Case of the Rapunzel Syndrome in a Child

Rapunzel syndrome is a rare form of gastric trichobezoar extending through the small bowel and develops after swallowing hairs or carpet which are trapped in the gastric mucosa and become enmeshed. In adult, it occurs most frequently after a gastric resection, but in children, it is frequently associated with pica, mental retardation, and coexistent psychiatric pathologic disorders. This syndrome is usually found in girls with varying gastrointestinal symptoms due to gastric outlet obstruction or secondary ulcerations. Although most small trichobezoars are removed easily by using a gastrofiberscope, surgical removal is recommended for large or complicated trichobezoar. In this syndrome, psychiatric treatment should follow to diminish the frequency of recurrence. We report the case report of a 6-year-old girl who frequently swallowed of her hairs for 3 years, resulting in frequent vomiting and an epigastric palpable mass in which a gastric trichobezoar extended to the duodenum and proximal jejunum.

Primary common bile duct closure and antegrade stent insertion in choledocholithiasis patients / 한국간담췌외과학회지

BACKGROUND/AIMS: After common bile duct exploration, placement of drainage tube was accepted as the standard treatment for choledocholithiasis patients. But placement of the drainage tube may create several complications including bile leakage. We undertake primary common bile duct closure with temorary antegrade stent after common duct exploration in cholodocholithiasis patients to prevent the complications due to drainage tube. METHODS: Between Febuary 1999 and January 2001, 38 patients underwent primary common bile duct closure with antegrade stent after common bile duct exploration without the placement of drainage tube. The study population included 19 men and 19 women with a median age of 61 years (range 26 to 84 years). Laparoscopic choledochotomy was perfromed in 10 patients . Open choledochotomy was performed in 28 patients. Antegrade stent was inserted using choledochoscope. RESULTS: Postoperative hospital stay of the laparoscopic choledochotomy patients were 6 +/- 1.8 days and of the open choledochotomy patients were 10 +/- 4.3 days. Antegrade stent was spontneously passed through the papailla and disappeared in the abdomen in 22 +/- 12.4 days postoperatively. Treatment-related morbidity was seen in 2 cases ( 5.3 %). CONCLUSION: Primary common bile duct closure with temporary antegrade stent after common bile duct exploration is a safe, effective alternative to the routine T-tube drainage in the choledocholithiasis patients.

A Popliteal Vein Aneurysm Causing Pulmonary Embolism

Popliteal vein aneurysm is a very uncommon and rarely reported although potentially life-threatening disease because it can be a source of pulmonary embolism. A patient with recurrent pulmonary embolism must be checked for lower extremity venous abnormalities. Recently, newer techniques including duplex scanning, computerized tomography and magnetic resonance imaging are useful in detecting popliteal fossa venous abnormalities. However, venography is also mandatory before operating on a popliteal vein aneurysm. Several methods are useful for the surgical treatment of popliteal vein aneurysms, including aneurysmectomy with lateral venorrhaphy, aneurysmectomy with vein transposition, aneurysmectomy with vein patch, etc. Following surgery, anticoagulation therapy is widely accepted. Here in, we present a case of popliteal vein aneurysm with pulmonary embolism. This patient was a 67-year-old woman exhibiting chest pain and exertional dyspnea. Lung scan and chest CT revealed multiple pulmonary embolisms and lower extremity venography revealed a right popliteal vein aneurysm with thromboembolism. This patient underwent aneurysmectomy with lateral venorrhaphy.

A Case of Morgagni Hernia

Morgagni hernia is a congenital diaphragmatic hernia that occurs secondary to potential anterior medial defects in the diaphragm. These hernias are uncommon, accounting for 3% of all diaphragmatic hernias, and the incidence is higher in patients over the age of 50 years than in younger patients. They are most commonly found incidentally on chest radiographs since most patients are asymptomatic, although symptoms of bowel obstruction may be present. Surgical repair is required in all cases and may be performed using a transabdominal, transthoracic, or laparoscopic approach. We report a case of a congenital diaphragmatic hernia through the Morgagni foramen in 70-year-old female, as well as a brief review of the literatures.

Fournier's Gangrene in a Boy of Three Years Old

Fournier's gangrene is a rare disease characterized by an aggressive necrotizing fascitis of perineum and genitalia which is caused by mixed bacterial infection. The cornerstone of therapy consists of immediate recognition, wide debridement of devitalized tissues, antibiotic therapy, search for the primary source and occasionally urinary and fecal diversion. Although Fournier's gangrene has been reported in almost all ages, most cases have been reported in adults and occurrence in children is very unusual. Despite advancement in management, morbility and mortality remain significantly high. We report a case of Fournier's gangrene in a boy of 3 years old preceded by diarrhea and upper respiratory tract infection.

Brachio-basilic Arteriovenous Fistula Using Transposed Basilic Vein: An Alternative Vascular Access for Hemodialysis

PURPOSE: Effective hemodialysis for a patient with end-stage renal disease (ERDS) is dependent upon a durable, low-morbidity vascular access. Although It is generally agreed that the distal radiocephalic fistula originally discribed by Brescia and Cimino is the most effective primary access constrruction, no consensus exists regarding primary and secondary alternatives for patients with inadequate of failed rediocephalic prodedures. Many options are available, but the relative value of these alternative operations is unclear. Therefore the place of the basilic vein in secondary acccess construction needs to be assessed. We evaluated if the basilic vein can be used to construct a durable, low-morbidity access. METHODS: A native brachio-basilic arterio-venous fistula with superficial transposition has been performed, for lack of usuable vein on 54 forearm in 47 patients from August 1995 to October 1999 (Male: 15, female: 32) with mean age 51 years (26 to 70 years). RESULTS: The main cause of renal insufficiency were: diabetes 27 (57.4%), hypertensive 19 (40.4%), renal tuberculosis 2 (4.3%) and renal cyst 1 (2.1%). The waiting period before vascular access puncture has been 28 6 days. Eight (17.0%) stenosis has been detected and, forearm and/or hand edema occured in three (6.4%); thrombosis in two (4.3%); bleeding in two (4.3%); pseudoaneurysm in one. Through the follow-up periods of 50 months, the primary patency was 80.9% at 12 months and 78.7% at 24 months. CONCLUSION: The brachio-basilic fistula with superficial transposition of basilic vein is a valuable vascular access for diabetes, female old patients, and can remain an alternative method for even younger patients by avoiding the installation of artificial graft after failed forearm arteriovenous fistula.

Surgical Treatment of Right Colon Diverticulitis

PURPOSE: Diverticular disease of the cecum and ascending colon is a relatively uncommon disease and there are some difficulties in the accurate preoperative diagnosis and the proper surgical treatment. This study is aimed to determine what is the proper procedure during the emergency operation of right colon diverticulitis. METHODS: This study is a retrospective clinical analysis of 86 cases of the right colon diverticulitis from January 1992 to December 1999. RESULTS: 1) The incidence of right colon diverticulitis (RCD) was 2.1% of that of appendicitis and the RCD to sigmoid colon diverticulitis ratio was 9.6:1.2) The highest incidence was noted at the fourth decades and average age was 37 years. Male to female ratio was 1.9:1. 3) Most patients (73 cases, 85%) had right lower quadrant abdominal pain. 4) The duration of symptom was less than 3 days in 54 cases (63%). 5) The preoperative confirmation by radiologic work-up was not decisive, but barium enema might be more accurate than other studies and CT was more accurate method than ultrasound. 6) The correct preoperative diagnosis was made only in 13 cases (15%) and the remaining misdiagnoses were appendicitis with or without complications in 72 cases (83%). 7) Operative procedures varied markedly according to multiplicity, extent of inflammation and complications; diverticulectomy and appendectomy in 48 cases (56%), ileocecectomy in 15 cases (17%) and right hemicolectomy in 11 cases (13%). 8) The most commom postoperative complication was wound infection. 9) Among the 30 cases who took diverticulectomy or diverticulectomy and appendectomy, remained diverticulums were found in 14 cases (47%), especially 11 cases (37%) on the right colon. And so multiplicity of right colon reached about 37%. CONCLUSIONS: The authors suggest that one should suspect RCD in fourth decade patients with right lower quadrant pain for more than 3 days with unusual clinical findings. Barium enema can be used because of the high accuracy rate but CT is a safe tool in complicated or urgent situation. The operative modalities should be selected on the extent of the disease and it is sufficient to treat a single diverticulitis with diverticulectomy or diverticulectomy and appendectomy but right hemicolectomy should be recommanded in the suspicious multiplicity or malignancy.

Functional Change of the Endothelial Cells of the Umbilical Vein Following Anoxia and Reoxygenation

BACKGROUND: Successful revascularization and reperfusion of ischemia are associated with high systemic complication rates and severe tissue injuries. Such complications with nonfunction are primarily related to the injuries that occur in the reperfusion process, but to date the exact mechanism is not clear. Anoxia or hypoxia and reoxygenation are principal components of ischemia and reperfusion (I/R) and have distinctive effects on the tissue. In the I/R injury model, endothelial cell injury is known to be an initial event, the microvasculature is highly sensitive, and the hyperadhesiveness of leukocytes to endothelial cells contributes to I/R-induced tissue injury. METHODS: Experimental groups were divided into 4 groups: a control group without any treatment, an anoxia group (A-G) treated with anoxic air (93% N2, 5% CO2, 2% H2) for 20 minutes, reoxygenation group (RO-G) treated with 100% O2 for 90 minutes, and a superoxide dismutase (SOD) group treated with SOD just before reoxygenation. Endothelial cells were isolated from human umbilical vein and cultured in an M-199 medium. Their purity was determined by immunofluorescent staining of factor VIII related antigen, phase-contrast, and scanning electron microscopy. Using a microelectrode, radio immunoassay, and Emzyme-linked immunosorbent assay (ELISA), we studied the time-course changes of the levels of nitric oxide (NO), prostaglandin I2 (PGI2), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule (VCAM) of the 4 groups. RESULTS: 1) Endothelial cell detachment was found in the A-G and more detachment with lysis was found in the RO-G but no significant detachment and lysis were noted in the SOD group. 2) The concentration of NO in the A-G was lower than that of the control group (P<0.05). The NO concentration of the RO-G reached its highest level of 4809.01+/-444.69 nM/1x10(5) cells/ml at 30 minutes(P<0.005) and decreased after that. 3) The concentration of PGI2 in the A-G was higher than that of the control group (P<0.05). The PGI2 concentration of the RO-G reached its highest level of 64.25+/-2.39 pg/1x10(5) cells/ml at 45 minutes (P<0.005) and decreased after that. 4) The concentration of ICAM-1 in the A-G was higher than that of the control group (P<0.005). The ICAM-1 concentration of the RO-G reached its highest level of 7.18+/-0.62 ng/1x105 cells/ml at 15 minutes (P<0.005), then decreased to its lowest level of 2.53+/-0.31 ng/1x105 cells/ml at 60 minutes, but after 75 minutes increased again. 5) The concentration of VCAM in the A-G was higher than that of the control group (P<0.005). The VCAM concentration of the RO-G reached its highest level of 5.50+/-0.55 ng/1x10(5) cells/ml at 15 minutes (P<0.05), then decreased to its lowest level of 3.15+/-0.40 ng/1x10(5) cells/ml at 45 minutes, but after 60 minutes increased again. 6) The SOD group showed little change of NO, PGI2, ICAM-1, and VCAM concentration compared with both the A-G and the RO-G. CONCLUSION: This study showed that cell destruction in the reoxygenation group was more severe than that in the anoxia group and that the endothelial cell function of the reoxygenation group decreased signi ficantly compared with that of the anoxia group. In the anoxia and the reoxygenation groups, the levels of the two adhesion molecules ICAM-1 and VCAM increased faster than those of NO and PGI2 and the change in the level of ICAM-1 was more sensitive than that (in the level) of VCAM. In reoxygenation group, SOD treatment could inhibit the changes in the levels of NO, PGI2, ICAM-1, and VCAM.

Complicated Nonspecific Small-Bowel Ulcers

BACKGROUND: Nonspecific small-bowel ulcers occurring beyond the duodenum are relatively uncommon, and it is difficult to make an exact diagnosis preoperatively. The majority of patients require surgical treatment for complications such as bleeding, perforation, or stenosis. METHODS: Fifteen cases (11 males and 5 females) of complicated nonspecific small-bowel ulcers occurring between 1990 and 1999 were retrospectively analyzed at the Department of Surgery, Holy Family Hospital, the Catholic University of Korea. RESULTS: The mean age of the patients was 52.4 years, and the most prevalent age was in the 4th decade (30%). The ratio of males to females was 2.8:1, and the predominant presenting symptoms were blood loss (13.3%), intestinal obstruction (20%), and an acute abdomen (66.7%). Two had chronic gastrointestinal hemorrhages, three had strictures, resulting in intestinal obstruction, and ten had perforations. The majority of ulcerations were located in the ileum (80%), and perforation was by far more common in the jejunum (100%) than in the ileum (58.3%). A small-bowel enema was a more reliable diagnostic technique than other radiologic modalities, such as sonography or computerized tomography, for delineating the bleeding or the stenotic foci. Surgical resections of the involved segments of the small bowels were curative in all but one perforation case, an 81-year-old female with postoperative multiple-organ failure. CONCLUSIONS: The exact diagnosis was rarely made preoperatively although abnormalities were noted roentgenographically in 80% (four out of five bleeding and stricture cases). Resection of the involved small bowel was the treatment of choice and was usually curative. Operative mortality was 6.7%. No etiologic causes could be determined pathologically.

Superior Lumbar Hernia: A case report

A lumbar hernia is a rare clinical disease entity which arises from the superior or the inferior lumbar triangle. The causes are congenital, traumatic, previous operation, and so on, but spontaneous occurrence is also encountered. We had a occasion to treat a 34-year-old female patient with a left superior lumbar hernia filled with retroperitoneal fats in a sac. The relatively large defect of the transversalis fascia was repaired with a PTFE (polytetrafluoroethylene) graft and an overlying approximation of external oblique and latissimus dorsi muscle. We report on this case with a brief review of the literature.

Superior Lumbar Hernia: A case report

A lumbar hernia is a rare clinical disease entity which arises from the superior or the inferior lumbar triangle. The causes are congenital, traumatic, previous operation, and so on, but spontaneous occurrence is also encountered. We had a occasion to treat a 34-year-old female patient with a left superior lumbar hernia filled with retroperitoneal fats in a sac. The relatively large defect of the transversalis fascia was repaired with a PTFE (polytetrafluoroethylene) graft and an overlying approximation of external oblique and latissimus dorsi muscle. We report on this case with a brief review of the literature.

A Clinical Study of Abdominal Stab Wounds

BACKGROUND: Nowdays, modernization and industrialization cause many social problems and the abdominal stab wound is one of them. Recently, the number of accidents has increased along with the population of Puchen city where Holy Family Hospital is located. For the treatment of abdominal stab wounds, it is important to make a proper diagnosis. METHODS: We perform a retrospective clinical study of 52 patients who were operated on for abdominal stab wounds at Holy Family Hospital during the 10 years from January 1989 to December 1998. RESULTS: The age distribution revealed a high incidence in the twenties (44%), and the sex distribution, with a male-to-female ratio of 3:1, showed a male predominance. The seasonal distribution showed the highest incidence in the summer (35%) but there was no prominent difference in the seasonal incidence. It was made by others (44%), self (31%) and accident (25%) but 5 cases (10%) were made by the family circle. The most common clinical manifestations and the most commonly used instrument were abdominal pain (69%) and a knife (69%). In the most anemic patients, major vessel injury and thoracic injuries were combined. Among the 29 gastrointestinal injuries, 6 cases (21%) showed free air on radiologic study, and in the 13 cases with abdominal paracentesis, the sensitivity was 83% and the predictability was 91%. Among the abdominal injuries, except those to the omentum, the most commonly injured organ and combined organ were the small bowel (48%) and the thorax (55%). The average time interval from emergency-room treatment to surgery was 60 minutes. In 23 cases (45%), there was no blood transfusion during treatment. Blood transfusions above 11 units were required in 4 cases (2%). The complication rate was 15% and, no injured organs were overlocked. CONCLUSIONS: This review revealed that abdominal stab wounds were mainly caused by unknown male in their twenties, in the summer, and with a knife, but 10% were caused by number of the family circle. The diagnosis to operate was made with various methods, but we recommend a diagnostic laparoscopy with paracentesis in order to decrease negative laparotomies.

Primary Malignant Lymphoma of the Breast: Report of two cases

Primary malignant lymphoma of the breast constitutes less than 1% of malignant breast neoplasms. There is general agreement that this lymphoma is usually of a non-Hodgkin's histology. Unfortunately, failure to recognize this possibility may result in unnecessarily radical surgery. Radical surgery is to be avoided and radiation therapy with limited surgery provides exellent local regional control. The addition of systemic, combined chemotherapy is warranted in the more aggressive histologic subtypes because death is generally due to subsequently disseminated disease. We present case reports for a 33-year-old and a 38-year-old female with malignant, large cell type, non-Hodgkin's lymphoma diffuse, of the right breast who were treated with a modified radical masectomy and lumpectomy with ipsilateral axillary dissection at Holy Family Hospital, College of Medicine, the Catholic University of Korea.

Spontaneous Rupture of the Esophagus (Boerhaave's Syndrome): A review of 10 cases

BACKGROUND: Boerhaave's syndrome is a spontaneous rupture of the esophagus. The classic symptom triad, vomiting, chest pain, and subcutaneous emphysema, rarely develop together. It is diagnosed by using plain chest film, an esophagogram with a water soluble contrast media, and computerized tomography, but it is somewhat difficult to make an early diagnosis. It is generally treated with a surgical procedure, but the most frequent complication is suture line leakage, which leads to a pyothorax, pneumonia, mediastinitis, and eventually an irreversible septic condition. METHODS: We retrospectively reviewed 10 cases of patients with spontaneous esophageal rupture treated by various surgical methods during the recent 6 years at the Department of Surgery and Internal Medicine, the Catholic University of Korea. RESULTS: The results of the clinical reviews are as follows: There were 9 males and 1 female, and the mean age was 53 years old. The main symptom was chest pain (70%), and that developed after severe vomiting in 6 cases (60%). Abnormal findings were revealed on the chest PA films of 6 cases. Esophagogram were used in 8 cases, and a combined chest CT in 5 cases. Seven (70%) received an operation in less than 24 hours after the attack and 3 cases after 72 hours. The lower one-third of the esophagus was perforated in 9 cases (90%), and the left side of the esophagus was perforated in 8 cases (80%). The methods of operation were primary repair (6 cases), an esophagectomy and esophagogastrostomy (3 cases), and a cardial ligation, proximal esophagostomy, gastrostomy, and feeding jejunostomy (1 case). Anastomosis leakage and empyema developed in each of 4 cases. The overall mortality rate was 20%; only two patients died due to a delayed hospital visit (surgery 72 hours after first attack of symptoms). CONCLUSIONS: We recommand that the most important factor affecting the prognosis for spontaneous rupture of the esophagus is early diagnosis and immediate surgical intervention.

Clinical Analysis of Anatomical Snuffbox Arteriovenous Fistula

This study concerns 110 patients who were underwent anatomical snuffbox arteriovenous fistula at Department of Surgery, Holy Family Hospital, College of Medicine, The Catholic University of Korea, from January 1995 to December 1997. We analysed the overall and success patency rate between diabetic and non-diabetic patients. The results obtained are as follows: 1) 52 operations were performed on male patients and 58, on females. And mean age was 51 years. 2) Average follow-up period was 19 months. 3) Early failure rate of all cases was 17 cases (15%), 2 cases (6%) in diabetic patients and 15 cases (9.7%) in non-diabetic patients. 4) Overall patency rates of all patients were 76.6, 72.0, 68.8 and 64.9% at 6, 12, 18 and 24 months and success patency rates were 90.7, 85.2, 81.4 and 76.8% after creation of anatomical snuffbox arteriovenous fistulas. 5) Overall patency rates of diabetic patients were 78.8, 74.8, 74.8 and 59.8% at 6, 12, 18 and 24 months and success patency rate were 83.4, 79.4, 79.4 and 63.5%. 6) Overall patency rate of non-diabetic patients were 75.9, 71.0, 66.6 and 66.6% at 6, 12, 18 and 24 months and success patency rate were 94.5, 88.4, 83.0 and 83.0%.

One-Stage Resection and Anastomosis of Left Colon Cancer Obstruction

Although the obstruction of the right colon is usually handled by primary anastomosis following resection, fear of the increased incidence of septic complication, especially anastomotic leakage with sepsis has turned surgeons away from doing anastomosis in the face of acute obstruction of the left colon. However, from recent reports, enough experiences have been accumulated to show that primary anastomosis is associated with minimum morbidity and mortality in the acute obstruction of the left colon. We experienced 54 cases of colon cancer obstruction at Holy Family Hospital from January 1988 to December 1997. Twenty six cases of them were right colon cancers, 24 cases were left colon cancers and 4 cases were rectal cancers. We reviewed these three groups for evaluation of the safety of one-stage resection and anastomosis of left colon cancer obstruction. The postoperative complication rate was 18% in right colon obstruction versus 38% in left colon obstruction. The most common complication was wound infection(43%). In using of primary resection and anastomosis, complication of right colon revealed 15% and left colon was 29%. But in a method of primary resection and anastomosis with decompression, complication of right colon was 17% and left colon was 13%. Especially on the left colon, primary resection and anastomosis with decompression revealed lower complication(13%) than that without decompression(67%). The mortality of colon cancer obstruction was 2% but this was a patient who had a poor general condition and took a primary resection and anastomosis without decompression. In cases of left colon cancer obstruction primary resection and anastomosis with decompression of left colon cancer obstruction can be a safe operation method with low morbidity and mortality.

A Case of Squamous Cell Carcinoma Arising in the Mature Cystic Teratoma with Direct Invasion to Transverse Colon and Jejunum

Malignant degeneration of mature cystic teratoma has been reported in 1~3% of cases, usually between the age of 30 and 70 years with a peak incidence of 40~60 years. The most common malignancy developing in such tumors is squamous cell carcinoma arising in a mature cystic teratoma. Hirakawa reported two patients with benign teratomas diagnosed 25 and 32 years prior to surgery for malignancy and Dorothea reported a patient who was diagnosed as benign teratoma 50 years prior to operate for carcinoma. But there has been no report of squamous cell carcinoma arising in the mature cystic teratoma with direct invasion to gastrointestinal tract. We report a case of squamous cell carcinoma with direct invasion to transverse colon and jejunum in 62-year-old female who was diagnosed as mature cystic teratoma 20 years ago.

A Case of Omental Actinomycosis

Actinomycosis is relatively rare infection which is produced by an anaerobic organism, actinomycetes, normally residing in the mouth, bowel and female genital tract. This disease is characterized by chronic inflammatory induration with abscess and multiple sinus formation. In most cases, the onset of this is preceded by an inflammatory or traumatic history on abdomen but diagnosis can't be made until operation. Recently this disease is treated with antimicrobial therapy and wide surgical excision. We experienced a case of omental actinomycosis and report it with brief review of literatures.

A Case of Multiple Endocrine Neoplasia Type 1

In 1903 Erdheim reported multiple endocrine neoplasia type 1 (MEN 1) by autopsy, and in 1954 Wermer reported a familial occurrence of multiple tumors which were associated with neoplastic transformation of parathyroid, pituitary and pancreatic islet cells. This complex association of abnormalities is inherited as an autosomal dominant trait and related to tumor suppressor gene on chromosome 11. In a 38-year-old woman with epigastric discomfort, general weakness and mental change, a pituitary gland tumor was diagnosed with sella magnetic resonance imaging and combined pituitary stimulation test. a pancreas insulinoma, an adrenal gland cortical adenoma and a thyroid adenoma were confirmed by pathology and they were diagnosed with biochemical test, CT scan, percutaneous transhepatic portal vein catheterization with insulin sampling, thyroid sonogram and scintigram. The blood glucose level was normalized after operation. In the 6 months follow up study, she has not presented any symptoms of hypoglycemia so far. Authors present this case briefly with a review of literature.

Enteral Nutrition with Isocal

To evaluate the effect and untoward reaction of "Isocal(Mead-Johnson B.V., Netherlands), lactose free polymeric enteral nutrient, 32 surgical or malnourished patients were selected. The nutritional parameters and indices after feeding of Isocal were compared to the pretreatment states. Routes of intake were oral(N=17) or nasoduodenal tube feeding(N=15). The average duration of treatment were 14.3 days(8 to 30 days). Among the 6 trial failures, 4 cases were directly related with Isocal feeding, such as intolerable diarrhea(N=3), and abdominal pain with partial ileus of recurrent stomach cancer(N=1). Transient diarrheas were in 3 cases. All of the cases with diarrhea were in oral feeding group. Nutritional parameters such as anthropometric scales and serum albumin showed progressive improving tendencies after Isocal, and transferrin(p=0.017) and total lymphocyte counts(TLC, p=0.057) in transitional feeding group revealed significant improvements. Nitrogen balance improved within the first week(p=0.000) of feeding. The Instant Nutritional Score(INS) of 9 cases got better, but 3 became worse, which includes 2 cases of terminal recurrent cancers. CPK revealed a significant drop(p=0.021) in one week. Blood chemical parameters didn't show any untoward changes during the periods. In conclusion, Isocal, via oral as well as nasoduodenal tube feeding, was an effective and useful enteral nutrient with acceptable side effects. Nasoduodenal tube feeding was preferable to avoid unwanted diarrhea. Transferrin, TLC, nitrogen balance, INS and CPK were reliable nutritional parameters even in two weeks' short period of clinical study.