Reliability of using random urine samples for "spot" determination of fractional excretion of electrolytes in cats

OBJECTIVE: To determine whether the "spot" method of determining fractional excretion (FE) of electrolytes in cats is accurate. ANIMALS: 5 clinically normal young adult female cats. PROCEDURE: Cats were acclimated to metabolism cages, and 2 consecutive 72-hour collections of urine were made to determine FE of total calcium, potassium, total magnesium, sodium, and phosphorus by conventional methods, using endogenous creatinine clearance as an estimate of glomerular filtration rate. During collections, small samples of urine were obtained by cystocentesis at 8 AM, 3 PM, and 9 PM for determination of FE of the electrolytes by use of the "spot" method. RESULTS: Values from "spot" determinations were highly variable, compared with 72-hour values, with a high percentage falling outside the range of mean +/- 2 SD for 72-hour FE values. CONCLUSIONS AND CLINICAL RELEVANCE: The "spot" method for determining FE is not precise, and if used, caution and judgement should be exercised in interpretation of the results.     

Comparison of plasma creatinine determined with the Greiner Selective Analyser GSA II and the glomerular filtration rate

1. Reference values for the plasma creatinine were established using the alkaline picrate method with the Greiner Selective Analyzer GSA II in relation to the Cr 51-EDTA Clearance. Individuals with normal GFR between 93 to 159 ml/min/1.73 m2 had creatinine values in men (n = 65) from 53.7 to 119.5 mumol/l (0.61 to 1.35 mg/100 ml) and in women (n = 59) from 37.7 to 107 mumol/l (0.42 to 121 mg/100 ml). 2. The creatine determinations with the GSA II were compared to those on the Technicon Analyzer, the Beckman Creatinine Analyzer, the Gemsaec-Fast Analyzer and to the enzymatic creatinine method. A good correlation (r = 0.9780-0.984) was observed. 3. With the GSA II and the enzymatic method, bilirubin showed a minor interference which was more marked with the Beckman analyzer.     

The role of urine sugar in diabetic management

The concentration of reducing sugar in the urine is commonly used in the management of diabetes in children. Supplemental doses of regular insulin are administered in response to the concentration of urine sugar according to a protocol termed the "sliding scale." This practice assumes that the concentration of sugar in urine is a good indicator of the plasma glucose concentration. This assumption was tested by comparing urine sugar concentrations in first and second voided urines with the plasma glucose concentrations in 220 children with diabetes. The correlation was good (r = .92) for both the first and second voided urine specimens. Thus, urine sugar concentrations in general define the level of plasma glucose. The large standard deviation of the plasma glucose at each concentration of urine sugar, however, limits the usefulness of urine sugar as an accurate reflection of the coincident plasma glucose concentration. The urine sugar concentration, although useful for the general management of diabetes, provides significant risk when used to guide frequent adjustments in insulin administration. Therefore, the "sliding scale" should not be used in the treatment of children with diabetes.     

Whole body bone resorption in the growing pig

Our knowledge of total body bone resorption during growth is limited. The primary purpose of this study was to determine if a commercially available bone resorption assay, developed for measuring human bone resorption, could be used to measure whole body bone resorption in young, growing pigs. A secondary purpose was to evaluate if this method could detect changes in bone resorption in response to certain dental appliances which have been shown to change mandibular and maxillary growth. Five growing 4-month-old male Hanford minipigs (Sus scrofa) were housed in metabolic cages for 24 h, every other day, over a period of 1 month. Three of the animals were fitted with a mandibular protrusive orthodontic appliance. Total 24 h urines were collected in which the concentration of creatinine and collagen type I N-telopeptide crosslinks (NTx, a marker of bone resorption) were measured. The NTx immunoassay was originally developed for the analysis of human urine. Pig bone was powdered, defatted, and decalcified, and the resulting powder digested with bacterial collagenase. The digest was screened for NTx content, in the same fashion as the pig urines. Bone extract and pig urines were cross-calibrated to a standard of adolescent human urine. This allowed calculation of the daily quantity of pig bone resorbed. Daily metabolite excretion was quite variable in these growing animals; for NTx the CV was 31%, for creatinine the CV was 25%. The mean daily quantities of bone resorption ranged between 26 and 46 grams of bone which amounted to 1.2-1.7% of estimated total skeletal mass. The protrusive appliances increased bone resorption significantly during the first two weeks of the trial. In conclusion: the NTx assay can be used to measure bone resorption in pigs; the assay is sensitive enough to indicate changes in bone resorption, such as those caused by an orthodontic mandibular protrusive appliance. During growth, bone resorption varies greatly from day to day. On average, every 24 h, 1.4% of the skeletal mass is resorbed.     

Accuracy of estimated creatinine clearance in obese patients with stable renal function in the intensive care unit

We compared agreement between creatinine clearance values in obese, critically ill patients calculated using three common empirically derived formulas and modifications thereof, with creatinine clearance obtained by conventional 24-hour urine collection. We selected the charts of 22 patients in intensive care units (86% medical, 14% surgical) according to the following criteria: actual body weight greater than 150% of ideal body weight; serum creatinine variation of less than 15% from the day of starting 24-hour urine collection to the day before or after the collection; presence of a urinary bladder catheter; no history of renal dialysis; and clinical indication for renal function assessment. Mean measured 24-hour urinary creatinine clearance for all patients was 72 +/- 64 ml/minute (range 8-248 ml/min). The method of estimating creatinine clearance that showed the least mean bias was the equation of Salazar and Corcoran using a corrected serum creatinine concentration (mean bias -2 ml/min); however, the corresponding 95% confidence intervals were wide (-133-129 ml/min). The narrowest range of 95% confidence intervals were seen with Jelliffe's equation (mean bias 25 ml/min, 95% confidence intervals -41-90 ml/min). In this sample, estimated creatinine clearances did not agree acceptably with measured values. Despite low mean bias values, none of the empirically derived equations that we studied had clinically acceptable 95% confidence intervals. We recommend using the 24-hour urine collection method when assessing creatinine clearance in obese, critically ill patients.     

Evaluation of the CLINITEK ATLAS for routine macroscopic urinalysis

OBJECTIVES: To evaluate the performance of a new, benchtop, fully automated urine analyzer the CLINITEK ATLAS and compare it with the URICHEM 1000 CHEMSTRIP UA analyzer. Macroscopic analysis included measurement of 8 urine analyte chemistries and specific gravity by the refractive index method (SgRl). METHODS: The analytical performance studies conducted were calibration stability, precision (within-run and day-to-day), comparison of results of 437 fresh patient urine specimens, analysis of time performance, and problem logging over a 16-day evaluation period. RESULTS: Satisfactory calibration reproducibility, within-run (n = 10), and day-to-day (n = 16) precision was found because results fell within the +/- one color-block by the proposed National Committee for Clinical Laboratory Standards (NCCLS) criteria. Patient results (n = 437) from the 2 analyzers giving the same color-block agreement was found to be for pH, 52%; glucose, 92%; ketones, 86%; protein, 79%; bilirubin, 97%; leukocytes, 72%; blood, 80%; and nitrite, 98%. The concordance defined by the NCCLS criteria as the agreement of results +/- one color-block between the 2 analyzers was found to be for pH, 96%; glucose, 99%; ketones, 100%; protein, 95%; bilirubin, 100%; leukocytes, 97%; and blood 86%. The SgRl determined on ATLAS was correlated with the RD-10 Rapid Density analyzer with the following results: slope = 0.97, intercept = 0.033, r = 0.94, Syx = 0.003, for a range of values from 1.002 to 1.070. CONCLUSION: Our preliminary data indicate that the analytical performance, and automatable features for complete walk-away function of this analyzer can significantly increase the overall testing efficiency in the urinalysis laboratory.     

Total hydroxyproline in urine of 4 to 6 year-old children--an investigation on its relationship to growth and nutrition

We analysed over a period of 30-32 days the daily total hydroxyproline and creatinine excretine in urine from 9 healthy, normally fed 4 to 6 year-old children (2 girls, 7 boys). The average urinary hydroxyproline excretion was 45.6 mg/24 hr, with a coefficient of variation of 25.6%. Urinary hydroxyproline for individual children showed distinct differences from day to day, which were independent of urine volume. There were significant differences between the mean values for urine hydroxyproline in individual children, which were independent of age. The average creatinine in urine was 346/24 hr with a coefficient of variation of 17.7%. The hydroxyproline-index did not define the nutritional state of these normally developed children on a normal diet. Dietary hydroxyproline contributed 7.4% to the total urinary hydroxyproline in our investigation. There was a close correlation between urine hydroxyproline excretion and growth velocity in each child.     

Urinary glucose and vitamin C

The recent popularization of self-prescribed large doses of vitamin C has increased the possibility for erroneous conclusions to be drawn from standard clinical methods used in urinary glucose monitoring, due to interference with these methods by the greatly elevated excretion of vitamin C. The coupled-enzyme-chromogen strip tests showed erroneously negative glucose levels in urines of both a diabetic individual and a subject with a genetic low renal threshold for glucose when they were supplementing their normal diets with 1-2 g vitamin C per day. With this regimen, their urinary vitamin C levels reached 200 mg/dl (11.4 mmol/l). For normal urine with vitamin C added, false-positive tests for glucose were found using Benedict's reagent when vitamin C was present at 250 mg/dl (14.3 mmol/l) or higher concentrations. In diabetic individuals consuming large quantities of vitamin C, this interference with standard coupled-enzyme-chromogen strip tests or Benedict's test could present a significant problem in diagnosis and clinical management of the disease. A simple anion exchange method of treating the urine was used to correct the false results.     

Evaluation of automated methods of measuring hemoglobin and hematocrit in horses

OBJECTIVE: To evaluate the accuracy of 3 automated methods of determining Hct and hemoglobin (Hb) concentration, compared with manual methods. Animals-22 clinically normal adult horses of various breeds. PROCEDURE: A blood sample was obtained from each horse. Six dilutions (representing Hct of 0, 10, 20, 40, 60, or 70%) were prepared from each sample and analyzed, using 1 of 2 blood gas analyzers or a hemoximeter (for automated determinations) or the Wintrobe macrohematocrit and cyanmethemoglobin methods (for manual determinations). Regression analysis was used to determine mean slope relationships between Hct and Hb measurements obtained by use of manual versus automated methods. Slopes were compared, using Student's t-test. RESULTS: Of the 3 automated methods examined, only 1 blood gas analyzer reported Hct and Hb values that were not significantly different from those determined by use of manual methods; however, this analyzer could not report Hb concentrations below 2.5 g/dl. The other blood gas analyzer reported values for Hct and Hb concentrations that were consistently higher than those obtained by use of manual methods at Hct < or = 20% and Hb < or = 6.6 g/dl. The hemoximeter yielded more accurate results if the Hb concentration was between 6.6 and 20 g/dl. CONCLUSION: Although there were some limitations in measuring at low Hb concentrations, the method of determining Hb concentration and Hct with blood gas analyzer 2 was more accurate than that with blood gas analyzer 1 (Hct and Hb concentration) or the hemoximeter (Hb only).     

Accurate and precise isotope dilution mass spectrometry method for determining glucose in whole blood

An accurate and precise method to determine glucose concentration in whole blood is presented. The method, based on isotope dilution gas chromatography-mass spectrometry (ID GC-MS), was developed to be used as a Reference Method for determining glucose concentration in capillary or venous whole blood. Blood samples and standards are pipetted manually with "microcap" micropipettes, which makes it possible to collect samples even at the patient's bedside. Glucose is quantified as its aldononitrile pentaacetate. [13C6]Glucose is used as an internal standard. Assay of Seronorm and Pathonorm L and H controls by ID GC-MS gave within-run CVs of 0.66%, 0.96%, and 0.92%, respectively. For whole blood with glucose concentrations in the low, normal, and high ranges, the within-run CVs were 1.27%, 0.91%, and 0.78%, respectively. The between-run CV for glucose calculated from 36 separate single analyses of Seronorm was 1.44%. In an accuracy assessment test of the HemoCue blood glucose analyzer, 140 capillary blood samples were measured in parallel after split-sampling. For all samples the HemoCue analyzer results had a mean bias of +2.0% compared with the ID GC-MS results.     

Sodium excretion in children with lithogenic disorders

INTRODUCTION: The causes of nephrolithisis are multifactorial and have not yet been enough investigated [1]. Hypercalciuria is the most common cause of metabolic nephrolithiasis [2-4]. Close relationship between urinary calcium and urinary sodium has been a subject of reported observations in the past, showing that high urinary sodium is associated with high urinary calcium [5-7]. Hyperoxaluria, hyperuricosuria and cystinuria are also metabolic disorders that can lead to nephrolithiasis. Recent studies have indicated that urinary elimination of cystine is influenced by urinary sodium excretion. Based on these observations it has been hypothesised that patients with high urinary sodium excretion are at high risk of urinary stone disease. The purpose of the study was to investigate sodium excretion in a 24-hour urine and first morning urine collected from children with lithogenic metabolic abnormalities (hypercalciuria, hyperoxaluria, hyperuricosuria, cystinuria), both with nephrolithiasis and without it, in order to determine its significance in urinary calculi formation. PATIENTS AND METHODS: Urinary sodium excretion was investigated in 2 groups of children: patients with lithogenic metabolic abnormalities, but without urinary stone disease (L group) and patients with nephrolithiasis (C group). Both groups were divided into 2 subgroups: patients with hypercalciuria and without it. There were 22 patients in group L (mean age 11.97 +/- 4.13 years), of whom 17 formed a hypercalciuric subgroup and 5 formed a non-hypercalciuric subgroup (3 patients with hyperuricosuria and 2 patients with hyperoxaluria). Group C consisted of 21 patients with nephrolithiasis (mean age 12.67 +/- 3.44 years), of whom 6 formed a hypercalciuric subgroup and 15 formed a non-hypercalciuric group (2 patients with cystinuria and 13 patients without lithogenic metabolic abnormalities). Control group consisted of 42 healthy age-matched children. All subjects had a normal renal function. A detailed history and clinical examination were done, and ultrasonography was performed in all patients. A 24-hour urine, first morning urine and serum specimen were analysed for sodium, potassium, calcium, uric acid, urea and creatinine. Fractional excretion of sodium, as well as urinary sodium to creatinin ratio and urinary sodium to potassium ratio, were calculated from the findings. Sodium and potassium levels were determined by flame photometry, calcium was measured by atomic absorption technique (Beckman Atomic Spectrophotometer, Synchron CX-5 model, USA), uric acid by carbonate method and creatinine by Jaffe technique. Cystine and dibasic amino acids were quantified by ion chromatography. Urinary oxalate excretion was determined by enzyme spectrophotometry. Hypercalciuria was defined by 24-hour calcium excretion greater than 3.5 mg/kg per day and/or calcium to creatinine ratio greater than 0.20 [8]. Uric acid excretion was expressed as uric acid excretion factored for glomerular filtration, according to Stapleton's and Nash's formula [9]. Normal values were lower than 0.57 mg/dl of glomerular filtration rate in 24-hour samples. Mean values were statistically analyzed by Pearson's linear correlation and analysis of variance (ANOVA). RESULTS: Urinary sodium concentration values including urinary sodium to potassium ratios, are shown in Table 1. We found that urinary sodium excretion was significantly increased in patients of both L and C groups when compared with controls (p < 0.05). Further analysis of the subgroups showed that urinary sodium excretion was significantly higher only in patients with hypercalciuria of both L and C groups in comparison to controls (p < 0.05) (Table 2). A significant positive correlation was found between 24-hour urinary sodium to creatinine ratio and urinary calcium to creatinine ratio (r = 0.31; p < 0.001) (Graph 1), as well as between urinary sodium to potassium ratio in 24-hour and first morning urine (r = 0.69; p < 0.001) (Graph 2). (A     

Insulin sensitivity of adipose tissue in vitro and the response to exogenous insulin in obese human subjects

The effect of varying concentrations of insulin on 1-14C-glucose conversion to 14CO2 was measured in subcutaneous adipose tissue samples obtained from 16 obese human subjects (10 nondiabetic, 6 diabetic). An index of insulin sensitivity in vitro, Kins, was calculated as the concentration of insulin stimulating one-half maximal 14CO2 production. An index of insulin sensitivity in vivo, Kitt, was calculated as the rate constant for decrease in blood glucose after rapid intravenous administration of 0.05 U/kg insulin. There was, over-all, a significant correlation between Kins and Kitt, indicating that insulin sensitivity of 1-14C-glucose oxidation by adipose tissue in vitro reflects the general state of sensitivity of glucose metabolism to insulin in vivo in obese human subjects. The mean values for both Kins and Kitt in the nondiabetic subjects were significantly different from those in the diabetic subjects, indicating greater sensitivity to insulin in the former group. The nondiabetic group was also distinguished by a significantly greater plasma insulin:blood glucose ratio in the oral glucose tolerance test. These results support the view that tissue insulin sensitivity as well as pancreatic beta cell response play an important role in determining glucose tolerance in obesity.     

Urine N-acetyl-beta-D-glucosaminidase activity in healthy cattle

OBJECTIVE: To measure urine N-acetyl-beta-D-glucosaminidase (NAG) activity of healthy cattle, using 3 substrates (4-methylumbelliferyl-N-acetyl-beta-D-glucosaminide, sodio-m-cresolsulfonphthaleinyl-N-acetyl-beta-D-glucosaminid e, and p-nitrophenyl-N-acetyl-beta-D-glucosaminide), and to determine the relations between the obtained values and age and sex of cattle. ANIMALS: 50 healthy lactating Holstein-Friesian cows and 10 healthy Holstein-Friesian steers. PROCEDURE: Untimed urine samples were collected, and urine NAG activity was measured, using the 3 aforementioned methods. Urine creatinine concentration also was measured, and NAG activity was expressed as units per gram of creatinine (NAG index). Correlations between urine NAG activity and age and sex of cattle were investigated. Furthermore, correlations among data obtained by each of the 3 methods were determined. RESULTS: Urine NAG activity in cows measured by each of the 3 methods was < 3.0 U/L. Urine NAG activity in steers was significantly higher than that in cows. However, there was no significant difference between the sexes in NAG index. There were no significant differences in mean values of NAG activity and index among cows of various age groups. Individual values of urine NAG activity determined by each method correlated significantly with each other. CONCLUSIONS AND CLINICAL RELEVANCE: Urine NAG activity and NAG index of healthy cattle will be useful for determining diagnostic criteria of renal disease in cattle.     

The influence of antenatal corticosteroids on hypoglycemia in newborn rats with intrauterine growth retardation

This study examines the effect of maternally injected glucocorticoid on the pattern of hypoglycemia exhibited by rat pups with intrauterine growth retardation (IUGR). The majority of surgical procedures designed to produce small-for-gestational age (SGA) newborns for biochemical studies were carried out on days 18 and 19 of gestation because of favorable vields of pups with IUGR at those operative days. At birth, normal controls showed a mean +/- SE plasma glucose value of 63 +/- 2 mg/dl; mean glucose for the group with IUGR was significantly lower at 43 +/- 2 mg/dl. There was a further decrease in the plasma glucose concentration of pups with IUGR at 2-4 hr of age, whereas values in the control littermates did not fall during this interval. Through the first 2 hr of neonatal life, 46% of the pups with IUGR exhibited plasma glucose values less than 40 mg/dl, whereas only 18% of the control littermates manifiested hypoglycemia. During the 2-4-hr interval, the incidence of hypoglycemia in animals with IUGR increased to 91%; however, the incidence in control remained at 18% from 2-4 hr and fell to 4% at 4-6 hr of age. At birth, the pups with IUGR had a lower mean liver weight compared to their control littermates, but glycogen concentration of liver was similar to the control mean +/- SE of 25.7 +/- 1.8 (IUGR = 22.2 +/- 1.3 mg/g wet weight). Total hepatic glycogen stores, however, were markedly lower in dysmature rat pups (IUGR = 2.96 +/- 0.17 mg; control = 7.23 +/- 0.43 mg). Concentrations of plasma glucose at birth of individual control and IUGR animals were found to correlate significantly (r = 0.64, p less than 0.001) with total liver glycogen content. The decline in plasma glucose values in pups with IUGR was not present in animals whose dams received glucocorticoid injection 24 and 48 hr before delivery. At 4-6 hr of age, for instance, the mean plasma glucose concentration in the corticoid-treated IUGR group (70.1 +/- 6.9 mg/dl) approximated that of the control group. Instead on the 91% incidence of hypoglycemia noted in the nontreated dysmature pups, an incidence of 55% was found at 2-4 hr of age in offspring of mothers given glucocorticoid. At 4-6 hr, the treated group showed an incidence of 18% compared to a 67% figure in the nontreated IUGR animals. The concentration of liver glycogen in these animals also differed in that the treated IUGR pups showed significantly higher values (26.9 +/- 1.7 mg/g wet weight, mean +/- SE) than nontreated progeny. It is concluded that antenatally administered corticosteroid influence the development of neonatal hypoglycemia in the dysmature rat pup and that the major effect is not at birth, but during the 2-4-hr period of neonatal life.     

Flow-cytometric analysis of reticulocytes in normal cord blood

We performed precise reticulocyte counts and a reticulocyte maturation study according to ribosomal RNA (rRNA) content, in normal cord blood. For this purpose we analyzed 35 cord blood specimens corresponding to a mean gestational age of 39.2 weeks (range 38-41). In all specimens complete blood counts were performed with the H*1 (Technicon, Bayer) analyzer. Reticulocyte maturation study and counts were conducted by the R-1000 (Sysmex) reticulocyte analyzer. We obtained the following measurements (mean +/- 1 SD): reticulocyte percentage 3.11 +/- 0.75% and reticulocyte absolute count 137.3 +/- 33.3 x 10(9)/l. There was no correlation between the reticulocyte counts and the duration of gestation or the type of labor (normal, forceps assisted or cesarean section). Reticulocyte subpopulations with different rRNA content and maturation were expressed as reticulocytes with high (HFR), median (MFR) and low (LFR) fluorescence of the fluorochrome auramine bound to rRNA. Normal cord values were: HFR% = 13.6 +/- 2.4, MFR% = 22.5 +/- 2.4 and LFR% = 63.9 +/- 4.3. Reference maturation subpopulations were assessed for comparison in 180 samples of healthy adults (90 males and 90 females) and were found HFR% = 1.0 +/- 0.8, MFR% = 9.7 +/- 3.3 and LFR% = 89.2 +/- 3.4. The HFR% and MFR% were significantly higher while LFR% was significantly lower (p < 0.001) in cord compared to adult blood, denoting a shift to more immature reticulocyte forms. The above values are provided as normal reference data of the reticulocyte maturation profile in full-term cord blood.     

Can two-, four- or eight-hour urine collections after voluntary voiding be used instead of twenty-four-hour collections for the estimation of creatinine clearance in healthy subjects?

The accuracy of creatinine clearance estimations obtained from 4-hour (16:00-20:00, 20:00-24:00, 08:00-12:00, 12:00-16:00) and 8-hour (16:00-24:00, 24:00-08:00 and 08:00-16:00) urine collections and the Cockcroft Gault formula compared with the standard 24-hour collection, as well as the cyclical variation in creatinine excretion were studied in a group of 22 healthy subjects (Serum creatinine < 1.5 mg/dl, Blood Urea Nitrogen < 50 mg/dl) after voluntary voiding. The mean 4-hour and 8-hour creatinine clearances were not significantly different from the 24-hour values. Clearance values from 8-hour collections between 24:00-08:00 and 16:00-24:00 were found to be the most accurate and gave the best correlations. Furthermore only the mean absolute percentage deviations of the 8-hour from the 24-hour clearance values were significantly less than 20%. Significant cyclical variations in creatinine clearance over 24 hours were not observed. Time intervals between 23:00-07:00 and 07:00-09:00 were chosen for the comparisons between 8-hour, 2-hour, Cockcroft Gault creatinine clearance estimations and the 24-hour values in 21 healthy subjects. The mean 2-hour and 8-hour creatinine clearances were not significantly different from the 24-hour values. However, once again only the 8-hour clearance values differed by less than 20% from the 24-hour values and they were more accurate and better correlated than the 2-hour values. As expected, in both groups of subjects, the percentage of clearance values that deviated by more than 20% from the 24-hour values decreased as the length of the collection times increased. The Cockcroft Gault formula in both groups of volunteers gave less accurate clearance estimations, smaller correlation coefficients (not statistically significant in Group I subjects) and percentage deviations from the 24-hour values greater than 20%. Undetected early stage renal insufficiency in three volunteers and the use of actual instead of normalized Scr values may have been the cause of these poor clearance estimations. In healthy subjects (Scr < 1.5 mg/dl) 24-hour creatinine clearance may be estimated from an 8-hour urine collection with voluntary voiding if a 20% deviation from the 24-hour value is considered clinically acceptable.     

Results with the Clinicard analyser in a paediatric hospital (author's transl)

The most important chemical pathological investigations which require to be undertaken in the emergency laboratory of a paediatric hospital are of the serum electrolytes, blood glucose, cerebrospinal fluid glucose, blood urea nitrogen, total proteins, bilirubin and calcium. It is imperative to have the opportunity of controlling these parameters both during the day and night. In order to be independent of the presence of a technician we were interested in finding an instrument which can be used by untrained personnel and gives results of sufficient accuracy. Hence, the clinicard analyser was tested in regard to reproducibility and accuracy of results when used by highly-trained technicians and by persons without knowledge of laboratory work. It was established that the values obtained by these two groups are similar and sufficiently reproducible for emergency use. The accuracy of the instrument was tested with 2 charges of cuvettes and with different control sera. In the case of total proteins differences were found between the different control sera used. The values obtained for blood urea nitrogen and for blood glucose lay within the range given for Labtrol and for Seronorm. The accuracy of bilirubin was tested with 5 different control sera and all values lay within the ranged given by the factory. Calcium was tested with Labtrol and Fluinorm and also with sera and urines from different patients. The values were within the range given for the test sera and were comparable to those measured with the calcium analyser of EEL, but were about 7% lower than those determined using atomic absorption. The values obtained for cerebrospinal fluid glucose correlated well with those obtained by the routine method.     

Quantification of orotic acid in dried filter-paper urine samples by stable isotope dilution

A rapid, sensitive, and specific method for quantification of orotic acid from dried filter-paper urine samples is described. The method involves stable isotope dilution with 1,3-[15N2]orotic acid analysis by gas chromatography-mass spectrometry. The assay is sufficiently sensitive to be used with solvent extraction techniques commonly used for urinary organic acid analysis. Extraction efficiencies of both native and isotopic orotic acid from dried filter paper and from water were 31% and 28%, respectively. The concentration of orotic acid in dried filter-paper urine specimens from 50 healthy controls was 1.1 +/- 0.67 (mean +/- SD) mmol/mol of urinary creatinine. The same 50 urine samples, analyzed directly from a 5-mL aliquot of liquid urine, gave values of 0.93 +/- 0.51. The correlation coefficient between the results obtained by the two different collection methods was 0.87. Age-related reference values in filter-paper samples are also reported. The concentrations, which are normalized to urinary creatinine, decrease with age. This method is applicable to rapid screening for urea cycle disorders and may also be used for carrier testing of ornithine transcarbamylase deficiency.     

Study on the determination of IgA, IgG, IgM, a1-antitrypsin, haptoglobin and transferrin with the kinetic nephelometric method. Comparison with the radial immunodiffusion method (author's transl)

The concentration of IgA, IgG, IgM, a1-antitrypsin, haptoglobin and transferrin was determined by the kinetic nephelometric method (Beckman immunochemistry analyzer) and by the radial immunodiffusion method (Behring partigen immunodiffusion plates). The investigation was carried out in 151 normal and pathological sera. The results obtained with the radial immunodiffusion method were for IgA, IgG and IgM in middle about 15%, for a1-antitrypsin about 50% and for haptoglobin about 80% higher as compared to the results determined with the kinetic nephelometric method. An acceptable correspondence between the two methods was found for the results of transferrin.     

Issues of sexuality in older women

A newly developed automated urinary flow cytometer allows clear discrimination of erythrocytes from other solid components of urine. In this study, the normal range of the urinary erythrocyte count and the source of urinary erythrocytes in healthy individuals were investigated using this analyzer. For the diagnosis of the source of the urinary erythrocytes, Kitasato University Kidney Center criteria for this analyzer were applied. The subjects were 133 regularly employed volunteers (age range 20-48 years, mean 30.5) who noted no urinary tract symptoms and showed normal blood pressure, consisting of 41 females not in their menstrual period (age range 20-39 years, mean 24.8) and 92 males (age range 20-48 years, mean 33.1). Mid-stream voided urine was collected from these subjects using urine sampling cups, immediately transferred to 50-ml sterilized Spitz tubes, and analyzed within 30 min using the automated urinary flow cytometer. Urinary erythrocytes were derived from glomeruli in all samples of healthy subjects. The urinary erythrocyte count showed a logarithmic normal distribution. Values 2 SD of the urinary erythrocyte count in healthy individuals or higher were regarded as abnormal, and hematuria was considered to be positive when 11.0/microliter or more erythrocytes were observed by this analyzer. The finding by this analyzer corresponded to the report of Birch et al.