The main purpose of medical care is to improve patients' satisfaction and quality of life rather than to fulfil clinicians' preferences in providing care. Recent years have witnessed a paradigm shift in the measurement of clinical outcomes, with increased focus on the patient's perspective. There is a growing interest in patient-reported outcomes (PROs) in the medical field, which goes along with a global trend calling for more 'patient-centered care'. The author studied a patient-reported outcome study carried out at the University of Michigan, in which a representative study of the effectiveness of using an implant in the proximal interphalangeal joint is introduced. Based on PROs measures, patients were found to be satisfied when pain was relieved and appearance improved, even if there was a relatively high rate of complications; complications did not affect patients' satisfaction, even when hand function was impaired, for example. PROs measures have a potential impact on our daily clinical practice and may become key tools in clinical practice in the near future.
Longer QT intervals have been shown to induce cardiovascular events, including atrioventricular (AV) block, ventricular tachycardia, and torsades de pointes in long QT syndrome (LQTS). We report the case of a male neonate with 2:1 AV block and congenital LQTS who died suddenly 45 days after birth. He was the first of dizygotic twins, born full-term, and weighed 2,516 g. His pulse was below 90 bpm, and electrocardiogram showed a 2:1 AV block and long QT interval (QTc 0.59). There was no history of sudden death in his family. In addition, no structural cardiac anomalies were detected on ultrasonography imaging. His pulse would rise to 120 bpm when he cried, and his QT interval tended to be shorter. He was discharged on day 7 and was kept under observation without medication. At day 45, he had syncope and was brought immediately to our hospital. He was in a state of cardiopulmonary arrest and died despite resuscitation. Although implantable cardioverter defibrillators have been successfully used in patients at high risk for LQTS, their use is controversial in asymptomatic patients or in those without a family history of sudden death. We report a case of neonatal LQTS and provide a review of the literature.
A 17-year-old boy presented with dyspnea and urticaria after eating okonomiyaki prepared at home with an okonomiyaki mix. Many mites were detected in the okonomiyaki mix, which was past its sell-buy date. We performed skin prick tests for several allergens, and obtained positive results for the okonomiyaki mix, house dust extract, and mite extract, among others. We diagnosed oral mite anaphylaxis (OMA) caused by the okonomiyaki mix. The mites were identified as Dermatophagoides siboney (D. siboney). D. siboney was also detected in house dust from the patient's home. This is the first time that D. siboney has been detected in Japan. Furthermore, this is the first case of OMA caused by D. siboney to be reported worldwide.
Primary cutaneous adenoid cystic carcinomas (ACCs) are rare. We report two cases of the primary cutaneous ACC. We resected dorsal crimson nodule in case 1 and resected crimson nodule of the back of the left side of head in case 2. Histopathological evaluation showed that luminal structure was formed of lumen epithelial cells and myoepithelial cells. The structure gathered and formed a cribriform pattern. Additionally, neuronal invasion was noted. No other obvious primary lesions were detected during the systemic examination. According to these findings, we therefore diagnosed this tumor as a primary cutaneous adenoid cystic carcinoma. Resection with an approximately 30 mm margin in both cases was performed. Local recurrence and metastasis are not detected now. ACC often shows neuronal invasion and local recurrence. Therefore, extended resection and a long-term follow-up are needed. When a skin tumor is examined, ACC should always be taken into consideration.