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Nara-shi, Japan

Kiyomizu K.,Yoshida Hospital | Kiyomizu K.,University of Miyazaki
Equilibrium Research | Year: 2013

We classified psychogenic dizziness into 3 types, such as the narrow type, the wide type and psychiatric comorbidity. Among these, 69.1% (362/524) of our patients with dizziness were diagnosed as having psychiatric comorbidity, and independently in a German facility, similar number of 68.3% (129/189) of patients with dizziness were diagnosed as having psychiatric comorbidity. Therefore, in our hospital, psychological tests are routinely performed on our patients with dizziness. Patients with dizziness of unknown cause (DUC), otogenic vertigo (OV) and Meniere's disease (MD) exhibited a higher prevalence of psychiatric comorbidity (DUC = 73.6%, OV = 69.5%, MD = 70.1%). Of patients with dizziness and psychiatric comorbidity, various types of psychiatric disorders were found, such as anxiety or panic disorders (F41), mood disorders (F3), adjustment disorders or posttraumatic stress disorders (F43), dissociative disorders (F44), other neurotic disorders, organic mental disorders (FO) and schizophrenia (F2). These patients suffering from dizziness were not only treated by otolaryngologists, but also received psychiatric therapy, and 72.9% of these patients were prescribed psychotropic drugs in our hospital. We believe that psychotropic drugs should be prescribed according to the advice given from psychiatrists or the doctors who are familiar with these drugs. Patients with depression often complain of somatic symptoms. In clinical practice 90% of these patients with depression are in general examined by physicians (non-expert psychiatrists) for their primary medical examination. However, it is not easy to distinguish patients with depression from those with bipolar disorder. Recently, serotonin selective re-uptake inhibitors (SSRI) have been prescribed more frequently by physicians, but caution should be exercised in the treatment of patients with depression when physicians prescribe SSRI because these patients may have bipolarity or mild manic symptoms. To reduce the risk of these incidents of misdiagnosis, physicians are strongly encouraged to consider referring these patients with psychiatric disorders to psychiatrists. We believe that collaboration between psychiatrists and physicians in the hospital and/or local doctors can improve the mental condition and the quality of life (QOL) of patients who are suffering from dizziness with psychiatric comorbidity.

Hara M.,Yoshida Hospital | Yamagata K.,University of Tsukuba | Tomino Y.,Juntendo University | Saito A.,Niigata University | And 5 more authors.
Diabetologia | Year: 2012

Aims/objective Nephropathy, a major complication of diabetes, is the leading cause of end-stage renal disease. Recent studies have demonstrated that podocyte injury is involved in the onset of and progression to renal insufficiency. Here, we describe a novel, highly sensitive ELISA for detecting urinary podocalyxin, a glycoconjugate on the podocyte apical surface that indicates podocyte injury, particularly in the early phase of diabetic nephropathy. Methods Urine samples from patients with glomerular diseases (n=142) and type 2 diabetes (n=71) were used to quantify urinary podocalyxin by ELISA. Urine samples were obtained from 69 healthy controls for whom laboratory data were within normal values. Podocalyxin was detected in urine by immunofluorescence, immunoelectron microscopy and western blotting. Results Morphologically, urinary podocalyxin was present as a vesicular structure; western blotting showed it as a positive band at 165-170 kDa. Levels of urinary podocalyxin were elevated in patients with various glomerular diseases and patients with diabetes. In patients with diabetes, urinary podocalyxin was higher than the cut-off value in 53.8% patients at the normoalbuminuric stage, 64.7% at the microalbuminuric stage and 66.7% at the macroalbuminuric stage. Positive correlations were observed between urinary podocalyxin levels and HbA1c, urinary β2 microglobulin, α1 microglobulin and urinary N-acetyl-β-D-glucosaminidase, although urinary podocalyxin levels were not correlated with other laboratory markers such as blood pressure, lipid level, serum creatinine, estimated GFR or proteinuria. Conclusions/interpretation Urinary podocalyxin may be a useful biomarker for detecting early podocyte injury in patients with diabetes. © The Author(s) 2012.

Asao R.,Juntendo University | Asanuma K.,Juntendo University | Kodama F.,Juntendo University | Akiba-Takagi M.,Juntendo University | And 15 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2012

Background and objectives Podocalyxin (PCX) is present on the apical cell membrane of podocytes and is shed in urine from injured podocytes. Urinary podocalyxin (u-PCX) is associated with severity of active glomerular injury in patients with glomerular diseases. This study examined the relationship between number of urinary podocytes, levels of u-PCX, and glomerular injury in adults with IgA nephropathy (IgAN). Design, setting, participants, & measurements Urine samples voided in the morning on the day of biopsy were obtained from 51 patients with IgAN (18 men and 33 women; mean age, 31 years). All renal biopsy specimens were analyzed histologically. Pathologic variables of IgAN were analyzed per Shigematsu classification, the Oxford classification of IgAN, and the Clinical Guidelines of IgAN in Japan. Levels of u-PCX were measured by sandwich ELISA. Results Histologic analysis based on Shigematsu classification revealed a significant correlation between levels of u-PCX and severity of acute extracapillary abnormalities (r=0.72; P,0.001), but levels of urinary protein excretion did not correlate with acute glomerular abnormalities. Levels of urinary protein excretion in patients with segmental sclerosis (n=19) were higher than in patients without (n=22) (0.49 [interquartile range (IQR), 0.20-0.88] g/g creatinine versus 0.20 [IQR, 0.10-0.33] g/g creatinine; P,0.01). The number of urinary podocytes in patients with segmental sclerosis was higher than in patients without (1.05 [IQR, 0.41-1.67] per mg creatinine versus 0.28 [IQR, 0.10-0.66] per mg creatinine; P,0.01). Conclusions Levels of u-PCX and the number of urinary podocytes are associatedwith histologic abnormalities in adults with IgAN. © 2012 by the American Society of Nephrology.

Takagi Y.,Yoshida Hospital
Japanese Journal of Clinical Ophthalmology | Year: 2011

Purpose: To report five cases who were unsatisfied after uneventful cataract surgery and whose ultimate cause proved to be blepharospasm. Cases: A total of 224 cataract surgery were performed during the past 18 months in our institution. There were 148 cases who showed no problems about postoperative refraction or visual acuity and who were free of other diseases. Twelve out of 148 cases were not satisfied with the outcome of cataract surgery. Results: There were 5 out of 12 cases who were suspected of dry eye as the cause of complaints. The series comprised 2 males and 3 females. The age ranged from 67 to 78 years, average 74 years. These 5 cases were found to have blepharospasm. Treatment with botulinum toxin was effective in all the 5 cases, resulting in identification of blepharospasm as the ultimate cause of complaint 8.8 months after surgery. Conclusion: Blepharospasm may be present at the time of cataract surgery and may act as the cause of complaint about the outcome of uneventful cataract surgery.

Takagi Y.,Yoshida Hospital
Neuro-Ophthalmology Japan | Year: 2011

Patients with psychosomatic problems are often encountered in daily ophthalmologic practice, including blepharospasm and somatoform disorder. Blepharospasm is often thought to be an undiagnosed disease because of limitations in medical knowledge. The quality of life of patients is notably impaired although their eyeballs are almost normal, but their problems can be alleviated as long as the right diagnosis and treatment are established. Several examples are presented. In ophthalmic practice, many patients with somatoform disorder complain of unexplained symptoms, and psychosomatic medicine is sometimes effective for these patients. Our hospital has not only an ophthalmic ward but also a psychiatric ward, and there are many opportunities to treat patients with psychiatric disorders or dementia. Two such cases are reported. Although it is not easy for medical staff to manage these patients during the perioperative periods of ophthalmic surgery, such operations should be performed without hesitation with the aid of staff from several departments in order to try to improve both their psychotic disorders and their vision.

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