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