Background: To know actual conditions and a balance between food intake and energy expenditure of each of the elderly in the super-aged society is very important.
Aim: To determine the resting energy expenditure (REE) of the elderly residing in the "Roken".
Methods: For Study 1, REEs of 47 elderly people in the Roken were measured. For Study 2, REEs of 22 patients who were admitted to a general hospital were measured.
Results: In Study 1, REE of the elderly people in the Roken ranged from 523 to 1,628 kcal/day/body; the mean value was 909 ± 239 kcal/day/body (mean ± SD) and 21.6 ± 4.5 kcal/kg/day. A discrepancy between REE and dietary energy intake was observed.
In Study 2, REE of patients in the hospital widely ranged from 589 to 2,549 kcal/day/body; the mean value was 1391 ± 459 kg/day/body (mean ± SD).
Conclusions: The mean value of REE of the elderly in the Roken was 74% lower than that of the healthy individuals in previous reports. The observed discrepancy between REE and dietary energy intake suggested the need for improvement in the effective absorption of nutrients from the digestive system, which may be more important than food intake.

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Bile leakage after laparoscopic cholecystectomy occurs in approximately 2% cases and most of them will be cured by drainage with an intraperitoneal tube inserted during the operation. Additional endoscopic procedures for bile leakage will generally not be needed. When an additional endoscopic procedure is performed to manage bile leakage, most of the time the leakage will improve. The rare cases of prolonged bile leakage can be effectively managed by endoscopic nasobiliary drainage (ENBD). We report a case of prolonged bile leakage after laparoscopic cholecystectomy treated using ENBD.

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A 67-year-old male complaining of muscular weakness and gait disturbance presented at our emergency room. He had a habit of excessive alcohol consumption, and suffered from severe diarrhea for more than 3 years. Laboratory examination performed at arrival showed that his serum potassium level was remarkably decreased (at 2.1 mEq/L). Endocrine levels were all within normal limits. The diagnosis of hypokalemic myopathy caused by excessive alcohol consumption was made based on and laboratory data. Upon admission, the symptoms of myopathy and diarrhea improved as the serum potassium level improved, and he was discharged on the 7 th day. Hypokalemia can become fatal and the causes of hypokalemic myopathy are diverse. Therefore, in addition to correcting the serum potassium level, it is important to search for the cause of hypokalemia.

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A male (>30 years old) presented with sudden swelling of his right orbital region after blowing his nose was transferred to our emergency room. During the previous evening, the patient's right oculus was struck by the head of his son. Computed tomography revealed a blowout fracture of the medial wall of his right orbit with orbital emphysema. No other abnormality was observed on ophthalmologic examination. The orbital emphysema was improved with conservative therapy. When sudden swelling of the right orbital region is observed, orbital emphysema complicated with orbital fracture should be considered as a differential diagnosis.

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