Ten days prior to being seen a 65-year-old man suffered a Wallenberg stroke involving the lateral medulla. This left him with difficulty swallowing. Since that time he had been treated with intravenous fluids, and attempts at eating led to mild aspiration with pneumonia. In that period he lost 6% of his usual body weight and was continuing to lose weight. He felt weak and was able to ambulate only with difficulty, both because of his stroke-related ataxia and generalized weakness. On physical examination there was an obvious squared-off appearance to his shoulders from subcutaneous tissue and muscle wasting. There was no edema.
A 63-year-old man was admitted to the hospital for gastric resection of an obstructing gastric carcinoma. He was well until 6 weeks prior to admission when he began to notice the rapid onset of early satiety. This progressed to the point where he