Patients with short bowel syndrome (SBS) receiving total parenteral nutrition (TPN) have a high incidence of catheter-related sepsis, one of its major complications. The aim of this study was to correlate the length of remaining small bowel (RSB) with septic episodes related to the central venous catheter in a group of patients with severe SBS with home TPN. The length of the RSB (<50 cm or > or = 50 cm) was related to the frequency of catheter sepsis, time until the first episode, and the agents responsible in eight SBS patients receiving home TPN. There were 13 episodes of catheter infection (0.88 per patient-year). The group with a shorter RSB length (five patients) presented 1.3 to 2.76 infections/year and 2 to 9 months until the first episode, compared to 0 to 0.75 infections/ year (p = 0.0357) and 11 to 65 months until the first episode (p = 0.0332) in the group with the longer RSB. In the first group, the agents isolated were Enterobacteriae (Enterobacter sp., Klebsiella sp., Pseudomonas sp., and Proteus sp.) in eight episodes and Candida sp. in one. In the latter sepsis was caused by Staphylococcus sp. in three episodes and Pseudomonas sp. in one. Therefore patients with remaining small bowel shorter than 50 cm have a higher frequency of catheter-related sepsis, particularly by enteric microorganisms. This might be an evidence of the occurrence of bacterial translocation and its role in the pathogenesis of catheter-related sepsis in patients with an extremely short RSB receiving home TPN.

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there are gaps in medical education. Only 13.3% were confident about NT, and their knowledge did not justify such confidence. There were no differences between the successes of confident and non-confident about NT in most subjects. The best results came from the group that claimed to be assisted by any NTMT. Better medical educational programs should be goal for this university.

Growth hormone (GH) and glutamine (GLN) are considered bowel trophic factors and are used experimentally after bowel resection. Their clinical uses in short bowel syndrome (SBS) are still not standardized. It is of interest to verify metabolic, nutritional and side effects of the association of GH and GLN in SBS. Three patients, 39 (A), 33 (B), and 01 years old (C) underwent bowel resection with jejunum anastomosis 15 cm (A) and 60 cm (B) distant from the Treitz angle, and 40 cm (C) preserving the ileo cecal valve. GH Saizen (Serono-A), Genotropin (Pharmacia-B), and Norditropin (Novonordisk C) were administered in doses of 0.14 mg/kg/day. GLN (0.4 g/kg/day) was given orally for 10 days (A), 30 days (B) and 60 days to patient C (0.28 g/kg/day). Central TPN and adequate oral diet was administered according to the bowel adaptation phase. On the first day after beginning treatment patient A exhibited symptoms of hypoglycemia. There were no other side effects. After treatment, body weight was higher and analysis by bioelectrical impedance showed more lean mass and less fat mass compared to pre-treatment measurements. Nitrogen retention was progressively higher with treatment. Simultaneous treatment with GH and GLN does not cause significant side effects, and is associated with a favorable distribution of the body compartments and nitrogen retention in patients with the short bowel syndrome.

INTRODUÇÃOPacientes cardiopatas podem desenvolver complicações cardíacas e sistêmicas com conseqüente repercussão negativa sobre o estado nutricional. Entre as cardiopatias com potencial de desnutrição encontram-se as síndromes relacionadas à insuficiência cardíaca congestiva, pós-operatório complicado de cirurgia cardíaca, patologias congênitas (transposição dos grandes vasos, comunicação interatrial, comunicação interventricular) limitação crônica ao fluxo aéreo, entre outras. Como complicação, pacientes cardiopatas desenvolvem inanição relacionada à caquexia da insuficiência cardíaca e alterações vasculares cerebrais isquêmicas e hemorrágicas. Essas situações serão de indicação precisa de tratamento nutricional enteral ou parenteral.Estabelecida a necessidade de terapia nutricional e possibilidade do uso da nutrição enteral, deve-se decidir pela via de acesso ao tubo digestivo. Inicialmente, opta-se pelo uso da sonda enteral locada em posição pré ou pós-pilórica, dependendo das condições do paciente e objetivos da terapia nutricional. O uso prolongado da sonda enteral, entretanto, pode proporcionar complicações mecânicas como erosão nasal e necrose, abscesso septonasal, sinusite aguda, rouquidão, otite, faringite, esofagite, ulceração e estenose esofágica, fístula traqueoesofágica, ruptura de varizes esofágicas, obstrução da sonda, saída ou migração acidental da mesma (5) .

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