이력데이터를 이용한 XML 문서의 개선된 버전관리 방법

김성록 ( Seong-rok Kim ),박희숙 ( Hee-sook Park ),조우현 ( Woo-hyun Cho ) 한국정보처리학회 2004 한국정보처리학회 학술대회논문집 Vol.11 No.2

XML은 인터넷 웹문서, EDI 등을 포함하여 다양한 분야에서 활용하는 문서이다. XML은 플랫폼에 독립적이며 문서의 정보를 손실 없이 전송 및 교환이 쉽고 웹상에서 구조화된 문서의 전송이 가능하다. 따라서 시간이 변화함에 따라 XML 문서의 변경에 따른 효율적인 버전 관리에 대한 중요성이 대두되었다. 본 논문에서는 XML문서 버전관리에 있어서 시간적인 정보를 제공하기 위해 이력 데이터베이스의 정보를 이용하고 문서의 빠른 재구성을 위해 Dewey ordering방식을 결합한 새로운 버전번호 관리방식을 제안한다.

Type 2 Cardiorenal Syndrome으로 투석을 시행한 환자의 특징과 생존율

조성 ( Seong Cho ),김성록 ( Sung Rok Kim ),이유지 ( Yu Ji Lee ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.6

Purpose: We evaluated clinical outcomes in patients with type 2 cardiorenal syndrome who were treated with peritoneal dialysis (PD) or hemodialysis (HD). Methods: A retrospective database of PD or HD patients with type 2 cardiorenal syndrome from January 2002 to December 32010 was established. We evaluated the mean survival on dialysis, days of hospitalizations and NYHA class changes. Results: Thirty-two patients with mean age at the start of dialysis of 68.4±10.8 years had mean survival on dialysis of 20.5±14.4 months (median survival 17.8 months). Survival after starting dialysis is highly variable, but long term survival was proved possible. The days of hospitalization for cardiovascular causes were reduced (25.1±17.predialysis vs. 9.5±32.8 days/patient/month, postdialysis, p= 0.013). All patients showed improvement in NYHA functional class. Kidney function stabilized, while significant improvement in hemoglobin (+16.5%, p<0.001) were achieved. Conclusion: After starting dialysis for Type 2 cardiorenal syndrome, the chances of hospitalization for cardiovascular causes were reduced for all patients. Survival on dialysis in these patients was highly variable.

수술 전 혈관평가와 수술자의 차이가 동정맥루의 종류와 개존율에 미치는 영향

조성 ( Seong Cho ),김성록 ( Sung Rok Kim ),이유지 ( Yu Ji Lee ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.3

To evaluate the effects of specialty of the operator and of preoperative ultrasonic mapping at the time of AVF creation on access outcomes, we studied 224 patients who received AVF surgery by nephrologist with preoperative sonographic mapping (Group 1, n=112) or by vascular surgeon with only physical examination (Group 2, n=112) from January 2008 to December 2009. We compared the rate of autogenous fistula formation, primary failure rate (immediate failure, maturation failure) and patency rate between two groups. Group 1 had more autogenous fistula (97.4 vs. 63.0%, p<0.05), more mid-arm fistula (20.7 vs. 0%, p<0.05) compared to group 2. Immediate failure was more common in group 2 (1 vs. 9, p<0.05). Maturation failure was not different between two groups (10 vs. 10, p=ns). Group 1 had higher primary patency rate at 1 year (74.40 vs. 68.27%, p<0.05) and also had higher secondary patency rate at 1 year (87.33 vs. 81.63%, p<0.05) compared to group 2. If active preoperative sonogram is planned, outcomes of AVF created by nephrologist are comparable to outcomes of AVF created by surgeon.

근위부 요골요측피 동정맥루의 임상적 경험

조성 ( Seong Cho ),이유지 ( Sung Rok Kim ),김성록 ( Yu Ji Lee ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.1

Purpose: The first choice of vascular access is a distal radiocephalic fistula (dRCF) at the wrist. In patients with a failed dRCF or with vessels unsuitable for dRCF, the recommendation is to place a brachiocephalic fistula (BC) in the upper arm. Proximal forearm radiocephalic fistulas (pRCF) are created infrequently, but may permit a second forearm fistula before proceeding to the upper arm BC. The goal of the present study was to evaluate the effect of pRCF in hemodialysis patients. Methods: We included 80 patients who received arteriovenous fistula operation between December, 2008 and July, 2010. The type of arteriovenous fistula (dRCF, pRCF, BC) was determined according to preoperative vascular mapping using doppler ultrasonography. The fistula operation was performed by one surgeon. We compared the non-maturation rates, primary and secondary patency rates among dRCF, pRCF, and BC. Results: The numbers of patients that underwent dRCF, pRCF, and BC operation were 27, 27, and 26, respectively. Only 33.8% of patients needed creation of a dRCF potentially. Non-maturation rates were similar among the patients that underwent dRCF, pRCF and BC (11.1%, 7.4%, and 3.8%, respectively, p>0.05). The primary patency rates of dRCF, pRCF, and BC were 81.5%, 92.6%, 80.8%, respectively (p>0.05). The secondary patency rates of dRCF, pRCF, and BC were 92.3%, 96.3%, and 92.3%, respectively (p>0.05). Conclusion: pRCF had non-maturation rate, primary and secondary patency rate, comparable to those of a dRCF and, a BC. pRCF may be an attractive alternative to a BC in patients who do not have vessel suitable for creation of a dRCF.

증례 : 복강경 시술로 치료한 염증성 대동맥류에 의한 후복막강 섬유화증 1예

오지은 ( Ji Eun Oh ),조성 ( Seong Cho ),김광민 ( Kwang Min Kim ),강구현 ( Gu Hyun Kang ),한대희 ( Dae Hui Han ),김윤영 ( Yun Young Kim ),김성록 ( Sung Rok Kim ) 대한내과학회 2006 대한내과학회지 Vol.71 No.1S

수술 전 초음파를 이용한 Venous Mapping이 혈관접근로 형성에 미치는 효과

이호명 ( Ho Myung Lee ),조성 ( Seong Cho ),김윤영 ( Yun Young Kim ),황종운 ( Jong Woon Hwang ),이진호 ( Jin Ho Lee ),허종훈 ( Jong Hoon Heo ),권경아 ( Kyung A Kwon ),김성록 ( Sung Rok Kim ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.2

목적: 최근 초음파를 사용한 적극적인 venous mapping으로 자가혈관 수술률이 높아지고 성숙장애 (maturation failure)가 줄어든다는 보고가 있으나 국내 보고는 드문 실정이다. 본원에서는 venous mapping이 자가혈관을 이용함에 어떠한 효과를 나타내고 있는지를 분석하였다. 방법: 이에 본원에서 2005년 1월부터 2006년 6월까지 영구투석이 필요하여 자가혈관, 인조혈관 혹은 영구도관을 삽입한 환자 73명을 대상으로 초음파를 사용, venous mapping을 실시하여 수술방법을 정한 군 (map군, n=40)과 대조군(n=33)으로 나눠 두 군 사이에 자가혈관 사용의 비율, 성숙장애의 빈도 및 그 원인 등을 후향적으로 분석하였다. 결과: 환자의 연령, 65세 이상 고령 환자비, 당뇨 환자비는 map군과 대조군에서 각각 58.95±19.93 (25-86)세 vs 60.76±11.93 (39-80)세, 20/40 vs 17/33, 14/40 vs 19/33로 양 군 사이에 차이는 없었다. 성별 (남/여)은 map군에서 12/28 대조군에서 21/12로 map군에서 여성이 많았다 (p=0.005). 첫 수술시 자가 혈관 사용비율은 map군은 40명 중 34명, 대조군은 33명 중 31명으로 두 군 사이에 차이는 없었다 (p=0.202). 수술 2달 후 map군은 40명 중 34명이 대조군은 33명 중 22명이 자가 혈관을 사용하고 있어 map군이 더 높은 자가혈관 사용 경향을 보였다 (p=0.059). Map군은 40명 중 36명, 대조군은 33명 중 16명이 수술 2달 후 별다른 처치 없이 투석이 가능해 map군이 유의하게 성숙장애 비율이 적었다 (p=0.000). 성숙장애의 원인으로 map군에서는 4예가 있었는데 4예는 혈관성형술 후에, 1예는 혈관성형술과 부경로차단수술 후에 투석이 가능했다. 대조군은 17예가 있었는데 13예는 재수술을 하였다. 그 원인은 동맥의 문제로 혈관의 확장이 오지 않은 군이 3명, 혈관의 연속성이 없어 문합 부위만 자라고 더 이상 정맥의 발달이 없는 경우가 10명 이었다. 3예는 정맥주행경로의 협착으로 인해 혈관성형술 시행 후 투석이 가능했고, 1예는 부경로차단수술 후 투석이 가능하였다. 결론: Venous mapping을 수술 전에 시행한다면 적절한 술기의 발달과 함께 자가혈관의 사용률을 증가시킬 것이라 생각된다. 또, 수술 후 성숙장애로 인한 재수술을 줄일 수 있다고 생각된다. Purpose: Active venous mapping by ultrasonography much increased the rate of autologous graft operations while significantly decreasing the rate of maturation failures. Reports on this phenomenon, however, have been rare in Korea. We here the effect of venous mapping by ultrasonography. Methods: From 2005.1 to 2006.6, we selected 73 patients with autologous or artificial vessel or tunneled catheter and put them into 2 groups: the group that had operation after venous mapping by ultrasonography (n=40) and the control group (n=33) and rate of autologous vessels and the frequency and cause of maturation failure were analysed retrospectively. Results: Patient`s age, patient ratio of age, DM ratio in the map group against the control group were respectively 58.95±19.93 (25-86) vs 60.76±11.93 (39-80), 20/40 vs 17/33, 14/40 vs 19/33 showing no signficant differences between them. Gender ratios (M/F) were 12/28 vs 21/12 showing more females in the mapping group. As for the rate of autologous vessel, 34 out of 40 in map group, and 31 out of 33 in the control group showed no significant difference. After the first operation, 36 out of 40 in map group and 16 out of 33 in the control group were using autologous vessel. The map group had tendency to use higher rate of autologous vessels than the control group (p=0.059). MF ratio was significantly low in the mapping group (p=0.000). Conclusion: Carrying out preoperative venous mapping would promote development of appropriate techniques, together with increased use of autologous vessels. It is also thought that MF reduced the chance of reoperation.

만성 신질환의 중증도와 동반된 빈혈의 빈도에 대한 연구

권정훈 ( Jeong Hun Kwen ),조성 ( Seong Cho ),김성록 ( Sung Rok Kim ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1

목적 : 만성 신질환의 조기 발견 및 치료는 신질환의 진행 억제 ㅣㅊ 심혈관계 합병증 방지를 위해 중요하다. 만성 신질환의 초기부토 동반되는 심한 빈혈을 조혈호르몬 등으로 교정할 수 있는 합병증으로 교정시 심혈관계 합병증을 예발할 수 있으리라 생각된다. 최근 발표된 K/DOQI-CKD Guideline은 신질환의 조기 발견 및 치료를 목표로 하고 있어 국내에서도 이에 대한 연구가 필요하나 현재까지 만성 신질환 정도와 이에 따른 빈혈의 정도, 그리고 빈혈에 영향을 미치는 인자에 대한 연구는 드문 편이다. 이에 본 센타 환자를 대상으로 만성 신질환 정도를 K/DOQI-CKD Guideline에 따라 나누고 이에 따른 빈혈의 빈도 및 정도, 그리고 빈혈에 영향을 미치는 인자를 알아보고자 본 연구를 시작하였다. 방법 : 3개월 이상 안정상태인 만성 신질환 환자를 Abbreviated MDRD Equation으로 계산된 GFR (Glomerular Filtration Rate)에 따라 K/DOQI-CKD Guideline의 5 stage로 분류하였다. 혈역학적 변화를 일으키는 혈색소치인 10.0 g/dL 이하를 빈혈이라 정의하였다. 각 stage에서의 빈혈의 빈도를 조사하였고 빈혈 및 혈색소치에 영향을 미치는 인자를 조사하였다. 결과 : Stage 1, 2, 3, 4, 5의 평균 크레아티닌 치는 각각 0.87±0.15 (0.7-1.1) mg/dL;1.04±0.18 (0.8-1.4) mg/dL; 1.69±0.36 (1.1-2.7) mg/dL; 2.90±0.66 (1.9-4.7) mg/dL; 5.01±1.28 (3.3-8.8) mg/dL이었다. 각 군의 평균 혈색소 및 빈혈의 빈도는 stage 1, 2, 3, 4, 5에서 각각 12.95±1.46 (10.5-15.4) g/dL, 0%; 13.31±2.20 (7.8-17.7) g/dL, 10.3%; 11.32±2.07 (7.4-16.6) g/dL, 25.5%; 10.10±1.71 (6.7-14.0) g/dL, 54.8%; 9.21±1.53 (6.2-12.2)g/dL, 76.9%이었다. Stage 3, 4, 5에서 당뇨군과 비당뇨군의 빈혈의 빈도는 가각 36.7 vs 12.0% (p=0.06); 70.6 vs 35.7% (p=0.000); 100 vs 64.7% (p=0.06)로 당뇨군이 높았다. 빈혈의 빈도에 영향을 미치는 독립적 인자로는 신기능에 따른 stage외에 원인질환이 당뇨별 (OR 2.53, p=0.033 compared with non-diabetes mellitys), 저알부민치 (OR 5.38, p=0.001 for 3.0-1.4 compared with 4.0-5.3 g/dL)로 나타났다. GFR, 성별, 당뇨병인 경우, 알부민치가 혈색소치와 독립적으로 유의한 관계가 있는 것으로 분석되었다 (R^2=0.571, p<0.001). 결론 : 만성신부전 환자의 빈혈은 신부전 초기인 stage 3에서 상당수 (25.5%) 발생하였고 stage 4, 5에서는 각각 54.8%, 76,9%로 신부전이 심해질수록 증가하였다. 원인 질환이 당뇨병인 경우, 심한 저알부민혈증 (3.0-1.4 g/dL)일 경우 빈혈의 빈도가 증가하였다. Background : Early detection and treatment of chronic kidney disease (CKD) are important for inhibition of kidney disease progression and prevention of cardiovascular complications. Treatment of Anemia that is frequently accompanied with CKD, are important for prevention of cardiovascular complications. The lastest K/SOQI-CKD guideline targets early detection and treatment of kidney disease, and the study for these are necessary in Korea. In Korea, until mowadays, the study for prevalence, severity of anemia and influencing factors on anemia in CKD, were rare. Thus in our center, we classified patient for severity of CKD as K/DOQI-CKD guideline and studied prevalence, severity of anemia and influencing factors on anemia. Methods : According to K/DOQI-CKD guideline, patients were staged by GFR calculated by Adbbreviated MDRD Study Equation. Anemia was defined by Hb lessl than 10.0 g/dL below which hemodynamic change develops. We examined the frequency of anemia and independent factors that influences on anemia in study patients. Results : Mean creatinine levels for stage 1 to 5 were 0.87±0.15 (0.7-1.1) mg/dL; 1.04±0.18 (0.8-1.4) mg/dL; 1.69±0.36 (1.1-2.7) mg/dL; 2.90±0.66 (1.9-4.7) mg/dL; 5.01±1.28 (3.3-8.8) mg/dL. Mean Hb levels and percentage of anemic patients in each stages were 12.95±1.46 (10.5-15.4) g/dL, 0%; 13.31±2.20 (7.8-17.7) g/dL, 10.3%; 11.32±2.07 (7.4-16.6) g/dL, 25.5%; 10.10±1.71 (6.7-14.0) g/dL, 54.8%; 9.21±1.53 (6.2-12.2) g/dL, 76.9%. The frequency of anemia were high in Diabeltes Mellitus Mellitus (DM) compared to Non-Diabeltes (Non-DM) at stage 3, 4, 5 [36.7 vs 12.0% (p=0.06); 70.6 vs 35.7% (p=0.000); 100 vs 64.7% (p=0.06)]. Multivariate logistic regression analysis revealed that DM as etiology (OR 2.53, p=0.033 compared with Non-DM), Albumin level (OR of 5.38 p=0.001 for 3.0-1.4 compared with 4.0-5.3 g/dL) were independent factor determing anemia state in addition to K/DOQI guideline stage. GFR, sex, DM, Albumin level were independent factors associated with hemoglobin levels (R^2=0.571, p<0.001). Conclusion : Anemia in CKD was developed relatively early and frequently at stage 3 (Cr, 1.69±0.36 mg/dL, 25.5%) and more aggravated as decreasing renal function (stage 4, 5; 54.8%, 76.9%). DM as underlying disease, hypoalbuminemia were, independently influenced Anemia development.

Propylthiouracil 복용 후 발생한 ANCA positive RPGN

정경원 ( Gyung Won Jung ),조성 ( Seong Cho ),김성록 ( Sung Rok Kim ),권오언 ( Oh Wen Kwon ),우재곤 ( Jae Gon Woo ),이지은 ( Ji Eun Yi ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.3

Anti neutrophil cytoplasmic antibody (ANCA)-positive vasculitis and crescentic glomerulonephritis has been rarely reported in patients suffering from Graves` disease and treated with Propylthiouracil. We experienced a case of ANCA-positive crescentic glomerulonephritis presenting good prognosis after discontinuing Propylthiouracil. A 40-year-old female visited due to the proteinuria and hematuria in urinalysis. She had been medicated Propylthiouracil for 3 years. Blood pressure was 100/60 mmHg. BUN and serum creatinine were 24.7 mg/dL, and 1.9 mg/dL, respectively. Urinalysis revealed protein 1481 mg/day, many RBC`s/HPF (dysmorphic 80%), Serological ANCA was positive, anti-myeloperoxidase (MPO) antibody 1,922 AAU/ mL (normal <150 AAU/mL). The histologic finding showed crescentic glomerulonephritis on light microscopy, but no immuno deposit on immunofluorescence and light microscopy. So we diagnosed ANCA positive pauci-immune glomerulonephritis. Propylthiouracil was discontinued and steroid, cyclophosphamide was medicated within about 1 month, but stopped due to cytopenia. Patient`s creatinine level was maintained 1.3 mg/dL and showed stable progress for about over 18 months. We report this case that showed good prognosis after discontinuation of Propylthiouracil.

전격성 간염 경과를 보인 원발성 신 아밀로이드증 1예

박건태 ( Gyen Tae Park ),조성 ( Seong Cho ),김성록 ( Sung Rok Kim ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

단일 신장 섬유근성 이형성증에 의한 급성신부전

권경아 ( Kyung A Kwon ),조성 ( Seong Cho ),김성록 ( Sung Rok Kim ),김정훈 ( Jung Hun Kim ),박건태 ( Geon Tae Park ),송준휘 ( Jun Hwi Song ),임상우 ( Sang Woo Ym ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.3

Among complications of fibromuscular dysplasia are uncontrolled hypertension, aneurysm and, albeit very rare, renal failure, especially in a single kidney. We report a case of severe stenosis of fibromuscular dysplasia leading to renal failure, in need of temporary hemodialysis in 29-year-old hypertensive woman. When she was 13-year-old, she underwent a left nephrectomy because of the left renal cyst and she was treated with antihypertensive medication for several years. A few day before admission, she complained of oliguria, generalized edema and aggravated dyspnea. On the day of admission, she took emergency hemodialysis. A renal angiogram showed focal irregular stenosis in the right proximal renal artery, compatible with fibromuscular dysplasia; therefore, we performed percutaneous renal artery angioplasty. Following successful renal angioplasty, her urine output increased and creatinine level was normalized.