A randomized controlled trial comparing a prepackaged low-residue diet with a restricted diet for colonoscopy preparation: the impact on the results of colonoscopy in adenoma detection.

AIM: This study aimed to investigate the clinical utility of a prepackaged low-residue diet (PLD) compared with a restricted diet (RD) for colonoscopic bowel preparation. METHOD: A prospective randomized controlled trial was carried out with patients undergoing colonoscopy. One hundred patients were randomly assigned to PLD and RD groups. In the RD group, the patients received an information sheet containing acceptable low-residue options and instructions from the medical staff. All patients received 10 ml sodium picosulphate the day before colonoscopy and 1 l of polyethylene glycol with ascorbic acid (PEG-A) on the day of the colonoscopy. If the bowel preparation was not adequate, an additional PEG-A solution was given. The primary outcome was the efficacy of colonic cleansing as rated by the Boston Bowel Preparation Scale (BBPS). The additional amount of PEG-A solution, adenoma detection rate and patient tolerance were assessed as secondary outcomes. RESULTS: The BBPS score in the PLD group was 7.3 ± 1.7 compared with 6.5 ± 1.7 in the RD group. The quality of bowel preparation was significantly better in the PLD group (P < 0.05). The mean amount of additional PEG-A solution in the PLD group was smaller than in the RD group (293.8 ± 474.8 vs 444.1 ± 625.0 ml), but there was no statistical difference between the two groups. Adenoma detection rates and patient tolerance were similar in the two groups. CONCLUSION: Prepackaged low-residue diets PLD is superior to RD for bowel preparation for colonoscopy.

[A tuberculosis outbreak in a mental hospital].

PURPOSE AND METHODS: We experienced a tuberculosis outbreak in a mental hospital and discussed preventive measures for nosocomial tuberculosis infection. RESULTS: There are 18 mental hospitals within the administrative area of Hachioji public health center (PHC). A Total of 18 pulmonary tuberculosis cases were diagnosed in one of these hospitals between December 1995 and November 1998. They were all inpatients and two of them had history of tuberculosis. Fifty-two persons became candidates for isoniazid (INH) chemoprophylaxis as a consequence of the first extraordinary health examination. Chest radiographs of the inpatients had not been taken regularly in this hospital. Our recognition of the tuberculosis outbreak was delayed by omission of not only the case notification from the doctor who had diagnosed tuberculosis but the information from the PHC that had received the application of public subsidy for medical treatment. All cultured bacilli from 8 patients were susceptible to INH, rifampicin, streptomycin and ethambutol. Restriction fragment length polymorphism (RFLP) analysis of 4 strains, which we could have obtained, demonstrated an identical pattern. CONCLUSIONS: To prevent tuberculosis outbreaks in mental hospitals, we should consider these problems as follows; 1) Physical conditions of inpatients should be observed carefully and suitable physical checkups on inpatients with tuberculosis symptoms should be carried out by mental hospitals. 2) The doctor who had diagnosed a patient as having tuberculosis must send the case notification to the nearest PHC. 3) The PHC that received the information should investigate the case carefully and notify all related PHC's. 4) Extraordinary health examinations should be done appropriately by leadership of the PHC. 5) RFLP analysis of the tubercle bacilli is very useful to probe the source and route of infection. 6) Criteria for chemoprophylaxis for more than middle-aged persons should be established.