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The aim of this study was to compare the colon-cleansing effectiveness, ease of consumption, and side effect profiles of two commercially available preparations of sodium phosphate: liquid Fleet Phospho-soda and Visicol tablets.Outpatients undergoing elective colonoscopy were sequentially randomized to one of two preparation groups: liquid: 45 ml at 7:00 PM, 45 ml 3 h before colonoscopy; or tablet: 20 tablets at 7:00 PM, 20 tablets 3-5 h before colonoscopy. Subjects rated preparation tolerability on a 5-point Likert scale. A Residual Stool Score was calculated for each subject based on the amount of stool, consistency of residual stool, and percent of bowel visualized (range 0-11, 0 = best). The endoscopists were blinded to the preparation used.A total of 101 subjects were enrolled (43 male, 58 female, mean age 58.2 yr). The groups were similar in age and indications for colonoscopy. Overall, bowel cleansing was rated "Excellent" or "Good" in 92% of liquid preparation subjects, compared with 74% of tablet preparation subjects (p = 0.03). Subjects in the liquid group demonstrated significantly less residual stool than did tablet subjects (Residual Stool Scores: liquid 1.3 +/- 1.2 vs tablet 1.9 +/- 1.5, p0.05). Subjects rated the liquid preparation easier to swallow (p0.005) and more convenient to take (p0.005) than tablets. Among liquid subjects, 45 of 50 reported a willingness to take their preparation for future colonoscopies, compared with 36 of 49 who took tablet sodium phosphate (p0.04).Liquid sodium phosphate is better tolerated and more effective at colon cleansing when compared with sodium phosphate in tablet form.

Magnetic resonance spectroscopy (MRS) provides a means to assess functional (metabolic activity) of the brain. It is now possible to perform MRS in a clinical setting with the use of an inexpensive software package called Proton Brain Exam/Single Voxel (PROBE/SV) developed by General Electric Medical System for use on their 1.5-T MR scanner. We have used PROBE for over a year and have found it to be useful in the evaluation of brain abnormalities. Most of our experience with MRS has been in the evaluation of children with brain tumors. In this first article of a two-part series, a simplified introduction to single-voxel MRS is presented, including: 1) the differences in the normal MRS spectra of the brains of infants, children, and adults demonstrating the variation in peaks of the common metabolities (N-acetylasparate, creatine, and choline); 2) the two types of MRS pulse sequences, stimulated echo acquisition mode (STEAM), a T1-weighted sequence, and point resolved spectroscopy (PRESS), a T2-weighted sequence; and 3) some of the factors that influence the production of diagnostic and nondiagnostic spectra. Part Two will report findings on the efficacy of MRS in children with brain tumors. With a basic understanding of MRS, the abnormal spectra in the diagnosis of brain tumors can be appreciated.

Multicenter endoscopist-blinded trial of low-dose bowel preparations for colonoscopy: liquid sodium phosphate vs. two dosing regimens of tablet sodium phosphate

In Part I of this article, we present our data collected over the past 8 years on the clinical evaluations of pediatric brain tumors with an emphasis placed on the more common neoplasms. Our data consists of 385 children ranging in age from newborn to 18 years. The majority of children presented with signs of raised intracranial pressure (including nausea, vomiting, and headaches), seizures or other focal neurologic deficits. Five percent of our children presented to outlying hospitals with symptoms that retrospectively turned out to be due to brain neoplasms but were misdiagnosed as "gastroenteritis," "viral upper respiratory tract infection," or even viral meningitis. These delays in diagnosis can cause serious negative outcomes for these patients and can be avoided through more careful neurologic and ophthalmologic examination at the time of first presentation. Central nervous system neoplasms are not uncommon in children and any child presenting with nausea, vomiting, and headaches should raise the suspicion of a primary brain tumor and should receive both a thorough neurologic exam and screening for papilledema. If papilledema is present, these children should be referred for proper neuroradiologic evaluation (which will be addressed in Part II.

This article reports the results of clinical testing in pediatric patients of a new contrast agent, gadoteridol injection (ProHance), developed by Squibb Diagnostic as a nonionic gadolinium agent for use in magnetic resonance imaging (MRI). Thirteen children (four girls and nine boys) ranging in age from 10 to 18 years were enrolled in the study. The children had MR studies of the brain and/or spine with T1-weighted, T2-weighted, and postgadoteridol injection T1-weighted sequences. Five children had primary brain or spine neoplasms, three children had metastatic disease to the central nervous system, one child had a recurrent brain neoplasm and spinal canal metastasis, one child had an arteriovenous malformation, and two children were normal on the MRI studies. No minor or major reactions to gadoteridol injection developed in the 13 patients. Gadoteridol injection provided excellent delineation and enhancement of the arteriovenous malformation and all of the primary and secondary neoplasms of the central nervous system except for one case of a grade 1 glioma of the midbrain. Gadoteridol injection is a safe and excellent contrast agent for use in MRI.

We have previously demonstrated in a pilot study that phospho-soda is equivalent to PEG lavage in colon cleansing effectiveness (Am J Gastro 1998;93:A1684). PURPOSE: To compare the colon cleansing effectiveness, ease of consumption, and metabolic effects of phospho-soda (PS) and PEG lavage given as colonoscopic preparation. METHODS: Outpatients undergoing elective colonoscopy were randomized to receive either a phospho-soda prep kit (PS 45cc at 6pm + bisacodyl 3 P.O. hs + bisacodyl enema am) or PEG lavage (4L at 4pm) prior to colonoscopy. Subjects with creatinine >2.0, cardiac disease, cirrhosis, or pregnancy were excluded. Subjects completed a questionnaire rating prep tolerability. A side effect score was calculated for each subject (range 0-21, 0 = best). Chemistry profiles were performed before the prep and on the morning of the procedure. The endoscopist was blinded to the prep used. A global prep assessment was recorded for each subject based on the amount and consistency of residual stool {range = 1 (poor) to 5 (excellent)}. RESULTS: 167 subjects (74M, 93F, mean age 59.9 yr.) were enrolled. The two groups were similar in age, sex distribution, and indications for colonoscopy. 64/82 (78%) phospho-soda preps were ranked very good or excellent vs. 63/85 (74%) PEG preps (p=NS). Among 42 PS subjects who had taken PEG during a previous colonoscopy, 38 (90%) ranked PS as more tolerable than PEG. Data shown [see table below] are mean ± SE. CONCLUSIONS: Phospho-soda preps are equally effective and better tolerated when compared to PEG lavage for pre-endoscopic colon cleansing. Increases in serum phosphorous with phospho-soda are small and are likely to be clinically insignificant. Phospho-soda is an appropriate alternative to PEG lavage for the preparation of healthy patients undergoing colonoscopy.