• Title/Summary/Keyword: short term

Search Result 6,081, Processing Time 0.043 seconds

Problems and Improvement Measures of Private Consulting Firms Working on Rural Area Development (농촌지역개발 민간컨설팅회사의 실태와 개선방안)

  • Kim, Jung Tae
    • Journal of Agricultural Extension & Community Development
    • /
    • v.21 no.2
    • /
    • pp.1-28
    • /
    • 2014
  • Private consulting firms that are currently participating in rural area development projects with a bottom-up approach are involved in nearly all areas of rural area development, and the policy environment that emphasizes the bottom-up approach will further expand their participation. Reviews of private consulting firms, which started out with high expectations in the beginning, are now becoming rather negative. Expertise is the key issue in the controversy over private consulting firms, and the analysis tends to limit the causes of the problems within firms. This study was conducted on the premise that the fixation on cause and structure results in policy issues in the promotion process. That is because the government authorities are responsible for managing and supervising the implementation of policies, not developing the policies. The current issues with consulting firms emerged because of the hasty implementation of private consulting through the government policy trend without sufficient consideration, as well as the policy environment that demanded short-term outcomes even though the purpose of bottom-up rural area development lies in the ideology of endogenous development focused on the changes in residents' perceptions. Research was conducted to determine how the problems of private consulting firms that emerged and were addressed in this context influenced the consulting market, using current data and based on the firms' business performance. In analyzing the types, firms were divided into three groups: top performers including market leaders (9), excellent performers (36), and average performers (34). An analysis of the correlation between the business performance of each type and managerial resources such as each firm's expertise revealed that there was only a correlation between human resources and regional development in excellent performers, and none was found with the other types. These results imply that external factors other than a firm's capabilities (e.g., expertise) play a significant role in the standards of selecting private consulting firms. Thus, government authorities must reflect on their error of hastily adopting private consulting firms without sufficient consideration and must urgently establish response measures.

NORMOBARIC OXYGEN($O_2$) ADMINISTRATION EFFECT ON ATTENTION AND MEMORY FUNCTION IN TEENAGE ADOLESCENTS (10대 청소년의 주의력과 기억능력에 미치는 정상기압 산소흡입 효과)

  • Kim, Byung-Hyo;Kim, Young-Mi;Cho, Soo-Churl;Kim, Boong-Nyun
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
    • /
    • v.13 no.1
    • /
    • pp.76-84
    • /
    • 2002
  • Objectives:This study was conducted to investigate the effect of oxygen on attention and memory functions in healthy adolescents. Methods:The participant subjects were recruited from local advertisement. All subjects are students attending ordinary middle and high school. Their degree of achievement was average or below average. Before the study, its nature and purpose were fully explained to the patients and their parents, and a written informed consent was obtained from each child's parent and a written assent from each child for entire the procedure. The Ethics Committee and Clinical Research Committee of Gyeongsang National University Hospital approved the protocol. For baseline assessment, all subjects received tests for attention and memory. All tests were conducted by a certified psychologist. Stroop test, continuous performance test and trail making test A and B were used for evaluation of attention. As memory tests, we used memory assessment scale(MAS), standardized memory assessment tools. Ten to fourteen days after initial assessments, same tests was applied to the same subjects after prior 5 minute oxygen inhalation. Results:1) Attention test:Improved performances in trail making part B, and stroop test were found in normobaric oxygen inhalation group compared to air inhalation group. Improved reaction time in those tests seemed to reflect the enhanced executive prefrontal activity. 2) Memory test:More words and digits memorization were found in short-term memory subscale score in MAS in oxygen inhalation group compared to air inhalation group. This finding suggested the improved working memory function after oxygen inhalation. Conclusion:Though interpreted cautiously, these results suggested that normobaric oxygen inhalation could enhance executive function and working memory of prefrontal lobe. Further study, however, should be performed to investigate the mechanism of effects of oxygen on cognitive enhancement.

  • PDF

Effect of Breed (Lean or Fat Pigs) and Sex on Performance and Feeding Behaviour of Group Housed Growing Pigs in a Tropical Climate

  • Renaudeau, D.;Giorgi, M.;Silou, F.;Weisbecker, J.L.
    • Asian-Australasian Journal of Animal Sciences
    • /
    • v.19 no.4
    • /
    • pp.593-600
    • /
    • 2006
  • The effects of breed and sex on individual growth performance and feeding behaviour were studied between 45 and 90 kg BW in two replicates of forty group-housed pigs. The first and the second replicates were carried out during the warm season (i.e. between February and April 2003) and during the hot season (i.e. between August and October 2003), respectively. During the warm season, ambient temperature and relative humidity averaged $25.3^{\circ}C$ and 86.0%. The corresponding values for the hot season were $27.9^{\circ}C$ and 83.6%. The pigs were grouped in pens of 10 animals on the basis of breed (Creole or Large White) and sex (gilt or castrated male) and given ad libitum access to a grower diet (9.0 MJ/kg net energy and 158 g/kg crude protein) via feed intake recording equipment (Acema 48). An ear-tag transponder was inserted into each pig and this allowed the time, duration, and size of individual visits to be recorded. The growth performance and feeding pattern were significantly affected by breed, sex, and season. The Creole pigs (CR) had a lower average daily gain (ADG) (642 vs. 861 g/d, p<0.01) and carcass lean content ($LC_{90kg}$) (35.4 vs. 54.5%; p<0.01) and a higher backfat thickness at 90 kg BW ($BT_{90kg}$) (23.4 vs. 10.4 mm; p<0.01) than Large White pigs (LW) whereas the average daily feed intake (ADFI) was not affected by breed (2.34 vs. 2.22 kg/d, respectively for CR and LW pigs; p>0.10). Consequently, the food:gain ratio was higher in CR than in LW (3.65 vs. 2.58; p<0.01). CR had less frequent meals but ate more feed per meal than LW (5.9 vs. 8.8 meals/d and 431 vs. 279 g/meal; p<0.01). The rate of feed intake was lower (27.6 vs. 33.9 g/min; p<0.01) and the ingestion time per day and per meal were higher in CR than in LW (87.1 vs. 69.7 min/d and 15.8 vs. 8.4 min/meal; p<0.01). The ADFI and BT90 kg were higher (2.38 vs. 2.17 kg/d and 18.1 vs. 15.9 mm; p<0.05) and LC90 kg was lower (43.5 vs. 46.4%; p<0.01) in castrated males (CM) than in gilts (G) whereas ADG was not affected by sex (p = 0.12). The difference in lean content between CM and G was greater in CR than in LW. The ADFI and ADG were reduced during the hot season (2.18 vs.2.38 kg/d and 726 vs. 777 g/d, respectively; p<0.05) whereas feed conversion and carcass lean content were not affected by season (p>0.05). Average feeding time per meal and meal size decreased during the hot season (10.9 vs. 13.2 min/meal and 316 vs. 396 g/meal; p<0.01) whereas the rate of feed intake was not affected by season (p = 0.83). On average, 0.69 of total feed intake was consumed during the diurnal period. However, this partition of feed intake was significantly affected by breed, sex, and season. In conclusion, the breed, sex and season significantly affect performance and feeding pattern in growing pigs raised in a tropical climate. Moreover, the results obtained in the present study suggest that differences observed in BW composition between CR and LW are associated with difference in feeding behaviour, in particular, the short-term regulation of feed intake.

The State of Marine Pollution in the Waters adjacent to Shipyards in Korea - 2. Assessment of the Pollution of Heavy Metals in Seawater around Major Shipyards in Summer 2010 (국내 조선소 주변해역의 해양오염 현황 - 2. 2010년 하계 대형조선소 주변 해수의 중금속오염 평가)

  • Kim, Kwang-Soo
    • Journal of the Korean Society of Marine Environment & Safety
    • /
    • v.21 no.1
    • /
    • pp.9-17
    • /
    • 2015
  • In order to elucidate the current state of marine pollution of heavy metals around major shipyards in Korea, seawater samples were collected at eleven sampling stations and four control stations around 4 major shipyards located in the southeastern coast of Korea in summer 2010, and 6 kinds of metals such as copper(Cu), zinc(Zn), iron(Fe), cadmium(Cd), lead(Pb) and mercury(Hg) in seawater samples were analyzed. The analyses of heavy metals in seawater showed that the mean Cu concentrations in seawater around 4 major shipyards were in the range of $0.817{\sim}1.638{\mu}g/L$ which were lower than Korean environmental standards of $20{\mu}g/L$ for the protection of human health(PHH) and of $3{\mu}g/L$ for short-term protection of marine ecosystem(SPME) but higher than Cu concentration at control station by a factor of up to 2.75. The mean Zn concentrations were in the range of $0.228{\sim}0.567{\mu}g/L$ which were lower than Korean environmental standards of $100{\mu}g/L$ for PHH and $34{\mu}g/L$ for SPME but higher than Zn concentration at control station by a factor of up to 5.91. The mean Fe concentrations were in the range of $3.332{\sim}7.410{\mu}g/L$ which were higher than Fe concentration at control station by a factor of up to 6.75. The mean Cd concentrations were in the range of $0.013{\sim}0.028{\mu}g/L$ which were lower than Korean environmental standards of $10{\mu}g/L$ for PHH and $19{\mu}g/L$ for SPME but higher than Cd concentration at control station by a factor of up to 2.33. The mean Pb concentrations were in the range of $0.007{\sim}0.126{\mu}g/L$ which were lower than Korean environmental standards of $50{\mu}g/L$ for PHH and $7.6{\mu}g/L$ for SPME. The mean Hg concentrations were in the range of $0.002{\sim}0.004{\mu}g/L$ which were lower than Korean environmental standards of $0.5{\mu}g/L$ for PHH and $1.8{\mu}g/L$ for SPME. Although the concentrations of metals such as Cu, Zn and Fe which were used in shipbuilding works were lower than Korean environmental standards for PHH and SPME, the fact that the concentrations of Cu, Zn and Fe at sampling stations around major shipyards were higher than those at control stations implies that the works in shipyards had some effects on marine water quality around shipyards. Therefore, marine environment management such as the prevention and control of the discharge of various pollutants from shipyards is required on national level.

A Study on Improvement Examination Standard for the Limit of changing Current State of the Cultural Properties (문화재 유형별 현상변경 검토기준 마련 연구)

  • Cho, Hong-Seok;Park, Hyun-Joon;Lee, You-Beom;Lee, Cheon-Woo;Kim, Chul-Ju;Park, Jung-Seop;Kim, Sang-Dong
    • Journal of the Korean Institute of Traditional Landscape Architecture
    • /
    • v.33 no.4
    • /
    • pp.148-165
    • /
    • 2015
  • The Cultural Properties Protection Law Act 1962 has been achieving its role for systematic preservation, management and application of the cultural heritage under rapid economic growth circumstances through continuing revisions. Introduced the influence review system for cultural heritages in 2000, and legislated the guideline for the state-change allowance standard for the National Cultural Heritage in 2006 in specific, the law has been contributing significantly for the cultural properties and historical/cultural environment preservation, along with increase in administrative efficiency and improvement on settlement environment. However, increase in public awareness about the cultural property's value and the needs for the local revitalization by utilizing the heritages, while some allowance standard not peoperly delivering the surrounding conditions, such as the value of the properties and their substantial characteristics, land utilization, etc. being applied, complaints from the local residents are increasing continuously. Thus this research focuses on clear vision/value of the heritage and apply them to create the review criteria for the state-change allowance per heritages. Here we set the Focus of Landscape Management Indicators in order to actively preserve and manage the physical characteristics and the native value by analyzing the Cultural Heritage Protection Laws and related guidelines, manuals and research papers, and redesign the cultural propertiy's classification scheme and propose the Review Standard for state-change from the view point of changing the current state. With this research, we expect increase in the satisfaction for the Property management system with public understanding promotion regarding the Standards by applying the reviewed state-change allowance Standards, white securing the consistency for the review criteria as well as the systematic management of historical/cultural environment with their typification characteristics and the value for short-term.

PRC Maritime Operational Capability and the Task for the ROK Military (중국군의 해양작전능력과 한국군의 과제)

  • Kim, Min-Seok
    • Strategy21
    • /
    • s.33
    • /
    • pp.65-112
    • /
    • 2014
  • Recent trends show that the PRC has stepped aside its "army-centered approach" and placed greater emphasis on its Navy and Air Force for a wider range of operations, thereby reducing its ground force and harnessing its economic power and military technology into naval development. A quantitative growth of the PLA Navy itself is no surprise as this is not a recent phenomenon. Now is the time to pay closer attention to the level of PRC naval force's performance and the extent of its warfighting capacity in the maritime domain. It is also worth asking what China can do with its widening naval power foundation. In short, it is time to delve into several possible scenarios I which the PRC poses a real threat. With this in mind, in Section Two the paper seeks to observe the construction progress of PRC's naval power and its future prospects up to the year 2020, and categorize time frame according to its major force improvement trends. By analyzing qualitative improvements made over time, such as the scale of investment and the number of ships compared to increase in displacement (tonnage), this paper attempts to identify salient features in the construction of naval power. Chapter Three sets out performance evaluation on each type of PRC naval ships as well as capabilities of the Navy, Air Force, the Second Artillery (i.e., strategic missile forces) and satellites that could support maritime warfare. Finall, the concluding chapter estimates the PRC's maritime warfighting capability as anticipated in respective conflict scenarios, and considers its impact on the Korean Peninsula and proposes the directions ROK should steer in response. First of all, since the 1980s the PRC navy has undergone transitions as the focus of its military strategic outlook shifted from ground warfare to maritime warfare, and within 30 years of its effort to construct naval power while greatly reducing the size of its ground forces, the PRC has succeeded in building its naval power next to the U.S.'s in the world in terms of number, with acquisition of an aircraft carrier, Chinese-version of the Aegis, submarines and so on. The PRC also enjoys great potentials to qualitatively develop its forces such as indigenous aircraft carriers, next-generation strategic submarines, next-generation destroyers and so forth, which is possible because the PRC has accumulated its independent production capabilities in the process of its 30-year-long efforts. Secondly, one could argue that ROK still has its chances of coping with the PRC in naval power since, despite its continuous efforts, many estimate that the PRC naval force is roughly ten or more years behind that of superpowers such as the U.S., on areas including radar detection capability, EW capability, C4I and data-link systems, doctrines on force employment as well as tactics, and such gap cannot be easily overcome. The most probable scenarios involving the PRC in sea areas surrounding the Korean Peninsula are: first, upon the outbreak of war in the peninsula, the PRC may pursue military intervention through sea, thereby undermining efforts of the ROK-U.S. combined operations; second, ROK-PRC or PRC-Japan conflicts over maritime jurisdiction or ownership over the Senkaku/Diaoyu islands could inflict damage to ROK territorial sovereignty or economic gains. The PRC would likely attempt to resolve the conflict employing blitzkrieg tactics before U.S. forces arrive on the scene, while at the same time delaying and denying access of the incoming U.S. forces. If this proves unattainable, the PRC could take a course of action adopting "long-term attrition warfare," thus weakening its enemy's sustainability. All in all, thiss paper makes three proposals on how the ROK should respond. First, modern warfare as well as the emergent future warfare demonstrates that the center stage of battle is no longer the domestic territory, but rather further away into the sea and space. In this respect, the ROKN should take advantage of the distinct feature of battle space on the peninsula, which is surrounded by the seas, and obtain capabilities to intercept more than 50 percent of the enemy's ballistic missiles, including those of North Korea. In tandem with this capacity, employment of a large scale of UAV/F Carrier for Kill Chain operations should enhance effectiveness. This is because conditions are more favorable to defend from sea, on matters concerning accuracy rates against enemy targets, minimized threat of friendly damage, and cost effectiveness. Second, to maintain readiness for a North Korean crisis where timely deployment of US forces is not possible, the ROKN ought to obtain capabilities to hold the enemy attack at bay while deterring PRC naval intervention. It is also argued that ROKN should strengthen its power so as to protect national interests in the seas surrounding the peninsula without support from the USN, should ROK-PRC or ROK-Japan conflict arise concerning maritime jurisprudence. Third, the ROK should fortify infrastructures for independent construction of naval power and expand its R&D efforts, and for this purpose, the ROK should make the most of the advantages stemming from the ROK-U.S. alliance inducing active support from the United States. The rationale behind this argument is that while it is strategically effective to rely on alliance or jump on the bandwagon, the ultimate goal is always to acquire an independent response capability as much as possible.

Internalizing Environmental Cost using TDM Alternatives (교통수요관리 기법을 활용한 환경오염비용의 내부화 방안연구)

  • 김운수;엄진기;황기연;장지희
    • Journal of Korean Society of Transportation
    • /
    • v.17 no.4
    • /
    • pp.99-110
    • /
    • 1999
  • With a growing awareness, transportation is the maior source of urban air pollution. Planners and policy-makers are strongly urged to care the impacts of transportation management strategies on environment. Since transport-related air Pollution can be regarded as negative externalities of transport, it is indispensable to evaluate chanties in air quality which seems to occur when proposed transport measures are implemented. In addition, transport measures should be integrated in a set of combined Paradigm regarding transport and environment. Based on the integrated Paradigm between transportation demand management(TDM) and environmental planning, the main focus is given to apply environment cost internalizing measures to the short-term congestion management Program(SCMP) in Seoul, that has been developed in 1998 by Seoul Development Institute. Three modules are analyzed: without and/or with ₩500, ₩1000 emission plus gas tax, respectively. From the empirical applications on Seoul city, one of the most exemplary findings in SCMP program is that, emission plus gas tax can be a very useful measure to reduce vehicular emissions by targeting major Pollutants differently, rather than by dealing with pollutants collectively. Further research that provides (1)showing the spatial variation of pollution levels along the intersections, (2)more developing combined Paradigm between transport, land use, and environment, (3)using environmental road capacity rather than Physical-aspects of road capacity, and (4)continuing R&D on air quality constrained TDM, can contribute significantly to applications of the real and efficient environment-constrained transportation planning.

  • PDF

A Short-Term Study of the Effects of UDCA on Gingival Inflammation in the Beagle Dog (우로수데옥시콜릭산이 치주질환 억제에 미치는 영향)

  • Park, Sang-Hyun;Han, Seoung-Min;Choi, Sang-Mook;Ku, Young;Rhyu, In-Chul;Han, Soo-Boo;Lee, Hak-Mo;Kim, Moon-Moo;Kim, Sang-Nyun;Chung, Chong-Pyoung
    • Journal of Periodontal and Implant Science
    • /
    • v.29 no.1
    • /
    • pp.1-14
    • /
    • 1999
  • Ursodeoxycholic acid(UDCA) is a hydrophilic gall bladder acid and has been used as a effective drug for liver disease related to in1munity. This drug inhibits secretions of IL-2, IL-4, and $IFN-{\gamma}$ from T-cells and production of immunoglobulin from B-cells. Also it has been reported that UDCA inhibits production of IL-1 related to the progression of periodontal disease and activation of collagenases. The purpose of the present study was to elucidate the effects of UDCA on inhibition of periodontal disease progression using clinical, microbiological and histometrical parameters. Twelve pure bred, 16 month-old-beagle dogs were used in the study. After ligature-induced periodontal diseases were formed, experimental drugs were applied twice a day and then the results of clinical, microbiological, and histometrical parameters were measured at baselie(initiation of experiment) , 4weeks and 8weeks. The gel with UDCA(concentration 0.5%, 5% 3 dogs in each) was applied to experimental group, chlorhexidine to positive control group(3dogs) and the gel without UDCA(base) to negative control group. After induction of general anesthesia, the maxillary 2nd, 3rd premolars and 1st molar and the mandibular 2nd, 3rd, 4th premolars and 1st molar were ligated in one side selected randomly and were not ligated in the opposite side. The plaque index(PI), gingival index(GI), pocket depth(PD) and gingival crevicular fluid(GCF) volum were measured clinically. The PI and GI were measured at 3 buccal points of all experimental teeth and the GCF was measured only at the 3rd premolar in the maxilla and the 4th premolar in the mandible. In the microbiological study, the samples extracted from the 3rd premolar of the maxilla and the 4th premolar of the mandible at the center of buccal surface were analyzed aerobics, anaerobics and Streptococcus colony forming units, After clinical and microbiological examination at 8weeks, the dogs were sacrificed by carotid artery perfusion. The samples were fixed and sectioned including interproximal area, and the distance from cementoenamel junction(CEJ) to alveolar crest was measured. The results were that PI, GI and PD increased until 4 weeks and decreased at 8 weeks in three groups but the differences between all the groups were not significant. The 0.5% UDCA in non-ligated group showed remarkable decrease of GCF. The experimental group applied 5% UDCA decreased the number of aerobics and anaerobics. The distance from CEJ to alveolar crest was greater in the negative control group on both ligated and non-ligated sides, but the differences were not significant stastically.

  • PDF

Variation of Hospital Costs and Product Heterogeneity

  • Shin, Young-Soo
    • Journal of Preventive Medicine and Public Health
    • /
    • v.11 no.1
    • /
    • pp.123-127
    • /
    • 1978
  • The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

  • PDF

Esophageal Atresia and Tracheoesophageal Fistula in Korea - A National Survey of Its Members by the Korean Association of Pediatric Surgeons - (선천성 식도 무공증 및 기관식도 누공 - 대한 소아외과학회 회원을 대상으로 한 전국 조사 -)

  • Park, W.H.;Kwon, S.I.;Kim, S.C.;Kim, S.K.;Kim, W.K.;Kim, I.K.;Kim, J.E.;Kim, H.H.;Park, K.W.;Park, Y.S.;Song, Y.T.;Yang, J.W.;Oh, S.M.;Yoo, S.Y.;Lee, D.S.;Lee, M.D.;Lee, S.C.;Lee, S.K.;Lee, T.S.;Chang, S.I.
    • Advances in pediatric surgery
    • /
    • v.1 no.2
    • /
    • pp.149-161
    • /
    • 1995
  • The first national survey on esophageal atresia and tracheoesophageal fistula was conducted to access the current status of its incidence, clinical manifestation, preoperative diagnosis and management, type of its anomaly, associated anomalies, and surgical results and course. The 43 members of the Korea Association of Pediatric Surgeons received questionnaires and registration forms to be filled out on each patient who were born during the three years from January 1, 1992 through December 31, 1994. Questionnaires composed of six broad areas which include 1) preoperative diagnosis and management, 2) surgical technic, 3) long gap, 4) postoperative management, and 5) complications and courses. A total of 148 cases was returned by 28 members working at 23 institutions and 27 members returned questionnaires. We obtained the following results by analysis of the 148 cases of tracheoesophageal anomalies. The incidence of tracheoesophageal anomaly was about 1/10,000-11,000 in 1994, which is one third of that of anorectal malformations in Korea and the distribution of the patients was almost proportionate to the size of each province. Both sexes are about equally affected. Majority of the members make diagnosis of tracheoesophageal anomaly by taking a simple infantogram with a radiopaque tube in upper pouch and a little under half(46%) prefers to perform echocardiography as a part of preoperative management to identify congenital heart disease and lateralize the aorta. Esophageal atresia with distal TEF(87.5%) was by far the most common and there were pure esophageal atresia(5.6%), H-type TEF(2.1%), and so on. About half(49%) of the patients had one or more associated anomalies in addition to tracheoesophageal anomalies. Congenital heart disease was associated in 46 cases(31%), anorectral malfomations in 19 cases(13%), musculoskeletal anomalies in 15 cases(10%), genitourinary anomalies in 10 cases(7%) and gastrointestinal anomalies in 7 cases(5%). Postoperatively, parenteral nutrition and assisted ventilation were given in 66% and 52% of patients respectively. Ninety three(74%) of 126 cases who underwent sugical procedure, experienced one or more complications such as respiratory complication(65%), leak(22%), stricture(21%) and so on. The survival rates related to the Waterston risk categories were 90.2% in group A, 71.4-75% in $B_1$, $B_2$, and $C_1$, groups, and 28% in group $C_2$, and the overall survival rate was 71.4%. Thirty six(28.6%) of 126 cases died of pneumonia/sepsis(12 cases), respiratory failure(12 cases), and congenital heart disease(4 cases). With short term follow-up, 69% of patients have been excellent whereas remainders of the cases have suffered from some sort of morbidity related to gastroesophageal reflux, recurrent respiratory infection, and esophageal stricture.

  • PDF