Surgical treatment of hepatocellular carcinoma

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The effect of local anesthetics on tear production

Local anesthetics act on any part of the nervous system and on every type of nerve and fibre. Different sensations are lost according to the size of the axon serving them. Lignocaine due to its moderate properties is one of the most versatile agents in anesthesia and as such is often used by optometrists and ophthalmologists alike in different clinical procedures. Tear production using Schirmer's technique was measure before and after the instillation of a local anesthetic (Lignocaine 2%) in fifty (50) subjects of both male and female within the age range 18 -35 years. Results from data collected showed that Lignocaine caused a slight reduction in tear production; with a mean percentage reduction of 29.06%. Statistical analysis also revealed the effect of lignocaine on tear production to be significant (

Consumer Reports of "Keto Flu" Associated With the Ketogenic Diet.

Background: The ketogenic diet (KD) is a high-fat, low-carbohydrate diet that limits glucose and results in the production of ketones by the liver and their uptake as an alternative energy source by the brain. KD is an evidence-based treatment for intractable epilepsy. KD is also self-administered, with limited evidence of efficacy, for conditions including weight loss, cognitive and memory enhancement, type II diabetes, cancer, neurological and psychiatric disorders. A commonly discussed side effect of KD in media and online forums is "keto flu," a cluster of transient symptoms generally reported as occurring within the first few weeks of KD. This study aimed to characterize the pattern of symptoms, severity and time course of keto flu as related by users of online forums. Method: Online forums referring to "keto flu," "keto-induction," or "keto-adaptation" in the URL were identified in Google. Passages describing personal experiences of keto flu were categorized manually with reference to pattern of symptoms, severity, time course, and remedies proposed. Results: The search criteria identified 75 online forums, 43 met inclusion criteria and contained 448 posts from 300 unique users. Seventy-three made more than one post (mean 3.12, range 2-11). Descriptors of personal experience of keto flu, reported by 101 of 300 users, included 256 symptom descriptions involving 54 discrete symptoms. Commonest symptoms were "flu," headache, fatigue, nausea, dizziness, "brain fog," gastrointestinal discomfort, decreased energy, feeling faint and heartbeat alterations. Symptom reports peaked in the first and dwindled after 4 weeks. Resolution of keto flu symptoms was reported by eight users between days 3 and 30 (median 4.5, IQR 3-15). Severity of symptoms, reported by 60 users in 40 forums, was categorized as mild (N = 15), moderate (N = 23), or severe (N = 22). Eighteen remedies were proposed by 121 individual users in 225 posts. Conclusions: Typically, individual posts provided fragmentary descriptions related to the flow of forum conversations. A composite picture emerged across 101 posts describing personally experienced symptoms. User conversations were generally supportive, sharing remedies for keto flu reflecting assumptions of physiological effects of KD

Global Justice and Harm

My thesis explores the question of how we should think of our duties to those worse off than us around the world. I assess ‘the harm approach’ to global justice, which claims that we have duties of justice towards the global poor because we harm them, arguing against it. I first argue that Thomas Pogge puts forward the harm approach without specifying a plausible notion of harm. I then argue that there is no conception of harm in the literature that can support the harm approach. My thesis yields the conclusion that the harm approach fails to fulfil its key aim, which is to break the stalemate between proponents and opponents of the view that principles of distributive justice are appropriate in the global context. I suggest that the misconceived harm approach, and the state of impasse in the global justice debate, highlight the need to reconceive the global justice project. Instead of assessing whether or not our theory of justice for the state extends to the global sphere, our starting point should be the global situation itself. To formulate the most plausible approach to our duties to those worse off than us globally, we should build a theory of global justice based on the moral facts of the global situation and our pre-theoretical convictions regarding it. I first outline Pogge’s harm approach and state its aims. I then point out why the way that Pogge uses the notion of harm cannot support the aims of the approach. I then turn to an investigation of moralised and non-moralised theories of harm in the literature, finding that none can help support the harm approach. The last part of my thesis points towards the direction we should take in building a plausible approach to our duties to the global poor

Somatostatin in the treatment of acute pancreatitis: A prospective randomised controlled trial

A prospective study was carried out to evaluate the efficacy of somatostatin in the treatment of acute pancreatitis. Seventy one patients were randomised to control (h = 36), or to the somatostatin group (h = 35) who received somatostatin 100 μg/h after a 250 μg bolus for the first two days. The following were compared in the two groups on admission and two days later: laboratory tests of prognostic significance, severity of pancreatitis, and also morbidity and mortality. Of the nine laboratory tests compared, the white blood cell count, lactate dehydrogenase, and urea concentrations were significantly lower in the somatostatin group two days after admission. Severity of pancreatitis after hospitalisation increased in fewer patients given somatostatin (NS). There was a trend toward fewer complications, especially local, in the somatostatin group. Mortality in both groups was low. Somatostatin appeared to reduce the local complications of acute pancreatitis. A larger trial is necessary to show its beneficial effect conclusively.published_or_final_versio

Early treatment of acute biliary pancreatitis by endoscopic papillotomy

Background. Most patients with acute biliary pancreatitis have stones in the biliary tract or ampulla of Vater. Because these stones may be passed spontaneously soon after a patient is admitted to the hospital, the importance of early operative removal is not known. We tested the hypothesis that endoscopic papillotomy within 24 hours of admission decreased the incidence of complications in patients with acute biliary pancreatitis. Methods. We studied 195 patients with acute pancreatitis who were randomly assigned to one of two groups: 97 patients underwent within 24 hours after admission emergency endoscopic retrograde cholangiopancreatography (ERCP) followed by endoscopic papillotomy for ampullary and common-bile-duct stones, and 98 patients received initial conservative treatment and selective ERCP with or without endoscopic papillotomy only if their condition deteriorated. Results. One hundred twenty-seven patients ultimately proved to have biliary stones. Emergency ERCP with or without endoscopic papillotomy resulted in a reduction in biliary sepsis as compared with conservative treatment (0 of 97 patients vs. 12 of 98 patients, P = 0.001). The decrease in biliary sepsis occurred both in patients predicted to have mild pancreatitis (0 of 56 patients in the group that received emergency ERCP vs. 4 of 58 patients in the conservative-treatment group, P = 0.14) and in patients predicted to have severe pancreatitis (0 of 41 patients vs. 8 of 40 patients, P = 0.008). In all patients who had unrelenting biliary sepsis, persistent ampullary or common-bile-duct stones were identified. There were no major differences in the incidence of local complications (10 patients in the group that received emergency ERCP vs. 12 patients in the conservative-treatment group) or systemic complications (10 patients vs. 14 patients) of acute pancreatitis between the two groups, but the hospital mortality rate was slightly lower in the group undergoing emergency ERCP with or without endoscopic papillotomy (5 patients vs. 9 patients, P = 0.4). Conclusions. Emergency ERCP with or without endoscopic papillotomy is indicated in the treatment of patients with acute pancreatitis.published_or_final_versio

Studies toward the synthesis of Amaryllidaceae alkaloids from Morita-Baylis-Hillman adducts. A straightforward synthesis of functionalized dihydroisoquinolin-5(6H)-one core

We disclose herein our results concerning a study aiming at the synthesis of the highly substituted carbon skeleton of alkaloids isolated from plants of the Amaryllidaceae family. The total synthesis of the functionalized dihydroisoquinolin-5(6H)-one core, which is the bottom part of the structure of alkaloids isolated from this botanic family, is described, using Morita-Baylis-Hillman adducts as substrate. This compound should be a useful and valuable intermediate for the total synthesis of alkaloids isolated from Amaryllidaceae.1871415143