Various kinds metals are present in varying concentrations in living bodies. They play important roles in the preservation of life functions. Owing to the recent advances in multidisciplinary research on biochemical and nutritional functions of trace elements, their deficiency and excess, etc., close attention is being paid to the importance of trace elements. During nutritional therapy, it is important to check for shortage of trace elements as nutritional indicators. It is known that prolonged nutritional therapy is associated with the risk of developing trace element deficiency.  We recently encountered patients suspected of having trace element deficiency. For a case of selenium deficiency, we added a selenium solution (homemade parental solution) to the solution for intravenous hyperalimentation. For a case of zinc deficiency accompanied by pressure ulcer, polaprezinc (a zinc-containing preparation for the treatment of gastric ulcers) was used. In both the cases, the serum trace element level improved, and the outcome was favorable.  Adequate precautions need to be exercised when the methods of medication, test, etc., are decided upon in the cases of trace element deficiency. Herein, we also discuss problems associated with tests and treatment of patients with trace element deficiency.

We report a case in which feelings of abdominal distension and discomfort of the abdominal wall caused by malignant ascites were relieved by ultrasound-guided rectus sheath block. Case report: A 59-year-old man developed gastric cancer with malignant ascites and experienced feelings of abdominal distension, but no nausea, dyspnea, poor mobility, or limb edema. Symptom control was inadequate with diuretic therapy and abdominal paracentesis. Feelings of distension improved temporarily with ultrasound-guided rectus sheath block. A percutaneous catheter was then used to administer an infusion of 0.25% ropivacaine triweekly until his death 20 days later. Conclusion: Feelings of abdominal distension is one of various symptoms of severe ascites and is difficult to manage. Ultrasound-guided rectus sheath block can be used to relieve this symptom on a case-by-case basis.

We report a case whose left lower limb neuropathic pain accompanied by pelvic tumor invasion was remarkably eliminated by ultrasound-guided sciatic nerve block. Case report: The subject was a sixty year old male. Pharmacological therapy was given according to the WHO analgesic ladder, but his left lower limb pain failed to respond to drugs. His intractable lower limb neuropathic pain was alleviated by ultrasound-guided sciatic nerve block. Drug delivery can be achieved with a percutaneous catheter and a disposable infusion pump. Infusions were run at 5mlh^-1 with 0.1% ropivacaine. Conclusion: Neuropahic pain is sometimes hard to be controlled only by opioids or adjuvant analgesics, but there is a possibility of providing pain relief by combination use with nerve blocks. Interventional techniques can be highly effective but also have the potentiality to produce significant adverse effects. Many patients have factors which would be considered a near absolute contra-indication to the use of nerve blocks such as immuno-compromise or impairment of coagulation. Skillful application of peripheral neural blockade with ultrasound imaging broadens the options for providing optimal pain management. Palliat Care Res 2011; 6(1): 313-315