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[in Japanese]

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[Objective] The purpose of this study is to evaluate whether two simple indicators, namely the CONUT Score and the Surgical Apgar Score, are useful for the risk assessment of gastrointestinal surgery in elderly patients.
[Materials and Methods] The subjects of this study consisted of 112 patients over 75 years of age that who underwent gastrointestinal surgery in this department between January 2008 and December 2010. They were divided into two groups with or without postoperative complications, especially infectious complications. The CONUT Score and the Surgical Apgar Score were compared between the two groups retrospectively.
[Results] The ratio of high-risk patients by Surgical Apgar Score was significantly higher in the group with complications (p=0.0159) . The ratio of patients who had moderate or severe malnutrition, judging from the CONUT Score, was significantly higher in the group with infectious complications (p=0.0145) . In addition, the results of the nutritional assessment by the CONUT Score influenced the value of the Surgical Apgar Score. Furthermore, poor scores for both the CONUT Score and the Surgical Apgar Score were considered to indicate“double positive,”and the incidence of postoperative infectious complications in the double positive group increased markedly. A multiple logistic regression analysis, identified“double positive”as a factor that predicted infectious complications.
[Conclusions] The CONUT Score and the Surgical Apgar Score are thus considered to be clinically useful for predicting postoperative complications and they can be successfully used to select high-risk patients after gastrointestinal surgery in elderly patients.

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[Purpose] We investigated the factors correlation with early enteral nutrition therapy in the patients of severe pneumonia.
[Patients and methods] Twenty patients aged 75 and over who admitted to our hospital from October 1, 2010 to October 31, 2011 were in this study. We diagnosed them malnourished and having risks of refeeding syndrome, so we gradually restored nutrition via naso-gastric tube. We extract the clinical findings and blood sampling correlation with number of days, Refeeding Days, which take to reach the energy target (25kcal/kg/day) . We categorized the patients into two groups, according to Refeeding Days bordering on seven days, and according to administration of phosphorus, then compared each clinical backgrounds of two groups.
[Results] CURB-65 which judges the severity of pneumonia, phosphorus and cholinesterase (ChE) had correlation with Refeeding days. In the two groups separated by Refeeding Days, there is a significant difference for each CURB-65, phosphorus and ChE. Although a significant difference was not accepted, there is a tendency of low ChE value in the group with the administration of phosphorus (P = 0.062) .
[Conclusion] Refeeding days had correlation with CURB-65, phosphorus and ChE. We could conclude that we need to continuously monitor the above items when we practice early enteral nutrition therapy.

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[Objectives] Vitamin deficiency can cause cognitive impairment. We measured various nutritional indexes centering on serum nicotinic acid levels in patients suspected of having malnutrition associated with cognitive impairment, and analyzed the measurement results.
[Subjects and Methods] The study involved 55 patients who had undergone treatment at our hospital. Investigation items were age, sex, height, weight, body-mass index (BMI), total serum protein level, serum albumin level, white blood cell count, lymphocyte count, serum vitamin B1 level, serum vitamin B12 level, serum nicotinic acid level, and the presence or absence of an alcohol drinking habit.
[Results] Serum nicotinic acid levels showed a correlation with serum albumin levels, total serum protein levels, and Onodera's prognostic nutrition index (p<0.05) in patients with malnutrition, but vitamin levels had no correlation with these levels.
[Conclusions] Nicotinic acid deficiency is known to cause symptoms similar to dementia known as pellagra encephalopathy. It was suggested that some of malnutrition patients with cognitive impairment might have latent nicotinic acid deficiency. It was considered that patients with malnutrition need a combination of vitamins and nicotinic acid.

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