Outcome of pregnancy in patients with liver cirrhosis

To evaluate the maternal and foetal outcomes in patients with liver cirrhosis and to determine the impact of pregnancy on the hepatic disease process. A prospective observational study. Setting: Sohag University hospital. Fifty one pregnant women with liver cirrhosis. They were followed throughout pregnancy to detect signs of hepatic decompensation and to detect any obstetric complication. Foetal growth curve was done bimonthly or monthly. 18% of patients developed hepatic decompensation during pregnancy; of whom 88% have occurred during the last 4 weeks of pregnancy. Only 2% of this decompensation has occurred before 32 weeks of gestation. 60% of patients developed obstetric complications. Preterm labour, HELLP syndrome, pre-eclpmsia and non-traumatic postpartum haemorrhage increase in patients with liver cirrhosis. The vast majority of these complications have occurred in patients delivered beyond 36 weeks of pregnancy. 30% of fetuses showed IUGR and 15% died intrauterine mainly in patients who developed hepatic decompensation. The maternal mortality was 8% and all were the result of hepatic coma occurring during labour. The risk of hepatic decompensation increases during the last 4 weeks of pregnancy. Preterm labour, HELLP, PET and PPH increases in decompensated patients. Hepatic coma during labour is the leading cause of maternal death. Termination of pregnancy at 36 weeks of pregnancy can decrease the maternal morbidity and mortality

Screening for human brucellosis in Sohag farms

Brucellosis is a zoonotic disease that exists worldwide. Several studies were conducted in different governorates, e.g. Menofia, Dakahlia, Giza, Assiut, to estimate the prevalence of brucellosis, but little is known about the problem in Sohag Governorate. The aim was to estimate the frequency of brucellosis in farm workers in Sohag Governorate using ELISA test and to treat positive cases. This study involved 141 persons [91 persons from three farms in Sohag Governorate [high risk group] and 50 persons, who have no contact to animals [control]]. Through this study complete clinical examination, ultrasound examination and complete blood count and ELISA test for brucellosis were done to all persons. The results revealed that the frequency of seropositivity to brucellosis was found to be 12% in the three farms as a whole [13.5% in Faculty of Agriculture Farm, 13% in El-Dyabat Farm and 0% in Shandaweel]. It was concluded that brucellosis is not uncommon among farm workers in Sohag Governorate. Animal vaccination and regular examination for detection of diseased animals was recommended. Health education of workers is of great importance to minimize the transmission of the disease

Reoperative thyroid surgery: approach and hazards

This study included 34 patients [25 females and 9 males with an age range from 25 to 72 years and a mean age of 38 years] subjected to reoperative thyroid surgery. 131I thyroid scan and whole body scan were performed. Surgical techniques were attempted, where different surgical procedures were performed. 131I ablation of thyroid remnants was carried out in patients with thyroid cancer and for those with relapsed toxic goiter. Operative complications were studied. Follow-up of patients with complications and those with thyroid cancer was done. The results showed that morphologically unilateral thyroid with isthmic involvement were found in 50% of patients. Diffuse thyroid enlargement accounted for about one-third of patients. Histologically, recurrent nodular goiter was found in 56% of patients, followed by recurrent toxic goiter [21%], thyroid carcinoma [21%] and chronic lymphocytic thyroiditis [one patient]. Surgically, the majority of patients were explored with standard Kocher incision [85%] and the remaining with adding lateral cervical approach. Extracapsular thyroidectomy was the commonest technique. Hemithyroidectomy followed by subtotal thyroidectomy were the commonest procedure, followed by near-total and total thyroidectomy. Recurrent laryngeal nerve was identified in 35% of patients, mainly in its lower cervical course, followed by middle third in relation to inferior thyroid artery. Temporary recurrent laryngeal nerve palsy occurred in 12% and permanent unilateral nerve palsy in 6% of patients. Parathyroid glands were identified in 24% of cases. Temporary and permanent hypocalcemia occurred in 15% and 12%, respectively. Complete ablation with 131I was achieved in four patients of thyroid carcinoma and partial ablation with 131I in the remaining three patients