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Goto F.,Hino Municipal Hospital | Tsutsumi T.,Hino Municipal Hospital | Oishi N.,Keio University | Mimura M.,Keio University
General Hospital Psychiatry | Year: 2012

Objective: To investigate the prevalence of depression among otolaryngology patients with medically unexplained symptoms (MUS) and the outcome of treatment with selective serotonin reuptake inhibitors (SSRIs). Method: Ninety patients with MUS from a population of 983 consecutive otolaryngology outpatients were enrolled. The Self-Rating Depression Scale (SDS) was used to screen for depression. In addition to standard treatment, all depressed and nondepressed patients received SSRIs for 8 weeks. The Clinical Global Impression-Improvement (CGI-I) scale was used to evaluate clinical changes in patients with MUS. Results: There were 49 patients with depression among those with MUS, according to the SDS criteria. The patients with depression showed a better outcome than those without depression, demonstrating more significantly improved CGI-I scores. Conclusion: More than half of the individuals with otolaryngological MUS had depression, and their MUS were successfully treated withSSRIs. © 2012 Elsevier Inc..


Goto F.,Hino Municipal Hospital | Nakai K.,Hino Municipal Hospital
European Archives of Oto-Rhino-Laryngology | Year: 2011

Data are limited on the role of psychotherapy in the treatment of Ménière disease. We sought to document the effect of a psychotherapeutic technique known as autogenic training on clinical outcome in Ménière disease. Six patients with Ménière disease were studied. Retrospective chart review was conducted. All patients were refractory to conventional therapy and completed a course of autogenic training, which was offered as a complementary treatment. Autogenic training with initial psychological counseling was conducted by a clinical psychologist during 45-min sessions. Outcome measures assessed were the frequency of vertigo and functional levels 2 years after initiation of autogenic training. Functional levels were evaluated according to the 1995 guidelines of the American Academy of Otolaryngology-Head Neck Surgery (AAO-HNS). As a personality measure, we used the Maudsley Personality Inventory (MPI), devised by Eysenck, which measures neuroticism (N), extraversion (E), and propensity to lie (L). Five of six patients showed improved functional level after three to eight sessions of psychotherapy; hearing level did not change. The score of the N scale of the MPI was closely related to the number of psychotherapy sessions. Prognosis was evaluated based on the AAO-HNS reporting guidelines, as follows: A = 3, B = 1, C = 1, F = 1. The value of N in MPI was closely related to the number of psychological counseling sessions (R = 0.97, P < 0.05). In conclusion, autogenic training may enhance the mental well-being of patients with Ménière disease and improve clinical outcome. © 2011 Springer-Verlag.


Goto F.,Hino Municipal Hospital | Ban Y.,Hino Municipal Hospital | Ban Y.,Keio University | Tsutumi T.,Hino Municipal Hospital
European Archives of Oto-Rhino-Laryngology | Year: 2011

A patient presenting with vertical diplopia along with ocular tilt reaction (OTR) due to peripheral vestibular dysfunction is a rare occurrence. OTR is an eye-head postural reaction consisting of head tilt, skew deviation, conjugated eye cyclotorsion, and alteration of vertical perception, and is thought to occur with central lesions, mainly brainstem lesions. Here, we report a case of a patient who was suffering from left acute peripheral cochleovestibular loss. He had profound deafness and absence of caloric response on the left side. No central lesion was observed on magnetic resonance images. Neuro-ophthalmological examination showed OTR consisting of head tilt, skew deviation with left hypotropia, excyclotorsion, and tilt of the static visual vertical directed to the left side. Both utricular and saccular dysfunctions were identified by the absence of cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) on the left side. Within a month, the OTR disappeared completely probably because of vestibular compensation. This is the first report to state that the peripheral otolith dysfunction causing reversible vertical diplopia was identified by objective examinations (VEMP). © 2011 Springer-Verlag.


Goto F.,Hino Municipal Hospital
Neuro-Ophthalmology Japan | Year: 2011

Otorhinolaryngologists are usually not keen on taking care of patients with psychosomatic disorders, however their clinical course is greatly affected by psychosocial factors. Most doctors find it difficult to take care of these patients during the limited time spent in the outpatient clinic. In addition, otorhinolaryngologists consider that their specialty does not include the care of patients with psychosomatic disorders, but that it is limited to surgical treatment. Nevertheless, it is reasonable to assume that collaboration with a clinical psychologist specializing in psychological disorders is also required. We conducted a statistical analysis using data from 44 patients who required psychological intervention. Meniere disease was the most frequent diagnosis. Psychological counseling was conducted in all cases, and the average number of counseling sessions was 6.4 ± 6.7 (for a duration of 214.8 ± 162.5 days). The prognosis was improved in 31 patients (70.5%). Collaboration between doctors and clinical psychologists is beneficial, especially to patients for whom administration of the conventional treatment is difficult.


Goto F.,National Hospital Organization | Goto F.,Keio University | Tsutsumi T.,Hino Municipal Hospital | Ogawa K.,Keio University
Experimental and Therapeutic Medicine | Year: 2014

Patients with Ménière's disease who have relapsed following endolymphatic sac surgery (EDS) or intratympanic gentamicin injection are occasionally treated with intratympanic gentamicin injections or revision surgery. However, there is a potential link between Ménière's disease and anxiety or depression. The use of serotonin selective reuptake inhibitors (SSRIs) is likely be beneficial in the treatment of patients with Ménière's disease. The aim of this report is to describe the benefits of SSRIs in patients with relapsed Meniere's disease. Over the course of two years, three patients were treated for symptoms associated with Ménière's disease with an SSRI (sertraline), with the complete resolution, or significant improvement, of symptoms. In these cases, the SSRI may have treated the associated morbidity and not Ménière's disease itself. Ménière's disease that appears to be resistant to typical otological treatment may not be just Ménière's disease. Ménière's disease may co-exist with three other conditions that are able to cause vestibular symptoms and respond to SSRIs: migraine-associated vertigo (MAV), panic disorders and chronic subjective dizziness (CSD).


Kitamura Y.,Hino Municipal Hospital | Hara C.,Hino Municipal Hospital | Tsunematsu K.,Hino Municipal Hospital
Neurologia Medico-Chirurgica | Year: 2014

Isolated cortical vein thrombosis (ICVT) is extremely rare. Only single case or small series of ICVT have been reported; clinical details are still uncertain. We report a case of isolated superficial sylvian vein thrombosis with exceedingly long cord sign. A 14-year-old female with severe sudden onset headache visited our hospital. Fluid attenuated inversion recovery and echo-planar T2* susceptibility-weighted imaging (T2*SW) showed a long cord sign on the surface of the sylvian fissure. The patency of dural sinuses and deep cerebral veins were confirmed by magnetic resonance venography (MRV), and diagnosis of ICVT was made. She recovered completely without anticoagulant agents. To clarify the clinical characteristics of ICVT, we reviewed 51 ICVT cases in the literature. In many cases, T2*SW was the most useful examination to diagnose ICVT. In contrast with general cerebral venous thrombosis, MRV and conventional angiography were either supporting or useless. Anastomotic cortical veins were involved frequently; symptoms of gyri around the veins were common. It also suggested that ICVTs of the silent area might have been overlooked because of nonspecific symptoms, and more patients with ICVT may exist. In cases involving patients with nonspecific symptoms, the possibility of ICVT should be considered.


Goto F.,Hino Municipal Hospital
Nihon rinsho. Japanese journal of clinical medicine | Year: 2012

There are some patients complaining of somatic symptom who has depression. The use of antidepressant to these patients would be quite useful. Patients with dispersion have a variety sort of physical symptom. The evaluation of depression based on physical complaints may be difficult for otorhinolaryngologists, but it is important to do so where possible to increase the focus on the subject's physical illness. The prevalence of somatic complaints in hospitalized patients whose chief complaint was either dizziness or vertigo was very high. These patients were usually accompanied with depression. Then the effect of paroxetine to the patients with tinnitus was investigated. The paroxetine may be effective in treating distressed tinnitus patients with depression and anxiety by reducing their tinnitus severity as well as their depression and anxiety.


Goto F.,Hino Municipal Hospital
Equilibrium Research | Year: 2012

Dizziness and psychogenic disorders, including depression and anxiety, are closely related. The diagnosis of dizziness includes not only an evaluation of vestibular dysfunction, but also a psychogenic evaluation. Using this approach, the following three different patterns of dizziness should be carefully identified: psychogenic, otogenic, and interactive. The common somatic symptoms in patients with chronic dizziness (N = 145) were investigated using questions designed to assess headache, insomnia, diarrhea, constipation, stomachache, chest pain, palpitations, dyspnea, and general fatigue. The prevalent somatic symptom in patients with dizziness included general fatigue, insomnia, and headache. These symptoms are very similar to those reported for patients with anxiety and depression. Patients with dizziness clearly had several somatic complaints related to anxiety or depression that could be attributed to the dizziness. Treatments included pharmacotherapy and physical therapy (including rehabilitation for vestibular dysfunction), surgical intervention, pharmacotherapy, and psychotherapy for anxiety and depression. Pharmacotherapy using serotonin reuptake inhibitors and psychotherapy, such as autogenic training, were also performed.


Ohno Y.,Keio University | Maekawa Y.,Keio University | Miyata H.,University of Tokyo | Inoue S.,Hino Municipal Hospital | And 6 more authors.
Journal of the American College of Cardiology | Year: 2013

Objectives This study sought to evaluate the association between contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention and severity of bleeding estimated from periprocedural hemoglobin (Hb) measurement. Background The relationship between CI-AKI and bleeding in contemporary practice remains controversial. Methods In a retrospective analysis of the prospectively maintained Japan Cardiovascular Database-Keio Interhospital Cardiovascular Studies (JCD-KICS) multicenter registry, we divided 2,646 consecutive patients into 5 groups according to the change of Hb level after compared with before percutaneous coronary intervention: Patients without a decrease in Hb level (group A) and patients with a decreased Hb level: <1 g/dl (group B); 1 to <2 g/dl (group C); 2 to <3g/dl (group D); and >3 g/dl (group E). CI-AKI was defined as an increase in serum creatinine level ≥0.5 mg/dl or ≥25% above baseline values at 48 h after administration of contrast media. Procedure and outcome variables were compared. Results The mean patient age was 67 ± 11 years. Of the 2,646 patients, CI-AKI developed in 315 (11.9%). The CI-AKI incidence was 6.2%, 7.5%, 10.7%, 17.0%, and 26.2%, in groups A through E, respectively (p < 0.01), whereas the incidence of major bleeding was 0.7%, 1.3%, 2.0%, 4.1%, and 28.3%, respectively (p < 0.01). CI-AKI was associated with higher rates of mortality (5.4% vs. 0.6%, p < 0.01) and of composite of heart failure, cardiogenic shock, and death (16.5% vs. 2.8%, p < 0.01). Conclusions Periprocedural bleeding was significantly associated with CI-AKI, with CI-AKI incidence correlating with bleeding severity. © 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.


Goto F.,Hino Municipal Hospital | Tsutsumi T.,Hino Municipal Hospital | Ogawa K.,Keio University
Acta Oto-Laryngologica | Year: 2011

Conclusion: The Japanese version of the Dizziness Handicap Inventory (DHI) is a reliable, comprehensively validated, and clinically useful tool to measure self-perceived handicap associated with dizziness. Objectives: The DHI is a useful instrument to document the consequences of vestibular and/or balance impairment. A Japanese version of this self-assessment inventory is needed to evaluate the handicapping effects imposed by vestibular system disease in Japanese patients. The purpose of this study was to determine the internal consistency of the reliability of the Japanese version of the DHI. Methods: We recruited 176 patients between January and September 2008 from the outpatients of the Department of Otolaryngology, Hino Municipal Hospital, Japan. The DHI was translated into Japanese, and the test was independently completed by each subject. We used principal component analysis to evaluate the different dimensions of the DHI. The internal consistency of the retained factors was investigated by estimating Cronbach's alpha coefficients and corrected item-total correlations. Results: Cronbach's coefficients for internal consistency were high for the total scale (0.93) and good for the subscales: functional subscale (0.87), physical subscale (0.82), and emotional subscale (0.85). The correlation matrix demonstrated that the variables were suited for factor analysis. The determinant was 1.26E 6, which is slightly under the recommended value. Bartlett's test was highly significant (p < 0.0001), and the KaiserMeyerOlkin measure of sampling adequacy was 0.91. © 2011 Informa Healthcare.

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