[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Purpose: To clarify the clinical usefulness of the two-step thickened water test (TTWT), which we developed as a bedside test, for the detection of paste food aspiration in patients with aspiration pneumonia. Subjects and Methods: Eighty elderly patients who were admitted to our hospital under the diagnosis of aspiration pneumonia, were examined. We defined TTWT as the combination of a bedside pretest and a direct swallowing test using thickened water. These patients were examined for swallowing function by TTWT. In addition, the fiberoptic endoscopic evaluation of swallowing (FEES) was performed in order to determine the swallowing function for paste food. Based on the results of TTWT and FEES, we calculated the sensitivity and the specificity of TTWT for the identification of dysphagia for paste food. For comparison, these values were also calculated under the same conditions by using normal water instead of thickened water in the direct swallowing test. Results: The sensitivity and the specificity of TTWT for detection paste food aspiration were 93.9% and 83.0%, respectively. The specificity decreased to 74.5% when normal water was applied in the test, although no decrease in the sensitivity was found. TTWT was completed in less than 10 minutes without any adverse effects in all the patients. Conclusions: TTWT developed by us might be a novel assessment tool for evaluating the risk of aspiration of paste food in the patients with aspiration pneumonia.

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[Aim] Although percutaneous endoscopic gastrostomy (PEG) has become widespread as a safer method for enteral feeding, few reports of patients' longterm prognosis after PEG have been published. In this study, the survival rate after PEG was investigated, and prognostic predictors in patients with PEG were examined.
[Methods] The subjects were 227 patients who had undergone PEG from January 2000 to December 2009 in our hospital. Their outcomes were confirmed by questionnaires sent to the doctors in charge.
[Results] 215 cases were followed for an average of 559.2±521.2 days. The survival rate after PEG was 95% at 30 days, 64.4% at 1 year, and 25.1% at 5 years. The survival rate of the group with a history of accidental ingestion was significantly lower than that of the group without. Survival of the group with a pre-gastrostomy serum albumin level >3.0 g/dL or Onodera's PNI >35 was significantly longer than that of the group with albumin <3.0 g/dL or Onodera's PNI <35. There was a large difference in survival between patients with albumin >3.0 g/dL and <3.0 g/dL or PNI >35 and <35 within 1 year after PEG, but no significant difference after 1 year.
[Conclusions] A history of accidental ingestion before PEG is an important prognostic predictor after PEG placement. Onodera's PNI and serum albumin are useful in predicting prognosis, especially within 1 year after PEG, but they are not helpful in predicting the long-term prognosis.

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[Objectives] Our nutritional screening for the inpatients on admission consists of these four items; equal or less than 80% ideal body weight ratio, pressure sore, oral intake problem include enteral feeding, malnutrition with the appearance. If there are any inpatients with more than one item, we interpret them as malnourished and perform intervention of NST (nutritional support team). We report the utility of our nutritional simple screening on admission (NSSA).
[Methods] For all 245 inpatients hospitalized to our medical wards during two months, we independently performed NSSA and subjective global assessment (SGA). We reviewed whether we were able to detect patients with malnutrition by NSSA compared with SGA, physical measurement and blood examinations adequately.
[Results] By NSSA, we decided 61 patients needing NST intervention and 184 patients with NST intervention-free. Comparing NST intervention-free patients, NST intervention pivot patients were more undernourished by SGA significantly. Furthermore, serum albumin, % triceps skinfold thickness (%TSF) and % arm muscle circumference (%AMC) of the NST intervention pivot group were lower than NST intervention-free group significantly. The sensitivity and specificity for malnutrition judged by SGA patients of our NSSA were good, which was 87.2% and 86.5% respectively.
[Conclusion] Our NSSA shows clinical benefit for its simplicity, because malnutrition patients can be detected adequately.

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[in Japanese]

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