Purpose: To identify personal causative factors for Ménière’s disease. Procedures: Patterns of hearing loss progression were studied in patients with Ménière’s disease and low-tone sensorineural hearing loss, and the involvement of stress and the relation of stressors to the onset or progression of the disease were analyzed. Results: Low-tone loss recurred in 40% of patients even after hearing was restored, and low-tone loss progressed to high-tone loss after frequent repetitions of recovery and recurrence. High-tone loss tended to proceed to all-tone loss. Eighty percent of patients reported that stress was involved or deeply involved in the onset or progression of the disease. Common causative stressors were business-related pressure, insufficient sleep, and troubles at the workplace or at home. Conclusions: The present findings indicate that recovery and recurrence may be influenced by the strength and duration of stress that is produced when patients do not feel rewarded for engrossment in their work or for self-inhibiting behaviors.
The results of the present study strongly suggest that there may be a link between an individual's specific behavior patterns and the onset of Meniere's disease.
A study of 29 neonates with intestinal obstruction has shown that a massively dilated, bulbous terminal segment of bowel is characteristic of neonatal infestinal obstruction of congenital origin. The sign is an important diagnostic indicator but its absence does not exclude intestinal atresia.
Aims: Although laparoscopic surgery has been widely adopted for also Hepato-biliary-pancreatic surgery, laparoscopic resection of hilar cholangiocarcinoma remains uncommon because of its difficult procedures consisted of major hepatectomy, lymph node dissection and biliary reconstruction. Methods: The patient was placed in left hemilateral position and five laparoscopic trocars were positioned. The right lobe and the caudate lobe were completely mobilized. After the Kocher maneuver, lymphadenectomy was performed using LCS. Then the common bile duct, the right hepatic artery and the right portal vein were divided. A hepatic parenchymal transection was performed by BiClamp using a modified hanging maneuver and the right hepatic vein was divided using a linear stapler. The left hepatic duct was divided adjacent to the umbilical portion and the specimen was retrieved through the minilaparotomy. End-to-side endoscopic hepaticojejunostomy was performed with running sutures. Results: From October 2012 through November 2014, three patients with hilar cholangiocarcinoma underwent laparoscopic extended right hepatectomy with biliary reconstruction. The median operative time was 867 min (range, 853e1010 min), and median estimated blood loss was 100 ml (range, 43e400 ml). The median length of hospital stay was 19 days (range, 16e23 days), and there was no postoperative mortality. Conclusions: Laparoscopic resections for hilar cholangiocarcinomas are safe and feasible in selected patients and when performed by surgeons with expertise in hepatic surgery and minimally invasive techniques. Further studies are still needed to confirm the benefit of this approach over conventional surgery for hilar cholangiocarcinoma.
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