Patient empowerment improves follow-up data collection after fetal surgery for spina bifida: institutional audit.

OBJECTIVES: To define and grade fetal and maternal adverse events following fetal surgery for spina bifida and to report on the impact of engaging patients in collecting follow-up data. METHODS: This prospective single-center audit included 100 consecutive patients undergoing fetal surgery for spina bifida between January 2012 and December 2021. In our setting, patients return to their referring unit for further pregnancy care and delivery. On discharge, referring hospitals were requested to return outcome data. For this audit, we prompted patients and referring hospitals to provide data in cases of missing outcomes. Outcomes were categorized as missing, returned spontaneously or returned following additional request, by the patient and/or referring center. Postoperative maternal and fetal complications until delivery were defined and graded according to Maternal and Fetal Adverse Event Terminology (MFAET) and the Clavien-Dindo classification. RESULTS: There were no maternal deaths, but severe maternal complications occurred in seven women (anemia in pregnancy, postpartum hemorrhage, pulmonary edema, lung atelectasis, urinary tract obstruction and placental abruption). No cases of uterine rupture were reported. Perinatal death occurred in 3% of fetuses and other severe fetal complications in 15% (perioperative fetal bradycardia/cardiac dysfunction, fistula-related oligohydramnios, chorioamnionitis and preterm prelabor rupture of membranes (PPROM) before 32 weeks). PPROM occurred in 42% of patients and, overall, delivery took place at a median gestational age of 35.3 weeks (interquartile range, 34.0-36.6 weeks). Information provided following additional request, from both centers and patients but mainly from the latter, reduced missing data by 21% for gestational age at delivery, 56% for uterine-scar status at birth and 67% for shunt insertion at 12 months. Compared with the generic Clavien-Dindo classification, the MFAET system ranked complications in a more clinically relevant way. CONCLUSIONS: The nature and rate of severe complications following fetal surgery for spina bifida were similar to those reported in other large series. Spontaneous return of outcome data by referring centers was low, yet patient empowerment improved data collection. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Renal injury in dogs with pyometra.

In a group of 58 dogs with proven pyometra, 10 bitches developed renal failure, combined with increased (p less than 0.01) urinary excretion of protein, glucose, gamma-glutamyltransferase (GGT), alkaline phosphatase (AP), amylase, lipase and casts. Thirty-two bitches without renal failure showed nevertheless signs of renal dysfunction as indicated by increased (p less than 0.01) urinary levels of protein, glucose, GGT, AP and amylase. Six bitches without significant proteinuria showed increased (p less than 0.02) urinary levels of GGT, AP as well as amylase. Thus renal injury was detected in 72 per cent of the bitches. Sixteen bitches showed normal urinary levels of protein, glucose, GGT, AP, amylase and lipase, indicating absence of renal disease.

The characteristic pattern of aspartate aminotransferase and alanine aminotransferase in the bitch with the cystic hyperplasia-pyometra complex: effect of medical or surgical treatment.

In 75 clinically normal unspayed female control dogs between two and eleven years old the average plasma level of aspartate aminotransferase (AST) was 21.6 +/- 5.7 (+/- SD) IU/l, of alanine aminotransferase (ALT) 40.4 +/- 13.0 IU/l and of the AST/ALT ratio 0.6 +/- 0.2. These values showed only minor changes over years. In 96 bitches with the cystic hyperplasia-pyometra complex there was a very significant increase of the AST, decrease of the ALT and increase of the AST/ALT ratio. The changes were more pronounced in 62 clinically ill bitches with typical endometritis post oestrum, in 18 dogs with gram negative organisms in the uterus and in 53 bitches with white blood cell (WBC) levels higher than 40 X 10(9)/1. Renal failure had no influence on the specific changed values. The changed values returned either temporarily to normal after prostaglandin (PGF2 alpha)-treatment or definitely after ovariohysterectomy.

The effect of Prussian blue and sodium-ethylenediaminetetraacetic acid on the faecal and urinary elimination of thallium by the dog.

After oral administration of sublethal doses of thallium (lower than 10 mg/kg) to dogs, 75.5 +/- 3.9 per cent of the dose was eliminated from the body--47 per cent faecal and 28 per cent urinary. Cumulative excretion reached 50 and 70 per cent after 10 and 25 days respectively, and was almost complete after 75 days. This was slightly lower at higher doses. The total body-burden of thallium, calculated from the cumulative excretion, decreased exponentially for at least the first 40 days with a half-time (T 1/2) of 6.5 days. Oral doses of Prussian blue after 10 days resulted in an acceleration of the thallium elimination from the body (T 1/2 2.5 days), an increase of the faecal (49 per cent) and a decrease of the urinary excretion (18 per cent). Nevertheless, the cumulative faecal and urinary thallium excretion was not influenced. Minor transitory influences of Prussian blue on the faecal thallium excretion could be observed up to day 26. After 40 days, Prussian blue could no longer influence the faecal thallium excretion. At no time did sodium-ethylenediaminetetraacetic (Na2EDTA) acid significantly change faecal or urinary thallium excretion.

The effect of urinary glucose excretion on the plasma glucose clearances and plasma insulin responses to intravenous glucose loads in unanaesthesized dogs.

The effect of urinary glucose excretion on the plasma glucose clearance and insulin response to varying sizes of glucose loads was studied in normal unanaesthesized dogs. Glucose loads ranging from 0.15 to 1.25 g/kg b.w. were infused intravenously in a standard time period of 30 seconds. Plasma glucose and plasma immunoreactive insulin (IRI) concentrations were determined during one-hour after infusion. All urine excreted during the one-hour was collected by a catheterization and bladder wash-out procedure. The urinary glucose excretion was expressed as the percent of the glucose load. The urinary glucose excretion varied directly with the size of the glucose load and ranged from minimal to 12%. This would indicate that urinary losses play a considerable role proportionate to the degree of hyperglycaemia above the renal threshold. Thus, urinary loss of glucose must be recognized as an important factor infuencing the plasma glucose clearance and hence the plasma IRI response. A glucose load of 0.5 g/kg b.w. given in 30 seconds with the k-value calculated between 15-45 min would minimize the influence of urinary loss and provide more accurate plasma clearance values.

In-vivo diagnosis of right renal aplasia in a pekingese bitch.

The physical, haematological, urinary and radiographic findings in a female pekingese dog with right renal aplasia are described. The right ureter was present and structurally normal. The left kidney was hypertrophied. The ovaries and uterus were normal.

Heterogeneity of bile pigments formed by the breakdown of haemoglobin in the isolated male-dog kidney.

Normothermic perfused isolated male-dog kidneys formed radioactive bile pigments by the breakdown of radioactive haemoglobin prepared from [2-14C]glycin. After column chromatographic separation and preparation of dipyrrolic azopigments, 86.3 +/- 2.2% of the bile pigments seemed to be conjugated bilirubin. Thin-layer chromatographic separation of the azopigments of ethyl anthranilate revealed a good correlation between photometric scanning, radiochromatographic scanning and the radioactivity of the azopigments scraped off the thin-layer glass plates and counted in a liquid scintillation counter. Although the same heterogenity of the azopigments was observed as in dog bile, the isolated male-dog kidney formed significantly less alpha2- and significantly more gamma-fractions.