Background: Sodium picosulphate (Picolax) is considered by most British surgeons as standard preparation for colonoscopy and elective surgery. Oral sodium phosphate may be better tolerated and more efficient as bowel preparation. Methods: A randomized trial was performed to compare oral sodium phosphate (n = 76) with Picolax (n = 77) as bowel preparation for elective colorectal surgery. A parallel study randomized colonoscopy patients to sodium phosphate (n = 51) or Picolax (n = 52). Patient acceptability was measured for seven symptoms with a linear analogue score. Quality of preparation was graded by the surgeon and faecal residue was measured in resection specimens. During colonoscopy, bowel preparation has graded 0–24 using an endoscopic score. Results: Abdominal pain, nausea, vomiting, embarrassment, fear and fatigue did not differ significantly between the groups. Surgeons grade of quality was judged poor or awful in 5 of 76 in the sodium phosphate group (9%) compared with 13 of 73 in the Picolax group (18%, p = 0.084). Mean faecal residue in the resection specimen was 0.1 g/cm after sodium phosphate compared with 0.45 g/cm after Picolax (p < 0.01). The endoscopic score was significantly lower using sodium phosphate (2.0 ± 2.2) than picolax (3.1 ± 2.9; p < 0.05). Conclusions: These results suggest that oral sodium phosphate is well tolerated and superior to Picolax in elective colorectal surgery and colonoscopy.

Background. Superior mesenteric artery (SMA) syndrome is a rare condition of duodenal obstruction, caused by the overlying SMA. Aim. To report on our experience with the management of SMA syndrome, drawing the attention to its existence. Material and Methods. We reviewed our records to identify cases diagnosed with SMA syndrome, in the period from October 1995 to January 2012. Results. Seven patients were identified, one male and six females. Their mean age was 17.1 years. Vomiting and abdominal pain were the presenting complaints in all patients and history of weight loss was present in six of them. In no patient was the diagnosis suspected initially on clinical grounds. Only after radiological investigations was the diagnosis declared. Radiology took the form of gastrografin/barium meal only in four patients and both gastrografin/barium meal and computerized tomography scan in the remaining three. Four patients responded to medical treatment and surgery was performed in the remaining three, with open duodenojejunostomy in two patients and laparoscopic dissection of the ligament of Treitz in the third. Long lasting improvement was sustained in all patients except one in the surgery group who, despite initial improvement, still has infrequent attacks of abdominal pain. Conclusion. Although the clinical manifestations of SMA syndrome are shared with many other disease entities, it has unique radiological as well as endoscopic features, which enables a confident diagnosis to be made. Once diagnosed, conservative treatment with nutritional support and positioning should be tried first. In case of unresponsiveness, surgery may give a lasting cure.

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We report the clinical findings and pathological lung changes in four children following a cultural practice of forced feeding with animal fat (ghee) during infancy. The clinical presentation was of acute or chronic chest infection which failed to respond to antimicrobial therapy. The radiographic features ranged from extensive bronchopneumonia to collapse/consolidation and bronchiectasis. The light microscopy findings included diffuse mononuclear interstitial pneumonia, intraalveolar desquamation of pneumocytes, lipid granuloma formation, lung atelectasis and bronchiectasis. In the two children with longstanding reactions, the striking feature was the minimal lipid engulfment by the macrophages, the continuation of the mononuclear interstitial pneumonia, bronchiectasis and minimal lung fibrosis. In these two older children, the lung lymphatics were probably the main channels for drainage of the aspirated ghee.

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