Pub Date : 2023-09-10DOI: 10.5124/jkma.2023.66.9.556
Min Ho Kang
Background: Allergic conjunctivitis is an immune disease primarily attributed to a type 1 hypersensitivity reaction in the conjunctiva of the eye. Based on clinical findings and pathogenesis, allergic conjunctivitis is classified into the following subtypes: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, atopic keratoconjunctivitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis.Current Concepts: The recommended initial treatment for allergic conjunctivitis involves the use of dual-effect agents exerting both antihistamine and mast cell stabilizing effects. If symptoms persist despite the application of these agents, coexisting allergic rhinitis should be considered a possible contributing factor, as this condition can also lead to ocular symptoms. Concurrent treatment of allergic rhinitis is necessary. Although oral antihistamines effectively alleviate symptoms associated with allergic conjunctivitis, potential systemic side effects must be carefully considered, particularly in older individuals and children. Steroid eye drops should be used for limited durations to minimize side effects. Unlike seasonal and perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis involve both type 1 hypersensitivity reactions and type 4 hypersensitivity mediated by T cells. In cases where dual-effect agents or steroid eye drops fail to yield improvements, topical immunosuppressants such as cyclosporine A or tacrolimus can be effective.Discussion and Conclusion: The pharmacological treatment of allergic conjunctivitis involves the initial use of dual-effect agents, with concurrent treatment of allergic rhinitis if present. Importantly, atopic and vernal keratoconjunctivitis can potentially lead to permanent vision loss, necessitating the application of steroid eye drops or immunosuppressant eye drops.
{"title":"Diagnosis and pharmacological management of allergic conjunctivitis","authors":"Min Ho Kang","doi":"10.5124/jkma.2023.66.9.556","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.9.556","url":null,"abstract":"Background: Allergic conjunctivitis is an immune disease primarily attributed to a type 1 hypersensitivity reaction in the conjunctiva of the eye. Based on clinical findings and pathogenesis, allergic conjunctivitis is classified into the following subtypes: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, atopic keratoconjunctivitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis.Current Concepts: The recommended initial treatment for allergic conjunctivitis involves the use of dual-effect agents exerting both antihistamine and mast cell stabilizing effects. If symptoms persist despite the application of these agents, coexisting allergic rhinitis should be considered a possible contributing factor, as this condition can also lead to ocular symptoms. Concurrent treatment of allergic rhinitis is necessary. Although oral antihistamines effectively alleviate symptoms associated with allergic conjunctivitis, potential systemic side effects must be carefully considered, particularly in older individuals and children. Steroid eye drops should be used for limited durations to minimize side effects. Unlike seasonal and perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis involve both type 1 hypersensitivity reactions and type 4 hypersensitivity mediated by T cells. In cases where dual-effect agents or steroid eye drops fail to yield improvements, topical immunosuppressants such as cyclosporine A or tacrolimus can be effective.Discussion and Conclusion: The pharmacological treatment of allergic conjunctivitis involves the initial use of dual-effect agents, with concurrent treatment of allergic rhinitis if present. Importantly, atopic and vernal keratoconjunctivitis can potentially lead to permanent vision loss, necessitating the application of steroid eye drops or immunosuppressant eye drops.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136073394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-10DOI: 10.5124/jkma.2023.66.8.479
Sang-Gyun Kim, Hwa Pyung Kim, Jae Hoon Kim, S. W. Lee, ae-Hyuk Yang
Background: Although patellofemoral arthritis is a common and debilitating orthopedic disorder, its treatment varies and remains controversial. This review aims to provide an overview of the current understanding of the pathophysiology of patellofemoral arthritis, as well as its various diagnostic and treatment options.Current Concepts: The pathophysiology of patellofemoral arthritis includes lower limb malalignment, trochlear and/or patellar dysplasia, patellar instability, trauma, and obesity. The disorder is characterized by chronic anterior knee pain aggravated by flexion of the knee joint. A critical imaging study of the Merchant and lateral knee radiographs may show the progression of patellofemoral arthritis and dysplasia of the patellofemoral joints. Non-pharmacologic treatment options for patellofemoral arthritis include patient education, self-management, exercise, weight loss, taping, bracing, and orthotics. Pharmacologic agents (non-steroidal anti-inflammatory drugs, acetaminophen, oral narcotics, and duloxetine) and intra-articular injection therapies (glucocorticoids, hyaluronic acid, platelet-rich plasma, and other regenerative therapies) can be helpful for symptom relief in patients with patellofemoral arthritis. The surgical treatment can begin with lateral retinacular release to realign and decompress the patellofemoral joint. If failure in the improvement of symptoms is noted, a tibial tubercle osteotomy can be considered in young and active patients. While the early design and technique of patellofemoral arthroplasty were less than encouraging, more recent implant design and surgical techniques have demonstrated robust results.Discussion and Conclusion: Patellofemoral arthritis is a unique entity compared with tibiofemoral arthritis marked by distinct epidemiology, biomechanics, and risk factors and treatment options. It is essential to understand its pathophysiology and ensure proper treatment options.
{"title":"Diagnosis and treatment of patellofemoral joint arthritis","authors":"Sang-Gyun Kim, Hwa Pyung Kim, Jae Hoon Kim, S. W. Lee, ae-Hyuk Yang","doi":"10.5124/jkma.2023.66.8.479","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.8.479","url":null,"abstract":"Background: Although patellofemoral arthritis is a common and debilitating orthopedic disorder, its treatment varies and remains controversial. This review aims to provide an overview of the current understanding of the pathophysiology of patellofemoral arthritis, as well as its various diagnostic and treatment options.Current Concepts: The pathophysiology of patellofemoral arthritis includes lower limb malalignment, trochlear and/or patellar dysplasia, patellar instability, trauma, and obesity. The disorder is characterized by chronic anterior knee pain aggravated by flexion of the knee joint. A critical imaging study of the Merchant and lateral knee radiographs may show the progression of patellofemoral arthritis and dysplasia of the patellofemoral joints. Non-pharmacologic treatment options for patellofemoral arthritis include patient education, self-management, exercise, weight loss, taping, bracing, and orthotics. Pharmacologic agents (non-steroidal anti-inflammatory drugs, acetaminophen, oral narcotics, and duloxetine) and intra-articular injection therapies (glucocorticoids, hyaluronic acid, platelet-rich plasma, and other regenerative therapies) can be helpful for symptom relief in patients with patellofemoral arthritis. The surgical treatment can begin with lateral retinacular release to realign and decompress the patellofemoral joint. If failure in the improvement of symptoms is noted, a tibial tubercle osteotomy can be considered in young and active patients. While the early design and technique of patellofemoral arthroplasty were less than encouraging, more recent implant design and surgical techniques have demonstrated robust results.Discussion and Conclusion: Patellofemoral arthritis is a unique entity compared with tibiofemoral arthritis marked by distinct epidemiology, biomechanics, and risk factors and treatment options. It is essential to understand its pathophysiology and ensure proper treatment options.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"49 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83177533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-10DOI: 10.5124/jkma.2023.66.8.464
K. Kang, Jae Hee Lee, Jung-Ro Yoon
Background: Patellofemoral joint problems refer to a spectrum of conditions affecting the patellofemoral joint, which is the joint between the patella and femur. These conditions can cause pain and instability in the knee and affect an individual’s ability to perform daily activities. Patellofemoral joint problems commonly cause knee pain, particularly among young athletes and physically active individuals. This review article discusses current patellofemoral joint problems, including their epidemiology, pathophysiology, diagnosis, and management.Current Concepts: Patellofemoral joint problems are presented as clinical symptoms of pain and instability. Dividing the diagnostic criteria into anterior knee pain, patella instability, and patellofemoral arthritis is useful. Anterior knee pain is diagnosed after excluding possible causes. Patellar instability is classified into recurrent dislocation, habitual dislocation (extension and flexion types), and permanent dislocation. Moreover, patellar instability can progress to the final stage of patellofemoral arthritis. Thus, patellar instability should be treated according to the Dejour criterion, and patellofemoral arthritis treatment requires artificial joint replacement surgery.Discussion and Conclusion: The pathological mechanism of patellofemoral joint problems still needs to be properly established, and multifactorial causes make it difficult to treat patellofemoral joint problems. Accurate diagnosis is considered an essential factor for successful treatment.
{"title":"Patellofemoral joint disorders","authors":"K. Kang, Jae Hee Lee, Jung-Ro Yoon","doi":"10.5124/jkma.2023.66.8.464","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.8.464","url":null,"abstract":"Background: Patellofemoral joint problems refer to a spectrum of conditions affecting the patellofemoral joint, which is the joint between the patella and femur. These conditions can cause pain and instability in the knee and affect an individual’s ability to perform daily activities. Patellofemoral joint problems commonly cause knee pain, particularly among young athletes and physically active individuals. This review article discusses current patellofemoral joint problems, including their epidemiology, pathophysiology, diagnosis, and management.Current Concepts: Patellofemoral joint problems are presented as clinical symptoms of pain and instability. Dividing the diagnostic criteria into anterior knee pain, patella instability, and patellofemoral arthritis is useful. Anterior knee pain is diagnosed after excluding possible causes. Patellar instability is classified into recurrent dislocation, habitual dislocation (extension and flexion types), and permanent dislocation. Moreover, patellar instability can progress to the final stage of patellofemoral arthritis. Thus, patellar instability should be treated according to the Dejour criterion, and patellofemoral arthritis treatment requires artificial joint replacement surgery.Discussion and Conclusion: The pathological mechanism of patellofemoral joint problems still needs to be properly established, and multifactorial causes make it difficult to treat patellofemoral joint problems. Accurate diagnosis is considered an essential factor for successful treatment.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"6 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75265335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-10DOI: 10.5124/jkma.2023.66.8.508
Sun Mi Lim, Jeong-Hun Park, J. Lim, K. Kim
Background: Many countries need help with the problem of an unbalanced distribution of physicians and hospitals. Moreover, various policies and strategies have been proposed to solve this problem. This study aimed to examine the determinants of the unbalanced distribution of physicians.Methods: From the 2020 Korean Physician Survey data, 4,181 physicians practicing in Korea were limited to the subjects of the study. We analyzed the factors influencing physicians’ choice of practice location and their willingness to change their practice location from an urban to a rural area.Results: The region of physicians’ hometown, medical school, and residency training hospitals determined their choice of practice location. The type of affiliated healthcare organization and the location of physicians’ hometown, medical school, and residency training hospitals affected their willingness to change their practice location from an urban to a rural area. Furthermore, the concordance rate of the regions of physicians’ hometown, medical school, and residency training hospitals with the region of their practice location was 24.9%.Conclusion: In South Korea, policies for doctors have been designed without considering why they are reluctant to work in rural hospitals. To have a balanced distribution of physicians and hospitals, it is necessary to accurately analyze the status of medical resources based on regions and identify the current and future medical demand. The social situation, such as future demographic change and regional extinction, must also be fully considered. Furthermore, policies should be implemented that encourage physicians to work in rural hospitals.
{"title":"Analysis of factors affecting the unbalanced distribution of physicians’ working regions in South Korea","authors":"Sun Mi Lim, Jeong-Hun Park, J. Lim, K. Kim","doi":"10.5124/jkma.2023.66.8.508","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.8.508","url":null,"abstract":"Background: Many countries need help with the problem of an unbalanced distribution of physicians and hospitals. Moreover, various policies and strategies have been proposed to solve this problem. This study aimed to examine the determinants of the unbalanced distribution of physicians.Methods: From the 2020 Korean Physician Survey data, 4,181 physicians practicing in Korea were limited to the subjects of the study. We analyzed the factors influencing physicians’ choice of practice location and their willingness to change their practice location from an urban to a rural area.Results: The region of physicians’ hometown, medical school, and residency training hospitals determined their choice of practice location. The type of affiliated healthcare organization and the location of physicians’ hometown, medical school, and residency training hospitals affected their willingness to change their practice location from an urban to a rural area. Furthermore, the concordance rate of the regions of physicians’ hometown, medical school, and residency training hospitals with the region of their practice location was 24.9%.Conclusion: In South Korea, policies for doctors have been designed without considering why they are reluctant to work in rural hospitals. To have a balanced distribution of physicians and hospitals, it is necessary to accurately analyze the status of medical resources based on regions and identify the current and future medical demand. The social situation, such as future demographic change and regional extinction, must also be fully considered. Furthermore, policies should be implemented that encourage physicians to work in rural hospitals.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"8 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72886623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-10DOI: 10.5124/jkma.2023.66.8.489
Seung Hoon Lee, Jae Hyuk Lee, Y. Lee
Background: Surgical management of the osteoarthritic knee joint consists of osteotomies such as a high tibial osteotomy (HTO), uni-compartmental knee arthroplasty (UKA), and total knee arthroplasty (TKA). These surgeries mainly treat the tibiofemoral joint but can also have an impact on the patellofemoral (PF) joint. These changes in PF joint can affect the surgical outcome.Current Concepts: PF joint problems are relative contraindications in UKA. However, recent studies have reported that these problems do not markedly affect the result of UKA. During HTO, the patella height and tracking can change, affecting the PF joint problem. The effect of the PF joint can be minimized through various methods of closing wedge HTO or modified opening wedge (OW) HTO, such as retro-tubercular biplanar OWHTO. However, this method is controversial regarding its impact on clinical outcomes. In TKA, pain caused by PF joint problems can be reduced using techniques such as patella resurfacing, patelloplasty, and denervation; however, there is no clear consensus.Discussion and Conclusion: The surgical treatment of degenerative knee osteoarthritis has an impact on the PF joint, which can affect the outcome of surgery and vice versa. However, these impacts only occasionally cause clinical difference. Conclusively, these surgeries should be done by considering the PF joint because changes in the joint can affect the surgical outcome.
{"title":"Surgical treatment of knee osteoarthritis focusing on the patellofemoral joint","authors":"Seung Hoon Lee, Jae Hyuk Lee, Y. Lee","doi":"10.5124/jkma.2023.66.8.489","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.8.489","url":null,"abstract":"Background: Surgical management of the osteoarthritic knee joint consists of osteotomies such as a high tibial osteotomy (HTO), uni-compartmental knee arthroplasty (UKA), and total knee arthroplasty (TKA). These surgeries mainly treat the tibiofemoral joint but can also have an impact on the patellofemoral (PF) joint. These changes in PF joint can affect the surgical outcome.Current Concepts: PF joint problems are relative contraindications in UKA. However, recent studies have reported that these problems do not markedly affect the result of UKA. During HTO, the patella height and tracking can change, affecting the PF joint problem. The effect of the PF joint can be minimized through various methods of closing wedge HTO or modified opening wedge (OW) HTO, such as retro-tubercular biplanar OWHTO. However, this method is controversial regarding its impact on clinical outcomes. In TKA, pain caused by PF joint problems can be reduced using techniques such as patella resurfacing, patelloplasty, and denervation; however, there is no clear consensus.Discussion and Conclusion: The surgical treatment of degenerative knee osteoarthritis has an impact on the PF joint, which can affect the outcome of surgery and vice versa. However, these impacts only occasionally cause clinical difference. Conclusively, these surgeries should be done by considering the PF joint because changes in the joint can affect the surgical outcome.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"65 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87590639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-10DOI: 10.5124/jkma.2023.66.8.497
Kwang-Ui Hong, S. Hyun, Jae-Koo Lee, Ki-Jeong Kim
Background: The diagnosis rate of adult spinal deformity (ASD) is increasing with increased life expectancy and the prevalence of degenerative spinal diseases. The prevalence of ASD in adults aged >60 years has been reported to be up to 68%. ASD has significant impact on the pain, disability, and mental health. Therefore, it is necessary to establish an effective surgical plan by accumulating modern knowledge on ASD, developing surgical techniques, and improving pre- and post-operative care so as to achieve optimal surgical outcomes.Current Concepts: ASD results from coronal and sagittal malalignments caused by degenerative diseases or iatrogenic factors. Recently, the significance of sagittal alignment correction has been emphasized, and the SRSSchwab classification of ASD is generally accepted. Individualized correction goals can be set through sufficient preoperative evaluations and imaging studies, and appropriate coronal and sagittal alignment correction can be achieved through intraoperative positioning of patient, anterior and posterior approach spine surgery, screw fixation, and osteotomies.Discussion and Conclusion: It is necessary to establish an optimal correction target and select the appropriate surgical approach for each patient with ASD, so as to improve patients’ quality of life. Surgical interventions for ASD can be safely completed by adequately comprehending and anticipating perioperative complications.
{"title":"Diagnosis and treatment of adult spinal deformity","authors":"Kwang-Ui Hong, S. Hyun, Jae-Koo Lee, Ki-Jeong Kim","doi":"10.5124/jkma.2023.66.8.497","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.8.497","url":null,"abstract":"Background: The diagnosis rate of adult spinal deformity (ASD) is increasing with increased life expectancy and the prevalence of degenerative spinal diseases. The prevalence of ASD in adults aged >60 years has been reported to be up to 68%. ASD has significant impact on the pain, disability, and mental health. Therefore, it is necessary to establish an effective surgical plan by accumulating modern knowledge on ASD, developing surgical techniques, and improving pre- and post-operative care so as to achieve optimal surgical outcomes.Current Concepts: ASD results from coronal and sagittal malalignments caused by degenerative diseases or iatrogenic factors. Recently, the significance of sagittal alignment correction has been emphasized, and the SRSSchwab classification of ASD is generally accepted. Individualized correction goals can be set through sufficient preoperative evaluations and imaging studies, and appropriate coronal and sagittal alignment correction can be achieved through intraoperative positioning of patient, anterior and posterior approach spine surgery, screw fixation, and osteotomies.Discussion and Conclusion: It is necessary to establish an optimal correction target and select the appropriate surgical approach for each patient with ASD, so as to improve patients’ quality of life. Surgical interventions for ASD can be safely completed by adequately comprehending and anticipating perioperative complications.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"10 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76295416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-10DOI: 10.5124/jkma.2023.66.8.470
Yun Seong Choi, J. Wang
Background: Patellofemoral instability, by definition, is a condition where the patella bone pathologically disarticulates out from the patellofemoral joint, either through subluxation or complete dislocation. The overall incidence of patellofemoral instability ranges between 5.8 and 29 per 100,000. Over time, patients with patellar instability can have debilitating pain, limitations in basic function, and long-term arthritis.Current Concepts: Risk factors for patellofemoral instability include trochlear dysplasia, patella alta, increased tibial tubercle-to-trochlear groove distance, abnormal patella lateral tilt, and coronal and torsional malalignment. The proper treatment is often debatable. Conservative treatment is suitable for acute dislocation but has a high failure rate for chronic instability, which usually necessitates surgical treatment. Today’s common surgical treatments focus on fixing anatomical defects, relieving symptoms of instability, and allowing patients to return to a suitable level of activity.Discussion and Conclusion: In this review, we summarize the relevant pathophysiology, categorization, clinical features, physical examination, imaging, and treatment options for patellofemoral instability.
{"title":"Diagnosis and treatment of patellofemoral joint instability","authors":"Yun Seong Choi, J. Wang","doi":"10.5124/jkma.2023.66.8.470","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.8.470","url":null,"abstract":"Background: Patellofemoral instability, by definition, is a condition where the patella bone pathologically disarticulates out from the patellofemoral joint, either through subluxation or complete dislocation. The overall incidence of patellofemoral instability ranges between 5.8 and 29 per 100,000. Over time, patients with patellar instability can have debilitating pain, limitations in basic function, and long-term arthritis.Current Concepts: Risk factors for patellofemoral instability include trochlear dysplasia, patella alta, increased tibial tubercle-to-trochlear groove distance, abnormal patella lateral tilt, and coronal and torsional malalignment. The proper treatment is often debatable. Conservative treatment is suitable for acute dislocation but has a high failure rate for chronic instability, which usually necessitates surgical treatment. Today’s common surgical treatments focus on fixing anatomical defects, relieving symptoms of instability, and allowing patients to return to a suitable level of activity.Discussion and Conclusion: In this review, we summarize the relevant pathophysiology, categorization, clinical features, physical examination, imaging, and treatment options for patellofemoral instability.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"853 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72433497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-10DOI: 10.5124/jkma.2023.66.8.460
Jung-Ro Yoon
Background: Anterior knee pain (AKP) syndrome is one of the most common conditions that prompt active young individuals to seek evaluation at sports injury clinics. Compared to the general population, patients with AKP appear to be at a higher risk of developing patellofemoral osteoarthritis. AKP can be detrimental to the affected patient’s quality of life and, in the larger context, it could markedly burden the economy with high healthcare costs. This opinion aims to present a comprehensive evaluation of AKP to improve its management in clinical practice.Current Concepts: AKP has a multifactorial etiology. It can be attributed not only to structures within and around the knee but also to external factors, such as limb malalignment, weakness of specific hip muscle groups, and core and ligamentous laxity. Hence, AKP warrants a detailed evaluation of patient’s medical history and a thorough clinical examination complemented by relevant radiological investigations to identify its origin in the knee and the underlying cause. Conservative management yields favorable outcomes in the majority of patients with AKP, whereas surgical management becomes necessary only when well-characterized structural abnormalities of the knee or limb correlate with the clinical presentation of AKP or when conservative measures fail to provide substantial and sustained symptoms relief.Discussion and Conclusion: The treatment strategy for AKP should be individualized based on the patient’s profile and the specific cause identified. Therefore, the management of AKP requires a focused evaluation of the patient’s medical history, clinical examination, and radiological investigations to identify the condition’s origin and underlying cause.
{"title":"Recent trends in the management of anterior knee pain","authors":"Jung-Ro Yoon","doi":"10.5124/jkma.2023.66.8.460","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.8.460","url":null,"abstract":"Background: Anterior knee pain (AKP) syndrome is one of the most common conditions that prompt active young individuals to seek evaluation at sports injury clinics. Compared to the general population, patients with AKP appear to be at a higher risk of developing patellofemoral osteoarthritis. AKP can be detrimental to the affected patient’s quality of life and, in the larger context, it could markedly burden the economy with high healthcare costs. This opinion aims to present a comprehensive evaluation of AKP to improve its management in clinical practice.Current Concepts: AKP has a multifactorial etiology. It can be attributed not only to structures within and around the knee but also to external factors, such as limb malalignment, weakness of specific hip muscle groups, and core and ligamentous laxity. Hence, AKP warrants a detailed evaluation of patient’s medical history and a thorough clinical examination complemented by relevant radiological investigations to identify its origin in the knee and the underlying cause. Conservative management yields favorable outcomes in the majority of patients with AKP, whereas surgical management becomes necessary only when well-characterized structural abnormalities of the knee or limb correlate with the clinical presentation of AKP or when conservative measures fail to provide substantial and sustained symptoms relief.Discussion and Conclusion: The treatment strategy for AKP should be individualized based on the patient’s profile and the specific cause identified. Therefore, the management of AKP requires a focused evaluation of the patient’s medical history, clinical examination, and radiological investigations to identify the condition’s origin and underlying cause.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"44 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85830855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-10DOI: 10.5124/jkma.2023.66.7.450
Sang-Chul Kim
Background: The lack of healthcare providers and financial resources in medically vulnerable areas results in reduced access to timely emergency care, leading to higher mortality rates. Utilizing information and communication technology (ICT) in the emergency medical services (EMS) system can potentially reduce health disparities and supplement the shortage of medical personnel. This study introduces the Chungbuk Smart Emergency Medical Service Project to improve EMS in Chungbuk province using ICT.Current Concepts: To improve regional EMS, the Chungbuk EMS Collaboration Committee initiated an ICT-EMS project that incorporates an algorithm-based patient triage system and real-time hospital selection for patient transfers. This initiative is funded by the Smart City Challenge project, which fosters a more comprehensive EMS system by promoting collaboration among local government agencies, local hospitals, and fire headquarters. The system allows the sharing of patients’ information from the notification stage through hospital transfer, thus ensuring efficient treatment and seamless communication between paramedics and health care providers.Discussion and Conclusion: Effective use of ICT for information sharing and coordination during EMS, from ambulance dispatch to hospital treatment, is essential for improving regional EMS. Clear communication, cooperation, and well-defined roles are necessary for the efficient use of ICT by emergency healthcare providers. Making healthcare providers understand the purpose of ICT equipment is crucial for its successful implementation. Verification of the effectiveness of ICT-based EMS improvement projects will lead to their global expansion, besides benefitting domestic EMS.
{"title":"Integration of information and communication technology in emergency medical services: The Chungbuk Smart Emergency Service Project","authors":"Sang-Chul Kim","doi":"10.5124/jkma.2023.66.7.450","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.7.450","url":null,"abstract":"Background: The lack of healthcare providers and financial resources in medically vulnerable areas results in reduced access to timely emergency care, leading to higher mortality rates. Utilizing information and communication technology (ICT) in the emergency medical services (EMS) system can potentially reduce health disparities and supplement the shortage of medical personnel. This study introduces the Chungbuk Smart Emergency Medical Service Project to improve EMS in Chungbuk province using ICT.Current Concepts: To improve regional EMS, the Chungbuk EMS Collaboration Committee initiated an ICT-EMS project that incorporates an algorithm-based patient triage system and real-time hospital selection for patient transfers. This initiative is funded by the Smart City Challenge project, which fosters a more comprehensive EMS system by promoting collaboration among local government agencies, local hospitals, and fire headquarters. The system allows the sharing of patients’ information from the notification stage through hospital transfer, thus ensuring efficient treatment and seamless communication between paramedics and health care providers.Discussion and Conclusion: Effective use of ICT for information sharing and coordination during EMS, from ambulance dispatch to hospital treatment, is essential for improving regional EMS. Clear communication, cooperation, and well-defined roles are necessary for the efficient use of ICT by emergency healthcare providers. Making healthcare providers understand the purpose of ICT equipment is crucial for its successful implementation. Verification of the effectiveness of ICT-based EMS improvement projects will lead to their global expansion, besides benefitting domestic EMS.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90381481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-10DOI: 10.5124/jkma.2023.66.7.404
H. Kwon
Background: The number of patients with diabetes mellitus in Korea has exceeded 6 million. Considering approximately 15.83 million patients in the prediabetic stage, more than 20 million Koreans have diabetes or are at risk of diabetes. In this study, we investigated the prevalence and treatment status of diabetes mellitus in Korea based on sex and age.Current Concepts: The prevalence of diabetes mellitus in Korea is higher in men than in women. Men develop diabetes at a younger age (30s and 40s), whereas women develop diabetes in their 50s after menopause. The rate of comorbidities, including abdominal obesity, hypertension, and hypercholesterolemia is higher in women than in men. Globally, more men develop diabetes than women; however, men develop diabetes at a younger age and at a lower body mass index. In contrast, women develop diabetes at a later age because female sex hormones play a protective role against obesity and metabolic diseases until menopause after which women tend to gain weight and develop insulin resistance. Therefore, women with diabetes have poorer metabolic markers such as abdominal obesity, hypertension, and dyslipidemia than those observed in men.Discussion and Conclusion: Prevention and control measures for patients with diabetes should be age- and sex-specific. The high prevalence of diabetes and prediabetes in men aged <50 years suggests that prevention measures are more important. In contrast, women aged <50 years with premenopausal diabetes should be more vigilant regarding weight, comorbidity, and diabetes management.
{"title":"Prevalence and treatment status of diabetes mellitus in Korea","authors":"H. Kwon","doi":"10.5124/jkma.2023.66.7.404","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.7.404","url":null,"abstract":"Background: The number of patients with diabetes mellitus in Korea has exceeded 6 million. Considering approximately 15.83 million patients in the prediabetic stage, more than 20 million Koreans have diabetes or are at risk of diabetes. In this study, we investigated the prevalence and treatment status of diabetes mellitus in Korea based on sex and age.Current Concepts: The prevalence of diabetes mellitus in Korea is higher in men than in women. Men develop diabetes at a younger age (30s and 40s), whereas women develop diabetes in their 50s after menopause. The rate of comorbidities, including abdominal obesity, hypertension, and hypercholesterolemia is higher in women than in men. Globally, more men develop diabetes than women; however, men develop diabetes at a younger age and at a lower body mass index. In contrast, women develop diabetes at a later age because female sex hormones play a protective role against obesity and metabolic diseases until menopause after which women tend to gain weight and develop insulin resistance. Therefore, women with diabetes have poorer metabolic markers such as abdominal obesity, hypertension, and dyslipidemia than those observed in men.Discussion and Conclusion: Prevention and control measures for patients with diabetes should be age- and sex-specific. The high prevalence of diabetes and prediabetes in men aged <50 years suggests that prevention measures are more important. In contrast, women aged <50 years with premenopausal diabetes should be more vigilant regarding weight, comorbidity, and diabetes management.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"72 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84503904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：