The patient is a 15-year-old female who initially presented to our hospital at the age of 6 with complaints of tachycardia. However, no significant abnormalities were identified, and she was subsequently placed under observation. At the age of 7, the patient developed symptoms including headache, chest pain, and absent pulses, accompanied by a pronounced inflammatory response. A thorough diagnostic evaluation was performed, which led to the diagnosis of Takayasu’s arteritis. At that time, computed tomography (CT) imaging revealed a fusiform aortic aneurysm with a maximum short axis diameter of 34 mm, extending from the ascending aorta to the proximal aortic arch. Under vigilant monitoring, by the age of 15, the maximum short diameter had increased to 45 mm, demonstrating progressive enlargement over time. Following a multidisciplinary discussion of treatment options in a heart team conference, it was determined that surgical intervention was warranted. Given that the patient was receiving maintenance therapy for a relapse of arteritis, the dose of prednisolone was reduced to 4 mg prior to performing an ascending partial arch aortic replacement. The postoperative course was uneventful, and the patient was discharged on postoperative day 13. She continues to receive maintenance therapy and undergoes regular CT scans at the outpatient clinic. Childhood-onset Takayasu’s arteritis is exceedingly rare, but with timely surgical intervention and sustained disease management, an improved long-term prognosis can be anticipated.

Purpose: The purpose of this study was to clarify the current status of Do-Not-Resuscitate discussions (DNRd) with terminally ill cancer patients in Japan and the psychological burden on bereaved families depending on whether or not a DNRd is performed. Method: A multicenter prospective observational study of advanced cancer patients admitted to 23 palliative care units (PCUs) in Japan was conducted, and a questionnaire survey of bereaved families was also conducted after patients died. Result: 1,605 patients were included in the analysis, and 71.4% of patients had a DNRd with doctors before PCU admission, 10.8% at admission, and 11.4% during admission. In contrast, 93.3% of family members had a DNRd with doctors before PCU admission, 48.4% at admission, and 52.1% during admission. Conclusion: Although DNRd was performed between patients and physicians in 72.3% of cases at any point throughout the course of time from before PCU admission to death, there was no evidence of psychological burden such as depression or complicated grief in the bereaved families due to patient participation in DNRd.

Objective: This study aimed to reveal the prevalence and characteristics of anguish among delirious patients with advanced cancer receiving specialized palliative care services. Methods: We conducted a subanalysis of a multicenter, prospective, observational study at 14 inpatient palliative care units and 10 general wards that offered psycho-oncology consultation service in Japan. We consecutively enrolled the patients with advanced cancer who were diagnosed with delirium and prescribed antipsychotics. Palliative care specialists decided whether patients suffered from anguish or not. We assessed patients’ background and severity of delirium with the Delirium Rating Scale-Revised (DRS-R-98). Results: Of 818 enrolled patients, 99 (12.1%) suffered from anguish. We observed a significant difference in the mean age (68.9±12.6 vs. 72.1±11.2, p=0.009), prevalence of dementia (2% vs. 10.4%, p=0.005) between patients with anguish and those without anguish. Patients with anguish had lower DRS-R-98 total scores before medication than those without anguish (15.3±8.1 vs. 17.3±7.8, p=0.018), but higher severity score in lability of affect (1.2±0.8 vs 1.0±0.9, p=0.023). Conclusions: The results of this study suggested that patients with anguish tend to be younger, mostly do not have dementia, and have lower delirium severity score but higher score in lability of affect. Nevertheless, further research, investigating appropriate evaluations and medical interventions for patients with anguish is warranted.