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Goto F.,Tokyo Medical Center | Tsutsumi T.,Hino Municipal Hospital | Ogawa K.,Keio University
Journal of Otolaryngology of Japan | Year: 2013

It has been reported that the dizziness or vertigo in about 10 to 30 patients visiting an otolaryngologist is of psychiatric origin. Since otolaryngologists are not familiar with the treatment for these patients, such treatment is usually not adequate. The clinical entity of chronic subjective dizziness (CSD) is one of psychiatric dizziness proposed by Staab and Ruckenstein. Fourteen percent (40/285) of patients were diagnosed as having psychiatric dizziness in Hino Municipal Hospital last year. Among them we had 7 cases with CSI). We report herein on the result of the clinical examinations and pharmacological treatment. In most of the cases, subjective symptoms were significantly improved after the pharmacological treatment with SSRIs (Serotonin reuptake inhibitors). From these results, CSD is important clinical entity treatable by otolaryngologist with SSRIs. To prescribe SSRIs, it is important to know the common adverse reactions associated with SSRIs. These include gastrointestinal symptoms including nausea and activation syndromes especially in early stage of treatment. CSD is an important clinical entity, which should be diagnosed and is treatable by otolaryngologists.


Goto F.,Tokyo Medical Center | 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).


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.

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