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Emergent Esophagectomy in Patients with Esophageal Malignancy Is Associated with Higher Rates of Perioperative Complications but No Independent Impact on Short-Term Mortality

  • Yahya Alwatari;Devon C. Freudenberger;Jad Khoraki;Lena Bless;Riley Payne;Walker A. Julliard;Rachit D. Shah;Carlos A. Puig
    • Journal of Chest Surgery
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    • v.57 no.2
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    • pp.160-168
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    • 2024
  • Background: Data on perioperative outcomes of emergent versus elective resection in esophageal cancer patients requiring esophagectomy are lacking. We investigated whether emergent resection was associated with increased risks of morbidity and mortality. Methods: Data on patients with esophageal malignancy who underwent esophagectomy from 2005 to 2020 were retrospectively analyzed from the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day complication and mortality rates were compared between emergent esophagectomy (EE) and non-emergent esophagectomy. Logistic regression assessed factors associated with complications and mortality. Results: Of 10,067 patients with malignancy who underwent esophagectomy, 181 (1.8%) had EE, 64% had preoperative systemic inflammatory response syndrome, sepsis, or septic shock, and 44% had bleeding requiring transfusion. The EE group had higher American Society of Anesthesiologists (ASA) class and functional dependency. More transhiatal esophagectomies and diversions were performed in the EE group. After EE, the rates of 30-day mortality (6.1% vs. 2.8%), overall complications (65.2% vs. 44.2%), bleeding, pneumonia, prolonged intubation, and positive margin (17.7% vs. 7.4%) were higher, while that of anastomotic leak was similar. On adjusted logistic regression, older age, lower albumin, higher ASA class, and fragility were associated with increased complications and mortality. McKeown esophagectomy and esophageal diversion were associated with a higher risk of postoperative complications. EE was associated with 30-day postoperative complications (odds ratio, 2.39; 95% confidence interval, 1.66-3.43; p<0.0001). Conclusion: EE was associated with a more than 2-fold increase in complications compared to elective procedures, but no independent increase in short-term mortality. These findings may help guide data-driven critical decision-making for surgery in select cases of complicated esophageal malignancy.

CT Evaluation of the Findings of Nutcracker Syndrome in Patients with Bladder Cancer after Radical Cystectomy and Ileal Neobladder Formation: A Correlation with Hematuria (근치적 방광적출 후 회장 신방광형성술을 시행받은 방광암 환자의 컴퓨터단층촬영: 호두까기 증후군 소견의 분석 및 혈뇨와의 관계)

  • Hae Min Shin;Joongyub Lee;Dong Hyeon Lee;Seung Hyup Kim
    • Journal of the Korean Society of Radiology
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    • v.84 no.2
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    • pp.409-417
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    • 2023
  • Purpose Patients with bladder cancer may show hematuria after radical cystectomy with ileal neobladder formation, causing anxiety regarding tumor recurrence. Here, we aim to show that the nutcracker syndrome (NCS) can be a cause of hematuria post-operation, and is a common, rather than a rare syndrome. Materials and Methods A retrospective review of contrast-enhanced abdominopelvic CT (CE-APCT) and urine analysis (UA) findings of 255 patients with bladder cancer who underwent radical cystectomy and ileal neobladder formation between 2011 and 2016 was performed. In the CE-APCT review, the left renal vein flow patterns were evaluated to determine the presence of NCS findings. In the UA review, patients were classified according to the percentage of UA tests with positive hematuria among the total number of UA tests. Results CT findings of NCS were present in 31.9% of the 135 patients. In the positive hematuria group, there were 26% more patients with NCS findings than those without. Conclusion NCS findings are prevalent even for bladder cancer patients after surgery, and there is a strong correlation between NCS findings and hematuria. Furthermore, the prevalence of NCS findings is much higher than urinary tract recurrence after the surgery.

Clinical Results and Risk Factor Analysis of Surgical Treatment for Esophageal Perforation (식도천공의 수술적 치료의 임상결과와 위험인자 분석)

  • Cho, Sung-Woo;Hong, Ki-Woo;Kim, Shin;Lee, Hee-Sung;Kim, Hyoung-Soo;Lee, Jae-Woong;Choi, Goang-Min;Shin, Yoon-Cheol;Shin, Ho-Seung;Lee, Won-Yong
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.347-353
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    • 2008
  • Background: Esophageal perforation is an emergency that. requires early diagnosis and effective treatment. A delay in diagnosis and treatment. significantly increases morbidity and mortality. Material and Method: Thirty-seven patients with esophageal perforation were surgically treated at our institutions between January 1990 and December 2006. We retrospectively reviewed the results of surgical treatment for esophageal perforation to understand the risk factors affecting survival inpatients. Result: Patients ranged in age from 21 to 87 years, with an average age of $52.7{\pm}16.98$ years. Thirty-one of the patients were men and six were women. There were 23 patients (62%) with spontaneous perforations, 10 patients (27%) with a traumatic perforation, and 4 patients (11%) with an iatrogenic perforation. The site of esophageal perforation was the cervical esophagus in 5 patients, the thoracic esophagus in 31 patients, and the abdominal esophagus in one patient. Twenty-nine patients underwent primary closure of the perforation and five patients had T-tube drainage. Exclusion-diversion procedures were performed in two patients and an esophagectomy was performed in one patient. There were six cases of mortality (16.22%) and 25 cases of postoperative complications in 15 patients (40.5%). Patients that were treated later than 24 hours after detection of the perforation showed a statistically significant high morbidity and mortality rate (p<0.05). Conclusion: The most important risk factor of esophageal perforation was the time interval between detection of the perforation and the initiation of treatment. A prompt diagnosis and effective treatment are necessary to decrease morbidity and mortality.

Menstrual Experience of Adolescent Girls (사춘기 여성들의 월경경험)

  • 정현숙
    • Journal of Korean Academy of Nursing
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    • v.26 no.2
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    • pp.257-270
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    • 1996
  • Studies on menstruation have focused only on menstruation itself and menstrual disorders. The menstruating girls or women have been neglected. So, the purpose of this study was to understand menstrual experience of adolescent girls in their perspective and build a theory on it, The specific purpose of this study were to find initial reaction of the girls, their strategies to adapt to menstruation. consequences of their efforts, influencing factor, and patterns of experience. The subjects of this study were eleven adolescent girls who experienced menarche three months to twenty-six months before the interview time. They were selected purposively. Their ages were in range of twelve and sixteen. One of them was a elementary school girl, three high school girls, and seven middle school girls. Two girls were handicapped because of cerebral palsy. All of them had some knowledge about menstrual physiology and hygiene during menstruation. Data were collected from September, 1994 to July, 1995. Data collection & analysis were done according to the grounded theory methodology by Strauss & Corbin(1990). Data collecting method was the long interviews and observation. Each interview took from 1 hour to 2 hours. Interview were tape-recorded and transcribed later by author. Data were analyzed immediately after interviews. Based on the results of previous interview, next interview were planned until gathered data reached the saturation point. Results were as follows. One hundred and six concepts were found. Those concepts were grouped into twenty eight categories and then fourteen higher categories. Twenty eight categories were as follows. “want to hide”, “bewildered”, “sense of burden”, “sense of heterogeneity”. “gladness”. “sense of superiority”, “negative empathy”, “positive empathy”, “limited hygenic control”, “sense of timing”, “lack of knowledge”, “lack of support”, “advance knowledge”, “informational support”, “emotional support”, “endurance”, “prayer”, “disclosing”, “avoidance”, “diversion”, “sense of powerlessness”, “discovery of sex identity”, “sense of maturation”, “sense of stability”, “acceptance of menstruation ”. fourteen higher categories were as follows. “negative feeling”, “posive feeling”, “exchange of feeling”, “limited hygenic control”, “sense of timing”, “accumulated experience”, “dysmenorrhea”, “level of knowledge”, “need for support”, “perceived support”, “sharing of feeling”, “self-control”, “passive acceptance”, “active acceptance”. The core category was “emotional shaking”, which consisted of “positive feeling” and “negative feeling”. “Emotional shaking”comes up to every adolescent girls experiencing menarche, independently of any contextual conditions, and its dimension has two directions : positive one and negative one. Its influencing factors were time of menarche, advance knowledge, support from the significant persons, expression and self-regulation. Even if they showed different process of adaptation to menstruation, general process of adaptation were as follows : 1. stage of emotional shaking 2. stage of acceptance 3. stage of internalization of the menstrual experience. Seven patterns existed on the process of adaptation to menstruation after menarche. Those are as follows. 1. If girls thought their menarche came too early and they had not much knowledge on menstruation, they had a kind of negative feeling. If they did not get enough support and dysmenorrhea superimposed, they came to accept menstruation passively. 2. If girls had menarche too early. they had negative feeling, even though they had enough advance knowledge. But support helped them accept menstruation easily. 3. If girls had menarche too early, they had negative feeling, even though they had enough advance knowledge on menstruation. But by experiencing subsequent menstruations and disclosing feeling, they began to accept menstruation. 4. If girls had menarche too lately and they had enough advance knowledge on menstruation. they had positive feeling. If dysmenorrhea superimposed later, their feeling turned in to negative one. But they came to accept menstruation positively by disclosing feeling and getting support. 5. If girls had menarche too early, they had negative feeling, even though they had enough advance knowledge on menstruation. In addition to this. if dysmenorrhes superimposed while they did not get enough support, they felt powerless and came to accept menstruation passively. 6. If girls had menarche too early and did not get enough advance knowledge, they had negative feeling. But disclosing feeling and support made them get sense of homogeneity and began to accept menstruation. 7. If girls had handicap, they had negative feeling, even though they had enough advance knowledge and menarche was late. But Menarche made them get feel sexual identity. Their limited hygenic control and negative empathy from their mothers made them accept menstruation passively. To let adolescent girls take their menstrual experience as a part of their lives forming a positive sense of feminine identity, it needs qualified teaching and, support and deep concern of the significant others. Nurses including school nurses should try to develop an educational program, which include menstrual physiology. hygiene during menstrual period, meaning of menstruation and impact of menstruation on the development of female sexual identity.

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Effects of Leukocyte Depleted Priming Solution on Cardiopulmonary Edema by Extracorporeal Circulation (백혈구제거 혈액성 충진액이 체외순환 후 심폐부종에 미치는 영향)

  • Kim, Si-Hoon;Kim, Young-Du;Jin, Ung;Jo, Keon-Hyun
    • Journal of Chest Surgery
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    • v.34 no.9
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    • pp.704-710
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    • 2001
  • Background: Extracorporeal circulation using pump-oxygenator is an inevitable process to keep vital sign during cardiac arrest for open heart surgery. However, the diversion of blood through nonendothelialized channels appears to stimulate inflammatory response, and leukocyte activation may lead to cardiopulmonary edema. Our study evaluated the effect of leukocyte-induced cardiopulmonary edema using three different pump-oxygenator priming solutions; non-hemic crystalloid solution ; leukocyte-depleted homologous blood; non leukocyte-depleted homologous blood in priming solutions. Material and Method: Each different priming solution was used on five dogs, and the effect of leukocyte-induced cardiopulmonary edema during cardiopulmonary bypass(CPB) was evaluated. For each dog after 2 hours of exracorporeal circulation and another 4 hours of post-pump period, the dog was sacrificed and its heart and lung tissues were obtained for measuring Wet/Dry ratio. Arterial $O_2$partial pressure(PaO$_2$) and $CO_2$partial pressure(Pa$CO_2$) were checked. For the evaluation of ventilatory function, $CO_2$partial pressure difference between arterial blood (Pa$CO_2$) and exhaled air(Et$CO_2$) was measured. Result: 1. No significant difference was seen in arterial PaO$_2$and Pa$CO_2$among groups. 2. Ventilatory function evaluated by Pa$CO_2$and Et$CO_2$showed no significant difference between non-hemic and blood-mixed priming solution (P<0.05). 3. Cardiac and lung Wet/Dry ratios were remarkedly lower in the leukocyte-depleted group. There was no significant difference between the non-hemic and blood-mixed groups. Conclusion: Based upon this result, we concluded that the leukocyte depletion from homologous blood of CPB priming solution has a beneficial effect in reducing cardiopulmonary edema compared with non leukocyte-depleted or crystalloid priming solutions.

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Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava

  • Lee, Sub;Kim, Han-Woong;Kang, Hyoung-Seok;Bae, Chi-Hoon;Jheon, Sang-Hoon;Kwon, Oh-Choon;Ahn, Wook-Su
    • Journal of Chest Surgery
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    • v.34 no.9
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    • pp.672-679
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    • 2001
  • Background: Surgical correction of partial anomalous pulmonary venous connection to the superior vena cava has been associated with postoperative venous obstruction and sinus node dysfunction. In this paper we describe our current approach and its short-term results. Material and Method: Between April 1999 and January 2000, 5 consecutive patients, ranging from 2 months to 66 years old, underwent corrective operation for partial anomalous pulmonary venous connection to the superior vena cava at Sejong General Hospital and Daegu Catholic University Medical Center. Surgical correction involved diversion of the pulmonary venous drainage to the left atrium using a right atrial flap(2 patients) or prosthetic patch(3 patients) with division of the superior vena cava superior to the restore site of the pulmonary veins and reimplantation on the right atrial appendage to restore systemic venous drainage. Result: All patients were discharged between postoperative day 9 and 15 without complications. One Russian boy returned to his country, therefore, he was lost to follow-up after discharge. Remaining 4 patients were asymptomatic and in normal regular sinus rhythm at a mean follow-up of 17.75$\pm$4.27 months. Follow-up echocardiographic study (range, 12 to 24 months) revealed no incidence of narrowing of the venous pathways or of residual shunt. Conclusion: Our current approach is relatively simple and reproducible in achieving unobstructive pulmonay venous and SVC pathways. By avoiding incision across the cavoatrial junction, surgical injury to the sinus node and its artery may be minimized. The presented surgical technique can be safely and effectively applied to the selected patients.

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A Study on Estimating Optimal Tonnage of Coastal Cargo Vessels in Korea (우리나라 연안화물선의 적정선복량 추정에 관한 연구)

  • 이청환;이철영
    • Journal of the Korean Institute of Navigation
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    • v.13 no.1
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    • pp.21-53
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    • 1989
  • In the past twenty years, there has been a rapid increase in the volume of traffic in Korea due to the Korean great growth of the Korean economy. Since transformation provides an infrastructure vital to economic growth, it becomes more and more an integral part of the Korea economy. The importance of coastal shipping stands out in particular, not only because of the expansion limit on the road network, but also because of saturation in the capacity of rail transportation. In spite of this increase and its importance, coastal shipping is falling behind partly because it is givenless emphasis than ocean-going shipping and other inland transportation systems and partly because of overcompetition due to excessive ship tonnage. Therefore, estimating and planning optimum ship tonnage is the first take to develop Korean coastal shipping. This paper aims to estimate the optimum coastal ship tonnage by computer simulation and finally to draw up plans for the ship tonnage balance according to supply and demand. The estimation of the optimum ship tonnage is peformed by the method of Origin -Destimation and time series analysis. The result are as follows : (1) The optimum ship tonnage in 1987 was 358, 680 DWT, which is 54% of the current ship tonnage (481 ships, 662, 664DWT) that is equal to the optimum ship tonnage in 1998. this overcapacity result is in excessive competition and financial difficulties in Korea coastal shipping. (2) The excessive ship tonnage can be broken down into ship types as follows : oil carrier 250, 926 DWT(350%), cement carrier 9, 977 DWT(119%), iron material/machinery carrier 25, 665 DWT(117%), general cargo carrier 17, 416DWT(112%). (3) the current total ship crew of 5, 079 is more than the verified optimally efficient figure of 3, 808 by 1271. (4) From the viewpoint of management strategy, it is necessary that excessive ship tonnage be reduced and uneconomic outdated vessels be broken up. And its found that the diversion into economically efficient fleets is urgently required in order to meet increasing annual rate in the amounts of cargo(23, 877DWT). (5) The plans for the ship tonnage balance according to supply and demand are as follows 1) The establishment of a legislative system for the arrangement of ship tonnage. This would involve; (a) The announcement of an optimum tonnage which guides the licensing of cargo vessels and ship tonnage supply. (b) The establishment of an organization that substantially arrangement tonnage in Korea coastal shipping. 2) The announcement of an optimum ship tonnage both per year and short-term that guides current tonnage supply plans. 3) The settlement of elastic tariffs resulting in the protect6ion of coastal shipping's share from other tonnage supply plans. 4) The settlement of elastic tariffs resulting in the protection of coastal shipping's share from other transportation systems. 4) Restriction of ocean-going vessels from participating in coastal shipping routes. 5) Business rationalization of coastal shipping company which reduces uneconomic outdated vessels and boosts the national economy. If we are to achieve these ends, the followings are prerequisites; I) Because many non-licensed vessels are actually operating and threatening the safe voyage of the others in Korea coastal routes, it is necessary that those ind of vessels be controlled and punished by the authorities. II) The supply of ship tonnage in Korean coastal routes should be predently monitored because most of the coastal vessels are to small to be diverted into ocean-going routes in case of excessive supply. III) Every ship type which is engaged in coastal shipping should be specialized according to the characteristics of its routes as soon possible.

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A Study on the Characteristics of Museum Projects by Richard Meier (리챠드 마이어의 미술관 특성에 관한 연구)

  • 김용립
    • Archives of design research
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    • v.12 no.4
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    • pp.231-241
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    • 1999
  • This study propose to analyze the design method and the form elements of museums, of works by Richard Meier, and through the analysis, spacial characteristics of museums will be understood. The museum works of Richard Meier, as an exhibition space, not only display the art works efficiently, but they also offer visitors the opportunity to experience the art of architecture, as a cultural space. Richard Meier, when working on the projects, has utilized the design methods and the architectural language, learned from Mies van der Rohe and Le Corbusier, resourcefully. Having the structural grid as basis, the rational rectangular forms were intended for exhibition space, while the circular and partial circular forms of geometry were utilized in formative space. This was able to maintain the balance between functional and formative space. In the museums of his works, the ramp and the glass wall separated from the structure become very important means of expression. The ramps, not only make people to enjoy the interior and exterior of museum, but also able them to see the works of art from different distances and angles repeatedly and the large glass wall reveals the various shapes of interior to exterior. In comparing with the design method and language of two masters mentioned, the design principles and elements, developed by Meier were applied to the site plans, exhibition space planning and elevations to manifest its originality. The design concept, derived from the urban fabric and historical buildings around, gave harmony to the museum with its surroundings, and employing the deformed axis brought variation and the effect of diversion to the site plan. The exhibition space is much vitalized by the well arrangement of various exhibition fixtures in the museum. The exhibion fixtures, which the partitions, shelves, miches, and stages were put together in flexibility, play multiple roles as partitions dividing spaces, as furniture displaying art works, and as elements creating forms. The systematically arranged fixtures, also produce several visual axes and centers, which have visitors appreciate the works of art in various perspectives, hence create a unique environment.

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Analysis of Prognostic Factors in Esophageal Perforation. (식도 천공의 예후 인자 분석)

  • 정인석;송상윤;안병희;오봉석;김상형
    • Journal of Chest Surgery
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    • v.34 no.6
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    • pp.477-484
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    • 2001
  • Background: Initial symptoms for esophageal perforation have not been clarified, but when there is no early diagnosis and proper treatment to follow immediately after the diagnosis, it is fatal for the patients. Therefore, this study attempted to discover the factors that influence the prognosis of esophageal perforation to contribute to the improvement of the treatment result. Material and Method: The subjects of this study are 32 patients who came to the hospital with esophageal perforation from October, 1984 to June, 2000. This study examined the items for clinical observation such as patients' sex, age, cause of the perforation, perforation site, the time spent until the beginning of the treatment, symptoms caused by the perforation and its complication, and treatment methods. This study tried to find out the relationship between the survival of patients and each item. Result: There were 24 male and 8 female patients and their mean age was 49.7+16.4. For the causes of perforation, there were 14 cases(43%) of iatrogenic perforation, which ranked first, caused by the medical instrument operation and surgical damage. As for the perforation sites, thoracic esophagus was the most common site(26 cases of 81.2%) and chest pain was the most frequent symptom. The complication caused by esophageal perforation showed the highest cases in the order of mediastinitis, empyema, sepsis and peritonitis. After the treatment, there were 23 cases of survival and 9 cases of mortality. The total mortality rate was 28.1% and the main causes of mortality were sepsis and acute respiratory distress syndrome(ARDS). As for the treatment, 8 cases(25.0%) treated the perforation successfully using conservative treatment only. As for the surgical treatment, there were 5 cases(15.6%) of cervical drainage, 7 cases (21.8%) of primary repair and 12 cases(37.5%) of esophageal reconstruction after performing an exclusion-diversion. There were 18 cases(56.2%) of complete treatment of esophageal perforation at its initial treatment and in 14 cases(43.8%) of treatment failure at its initial treatment, patients were completely cured in the next treatment stage or died during the treatment. The cases of perforation in thoracic esophagus, complication into severe mediastinitis or sepsis and the cases of failure at initial treatment showed a statistically significant mortality rate (p<0.05).

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The Abolition Type and The Regional Characteristics of The Elementary Schools in Chungbuk Province (忠淸北道의 國民學校 廢校類型과 그 地域的 特性)

  • ;Chae, Son-Ha
    • Journal of the Korean Geographical Society
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    • v.29 no.1
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    • pp.84-104
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    • 1994
  • The migration of population into the city has been on the increase according as Korea has been industrialized repidly since the 1960's. And there is a steady decrease in rural population. Thus lack of the number of the students forced many elementary Schools to be abolished. The aim of this study is to grasp the abolition types and the regional characteristics with the subject region of Chungbuk province. From the viewpoint of the increasing abolition of the elementary schools, I think it is very important to understand how the elementary schools have been abolished so far and predict how the subject region will have been changed in geography. Data for this study are based on Annual Establishment-Abolition Situation of the Schools published by Chungbuk office of Education in 1992, and many Kinds of the statistical reports, and the interview with the related. The results are as follows: 1. By examining the change of the number of the elementary schools and students in Chnugbuk, the numder of the students had also decreased since 1969 and was less than the half in 1990. As the number of the schools began to decrease ten years later than the students began to, the abolition of the elementary schools has started in reality from 1980's. 2. The 72 elementary schools were aboilshed between 1980 and 1992: the principal school is 9.7%, the branch school is 90.3%. The most fifteen schools are abolished in Yongdong-county and Chechon-county, and the least one school is abolished in Chechon-city and Okchon-county, and there is no abolition in Chongju-city and Chungju-city: According to the type of the abolition process, the least seven principal schools are abolished, and the principal school is reorganized as a branch school and twenty eight branch schools are abolished, and the most thirty seven branch schools are abolished. 3. When special change of the abolition is classified into the first perio (1980-1986) and the second period (1987-1992), in the first period the principal and branch schools were abolished and they are 13.9% of total abolition. The abolition out of them by building a dam is 60%. The principal schools in the submerged area though they have many students, were abolished. In the second period sixty two branch schools are abolished and they are 86.1% of total abolition. The most fifteen schools are abolished in Yongdong-county, thirteen in Chechon-county, seven in Tanyang-county, six in Chongwon-county, five in Chungwon-county and Koesan-county. Unlike the first period, the schools were abolished in this period because the number of students was so small. In this period sixty branch schools were abolished. All the students in the abolished schools except six schools transfered to the principal schools. The 58 school authorities help the students attend school by bus or support the expenses for attending school after that. 4. The abolition types of city, county and myon are classified into five types by the number of the abolished schools. The most forty nine abolished schools in type II are 68.1 of the total abolition. The least three abolished ones in type I are 12.5%. Considering the relation between the abolition type ane the number of schools and students, the number of the schools, increased in type I, II, III, V except IV from 1980 and then have decreased by abolition since 1980, while the more students decreased than they did in 1970 and the more the abolished school increases, the less the students decreases. The average students per school decreased in every abolition type and the most students decreased in type IV. 5. Considering the relation between the abolition type and the regional characteristics, most abolished schools were located between 100m and 300m above the sea level and it is 71% of the total abolition. The region without the abolition is high in the ratio of the cultivate land, ratio of rice field, and the part-time farmer, but the region with many abolition is low in the ratio of cultivated land. As for the manufacturing there are the most city, county and myon in the abolition type in Youngdong-county and Chechon-county where the manufacturing ratio of employing is low but Chongju-city without the abolition is a region where the manufacturing ratio is high. Consequently the development of the manufacturing causes the population to emigation out and the decrease of the population leads the transport is difficult of access, the facilities sold after being abolished are not being used in many ways. 7. Take an example of Youndong-county where the most schools were abolished, I have examined the school district and the population characteristics of the abolition. Though there were more villages, households, populations in the region that is higher than low above the sea level, the schools were abolished. Therefore we know that above the sea level had a great effect on the abolition. As a result of the regional analysis of the abolition, many schools were abolished by the artificial buildings such as a dam in the early 1980's but the schools in the late 1980's were abolished ten years later after the students decreased. More schools were abolished in the region where the manufacturing industry didn't develop. And the higher the school position was above the sea level, the sooner the school was abolished. It is also proved that both the beautiful natural scenery and accessibility are the important factor in using the abolished facilities practically.

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