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Articles by Y. H. Kim
Total Records ( 3 ) for Y. H. Kim
  H Seo , K. H Lee , H. J Kim , K Kim , S. B Kang , S. Y Kim and Y. H. Kim
 

OBJECTIVE. The purpose of this study was to compare low-dose unenhanced CT with standard-dose IV contrast-enhanced CT in the diagnosis of appendicitis.

MATERIALS AND METHODS. Two hundred seven adults with suspected appendicitis underwent CT with mean effective doses of both 4.2 and 8.0 mSv. Two radiologists retrospectively reviewed thin-section images by sliding a 5-mm-thick ray-sum slab. They rated the likelihood of appendicitis and appendiceal visualization on 5- and 3-point scales, respectively, and proposed alternative diagnoses. Likelihood ≥ 3 was considered a positive diagnosis. Receiver operating characteristics analysis, the McNemar test, and the Wilcoxon's signed-rank test were used.

RESULTS. Seventy-eight patients had appendicitis. The values of the area under the receiver operating characteristics curve were 0.98 for the low-dose unenhanced acquisition and 0.97 for the standard-dose contrast-enhanced acquisition for reader 1 (95% CI for the difference, -0.02 to 0.03) and 0.99 and 0.98 (-0.02 to 0.02) for reader 2. Sensitivity was 98.7% for low-dose unenhanced CT and 100% for standard-dose contrast-enhanced CT for reader 1 (p = 1.00) and 100% for both techniques for reader 2. Specificity was 95.3% and 93.0% (p = 0.25) and 96.9% and 96.9%. The interpretation was indeterminate (score 3) in 0.5% and 1.4% of cases for reader 1 (p = 0.63) and 0.5% and 0% for reader 2 (p = 1.00). A normal appendix was not visualized in 5.4% and 3.9% of cases by reader 1 (p = 0.63) and 3.9% and 2.3% of cases by reader 2 (p = 0.50). None of the patients whose appendix was not visualized had appendicitis. Diagnostic confidence, visualization score for a normal appendix, and correct alternative diagnosis tended to be compromised with use of low-dose unenhanced CT, showing a significant difference for a reader's confidence in the diagnosis of appendicitis (p = 0.004). The two techniques were comparable in the diagnosis of appendiceal perforation.

CONCLUSION. Low-dose unenhanced CT is potentially useful in the diagnosis of appendicitis.

  D. K Woo , C. R Jones , M. N Vanoli Storz , S Kohler , S Reddy , R Advani , R. T Hoppe and Y. H. Kim
 

Objectives  To identify prognostic factors in primary cutaneous anaplastic large cell lymphoma (pcALCL), focusing on extensive limb disease (ELD), defined as initial presentation or progression to multiple skin tumors in 1 limb or contiguous body regions, and to study gene expression profiles of patients with pcALCL.

Design  Retrospective cohort study.

Setting  The Stanford Comprehensive Cancer Center and dermatology ambulatory clinics.

Patients  A total of 48 patients with pcALCL evaluated from 1990 through 2005.

Main Outcome Measures  Hazard ratios (HRs) for prognostic factors for overall survival (OS) and disease-specific survival (DSS) and risk factors for progression to extracutaneous disease were identified using Cox regression. Gene expression profiles of 9 typical pcALCL and 3 ELD samples were investigated using complementary DNA microarrays.

Results  Univariate analysis demonstrated age, ELD, and progression to extracutaneous disease as significant prognostic factors for OS, whereas ELD and progression to extracutaneous disease were significant for DSS. In multivariate analysis, age (HR, 1.83; 95% confidence interval [CI], 1.02-3.26) and progression to extracutaneous disease (HR, 6.42; 95% CI, 1.39-29.68) remained significant for OS, whereas ELD (HR, 29.31; 95% CI, 1.72-500.82) and progression to extracutaneous disease (HR, 13.12; 95% CI, 1.03-167.96) remained independent prognostic factors for DSS. Presentation with T3 disease was a risk factor for progression to extracutaneous disease (HR, 10.20; 95% CI, 1.84-56.72). Microarray data revealed that patients with ELD and typical pcALCL formed distinct clusters.

Conclusions  Patients with ELD have a more aggressive course associated with a differential gene expression profile. More aggressive treatments may be indicated for patients with ELD and those whose disease progresses to extracutaneous disease because they have poorer outcomes.

  J. H Oh , K. H Jo , W. S Kim , H. S Gong , S. G Han and Y. H. Kim
  Background

Various shoulder outcome instruments have been used despite lack of information on their measurement properties; reliability, responsiveness, and validity; and correlation with health-related quality of life.

Hypothesis

Most shoulder outcome instruments have poor correlation with Short Form–36, a general measure of health-related quality of life, and with each other.

Study Design

Cohort study (diagnosis); Level of evidence, 2.

Methods

A consecutive group of 285 patients who had undergone shoulder surgery completed several shoulder outcome instruments—Short Form–36; University of California, Los Angeles shoulder score; American Shoulder and Elbow Surgeons shoulder evaluation form; Constant score; Simple Shoulder Test; Western Ontario Shoulder Instability Index; and the rating sheet for Bankart repair (Rowe score)—preoperatively and at 3, 6, 9, and 12 months postoperatively. Internal consistency, standardized response mean, effect size, and Pearson correlation were used to evaluate reliability, responsiveness, and validity.

Results

The American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and Western Ontario Shoulder Instability Index displayed good internal consistency. The University of California, Los Angeles shoulder score and American Shoulder and Elbow Surgeons form exhibited good responsiveness, whereas Short Form–36 showed the least responsiveness. Pearson correlation coefficients between the shoulder outcome instruments and Short Form–36 were less than excellent (r < .60). Pearson correlation coefficients between the outcome instruments were generally low except for the Constant score and University of California, Los Angeles shoulder score (r = .673, P < .01).

Conclusion

There was no single shoulder outcome instrument that was superior to the others in terms of the measurement properties. Most of the tested shoulder outcome instruments did not reflect health-related quality of life well and poorly correlated with each other. This meant that the comparison of a given surgical result with different outcome instruments might be of little practical utility. Further prospective and serial studies should be conducted to develop better shoulder outcome instruments that have significant reliability, responsiveness, validity, and correlation with health-related quality of life. A careful combination of outcome instruments might be necessary to compensate the current evaluation systems.

 
 
 
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