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Journal of the Korean Medical Association.2006;49(3):202-208. doi:10.5124/jkma.2006.49.3.202

Korea has one of the most advanced information infrastructure in the world. The issue of internet or cyberspace addiction came along with the advancement of high-speed internet and personal computers a decade ago. Internet addiction, once introduced humorously as webaholism, has now become one of the most important adolescent behavioral problems including sex, drug and other delinquent behaviors. Boosted by PC-room and innovative online game industries, the adverse effect of online game overuse now overwhelms other media including video game, online chatting, and cyberporn. Teenagers tend to prefer interactive media such as internet, mobile and peer-to-peer communications to classical uni-directional media such as T.V. and newspaper. The age of initial exposure to these media gets younger. Social and medical support network to remedy the problems does not seem to catch up with the rapidly evolving internet and game industry. The highly addictive and pervasive nature of role-playing and recent casual games are discussed, along with the medico-social and legislative efforts in need from the government, communities, schools and families.
Adolescent ; Adolescent Behavior ; Humans ; Interactive Tutorial ; Internet* ; Korea ; Microcomputers ; Periodicals ; Video Games

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Ethical Review on Science of Life.

Hyo Sung JUNG

Journal of the Korean Medical Association.2006;49(3):196-200. doi:10.5124/jkma.2006.49.3.196

No abstract available.
Ethical Review*

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On the Medical Fees Review.

Jong Mann KIM

Journal of the Korean Medical Association.2001;44(12):1342-1354. doi:10.5124/jkma.2001.44.12.1342

With remarkable advances in medicine, the total bill of health care expenditure in Korea continues to rise at an ever increasing rate. Under the health insurance, however, to provide the appropriate medical care in limited resources and finite economy, efficient ways of approach to medical services are needed. One of them is to weigh the justification of sophisticated application of medical practice, taking into consideration both cost and effectiveness. Sice medical services have indispensable relation to health insurance, both sides should try to make good companion in order to accomplish the ultimate goal of health improvement and everythhing about health insurance. Especially the basic principles of medical fees review must be kept in mind.
Delivery of Health Care ; Fees, Medical* ; Friends ; Health Expenditures ; Humans ; Insurance, Health ; Korea

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Management of Poisoning by Chemical Agents.

Yun Chul HONG

Journal of the Korean Medical Association.2001;44(12):1336-1341. doi:10.5124/jkma.2001.44.12.1336

Obtaining a complete and accurate history is one of the most crucial steps in the initial diagnosis and subsequent management of the poisoned patients. This information can then be integrated with physical evidence, clinical examination, laboratory and toxicological data in designing a therapeutic approach. Such information may include patient data, product information, and nature of exposure. The basic treatment for acute poisoning, whether of drug or chemical, is mainly symptomatic and supportive. The four cardinal principles of good management are ① identification of the causative drug or chemical as quickly as possible, ② evacuation of the poison from the stomach, except when contraindicated, ③ administration of an antidote if available, and ④ symptomatic and supportive therapy as indicated. Management in most cases of toxicity consists of supportive care, symptomatic treatment, and avoidance of exposure to the toxic material. In cases of life-threatening toxicity, maintenance of cardiopulmonary function and fluid and electrolyte balance are important. There are limited specific methods of treatment, or "antidotes". Use of oxygen counters the foxic effect and enhances the elimination of carbon monoxide. In cases acute cyanide of hydrogen sulfide poisoning, nitrites may be used to generate formation of cyanmethemoglobin or sulfmethemoglobin. Hydroxocobalamin can also be used as an antidote for cyanide. Atropine and pralidoxime can be life-saying in reversing the acute cholinesterase-inhibiting effects of organophosphate pesticides. Chelating agents may reverse acute toxicity caused by some metals.
Atropine ; Carbon Monoxide ; Chelating Agents ; Diagnosis ; Humans ; Hydrogen Sulfide ; Hydroxocobalamin ; Metals ; Nitrites ; Oxygen ; Pesticides ; Poisoning* ; Stomach ; Water-Electrolyte Balance

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Central Pontine and EXtrapontine Myelinolysis.

Byung Jo KIM ; Dae Hie LEE

Journal of the Korean Medical Association.2001;44(12):1329-1335. doi:10.5124/jkma.2001.44.12.1329

The knowledge about nutritional, toxic, and metabolic causes of dementia is particularly important, because they may be reversible. Central pontine myelinolysis(CPM) is one of these causes. CPM is a well known but rare metabolic disease of unknown etiology linked to overly aggressive correction of hyponatremia. We report a 74-year-old woman who developed disorientation, memory disturbance, and behavioral problem following intensive care unit management for pneumonia. Mini-mental status examination-Korean version(MMSE-K) study revealed severe cognitive dysfunction. Brain magnetic resonance imaging showed changes consistent with CPM and extrapontine myelinolysis. After supportive care, patient's clinical status was significantly improved. We suggest that a metabolic problem such as CPM should be considered in the diagnosis of acute or subacute cognitive deterioration in elderly patients.
Aged ; Brain ; Dementia ; Diagnosis ; Female ; Humans ; Hyponatremia ; Intensive Care Units ; Magnetic Resonance Imaging ; Memory ; Metabolic Diseases ; Myelinolysis, Central Pontine* ; Pneumonia ; Problem Behavior

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Postcoital Contraceptive Pills.

Jong Pyo LEE

Journal of the Korean Medical Association.2001;44(12):1319-1328. doi:10.5124/jkma.2001.44.12.1319

Postcoital contraception or emergency contraception(EC), commonly known as the "morning after pills", prevents pregnancy after unprotected intercourse. A comprehensive definition of EC is as follows : "specific contraceptive methods that can be used as emergency measures to prevent pregnancy after unproteted intercourse". Both drugs and certain devices can be used for emergency contraception. The best-studied regimen(Yuzpe) consists of an ordinary combination of oral contraceptives containing ethinyl estradiol and norgestrel. Conventional clinical guidelines recommend a first dose within 72 hours after unprotected intercourse and a second dose 12 hours thereafter. These drugs are most effective when taken as soon as possible after the intercourse. The Yuzpe regimen reduced the risk of unintended pregnancy by at least 75% in clinical trials. The most common side effects of the Yuzpe method are nausea and vomiting. Levonorgestrel is the synthetic progesterone. The major benefits of levonorgestrel are the decreased side effects and greater contraceptive efficacy than Yuzpe regimen. Mifepristone (RU486) is a synthetic steroid that prevents progesterone from binding to the progesterone receptors and glucocorticoid receptors. It has been used extensively in Europe as an abortifacient and also has been used as an effective EC. Its common side effect is a delay in the onset of menses, leading to anxiety for the user. The intrauterine contraceptive device(IUCD) is the only method of emergency contraception available to women presenting beyond 72 h and within 5 days from unprotected intercourse. EC is not protective against infections such as STD(sexually transmitted diseases). There are many situations where EC is indicated, including condom rupture or slip, unplanned unprotected intercourse, incidental misuse of regular contraceptive methods, and sexual assault. Emergency contraceptive pills can prevent ovulation, but an alternative major mechanism of action is to prevent uterine implantation of the embryo at the endometrial level. A 3-week follow-up visit should be scheduled to assess the result and to counsel for regular contraception. EC provides a second chance at preventing undesired pregnancies. but it should not be used as a routine birth control method, because it is actually less effective and needs a higher dose at preventing pregnancies than most types of oral contraceptives. Widespread and appropriate use of EC will provide a promising means to reduce the incidence of unplanned pregnancy and to contribute to the women's health.
Anxiety ; Condoms ; Contraception ; Contraception, Postcoital ; Contraceptives, Oral ; Embryonic Structures ; Emergencies ; Ethinyl Estradiol ; Europe ; Female ; Follow-Up Studies ; Humans ; Incidence ; Levonorgestrel ; Methods ; Mifepristone ; Nausea ; Norgestrel ; Ovulation ; Pregnancy ; Pregnancy, Unplanned ; Progesterone ; Receptors, Glucocorticoid ; Receptors, Progesterone ; Rupture ; Vomiting ; Women's Health

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Asymptomatic Urinary Abnormalities.

Hyang KIM

Journal of the Korean Medical Association.2001;44(12):1311-1318. doi:10.5124/jkma.2001.44.12.1311

Urinalysis is the most convenient and important diagnostic tool for the kidney diseases. Abnormal urinary findings provide powerful information for the diagnosis of a kidney disease. There are several common urinary abnormalities without subjective symptoms : hematuria, proteinuria, and asymptomatic bacteriuria. There are many causes of hematuria : glomerulonephritis, interstitial nephritis, vascular diseases, cystic kidney disease, renal calculi, coagulation disorders, urinary tract infection, trauma, and tumors. It is essential to clarify the origin of hematuria by the use of diagnostic flow sheets. Despite all the diagnostic approaches, however, unexplained hematuria is found in 10~15% of subjects with hematuria. Periodic follow-up is recommended per 3 to 6 months for at least three years for them. The proteinuria of the glomerular origin is important for the progression of the renal diseases. We have to differentiate the proteinuria according to its origin and underlying systemic diseases including diabetes mellitus and hypertension. We also recommend a kidney biopsy for nephrotic range proteinuria for the diagnosis, treatment, and prognosis of the disease. Asymptomatic bacteriuria is define as a bacterial colony count above 105/ml in two consecutive urine cultures. Management is generally not recommended for the asymptomatic bacteriuria in elderly patients but recommended in pregnant women and diabetes mellitus patients. From our point of view, subjects showing urinary abnormalities, such as hematuria, proteinuria, and bacteriuria, must be kept under close surveillance.
Aged ; Bacteriuria ; Biopsy ; Diabetes Mellitus ; Diagnosis ; Female ; Follow-Up Studies ; Glomerulonephritis ; Hematuria ; Humans ; Hypertension ; Kidney ; Kidney Calculi ; Kidney Diseases ; Kidney Diseases, Cystic ; Nephritis, Interstitial ; Pregnant Women ; Prognosis ; Proteinuria ; Urinalysis ; Urinary Tract Infections ; Vascular Diseases

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Pain Management in Cancer Patients.

Seong Wan BAIK

Journal of the Korean Medical Association.2001;44(12):1299-1310. doi:10.5124/jkma.2001.44.12.1299

In 1990, WHO developed the analgesic ladder for rational titration of medication for cancer pain, because 50% of patients with cancer and 75% of those with advanced malignant disease will likely experience moderate to severe pain according to the report of Agency for Health Care Policy and Research(AHCPR). Actually, However, about 62% of cancer pain are not adequately controlled for several reasons, such as inappropriate dosage of analgesics, strict regulation of narcotics, physicians' indifference to cancer pain, and lack of knowledge for pain assessment in Korea. In this chapter, I would like to introduce techniques to relieve pain in cancer patients using some kinds of analgesics including narcotics, adjuvants, and verve blocks. By using medications and nerve block, more than 95% of cancer pain can be relieved effectively. One may be unfamiliar with the fact that cancer pain is not single isolated entity itself, but has multiple etiologies that may or may not be directly related to the cancer itself. This fact has resulted in the awareness that the treatment must be directed toward the perceived etiology of pain once it is identified. Pain does not occur in a vacuum ; the psychological manifestations of pain must be treated as well as any possible side effects of the treatment. With regards to cancer pain, this is generally stressed in all fields of medicine, particularly in the field of pain medicine.
Analgesics ; Delivery of Health Care ; Humans ; Korea ; Narcotics ; Nerve Block ; Pain Management* ; Pain Measurement ; Vacuum

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Management of Chronic Pain.

Chong Min PARK

Journal of the Korean Medical Association.2001;44(12):1293-1298. doi:10.5124/jkma.2001.44.12.1293

Chronic pain defined as pain that persists beyond the period of healing, in the absence of ongoing pathology, usually means pain over 3 to 6 months after the cure of the original disease. In this situation, the pain itself loses its protective function only to fall into a disease entity. There have been many efforts to treat chronic pain, with analgesics being the most commonly used modality, which include non-steroidal anti-inflammatory drug, opioids, antidepressant, and anxiolytic agents. Pain clinicians especially use nerve blocks for the control of intractable pain. Although the effect of nerve block or trigger point injection with local anesthetics is temporary, its effect of breaking the vicious cycle of pain patheway gives a long-term effect of analgesia. There are many diseases managed at pain clinics, including headache, trigeminal neuralgia, neck and shoulder pain, low back pain, complex regional pain syndrome, herpes zoster and postherpetic neuralgia, fantom pain, peripheral neuralgia, and vascular disease. The main nerve indicated for pain control may be any kind of somatic and sympathetic nerves and ganglions responsible for the pain.
Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthetics, Local ; Anti-Anxiety Agents ; Chronic Pain* ; Ganglion Cysts ; Headache ; Herpes Zoster ; Low Back Pain ; Neck ; Nerve Block ; Neuralgia ; Neuralgia, Postherpetic ; Pain Clinics ; Pain, Intractable ; Pathology ; Shoulder Pain ; Trigeminal Neuralgia ; Trigger Points ; Vascular Diseases

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Neural Blockade.

Jae Chol SHIM

Journal of the Korean Medical Association.2001;44(12):1284-1292. doi:10.5124/jkma.2001.44.12.1284

The sympathetic nervous system has been implicated in the maintenance of numerous pain syndromes. Interruption of sympathetic pathways has been widely applied to relieve pain. Neurolytic sympathetic block is often well tolerated, because numbness and motor weakness are uncommon and neuritis rarely develops. The classic targets for sympatholysis are the stellate or cervicothoracic ganglion for facial and upper extremity pain, celiac plexus for abdominal pin, and lumbar sympathetic chain for lower extremity pain. In addition, the thoracic ganglion is occasionally blocked for the treatment of hyperhidrosis and of pain emanating from the pleura and esophagus. The recognition of the clinical utility of cervical epidural nerve block in the management of head, face, neck, shoulder, and upper extremity pain has brought the technique into the mainstream of contemporary pain management practice. Lumbar epidural nerve block has great utility in the management of a variety of acute, chronic, and cancer-related pain syndromes. The nerve root sleeve is particularly accessible to precise local anesthetic blocks. Segmental information gained from such nerve root blocks can be helpful in sorting out confusing patterns of referred pain to the limbs. The pathway for insertion of spinal needles must be planned so as to avoid damaging neural structures. Spinal nerve roots are particularly delicate structures and do not take kindly to being impaled.
Celiac Plexus ; Esophagus ; Extremities ; Ganglion Cysts ; Head ; Hyperhidrosis ; Hypesthesia ; Lower Extremity ; Neck ; Needles ; Nerve Block ; Neuritis ; Pain Management ; Pain, Referred ; Pleura ; Shoulder ; Spinal Nerve Roots ; Stellate Ganglion ; Sympathetic Nervous System ; Upper Extremity

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