Pub Date : 2023-02-10DOI: 10.5124/jkma.2023.66.2.143
P. Kim
Background: In December 2022, the Ministry of Health and Welfare of the Korean government announced the “action plan for essential medicine (EM),” featuring that the regional emergency centers in tertiary general hospitals would be responsible for emergency medical care. There have been several limitations in regional emergency centers because of lacking operating rooms, intensive care units, and wards during weekdays and surgery staff during the nighttime and holidays. Thus, this plan may be insufficient to achieve the goal.Current Concepts: This paper proposes special hospitals for EM, especially essential surgery in which there are no scheduled surgeries and outpatient clinics during weekdays. At least half of wards should be reserved for EM patients because of lacking wards, and these empty wards should be financially rewarded. During weekends, a team of five surgical specialists works 16 h per day to prevent the so-called weekend or Friday effect because of lacking surgeons. The special hospital would operate 365 days and 24 hours with an EM surgeon pool in the digital twin system—virtual and real hospitals (so-called smart essential surgery metaverse hospital).Discussion and Conclusion: This paper proposes a pilot project to establish a smart essential surgery metaverse hospital to compare the efficiency of EM with the regional emergency centers in tertiary general hospitals.
{"title":"Proposal to establish a hospital dedicated for surgical essential medicines: a pilot project to strengthen the essential medical service in Korea","authors":"P. Kim","doi":"10.5124/jkma.2023.66.2.143","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.2.143","url":null,"abstract":"Background: In December 2022, the Ministry of Health and Welfare of the Korean government announced the “action plan for essential medicine (EM),” featuring that the regional emergency centers in tertiary general hospitals would be responsible for emergency medical care. There have been several limitations in regional emergency centers because of lacking operating rooms, intensive care units, and wards during weekdays and surgery staff during the nighttime and holidays. Thus, this plan may be insufficient to achieve the goal.Current Concepts: This paper proposes special hospitals for EM, especially essential surgery in which there are no scheduled surgeries and outpatient clinics during weekdays. At least half of wards should be reserved for EM patients because of lacking wards, and these empty wards should be financially rewarded. During weekends, a team of five surgical specialists works 16 h per day to prevent the so-called weekend or Friday effect because of lacking surgeons. The special hospital would operate 365 days and 24 hours with an EM surgeon pool in the digital twin system—virtual and real hospitals (so-called smart essential surgery metaverse hospital).Discussion and Conclusion: This paper proposes a pilot project to establish a smart essential surgery metaverse hospital to compare the efficiency of EM with the regional emergency centers in tertiary general hospitals.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"46 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89436170","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 : 2023-02-10DOI: 10.5124/jkma.2023.66.2.123
J. Moon, B. Chun, Y. Cho
Background: Sodium hypochlorite is commonly used as a household bleaching agent (for example, the Clorox brand). Sodium hypochlorite poisoning with ingestion of a bleaching agent is often observed in clinical practice.Current Concepts: Ingestion (intentional or accidental) is the most common route of exposure to household bleaching agents. Accidental ingestion of household bleaching agents is rarely clinically important. However, ingestion of a large amount of a dilute formulation or a high-concentration preparation of bleaching agents can result in severe and rarely fatal corrosive injury. Therefore, prompt supportive care is essential because a specific antidote is currently unavailable. Severe poisoning requires hospital admission. Emergency endoscopy and thoracic and abdominal computed tomography are warranted to aid with diagnosis and management of hypochlorite-induced corrosive injury in patients with severe poisoning, who develop clinical features suggestive of corrosive injury.Discussion and Conclusion: Intentional poisoning, which accounts for most cases of household bleaching agent poisonings in Korea, is likely to cause severe corrosive injuries. Therefore, it is necessary to gain deeper and accurate understanding of the clinical aspects and treatment of poisoning by household bleaching agents.
{"title":"Diagnosis and treatment of sodium hypochlorite poisoning with ingestion of household bleaching agents","authors":"J. Moon, B. Chun, Y. Cho","doi":"10.5124/jkma.2023.66.2.123","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.2.123","url":null,"abstract":"Background: Sodium hypochlorite is commonly used as a household bleaching agent (for example, the Clorox brand). Sodium hypochlorite poisoning with ingestion of a bleaching agent is often observed in clinical practice.Current Concepts: Ingestion (intentional or accidental) is the most common route of exposure to household bleaching agents. Accidental ingestion of household bleaching agents is rarely clinically important. However, ingestion of a large amount of a dilute formulation or a high-concentration preparation of bleaching agents can result in severe and rarely fatal corrosive injury. Therefore, prompt supportive care is essential because a specific antidote is currently unavailable. Severe poisoning requires hospital admission. Emergency endoscopy and thoracic and abdominal computed tomography are warranted to aid with diagnosis and management of hypochlorite-induced corrosive injury in patients with severe poisoning, who develop clinical features suggestive of corrosive injury.Discussion and Conclusion: Intentional poisoning, which accounts for most cases of household bleaching agent poisonings in Korea, is likely to cause severe corrosive injuries. Therefore, it is necessary to gain deeper and accurate understanding of the clinical aspects and treatment of poisoning by household bleaching agents.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"78 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86298800","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 : 2023-02-10DOI: 10.5124/jkma.2023.66.2.116
Song-Ee Park
Background: The incidence of adverse toxic reactions to immunotherapy using immune checkpoint inhibitors is 2-10% in the respiratory system and 3.9% to 12% in the neurologic system. The severity of adverse effects increases when combined immunotherapeutic agents are administered.Current Concepts: In cases of high-grade toxicity, it is important to discontinue immunotherapy immediately. In cases of grade 3 to 4 toxicity, immunosuppressive corticosteroid therapy is the first-line treatment. Short-term steroid treatment does not affect anti-tumor efficacy. It is thus necessary to use steroids for an appropriate period then carefully taper the steroid dose to prevent recurrence. If no improvement is achieved within 48-72 hours after the administration of steroids, it is essential to initiate multidisciplinary treatment involving related departments and add immunosuppressive drugs. If the patient is administrated immunotherapy again, it may be necessary to permanently discontinue the immunotherapy depending on the toxicity grade that first occurred.Discussion and Conclusion: The primary goals for effective management of immunotherapy-related adverse events are early recognition of symptoms and immediate treatment.
{"title":"Management of the adverse effects of cancer immunotherapy with a focus on the respiratory and nervous systems","authors":"Song-Ee Park","doi":"10.5124/jkma.2023.66.2.116","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.2.116","url":null,"abstract":"Background: The incidence of adverse toxic reactions to immunotherapy using immune checkpoint inhibitors is 2-10% in the respiratory system and 3.9% to 12% in the neurologic system. The severity of adverse effects increases when combined immunotherapeutic agents are administered.Current Concepts: In cases of high-grade toxicity, it is important to discontinue immunotherapy immediately. In cases of grade 3 to 4 toxicity, immunosuppressive corticosteroid therapy is the first-line treatment. Short-term steroid treatment does not affect anti-tumor efficacy. It is thus necessary to use steroids for an appropriate period then carefully taper the steroid dose to prevent recurrence. If no improvement is achieved within 48-72 hours after the administration of steroids, it is essential to initiate multidisciplinary treatment involving related departments and add immunosuppressive drugs. If the patient is administrated immunotherapy again, it may be necessary to permanently discontinue the immunotherapy depending on the toxicity grade that first occurred.Discussion and Conclusion: The primary goals for effective management of immunotherapy-related adverse events are early recognition of symptoms and immediate treatment.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":" 13","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72382248","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 : 2023-02-10DOI: 10.5124/jkma.2023.66.2.86
D. Y. Kim
Background: The overall survival rate of advanced cancer patients has improved thanks to the development of modern medical treatments, particularly new and innovative chemotherapeutic agents such as targeted therapies and immune checkpoint inhibitors.Current Concepts: Chemotherapy is administered in neoadjuvant, adjuvant, and palliative settings, and its ultimate goal is to improve overall survival. Chemotherapy has several proven and valuable clinical benefits, but also many side effects that cannot be ignored, especially in patients with poor European Cancer Oncology Group performance status. Therefore, we must carefully weigh and trade off the benefits and harms from many chemotherapy agents. In fact, it can be difficult to determine whether advanced cancer patients really benefit from chemotherapy, which is why a number of value measurement tools such as the American Society Clinical Oncology-Value Framework and the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale have been developed.Discussion and Conclusion: We need to include individual cancer patients in decision-making processes and use appropriate shared decision-making to decide whether or not to administer chemotherapy. Furthermore, we should perform rational trade-offs in consideration of limited health resources.
{"title":"How do we trade off benefits and harms of anticancer drugs for advanced cancer patients?","authors":"D. Y. Kim","doi":"10.5124/jkma.2023.66.2.86","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.2.86","url":null,"abstract":"Background: The overall survival rate of advanced cancer patients has improved thanks to the development of modern medical treatments, particularly new and innovative chemotherapeutic agents such as targeted therapies and immune checkpoint inhibitors.Current Concepts: Chemotherapy is administered in neoadjuvant, adjuvant, and palliative settings, and its ultimate goal is to improve overall survival. Chemotherapy has several proven and valuable clinical benefits, but also many side effects that cannot be ignored, especially in patients with poor European Cancer Oncology Group performance status. Therefore, we must carefully weigh and trade off the benefits and harms from many chemotherapy agents. In fact, it can be difficult to determine whether advanced cancer patients really benefit from chemotherapy, which is why a number of value measurement tools such as the American Society Clinical Oncology-Value Framework and the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale have been developed.Discussion and Conclusion: We need to include individual cancer patients in decision-making processes and use appropriate shared decision-making to decide whether or not to administer chemotherapy. Furthermore, we should perform rational trade-offs in consideration of limited health resources.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"21 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77344931","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 : 2023-02-10DOI: 10.5124/jkma.2023.66.2.132
Hyongjoon Noh, Juhee Seo, Seokmin Lee, Nari Yi, Sanghee Park, Yong-Jun Choi, Sun Huh
Background: This study analyzed the causes of death in the Korean population in 2020.Methods: Cause-of-death data for 2020 from Statistics Korea were examined based on the Korean Standard Classification of Diseases and Causes of Death, 7th revision and the International Statistical Classification of Diseases and Related Health Problems, 10th revision.Results: In total, 304,948 deaths occurred, reflecting an increase of 9,838 (3.3%) from 2019. The crude death rate (the number of deaths per 100,000 people) was 593.9, corresponding to an increase of 19.0 (3.3%) from 2019. The 10 leading causes of death, in descending order, were malignant neoplasms, heart diseases, pneumonia, cerebrovascular diseases, intentional self-harm, diabetes mellitus, Alzheimer disease, liver diseases, hypertensive diseases, and sepsis. Cancer accounted for 27.0% of deaths. Within the category of malignant neoplasms, the top 5 leading organs of involvement were the lung, liver, colon, stomach, and pancreas. Sepsis was included in the 10 leading causes of death for the first time. Mortality due to pneumonia decreased to 43.3 (per 100,000 people) from 45.1 in 2019. The number of deaths due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 950, of which 54.5% were in people aged 80 or older.Conclusion: These changes reflect the continuing increase in deaths due to diseases of old age, including sepsis. The decrease in deaths due to pneumonia may have been due to protective measures against SARS-CoV-2. With the concomitant decrease in fertility, 2020 became the first year in which Korea’s natural total population decreased.
{"title":"Cause-of-death statistics in 2020 in the Republic of Korea","authors":"Hyongjoon Noh, Juhee Seo, Seokmin Lee, Nari Yi, Sanghee Park, Yong-Jun Choi, Sun Huh","doi":"10.5124/jkma.2023.66.2.132","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.2.132","url":null,"abstract":"Background: This study analyzed the causes of death in the Korean population in 2020.Methods: Cause-of-death data for 2020 from Statistics Korea were examined based on the Korean Standard Classification of Diseases and Causes of Death, 7th revision and the International Statistical Classification of Diseases and Related Health Problems, 10th revision.Results: In total, 304,948 deaths occurred, reflecting an increase of 9,838 (3.3%) from 2019. The crude death rate (the number of deaths per 100,000 people) was 593.9, corresponding to an increase of 19.0 (3.3%) from 2019. The 10 leading causes of death, in descending order, were malignant neoplasms, heart diseases, pneumonia, cerebrovascular diseases, intentional self-harm, diabetes mellitus, Alzheimer disease, liver diseases, hypertensive diseases, and sepsis. Cancer accounted for 27.0% of deaths. Within the category of malignant neoplasms, the top 5 leading organs of involvement were the lung, liver, colon, stomach, and pancreas. Sepsis was included in the 10 leading causes of death for the first time. Mortality due to pneumonia decreased to 43.3 (per 100,000 people) from 45.1 in 2019. The number of deaths due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 950, of which 54.5% were in people aged 80 or older.Conclusion: These changes reflect the continuing increase in deaths due to diseases of old age, including sepsis. The decrease in deaths due to pneumonia may have been due to protective measures against SARS-CoV-2. With the concomitant decrease in fertility, 2020 became the first year in which Korea’s natural total population decreased.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"294 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136052307","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 : 2023-01-10DOI: 10.5124/jkma.2023.66.1.11
C. Park, S. Lim, B. Park
Background: Trigeminal neuralgia is a sudden and painful facial condition that is triggered by activities of daily living. The pain is debilitating and patients are often unable to perform routine daily tasks such as washing their face, shaving, and brushing their teeth, which in turn has an impact on their social life and mental well-being as they are often anxious and fearful of not knowing when the pain may occur.Current Concepts: Treatment for trigeminal neuralgia involves local nerve destruction surgeries, including neuroblocking, percutaneous ethanol injection therapy, percutaneous radio-frequency rhizotomy, and gamma knife surgery. Although these types of surgeries reduce pain, the side effects are unpleasant and include decreased facial sensation, which originates from the damage to the trigeminal nerve. Furthermore, these surgeries provide insufficient long-term outcomes and symptoms often recur. Microvascular decompression is a radical surgical approach that separates the blood vessels that cause pain from the nerves. In a large-scale study, microvascular decompression significantly reduced the pain in 80–96% of the patients who underwent initial treatment. Of these, 85% experienced significant pain reduction 38 months post-surgery, and 72–85% reported that they were able to manage their pain 5 years post-surgery. Currently, microvascular decompression is the most appropriate surgical approach to control pain in patients with trigeminal neuralgia, as it exhibits the highest rate of pain control and lowest rate of recurrence.Discussion and Conclusion: The accurate diagnosis of trigeminal neuralgia, through clinical symptoms and imaging, is important to obtain good treatment outcomes. Microvascular decompression should be considered when a patient responds poorly to initial treatment approaches, cannot receive surgical treatment due to side effects, or experiences pain recurrence following local nerve destruction.
{"title":"Diagnosis and treatment of trigeminal neuralgia","authors":"C. Park, S. Lim, B. Park","doi":"10.5124/jkma.2023.66.1.11","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.1.11","url":null,"abstract":"Background: Trigeminal neuralgia is a sudden and painful facial condition that is triggered by activities of daily living. The pain is debilitating and patients are often unable to perform routine daily tasks such as washing their face, shaving, and brushing their teeth, which in turn has an impact on their social life and mental well-being as they are often anxious and fearful of not knowing when the pain may occur.Current Concepts: Treatment for trigeminal neuralgia involves local nerve destruction surgeries, including neuroblocking, percutaneous ethanol injection therapy, percutaneous radio-frequency rhizotomy, and gamma knife surgery. Although these types of surgeries reduce pain, the side effects are unpleasant and include decreased facial sensation, which originates from the damage to the trigeminal nerve. Furthermore, these surgeries provide insufficient long-term outcomes and symptoms often recur. Microvascular decompression is a radical surgical approach that separates the blood vessels that cause pain from the nerves. In a large-scale study, microvascular decompression significantly reduced the pain in 80–96% of the patients who underwent initial treatment. Of these, 85% experienced significant pain reduction 38 months post-surgery, and 72–85% reported that they were able to manage their pain 5 years post-surgery. Currently, microvascular decompression is the most appropriate surgical approach to control pain in patients with trigeminal neuralgia, as it exhibits the highest rate of pain control and lowest rate of recurrence.Discussion and Conclusion: The accurate diagnosis of trigeminal neuralgia, through clinical symptoms and imaging, is important to obtain good treatment outcomes. Microvascular decompression should be considered when a patient responds poorly to initial treatment approaches, cannot receive surgical treatment due to side effects, or experiences pain recurrence following local nerve destruction.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"36 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82832531","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 : 2023-01-10DOI: 10.5124/jkma.2023.66.1.41
Eun Hye Lee, Y. Jang
Background: Cutaneous adverse drug reactions are common and produce easily identifiable clinical symptoms. These may range from mild maculopapular rashes to severe reactions associated with systemic disease.Current Concepts: The most common presentation of a drug eruption is in the form of a maculopapular rash or exanthematous skin eruption, followed by fixed drug eruptions and urticaria. Severe cutaneous adverse drug reactions include Stevens-Johnson syndrome/toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms, which are rare but potentially life-threatening. Recently, it has emerged that cutaneous adverse drug reactions associated with newly developed drugs, such as epidermal growth factor receptor inhibitors, may induce a variety of cutaneous manifestations.Discussion and Conclusion: Although certain drugs, such as antimicrobials and anticonvulsants, can frequently cause drug eruptions, their effects may change, depending on the situation and timing. Therefore, in order to resolve symptoms and prevent complications, early diagnosis, drug identification, and appropriate treatment should be performed, in consideration of the various factors involved.
{"title":"Cutaneous adverse drug reactions","authors":"Eun Hye Lee, Y. Jang","doi":"10.5124/jkma.2023.66.1.41","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.1.41","url":null,"abstract":"Background: Cutaneous adverse drug reactions are common and produce easily identifiable clinical symptoms. These may range from mild maculopapular rashes to severe reactions associated with systemic disease.Current Concepts: The most common presentation of a drug eruption is in the form of a maculopapular rash or exanthematous skin eruption, followed by fixed drug eruptions and urticaria. Severe cutaneous adverse drug reactions include Stevens-Johnson syndrome/toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms, which are rare but potentially life-threatening. Recently, it has emerged that cutaneous adverse drug reactions associated with newly developed drugs, such as epidermal growth factor receptor inhibitors, may induce a variety of cutaneous manifestations.Discussion and Conclusion: Although certain drugs, such as antimicrobials and anticonvulsants, can frequently cause drug eruptions, their effects may change, depending on the situation and timing. Therefore, in order to resolve symptoms and prevent complications, early diagnosis, drug identification, and appropriate treatment should be performed, in consideration of the various factors involved.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"2 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89698844","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 : 2023-01-10DOI: 10.5124/jkma.2023.66.1.19
Y. Ahn
Background: Glossopharyngeal neuralgia (GPN) is a rare type of cranial nerve rhizopathy that accounts for roughly 1% of trigeminal neuralgia cases and presents as extreme neuralgic pain in the ipsilateral deep throat, tongue base, or ear. Pain is usually intense and electric shock-like, occurring either without warning or triggered by swallowing. The purpose of this article is to provide a comprehensive review of the diagnosis and treatment of GPN and to differentiate it from trigeminal neuralgia.Current Concepts: In this review, our experiences, including cases of misdiagnosis and diagnostic pitfalls, are presented in detail. Treatment of GPN with microvascular decompression (MVD) has a success rate of over 90%. The use of “off-the-root entry zone” MVD, which eliminates the need for an adjuvant rhizotomy, is the best treatment for GPN. In addition, although gamma knife radiosurgery is categorized as a destructive procedure, it can still be another option if a patient is ineligible for MVD.Discussion and Conclusion: Practitioners must consider GPN when diagnosing patients with cranial nerve rhizopathy; it should be distinguished from other pain syndromes, especially trigeminal neuralgia. With an accurate diagnosis, an appropriate treatment plan can be developed.
{"title":"Diagnosis and treatment of glossopharyngeal neuralgia","authors":"Y. Ahn","doi":"10.5124/jkma.2023.66.1.19","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.1.19","url":null,"abstract":"Background: Glossopharyngeal neuralgia (GPN) is a rare type of cranial nerve rhizopathy that accounts for roughly 1% of trigeminal neuralgia cases and presents as extreme neuralgic pain in the ipsilateral deep throat, tongue base, or ear. Pain is usually intense and electric shock-like, occurring either without warning or triggered by swallowing. The purpose of this article is to provide a comprehensive review of the diagnosis and treatment of GPN and to differentiate it from trigeminal neuralgia.Current Concepts: In this review, our experiences, including cases of misdiagnosis and diagnostic pitfalls, are presented in detail. Treatment of GPN with microvascular decompression (MVD) has a success rate of over 90%. The use of “off-the-root entry zone” MVD, which eliminates the need for an adjuvant rhizotomy, is the best treatment for GPN. In addition, although gamma knife radiosurgery is categorized as a destructive procedure, it can still be another option if a patient is ineligible for MVD.Discussion and Conclusion: Practitioners must consider GPN when diagnosing patients with cranial nerve rhizopathy; it should be distinguished from other pain syndromes, especially trigeminal neuralgia. With an accurate diagnosis, an appropriate treatment plan can be developed.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"15 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76890197","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 : 2023-01-10DOI: 10.5124/jkma.2023.66.1.4
J. Bang
Background: Although it is naturally included in essential medical services (EMS), neurosurgery is not included in the current EMS set by the Ministry of Health and Welfare of South Korea. Therefore, as of 2023, I would like to describe the causes and current status of the progressively decreasing number of brain surgeons, which are responsible for an important axis of EMS, and the efforts needed to maintain and develop EMS.Current Concepts: The resident application rate for neurosurgery has not deviated much from 80 to 120 annually over the past 20 years; therefore, it does not seem to be included in the so-called “dying EMS.” However, the number of individuals who withdraw during the 4-year resident training period is as high as 15.43%, and the number of new neurosurgery specialists after resident training decreases gradually. The number of brain surgeons is declining, as many neurosurgeons specialize in the spine rather than the brain. Moreover, the extremely low cost of neurosurgery compared to that of Organization for Economic Co-operation and Development countries and cruel reality of Korea sets brain surgeons in a dangerous situation.Discussion and Conclusion: To save essential medical neurosurgeons, especially brain specialists, it is extremely necessary to make the medical fee realistic, improve the status of neurosurgeons, and improve the excessive criminal punishment for medical accidents that occur during treatment and surgery. There is no future for Korean neurosurgery without proper compensation for neurosurgeons who work with many dangerous surgeries and shorten the lifespan of doctors.
{"title":"Efforts needed to maintain and develop essential medical services in the neurosurgery field","authors":"J. Bang","doi":"10.5124/jkma.2023.66.1.4","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.1.4","url":null,"abstract":"Background: Although it is naturally included in essential medical services (EMS), neurosurgery is not included in the current EMS set by the Ministry of Health and Welfare of South Korea. Therefore, as of 2023, I would like to describe the causes and current status of the progressively decreasing number of brain surgeons, which are responsible for an important axis of EMS, and the efforts needed to maintain and develop EMS.Current Concepts: The resident application rate for neurosurgery has not deviated much from 80 to 120 annually over the past 20 years; therefore, it does not seem to be included in the so-called “dying EMS.” However, the number of individuals who withdraw during the 4-year resident training period is as high as 15.43%, and the number of new neurosurgery specialists after resident training decreases gradually. The number of brain surgeons is declining, as many neurosurgeons specialize in the spine rather than the brain. Moreover, the extremely low cost of neurosurgery compared to that of Organization for Economic Co-operation and Development countries and cruel reality of Korea sets brain surgeons in a dangerous situation.Discussion and Conclusion: To save essential medical neurosurgeons, especially brain specialists, it is extremely necessary to make the medical fee realistic, improve the status of neurosurgeons, and improve the excessive criminal punishment for medical accidents that occur during treatment and surgery. There is no future for Korean neurosurgery without proper compensation for neurosurgeons who work with many dangerous surgeries and shorten the lifespan of doctors.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80441242","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 : 2023-01-10DOI: 10.5124/jkma.2023.66.1.50
Hye-Jun Kim, Jihun Song, Sang Min Park
Background: Coronavirus disease (COVID-19), first reported at the end of 2019, is characterized by a broad spectrum of clinical manifestations ranging from asymptomatic to multi-organ dysfunction. These symptoms may persist even after the acute phase has passed. Post-acute COVID-19 syndrome (long-COVID) is a condition characterized by COVID-19 symptoms that persist for longer than two months after infection. Fatigue, muscle and joint pain, dyspnea, cognitive impairment, and anxiety are the most common symptoms of long-COVID. Given the substantial impact of COVID-19 sequelae on the quality of life of its survivors, as well as its socioeconomic burden, proactive measures are required.Current Concepts: Following the identification of long-COVID characteristics and symptoms, patient-centered care based on vaccination, COVID-19 medications, and digital healthcare is recommended. Furthermore, people who are more vulnerable to long-COVID, such as those with respiratory dysfunctions or the older adults, require more specialized and attentive management. Big data and artificial intelligence will hopefully enable a more timely and effective response to this healthcare issue.Discussion and Conclusion: Infectious diseases threaten our lives constantly, as evidenced by the recent COVID-19 pandemic and its lingering consequences. A novel virus can emerge at any time and place, resulting in substantial clinical and economic loss. At this stage, it is crucial to establish prompt and effective strategies against long-COVID, as well as against potential pandemics.
{"title":"Healthcare response strategies for the long-COVID era","authors":"Hye-Jun Kim, Jihun Song, Sang Min Park","doi":"10.5124/jkma.2023.66.1.50","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.1.50","url":null,"abstract":"Background: Coronavirus disease (COVID-19), first reported at the end of 2019, is characterized by a broad spectrum of clinical manifestations ranging from asymptomatic to multi-organ dysfunction. These symptoms may persist even after the acute phase has passed. Post-acute COVID-19 syndrome (long-COVID) is a condition characterized by COVID-19 symptoms that persist for longer than two months after infection. Fatigue, muscle and joint pain, dyspnea, cognitive impairment, and anxiety are the most common symptoms of long-COVID. Given the substantial impact of COVID-19 sequelae on the quality of life of its survivors, as well as its socioeconomic burden, proactive measures are required.Current Concepts: Following the identification of long-COVID characteristics and symptoms, patient-centered care based on vaccination, COVID-19 medications, and digital healthcare is recommended. Furthermore, people who are more vulnerable to long-COVID, such as those with respiratory dysfunctions or the older adults, require more specialized and attentive management. Big data and artificial intelligence will hopefully enable a more timely and effective response to this healthcare issue.Discussion and Conclusion: Infectious diseases threaten our lives constantly, as evidenced by the recent COVID-19 pandemic and its lingering consequences. A novel virus can emerge at any time and place, resulting in substantial clinical and economic loss. At this stage, it is crucial to establish prompt and effective strategies against long-COVID, as well as against potential pandemics.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77982706","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：