality). 305 patients (91%) had discharge summaries of which 290 (95%) were completed on time. Patients who died or were transferred to other specialities were not included.