[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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L‐carnitine is an essential nutrient that plays critical roles in energy metabolism. Although L‐carnitine has not been listed as an essential nutrient in Japanese Dietary Reference Intake, a variety of severe clinical symptoms appears when L‐carnitine is deficient in the body, resulting in deterioration of quality of life. While L‐carnitine is partially bio‐synthetized in the body, it could easily be deficient, when oral intake is insufficient, because the majority of L‐carnitine in the body is derived from food intake. Therefore, patients, particularly elderly, with no or poor oral intake who are malnourished and/or sarcopenia definitely need intensive nutritional management and are required to use nutritional formulas of total parenteral and enteral nutrition that contain sufficient amount of L‐carnitine in order to prevent L‐carnitine deficiency as well as to reduce pain and oxidative stress of skeletal muscle. L‐carnitine is also expected to be useful for power athletes who are not L‐carnitine deficient to boost athletic performance because of the efficient energy supply by stimulating fat oxidation. These results suggest that supplementation of L‐carnitine is useful for patients with L‐carnitine deficiency, as well as for normal healthy subjects and power athletes by increasing L‐carnitine pool in the body．

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Jejunocutaneous fistula is difficult to treat without drainage and management of the nutritional status. We report a case of intractable jejunocutaneous fistula treated by negative‐pressure wound therapy and fistuloclysis after elective radical surgery. An 80‐year‐old female was transferred to our hospital due to abdominal pain. A diagnosis of sigmoid colon diverticulum perforation was made and emergency laparotomy with Hartmann’s operation was performed. On the 16th day after surgery, although intestinal fluid leaked out from wound, her general condition was poor and conservative treatment was initiated. Negative‐pressure wound therapy was performed to induce drainage. The fistula was found in the proximal jejunum, 40cm from the Treitz ligament. An enteral feeding tube was placed in the intestinal tract distal to the fistula and fistuloclysis was started. The Alb and T‐cho values improved. Partial resection of the small intestine containing the fistula was performed on a standby basis 149 days after the initial operation. Negative‐pressure wound therapy and fistuloclysis for intractable jejunocutaneous fistula were considered to be useful.

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