Effect and Safety of Oral Desmopressin for Nocturia in Brain Injured Patients

OBJECTIVE: To assess the effect of oral desmopressin administration for nocturia and sleeping in brain injured patients and to confirm its safety. METHOD: 20 brain injured patients waking up more than twice a night for urination during sleeping have been subjected to take 0.1 mg of desmopressin at 9 p.m. everyday for 30 days. To analyze the effect of the drug before and after its administration, the frequency of patient's awakening for urination, duration of time to first urination after sleeping, total urination volume during sleeping and Pittsburgh sleep quality index (PSQI) were evaluated. All newly found symptoms one month after taking the medication were recorded to confirm the safety of the drug. RESULTS: After taking the medication, the mean urination frequency of 20 patients was reduced from 2.4 to 1.4, the mean duration of time to the first urination after sleeping was increased from 3.4 hours to 4.9 hours (p<0.01). The mean PSQI score of 20 patients was decreased from 9.7 to 4.8 (p<0.01). 2 patients had side effects (hyponatremia, headache). CONCLUSION: The oral administration of desmopressin was relatively safe and effective on brain injured patients with nocturia.

Function and Environmental Factors Analysis using ICF (International Classification of Functioning, Disability and Health) for People with Disabilities

OBJECTIVE: To evaluate the clinical usefulness of ICF (International Classification of Functioning, Disability and Health) through correlation among existing functional evaluation tools and examined environmental factors affecting its function. METHOD: One hundred eight persons with disabilities living in Seoul were randomly selected according to disability severity categories. Functional Independence Measure (FIM), modified Barthel index (MBI) and ICF were examined and subjects were interviewed by trained rehabilitation doctors and occupational therapists. We compared correlation between these three functional measurements. We coded environmental factors affecting function. That was used in second level of 74 ICF items. RESULTS: The average of FIM, modified Barthel index, capacity and performance scores of ICF was 112.76, 92.97, 5.74 and 3.19. There was a statistical correlation among FIM, Barthel index, and ICF. The facilitator chapters among ICF's environmental factors were support and relationships (51.9%), attitudes (45.8%) in order. Most facilitated second level domains among the 68 items were immediate family (66.77%) and health professionals (52.8%). The most barrier chapters in ICF were product and a technology (19.5%), environment changes (15.5%) in order. Most barrier second level domains were design, construction and technology of buildings for public use (37%) and assets (37.0%). CONCLUSION: ICF correlates with the existing functional evaluation tool and can facilitate management of activity and participation by linking the result with the environmental factors, which may exacerbate or minimize them

Nutritional Assessment of Geriatric Stroke Patients in a Rehabilitation Hospital

OBJECTIVE: It was aimed to evaluate the nutritional status of geriatric stroke patients admitted to a convalescent and rehabilitation hospital and the clinical usefulness of the mini-nutritional assessment (MNA) to identify malnutrition in elderly stroke patients. METHOD: We performed a nutritional evaluation using the MNA questionnaire, anthropometric, haematological, and biochemical parameters in 30 stroke patients. Malnutrition was defined if there were abnormalities in at least one of the following parameters: serum values of albumin and transferrin, hemoglobin and total lymphocytes in blood, and body mass index. The sensitivity, specificity, and predictive values of MNA for malnutrition were assessed. RESULTS: The mean age of patients was 69.5 years and mean body mass index was 22.8 kg/m2. The prevalence of malnutrition was 46.7% while malnutrition or risk of malnutrition by MNA was 80%. The sensitivity, specificity, and positive/negative predictive values of MNA for malnutrition were respectively 92.9%, 31.3%, 54.2%, and 83.3% with a cutoff point lower than 23.5. There was a significant difference of hemoglobin value between malnourished and nourished group (p<0.05). CONCLUSION: Malnutrition was common in geriatric stroke patients. MNA was a useful screening tool to exclude nourished geriatric patients.

A Case of Small Bowel Perforation Associated with Sclerosing Encapsulating Peritonitis in Patient with Intermittent Peritoneal Dialysis (IPD) / 대한신장학회잡지

Sclerosing ecapsulating peritonitis (SEP) first described by Gandhi and Humyn at 1980 is generally recognized, but uncommon complication of continous ambulatory peritoneal dialysis (CAPD) and the prognosis is very poor. A 62-year old female was admitted to our hospital with chief complaint of abdominal pain, nausea, vomiting. On physical examination, abdominal pain was not detected. Abdominal CT demonstrated paralytic ileus and adhesion in proximal ileum. She underwent adhesilolysis of ileum and repair of perforated ileum. We experienced one case of SEP presenting small bowel perforation and peritonitis in patient with IPD. We report this case with review of the literature.