[in Japanese]

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The clinical effects of administration of flora (probiotics), supplied fibers (prebiotics), and their combination (synbiotics) with or without enteral nutrition have been reported in meta-analysis of randomized control for critically ill and postoperative patients. The rate of infectious complication is improved by the probiotics/synbiotics treatment in major trauma and patients after gastroenterological surgery, but not acute severe pancreatitis and IUC critically ill patients. The use of probiotics/synbiotics as potential strategy of nutritional therapy is valuable for maintenance of the gut environment and systemic immunity in patients with severe surgical stress. Future major concerns are selection of probiotic species and prebiotics with their combination, their dosage, and duration of treatment.

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[in Japanese]

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Purpose : With aging, the serum copper and hepcidin-25 concentrations become relatively high. The supplement effects of copper and induction of hepcidin-25 were confirmed in aged rat by administration of a trace element preparation for total parenteral nutrition solution.
Method : The serum copper and hepcidin-25 concentrations were measured after 7 days of administration of total parenteral nutrition solution with or without the trace element preparation.
Results : In the administration group of total parenteral nutrition solution without the trace element in young rat, the serum copper concentration was decreased, though in the aged rat the administration of the same formulation did not cause a reduction of serum copper. In addition, the administration via infusion with the trace element preparation facilitated the hepcidin-25 induction in young rat, but a higher serum hepcidin-25 concentration was shown even before the administration of the infusion with the trace element preparation and further induction of hepcidin-25 was not achieved by administration.
Discussion : This report demonstrates that the optimal administration dose of a trace element preparation in the elderly should be considered since the necessity of copper and iron in the infusion of total parenteral nutrition differs by age.

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Pulmonary embolism caused by long-term catheterization of the central venous port system is rare. A woman in her 60s underwent subtotal colectomy for familial adenomatous polyposis with transverse colon cancer in 2003. She underwent surgery due to desmoid tumor in the mesentery of the jejunum and received a jejunal stoma because of anastomotic insufficiency, which had developed into short bowel syndrome in 2005. In September 2006 she was treated as an inpatient for septic DIC syndrome caused by infection of the central venous port. For four months in 2007 she was treated as an inpatient for pyogenic spondylitis of the lumbar spine due to MRSA infection. In 2008 she received inpatient treatment for fungal infection of the central venous port and in 2011 she was treated as an inpatient for a similar septic DIC syndrome. We attempted re-catheterization of the central venous port system, but catheterization to SVC failed. Therefore, we catheterized the tip to the pericardiacophrenic vein. Multiple polyps were detected on the residual rectum and reoperation was under consideration, however thrombosis developed in the right pulmonary artery, as shown by contrast-enhanced CT in September 2011. She had normal cardiac function with no pulmonary hypertension and no history of deep venous thrombosis. The central venous port was suspected to be the cause of thrombus formation. Therefore, warfarin treatment was attempted, but it had no effect. Resection of the residual rectum was performed in January 2012. Home parenteral nutrition has been continued with oral warfarin. It is critical to monitor for venous thromboembolism & pulmonary embolism during long-term home parenteral nutrition.

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