Translation, reliability, and validity of Japanese version of the Respiratory Distress Observation Scale.

Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases and is defined as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity." However, Japanese intensive care units (ICUs) do not routinely screen for dyspnea, as no validated Japanese version of the Respiratory Distress Observation Scale (RDOS) is available. Therefore, we aimed to translate the English version of this questionnaire into Japanese and assess its validity and reliability. To translate the RDOS, we conducted a prospective observational study in a 12-bed ICU of a universal hospital that included 42 healthcare professionals, 10 expert panels, and 128 ventilated patients. The English version was translated into Japanese, and several cross-sectional web-based questionnaires were administered to the healthcare professionals. After completing the translation process, a validity and reliability evaluation was performed in the ventilated patients. Inter-rater reliability was evaluated using Cohen's weighted kappa coefficient. Criterion validity was ascertained based on the correlation between RDOS and the dyspnea visual analog scale. The area under the receiver operating characteristic curve analysis was used to evaluate the ability of the RDOS to identify patients with self-reported dyspnea. The average content validity index at the scale level was 0.95. Data from the 128 patients were collected and analyzed. Cohen's weighted kappa coefficient and the correlation coefficient between the two scales were 0.76 and 0.443 (95% confidence intervals 0.70-0.82 and 0.23-0.62), respectively. For predicting self-reported dyspnea, the area under the receiver operating characteristic curve was 0.81 (95% confidence interval 0.67-0.97). The optimal cutoff used was 1, with a sensitivity and specificity of 0.89 and 0.61, respectively. Our findings indicated that the Japanese version of the RDOS is acceptable for face validity, understandability, criterion validity, and inter-rater reliability in lightly sedated mechanically ventilated patients, indicating its clinical utility.

Progressing subglottic and tracheobronchial stenosis in a patient with CHARGE syndrome diagnosed in adulthood.

A 33-year-old woman was admitted for a pseudocroup-like cough and wheezing after general anesthesia. Several months ago, she had undergone cardiac re-operation and turbinectomy, both of which had involved difficult intubations. Bronchoscopy indicated a pin-hall-like subglottic stenosis; therefore, emergency tracheotomy was performed. Six years later, a computed tomography scan demonstrated progressive stenosis of the entire circumference of the trachea and main bronchi. She died at 40 years. Her autopsy revealed marked tracheobronchial stenosis. She had many medical histories that had gone undiagnosed and had been clinically ill with only heart defects. She did not have coloboma but had microphthalmos, atresia choanae, retarded growth development, and deafness; thus, we diagnosed CHARGE syndrome that refers to multiple congenital anomalies, including airway abnormalities, which can lead to secondary complications such as traumatic stenosis after intubation. Physicians should have knowledge of this rare disease and should pay special attention to potential airway problems.

[A case of angioimmunoblastic T-cell lymphoma arising in the cervical region].

A case of angioimmmunoblastic T-cell lymphoma (AITL) is herein reported. The patient was a 33-year-old female who presented with a tumor arising in the rear of the left lobe of the thyroid. Total removal of the tumor was easily undertaken. Histopathological examinations with Anti-CD3, CD10, CD45RO positive stainings confirmed the diagnosis of AITL. After the determination of stage-categories with IA, 3 courses of chemotherapy with CHOP were administered followed by X-ray irradiation of the cervix with 40 Gy. Thereafter close follow-up has not revealed any recurrence. Serum levels of soluble IL-2 receptor (sIL-2R) gradually decreased according to the round of treatments. AITL is a rare clinical entity included in 1.2-2.5% of non-Hodgkin's lymphomas, which has not at all been reported in the issues concerning otorhinolaryngology. Clinical symptoms and findings include general lymphoadenopathy, hepatosplenomegaly, skin rash, anemia and hypergannmagloburinemia. Diagnosis is determined by histopathological, immunohistochemical and clonality examination. Chemotherapy regimens using multi-agents combined with anthracycline i.e. CHOP have been playing the fundamental role in the therapeutic paradigm, but because of the poorer survival of 20-50% at the 5-year point, AITL is classified as a high-grade malignancy.